Menorrhagia associated with the wearing of IUD--the results of treatment with clomiphene citrate

The influence of clomiphene citrate was tested in 206 women suffering from menorrhagia following the insertion of an intrauterine device (IUD). Eighty-three percent felt relief during the therapy, 10% did not benefit and 7% complained of a worsening of their symptoms. Among the women who felt an improvement, 85% responded to the 250 mg/cycle dosage, and 15% required the 350 mg/cycle dosage. Women with shortened menstrual cycles required the higher dose treatment, i.e. 350 mg, compared with women with normal cycles (36% vs. 28%, respectively). The influence of placebo was 6%. The hypothesis is raised that the mechanism of action of clomiphene citrate is the correction of the hormonal disturbances in the luteal phase of the cycle following insertion of the IUD.

The importance of cuff width in measurement of blood pressure in pregnancy

Blood pressure was measured indirectly in 218 normotensive primigravidas with arm circumferences ranging from 21.7 to 36.1 cm using three standard blood pressure cuffs. It was found that the medical profession's lack of awareness as to the proper use of cuffs in prenatal care may involve 40% of the patients--20% of these have a small arm circumference, will not show a true blood pressure reading, and may fail to get the proper treatment. On the other hand, 20% of these patients who have a rather large arm circumference, may be grouped among those who need special care and attention, and may be given unnecessary treatment--a fact which may bring about clinical complications, unnecessary expense, incorrect statistical data and a misleading demographic impact.

Changes in menstrual blood loss and libido after different methods of tubal ligation

A study was carried out to investigate the menstrual blood loss and changes in sexual life following two methods of tubal sterilization, the Pomeroy procedure and fimbriectomy, as compared with a control group having undergone Cesarean section alone. Results support the approach that hysterectomy be performed in older women, over the age of 40, and fimbriectomy in younger patients, in whom further pregnancy or reanastomosis of the Fallopian tube is absolutely contraindicated.

Placenta previa. The ultrasonographic placental localization and its influence on the mode of delivery

In a group of 168 patients who presented with third-trimester bleeding, ultrasonographic placental localization did not provide either positive or negative false results concerning the placental site. In a group of 47 patients for whom an ultrasonographic diagnosis of placenta previa was established, an erroneous typing was done in 4 (8.5%). Of these four, one (2.1%) underwent an elective cesarean section instead of being allowed a vaginal trial of labor.

Detachment of posterior uterine cervical lip associated with spontaneous delivery

Various forms of detachment and amputation of the uterine cervix during labor have been described as an unusual and uncommon obstetrical complication (Jeffcoate and Lister, 1952). These cases most probably are not so rare as the few papers dealing with them would suggest. Since most of these papers deal with total amputation (annular detachment) of the uterine cervix and detachment of anterior uterine cervical lip, a case of spontaneous detachment of posterior uterine cervical lip is described.

Chemical and biochemical studies in fetuses affected with Nieman-Pick disease type A

Chemical and biochemical studies were performed on two unrelated fetuses affected with Niemann-Pick disease type A, following abortion at about the 19th week of gestation. Abortion was performed as a consequence of previous findings, in amniotic fluid cell cultures, that sphingomyelinase activity was completely absent. Phospholipid analyses of various organs of the fetuses, spleen and liver were the organs mostly affected. Interestingly enough considerable accumulation of sphingomyelin was found in the placenta. The brain was the only organ in which sphingomyelin storage could not be proved. In addition to sphingomyelin a slight accumulation of cholesterol was noticed. Deficiency of sphingomyelinase activity measured at pH 5.0 was the general characteristic of the affected tissues. It is concluded that the accumulation of sphingomyelin in various organs throughout the body of fetuses affected with Niemann-Pick disease is suggestive of the essential role of the enzyme sphingomyelinase and its biochemical maturation, even during the early stages of gestation.

Intravascular leiomyomatosis

Two cases of intravascular leiomyomatosis are described. In 1 case, a 66-year-old woman was seen with an extension of the tumor to the myometrium, cervix, and left parametrium and with radiologic evidence of tumor extension to the left external and common iliac veins and the inferior vena cava; subsequently, the tumor invaded the left renal, suprarenal and ovarian veins, hepatic veins, and the right atrium, causing severe heart failure and death. The second case is that of a 28-year-old woman with an advanced tumor in the interior vena cava, right atrium, and ventricle who died during cardiac surgery. Review of the literature is presented, with special comment on the management of this disease entity.

"In vitro" colony growth of blood T-lymphocytes from B-cell chronic lymphocytic leukemia

T-lymphocyte colony formation in agar culture was investigated in 20 untreated B-cell Chronic Lymphocytic Leukemia (CLL) patients in stage O. As compared to the controls, colony growth was very poor when unseparated peripheral-blood lymphocytes from CLL-patients were seeded. The number of colonies was greatly higher when T-cell enriched fractions from CLL were plated; however, they failed to reach the normal range even in this experimental condition. The role of adherent cells in the colony growth was also investigated. Depletion of these cells resulted in impaired colony generation either in normals or in CLL-patients, which was subsequently restored by the addition of the same adherent cells. In the patients investigated in this study, an imbalance of T-subsets was found with increase of OKT8-positive cells (T-suppressors). When the number of colonies and the percentage of OKT8-positive cells were plotted, an inverse correlation was found. Conversely, a linear relationship was detected between the percentage of OKT4-positive cells (T-helpers) and the values of colonies. On the basis of the present experiments, it is suggested that the defective colony growth of T-cell fractions in B-cell CLL may be related to the low number of OKT4-positive cells plated, which are known to be mainly responsible for the colony generation in agar culture.

Development and biologic properties of malignant cell sublines and clones of a spontaneously metastasizing rat mammary adenocarcinoma

With the use of the rat 13762 mammary adenocarcinoma tumor, an animal model for spontaneous mammary tumor metastasis was developed. The parental tumor implanted sc into the mammary fat pads of female Fischer 344 rats metastasized at low frequency to lymph nodes and lung and did not metastasize to other organs. Oophorectomy did not modify the metastatic properties of the parental 13762 tumor. Cell lines were adapted to tissue culture from lymph node or lung metastases, and these were compared to parental tumor transplants in spontaneous metastasis assays. Only the cell lines established from metastases were spontaneously metastatic within 23 days after sc implantation, indicating that tumor cell populations from metastases are more metastatic than are cells from the parental tumor. Several individual parental tumor-derived and lung metastasis-derived clones were compared for spontaneous metastatic potentials, cell culture morphologies, histologic structures at primary implant and secondary metastatic sites, and growth characteristics in vivo and in vitro. There was no correlation between any of these tumor and cellular properties and metastatic potential. The parental mammary tumor-derived, lymph node metastasis-derived, and lung metastasis-derived cell lines and clones with differing spontaneous metastatic properties should prove useful in studies on the roles of tumor cell and host properties in lymphatic and blood-borne metastasis.

Placenta previa with focal accretion

A series of eight women in whom a diagnosis of placenta previa with focal accretion was established, is presented. They were selected from a group of 153 women with placenta previa who delivered during the period 1968-77. The women with placenta previa accreta did not differ from those with placenta previa per se with respect to age, parity, obstetrical history, and antenatal, intrapartum or perinatal outcome. Three women delivered vaginally and five by cesarean section. Postpartum hemorrhage occurred in four of the women, three of whom were delivered vaginally. Of seven women who were managed conservatively, one required a hysterectomy to control bleeding. It is suggested that cases of placenta previa with focal accretion be managed conservatively.

Distribution of fibronectin on clonal cell lines of a rat mammary adenocarcinoma growing in vitro and in vivo at primary and metastatic sites

With the use of a rat 13762 mammary adenocarcinoma tumor, we have examined the relationship between cellular fibronectin (FN) expression and ability to metastasize spontaneously to regional lymphatic and distant blood-borne sites. This model is based on the isolation and establishment of cell clones from primary parental tumor and from spontaneous metastases that show differing metastatic potentials when implanted s.c. into the mammary fat pads of syngeneic female Fischer 344/CRBL rats. Cellular FN expression was determined in tissue culture as well as primary and secondary tumor sites, utilizing: (a) indirect immunofluorescence microscopy with a specific anti-rat FN antibody (in vitro and in vivo grown cells); (b) competition radioimmunoassay for cell-released FN (in vitro grown cells); and (c) surface labeling by radioiodination-sodium dodecyl sulfate-polyacrylamide gel electrophoresis-autoradiography for cell surface-bound FN (in vitro grown cells). Tissue culture-grown parental tumor clones displayed FN at their cell surfaces. At confluency, they expressed higher quantities of FN at their peripheries and in fibrillar structures between adjacent cells and released greater amounts of this glycoprotein. Lung metastases-derived tumor clones released negligible amounts of FN by radioimmunoassay and failed to express detectable amounts of FN by indirect immunofluorescence and cell surface-labeling techniques. However, when parental tumor- and metastasis-derived clones of widely different metastatic potentials were carefully examined for FN expression and release, there was no obvious relationship between metastasis and FN expression or release in culture or display in tumors at primary or secondary sites. The results suggest that expression or release of FN per se is not a determinant of metastasis, although it may be a factor in certain steps of the metastatic sequence.

Phenotypic drift of metastatic and cell-surface properties of mammary adenocarcinoma cell clones during growth in vitro

We have examined cell clones obtained from a 13762 mammary adenocarcinoma tumor and its spontaneous lung metastasis for phenotypic stability during serial culture passage in vitro. Two clones that varied markedly in their metastatic properties were chosen for further examination. One of these clones (MTC) obtained from the parental transplanted tumor initially failed to metastasize within 23 days post-injection s.c. but gained the ability to form spontaneous pulmonary metastases after several serial passages in vitro. Another clone (MTLn3) derived from a spontaneous lung metastasis was initially higher metastatic from short-term culture, but lost the potential to form large numbers of spontaneous lung metastases with long-term culture. In contrast to MTA, clone MTLn3 displayed lymph-node metastasis, and the frequency of lymph-node involvement increased when late-passage cultures of MTLn3 cells were assayed in vivo. Both clones from late-passage cultures produced larger tumor sizes at the primary (mammary fat pad) injection sites compared to early passage cells. The morphologies of MTC cells changed with serial tissue culture passage, while the morphologies of MTLn3 cells did not change. The display of fibronectin on MTC cells by immunofluorescence did not change with culture passage; fibronectin was not detected in cultures of clone MTLn3. Fibronectin was also found on MTC cells by cell surface labelling using lactoperoxidase-catalyzed iodination-sodium dodecylsulfate polyacrylamide gel electrophoresis-autoradiography. Iodination of fibronectin on MTC cells did not vary with culture passage, and as in immunofluorescence experiments it was not detected on MTLn3 cells. There was a decrease in exposure of certain cell surface proteins on MTC cells with culture passage, but we did not detect modifications with this procedure that correlated with culture passage of MTLn3 cells. We conclude that prolonged culture in vitro can result in modifications fo metastatic and cell-surface properties of tumor cell clones.

Reduced natural killer cell activity in non-hodgkin's lymphoma

Natural Killer (NK) activity is investigated in 20 patients with non-Hodgkin's Lymphoma (NHL) and in 20 healthy subjects. Peripheral blood lymphocytes are used as effector cells, and 51Cr labelled K562 myeloid cells as targets. Experiments are carried out either at effector/target ratio of 20:1 or 40:1, in 4 hrs Cr released assay. As compared to controls, a reduced NK activity is found in NHL patients, but that difference is statistically significant only for the patients in active disease. Thus, patients in clinical remission display a better preservation of NK function. It is suggested that the study of NK function might offer a helpful tool in following the clinical course and the efficacy of therapy in NHL.

Recurrent placenta previa

Among a group of 33 135 women who delivered at Beilinson Medical Center, Israel, during the years 1968 to 1978, recurrent placenta previa occurred in 3.2% of the women, i.e., 6 times higher than the incidence of placenta previa in the general population (0.5%). Analysis of the data revealed that women over 36 yr of age with a history of placenta previa are at risk for recurrent placenta previa. Maternal and perinatal morbidity and mortality were similar in cases of single and recurrent placenta previa.

Ph1-negative T lymphocytic colonies in agar cultures of peripheral blood in chronic myeloid leukemia

T lymphocytic colony formation by peripheral lymphocytes separated by discontinuous albumin gradient centrifugation was evaluated in 8 patients with Philadelphia (Ph1)-positive chronic myeloid leukemia (CML). Colonies were obtained using a liquid-on-agar culture system recently introduced (PHA overlayer-leukocyte feeder layer assay) which has been shown to be simple and reliable. The pattern of colony growth in CML and in normal controls was similar, the peak ranging from the 4th to the 6th day. Also the morphological aspects of colonies did not differ in the two groups. Cells recovered from CML lymphocytic colonies were shown to belong to T cell lineage, as they are able to form spontaneous E-rosettes and to respond to mitogenic stimulation in vitro. In contrast, cells recovered from all other cultured fractions failed to display these properties. Cytogenetic analysis showed that T colony cells were Ph1-negative whereas the chromosome anomaly was found in nonlymphoid colonies of the same patients, thus suggesting a nonclonal origin of T lymphocytes in CML.