Perinatal Infection with listeria Monocytogenes

Summary: Listeria monocytogenes has been increasingly recognized as a cause of intrauterine sepsis with associated perinatal wastage. The condition is mostly acquired through dietary intake and appropriate advice should be given to all pregnant women. The most common presentations in pregnancy include premature labour, an influenza-like illness and reduced fetal movements.
In this report, we present a series of 24 cases of perinatal listeria infection presenting to either our obstetric or neonatal units and confirmed by the microbiology department of the hospital. In particular, we wish to highlight 3 cases in which antenatal diagnosis and aggressive therapy was associated with a successful outcome. Amongst the remaining 21 cases in which an antenatal diagnosis was not made, there were 5 perinatal deaths and 1 mid-trimester loss at 18 weeks.
Clinicians must maintain a high index of suspicion for listeria, particularly in gravid patients who present with fever in the setting of a persistent 'flu-like' illness and premature labour. Once suspected, appropriate specimens for listeria culture should include blood, cervical swabs and midstream urine. Empirical antibiotic therapy with amoxicillin should be instituted while waiting for culture results in patients with possible Listeria monocytogenes sepsis.     

腹腔镜子宫肌瘤剜除术对人体蛋白质氧化、脂质过氧化影响的研究

目的探讨腹腔镜手术对子宫肌瘤患者体内蛋白质氧化、脂质过氧化的影响。方法将40例子宫肌瘤患者随机分为腹腔镜组和开腹组两组,每组20例。测定两组患者腹腔镜手术前、手术结束时(气腹解除后5min)及术后24h血浆晚期氧化蛋白产物(AOPP)、丙二醛、血浆谷胱甘肽过氧化物酶(GPx)活性和血浆总抗氧化能力(AOA)的水平,以及开腹手术术前、手术结束(缝合腹壁时)及术后24h的水平。结果(1)腹腔镜组手术结束时血浆AOPP、丙二醛水平高于术前[(69±13)μmol/Lvs(50±9)μmol/L,P<001;(252±055)μmol/Lvs(185±019)μmol/L,P<001],血浆GPx活性、AOA水平低于术前[(029±009)U/mlvs(062±027)U/ml,P<001;(090±024)mmol/Lvs(141±039)mmol/L,P<001];术后24h血浆AOPP、丙二醛、GPx与术前比较差异无统计学意义[(50±10)μmol/L,P>005;(205±068)μmol/L,P>005;(052±006)U/ml,P>005],但AOA水平仍低[(100±031)mmol/L,P<001]。(2)开腹组手术结束时血浆AOPP、丙二醛含量比术前略有升高[(53±100μmol/Lvs(52±70)μmol/L,P>005;(209±051)μmol/Lvs(183±064)μmol/L,P>005],GPx活性、AOA水平比术前略有下降[(051±017)U/mlvs(057±021)U/ml,P>005;(120±046)mmol/Lvs133±037,P>005];术后24h血浆AOPP、丙二醛与术前相比升高[     

Testicular Steroid Metabolism In Vitro in an XX-Male

XX-males are known to display dysgenetic gonads with failing sperm production. Since defective male gametogenesis has in certain instances been proposed to be related to an aberrant intratesticular steroid biosynthesis (Steinberger et al. 1974), we have analysed the metabolism of [³H] progesterone in vitro in an XX-male.
The 33-year-old patient was sterile and demonstrated high levels of gonadotrophic hormones in the peripheral circulation, though he displayed ordinary male secondary sex characteristics. Testicular biopsy specimens were incubated with [³H] progesterone. This radiolabelled precursor was found to be avidly metabolized along the so-called "Δ⁴-pathway" towards biologically active C₁₉-androgens in this XX-male, as in testicular tissue derived from adult control subjects.
Furthermore, the relative metabolism of [³H] progesterone per mg of testicular tissue incubated, was observed to be significantly higher in the dysgenetic gonadal tissue derived from the present XX-male as compared to the metabolism in the control subjects.
The amount of [³H] 17α-hydroxyprogesterone synthesized in the XX-male was very high, and also the ratio of [³H] 20α-dihydroprogesterone:[³H]-17α-hydroxyprogesterone was found to be remarkably small, i. e. a pattern repeatedly observed in other hypergonadotrophic individuals (Kjessler & Berg 1976b).
The present investigation thus demonstrated that intratesticular steroidogenesis along the Δ⁴-pathway in vitro may be excellent in dysgenetic gonadal tissue with an XX-chromosomal constitution.     

Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma

PURPOSE: Intracavitary brachytherapy plays an important role in the treatment of cervical carcinoma. Previous results have shown controversy between the effect of dose rate on tumor control and the occurrence of complications. We performed a prospective randomized clinical trial to compare the clinical outcomes between low-dose-rate (LDR) and high-dose-rate (HDR) intracavitary brachytherapy for treatment of invasive uterine cervical carcinoma. METHODS AND MATERIALS: A total of 237 patients with previously untreated invasive carcinoma of the uterine cervix treated at King Chulalongkorn Memorial Hospital were randomized between June 1995 and December 2001. Excluding ineligible, incomplete treatment, and incomplete data patients, 109 and 112 patients were in the LDR and HDR groups, respectively. All patients were treated with external beam radiotherapy and LDR or HDR intracavitary brachytherapy using the Chulalongkorn treatment schedule. RESULTS: The median follow-up for the LDR and HDR groups was 40.2 and 37.2 months, respectively. The actuarial 3-year overall and relapse-free survival rate for all patients was 69.6% and 70%, respectively. The 3-year overall survival rate in the LDR and HDR groups was 70.9% and 68.4% (p = 0.75) and the 3-year pelvic control rate was 89.1% and 86.4% (p = 0.51), respectively. The 3-year relapse-free survival rate in both groups was 69.9% (p = 0.35). Most recurrences were distant metastases, especially in Stage IIB and IIIB patients. Grade 3 and 4 complications were found in 2.8% and 7.1% of the LDR and HDR groups (p = 0.23). CONCLUSION: Comparable outcomes were demonstrated between LDR and HDR intracavitary brachytherapy. Concerning patient convenience, the lower number of medical personnel needed, and decreased radiation to health care workers, HDR intracavitary brachytherapy is an alternative to conventional LDR brachytherapy. The high number of distant failure suggests that other modalities such as systemic concurrent or adjuvant chemotherapy might lower this high recurrence, especially in Stage IIB and IIIB.     

Correlating Papanicolaou Smear, Colposcopic Impression, and Biopsy: Results from the Women's Interagency HIV Study

OBJECTIVE: To determine associations among cervical cytology, colposcopy, and biopsy in HIV-seropositive women. MATERIALS AND METHODS: HIV-seropositive women and uninfected comparison women in a multicenter prospective cohort study underwent colposcopy for protocol indications. Women were eligible if they had a cervix, satisfactory cytology, and colposcopy between October 1994 and September 1999. Cytology, colposcopic impression, and biopsy were compared using equivalent categorizations. Kappa statistics with bootstrap sampling assessed strength of associations. RESULTS: Colposcopy was performed in 978/1370 HIV-seropositive women and in 154/224 seronegative women. Biopsies were performed on 603 (44%) seropositive women at least once during 1015 colposcopy visits and on 82 (37%) seronegative women at 116 visits. The positive predictive value of cytology was 72% for seropositive women and 60% for seronegative women. The positive predictive value of colposcopy was 71% for seropositive women and 55% for seronegative women. CONCLUSION: The correlation between either cervical cytology or colposcopic impression and colposcopic biopsy was poor.     

Adenocarcinoma in situ of the cervix-controversies in diagnosis and treatment

Adenocarcinoma in situ (AIS) of the uterine cervix is a rare condition. Pap smear screening is unsatisfactory, and the disease has no morphologic reliable colposcopic features. Diagnosis is often made by chance during the treatment of squamous pre-invasive disease, which commonly coexists with AIS. Although the entire endocervical canal can be the site of disease, most lesions lie within 1 cm of the squamocolumnar junction. Skip lesions are rare, making fertility-sparing surgery a possibility under certain conditions. Recurrent disease occurs in 14% of cases when cone margins are free of disease and rise to more than 50% if the margins are involved. The method of conization is immaterial provided a large enough specimen is taken and that the endocervical margins can be evaluated by the pathologist. Follow-up of conservatively managed women is not defined; however, we recommend that regular endocervical cytology be performed in addition to conventional cytology and colposcopy.     

Characteristics of antenatal care attenders in a rural population in Tamil Nadu, South India: a community-based cross-sectional study

The objectives of the study were to identify factors associated with utilisation of antenatal care facilities in a rural population in South India. A community-based, cross-sectional questionnaire study of 30 randomly selected areas was used. A total of 1254 women (95%) had at least one antenatal care visit. The median number of visits was four. High utilisation of antenatal care facilities was associated with low parity and adverse obstetrical history, short distance to healthcare facilities and literacy. It was concluded that antenatal care coverage was high. Information about the above few aspects can be used to target women who are at risk of getting inadequate antenatal care.     

Reproductive Failure after Oomiphene Induced Ovulation

Summary: In a group of infertile patients with oligo-ovulatory and anovu-latory menstruation, pregnancy is frequently achieved by the use of placebo or cyclic hormone treatment. In those not responding to such treatment, clomiphene citrate appears to be relatively ineffective in achieving pregnancy. The possible causes of the low pregnancy yield and suggestions as to how this may be improved are discussed.