A partial hydatidiform mole with 2N/3N mosaicism identified by molecular analysis

PURPOSE

A placenta with a partial hydatidiform mole was studied using DNA polymorphic markers to determine whether it has a triploid cell line.

METHOD

Parent-mole transmission of alleles at 23 polymorphic loci was traced in cells from a molar region and a normal-looking region of the placenta by polymerase chain reaction (PCR) amplification or Southern blot analysis, both followed by densitometric analysis.

RESULTS

Allele patterns for 8 of the 23 loci were identical between the DNA from the molar and normal regions of the placenta, while those of the remaining 15 loci were uninformative. In the molar region, the band intensity for the paternally derived allele at each informative locus was always greater than that of the maternally derived allele, the average intensity ratio of the former to the latter being 1.5, whereas the ratio in the normal region was even.

CONCLUSIONS

The results suggested that the molar region was a mixoploid consisting of diploid and triploid cells and the phenotypically normal region had a mainly diploid constitution. It is most likely that the placenta may have originated from a single diploid or triploid conceptus, followed by postzygotic gain or loss of a paternal haploid set, and that an extra paternal set contributed to hydropic changes of the placenta.

Influence of serum follicle stimulating hormone to luteinizing hormone ratio during buserelin acetate-induced pituitary desensitization on ovarian response to exogenous gonadotrophins in an in-vitro fertilization and embryo transfer programme

We investigated the effect of endogenous gonadotrophins during pituitary desensitization with gonadotrophin-releasing hormone agonist (GnRHa) on ovarian responsiveness or the outcome of in-vitro fertilization (IVF) and embryo transfer. The results of 67 women who participated in the IFV programme at Nagasaki University Hospital, Japan, were analysed retrospectively. All women received GnRHa from the third day of menstrual cycle, and ovarian stimulation with exogenous gonadotrophins was initiated when the serum oestradiol concentration decreased to < 30 pg/ml. The serum follicle stimulating hormone (FSH)/luteinizing hormone (LH) ratio, rather than serum FSH or LH concentrations during GnRHa-induced pituitary desensitization, showed a significant positive correlation with age and the total dose of exogenous gonadotrophins. The FSH/LH ratio also showed a significant negative correlation with oestradiol response and the number of retrieved oocytes, and was significantly lower in pregnant women compared with the non-pregnant group during pituitary desensitization. Our results indicate that, even under pituitary desensitization with GnRHa, the serum FSH/LH ratio influences individual ovarian responsiveness and the state of the intra-ovarian hormonal environment. Our results suggest that the FSH/LH ratio may be a useful clinical predictor of the ovarian response to exogenous gonadotrophins under pituitary desensitization.

Ultrasonographic prediction of lethal pulmonary hypoplasia: comparison of eight different ultrasonographic parameters

OBJECTIVE

The aim of this study was to determine the usefulness of eight different ultrasonographic fetal parameters for predicting fetal pulmonary hypoplasia.

STUDY DESIGN

Nomograms of eight different ultrasonographic fetal parameters were evaluated by studying uncomplicated single fetus pregnancies with well-established dates between 18 and 40 weeks of gestation. The eight parameters, which could reflect fetal lung mass, were as follows: thoracic circumference, thoracic area, thoracic area minus heart area, lung area, thoracic circumference/abdominal circumference ratio, thoracic area/heart area ratio, thoracic area minus heart area/thoracic area ratio and lung area/thoracic area ratio. The relative efficacy of the eight parameters was determined by studying 21 fetuses at high risk for development of lethal pulmonary hypoplasia and 30 fetuses with premature rupture of membranes within 1 week.

RESULTS

The lung area (gestational age-dependent parameter) and the thoracic circumference/abdominal circumference (gestational age-independent parameter) ratio had the best diagnostic accuracy (sensitivity 81.3% and 90.5%, specificity 100% and 90.0%, positive predictive value 100% and 86.4%, negative predictive value 90.9% and 93.1%, respectively). There were significant linear relationships between lung weight and lung area and between the lung weight/body weight ratio and the thoracic circumference/abdominal circumference ratio.

CONCLUSION

These data suggested that the application of lung area and the thoracic circumference/abdominal circumference ratio are clinically useful for the evaluation of fetal pulmonary hypoplasia.

Mouse/human sequence divergence in a region with a paternal-specific methylation imprint at the human H19 locus

We have identified a region with characteristics of a paternal-specific methylation imprint at the human H19 locus. This region, extending from -2.0 kb upstream to the start of transcription, is heavily methylated in sperm and on the paternal allele in somatic cells. This methylation was preserved during pre-implantation. Structural analysis revealed the presence of CpG islands and a large direct repeat with a 400 bp sequence reiterated several times, but no significant sequence homology to the corresponding region of the mouse H19 gene. These findings could suggest a role for secondary DNA structure in genomic imprinting across the species, and they also present a puzzling aspect of the evolution of the H19 regulatory region in human and mouse.

[Effect of prolonged intravenous ritodrine tocolysis on diurnal glucose profiles in pregnant women with normal carbohydrate tolerance]

Our purpose was to investigate an effect of prolonged intravenous ritodrine tocolysis on maternal carbohydrate metabolism in women with normal glucose tolerance. In patients with preterm labor, diurnal plasma glucose levels were measured both during the 24 hours after beginning the therapy (phase 1) and each day during over five days of continuous ritodrine tocolysis (phase 2). We also measured diurnal plasma glucose levels in normal pregnant women without any therapy (control group). In phase 1, in comparison with before therapy, a significant increase in the plasma glucose levels was observed with the highest level at 9 hours after starting ritodrine (146.4 +/- 31.6mg/dl). The higher plasma glucose levels persisted during phase 1. Although infusion rates were similar in both phases, maternal plasma glucose levels in phase 1 were significantly higher than in phase 2 (mean plasma glucose level, 128.1 +/- 21.3mg/dl vs. 92.7 +/- 11.6 mg/dl, p < 0.05; maximum plasma glucose level, 159.5 +/- 25.2mg/dl vs. 106.6 +/- 14.5mg/dl, p < 0.05). Diurnal glucose levels in phase 2 were similar to those in the control group. In phase 1, there seemed to be a dose-dependent relation between the ritodrine infusion rates and plasma glucose levels, but we did not find any relationship between them in phase 2. In conclusion, although hyperglycemia occurs during the initial phase of continuous ritodrine therapy (at least 24 hours), prolonged ritodrine infusion leads to normalization of the maternal plasma glucose levels.

Transvaginal color Doppler studies in gestational trophoblastic disease

Three women with gestational trophoblastic disease were examined using transvaginal color Doppler at the initial diagnosis and after each course of chemotherapy. In all cases, the examination before chemotherapy revealed hypoechoic areas surrounded by irregular echogenic areas and numerous intramyometrial flow signals. Pulsed Doppler examination revealed a low pulsatility index (PI) in the uterine arteries. After the completion of chemotherapy, a decrease in the vascularity and increase in the PI of the uterine arteries were demonstrated in two cases. These findings were closely consistent with the decrease in serum levels of beta-human chorionic gonadotropin. However, in the patient who developed permanent arteriovenous communication, hypervascularity persisted and the PI of the uterine arteries remained low, even after clinical remission was achieved. The present study indicates that transvaginal color Doppler ultrasonography is useful for the evaluation of gestational trophoblastic disease, both at the time of diagnosis and after chemotherapy.

[Rapidly progressive T-cell angiocentric lymphoma with CD56+ phenotype involving bilateral orbits and skin in a patient with anti-HTLV-I antibody]

A 57-year-old woman was admitted to our hospital complaining of left exophthalmos in July, 1991. Biopsy specimen of a tumor in the left orbit suggested an inflammatory pseudotumor. The orbit was irradiated and the exophthalmos disappeared. During admission, an erythema was noted on her anterior chest wall. After discharge, right exophthalmos and generalized skin eruptions developed. The skin eruption on her anterior chest wall was histopathologically diagnosed as angiocentric lymphoma and she was readmitted. Since her serum was positive for anti-HTLV-I antibody, adult T-cell leukemia/lymphoma was suspected. Chemotherapy yielded limited relief of the right exophthalmos and transient fading of the skin eruptions. She died due to progression of the disease. Close examination of the skin eruption on the calf revealed that the lymphoma cells were CD56-positive immunohistochemically and electron microscopy revealed that they had large membrane-bound granules. Rearrangement of the T-cell receptor beta chain gene was observed. Incorporation of HTLV-I proviral DNA was not observed. Re-examination of the left orbital tumor confirmed the infiltration of these lymphoma cells. This is a rare case of T-cell lymphoma with NK cell phenotype involving orbits and skin, and showing a rapid clinical course.

Olfactory evoked potentials produced by electrical stimulation of the olfactory mucosa

We stimulated the olfactory mucosa electrically and elicited evoked potentials in rabbits. A bipolar stimulating electrode was placed on the olfactory region of the nasal mucosa via an anterior naris non-invasively. Evoked potentials were detected from the surface of a head. In most instances they were composed of triphasic negative-positive-negative peaks, the latencies of these peaks were about 25, 40, and 65 ms, respectively. This peak complex seemed to originate in the olfactory bulb. This method is non-invasive and is applicable to studying the olfactory system in animals and also in humans.

[The relationship between blood flow redistribution in umbilical artery and middle cerebral artery and fetal growth in intrauterine growth retardation]

The aim of this study was to evaluate the usefulness of umbilical artery and middle cerebral artery PI and the ratio of these values as predictors of fetal growth-retardation and adverse perinatal outcome. In 100 normal fetuses and 105 intrauterine growth-retarded fetuses Doppler velocity waveforms were recorded from the umbilical artery and middle cerebral artery, and we calculated the incidence of low birth weight, gestational age at delivery, fetal distress and umbilical artery blood gas. The results were as follows: 1. There were moderate correlations between umbilical PI and birth weight (r = -0.43, p < 0.0001) and between middle cerebral artery PI and birth weight (r = 0.37, p < 0.0001) and a close correlation between cerebral-umbilical PI ratio and birth weight (r = 0.71, p < 0.0001). 2. There was a significant association between the cerebral-umbilical PI ratio and the HC/AC ratio (r = -0.46, p < 0.0001). 3. The cerebral-umbilical PI ratio was the best predictor of birth weight, fetal distress and neonatal mortality compared with umbilical artery PI and middle cerebral artery PI. In growth retarded fetuses, high umbilical artery PI and low middle cerebral artery PI, the so called "brain sparing effect" was demonstrated. The cerebral-umbilical PI ratio provided a better predictor of IUGR and adverse perinatal outcome than umbilical artery PI and middle cerebral artery PI alone.

Local injection of methotrexate dissolved in saline versus methotrexate suspensions for the conservative treatment of ectopic pregnancy

To compare the local injection of methotrexate (MTX) dissolved in saline and MTX suspensions for the laparoscopic treatment of ectopic pregnancy in terms of success rate and postoperative tubal patency. A total of 26 patients with unruptured ectopic pregnancies were selected from among 60 women with ectopic pregnancies admitted to the Nagasaki University clinic. Of these patients, 12 were treated with MTX dissolved in saline solution (solution group) and 14 with MTX suspensions consisting of lipiodol (LPD) with phosphatidylcholine (PC) added as a dispersing stabilizer (suspension group). Except for one case treated under transvaginal guidance, all the patients were treated by laparoscopy. Persistent ectopic pregnancy was recognized in seven cases (58%) in the solution group but in only two cases (14%) in the suspension group. Moreover, rupture occurred in two cases in the solution group but in no case in the suspension group. A patent treated tube was found in seven of 10 cases in the saline group and in 10 of 12 cases in the suspension group. During the follow-up period of 6-31 months, five women in the saline group and three women in the suspension group had an intrauterine pregnancy. In this study, the local injection of MTX is considered to be a reasonable method for the treatment of unruptured ectopic pregnancy, and the MTX suspension seems to be more effective and useful than MTX solution.

[Comparative examinations of serum pepsinogen I, II and gastric area using computed radiography in the atrophic gastritis]

The relationship between serum PG I, PG II levels and extent of atrophic gastritis was examined. On 64 patients (male: 32, female: 32, 51.9 years old on average) with established diagnosis of either atrophic gastritis or normal. In the X-ray gastric examination, Fuji Computed Radiography (FCR) was used to obtain clear-cut images of the gastric area. Concerning the serum PG I level, patients in the group with atrophic gastritis showed lower levels than those of the people in the group with no atrophic change, but the variation was wide, and no definite tendency was seen in the relationship between the atrophic change and the serum PG I levels. Concerning the serum PG II level, as the atrophic change progresses, the serum PG II level tended to increase gradually. A significant reduction in the PG I/II ratio was seen in the group with atrophic changes (p < 0.01) in comparison with the group with no atrophic changes, and the PG I/II value tended to decrease. In conclusion, as a relationship between the atrophic change and the serum PG levels had a wide variation, we considered to be difficult by to measure the serum PG level to understand the presence and extent of the atrophic gastritis.

A new approach to methotrexate and lipiodol suspensions for ectopic pregnancy: preliminary in vitro and animal experiments

OBJECTIVES

To measure and evaluate the in vitro release of MTX from suspensions of methotrexate (MTX) and lipiodol (LPD), and to investigate the MTX concentration and fertility rate using an animal model.

METHODS

This study was divided into three components: a) An in vitro Release Study, b) Animal Study No. 1 (concentration of tissue and plasma levels), and c) Animal Study No. 2 (fertility rate after MTX suspension).

RESULT

The releasing rate in vitro was more rapid with MTX-S (MTX dissolved in saline) than with either MTX-LPD (MTX dissolved in lipiodol) or MTX-LPD-PC (MTX suspended in lipiodol and phosphatidylcholin, i.e., MTX suspension). The tissue concentration tended to be higher with an MTX suspension than with MTX-S. There was no significant difference in the fertility rate or the nidation index among the 3 groups (Groups 1, 2, and 3).

CONCLUSION

The injection of an MTX suspension is useful for increasing the tissue concentration and maintaining the long-term effectiveness of MTX, and this technique might offer a new approach in the treatment of ectopic pregnancy (EP) or in second-line therapy for persistent EP.

Novel, potent, and orally active substance P antagonists: synthesis and antagonist activity of N-benzylcarboxamide derivatives of pyrido[3,4-b]pyridine

A series of 4-phenylisoquinolone derivatives were synthesized and evaluated for NK1 (substance P) antagonist activity. Highly potent antagonists, 4-phenyl-3-isoquinolone-N-benzylcarboxamides (11), were discovered from the structure-activity relationship studies on the isoquinolone-urea lead 1a. Optimization of the activity in this series resulted in the development of 5-phenyl-6-pyrido[3,4-b]pyridine-N-benzylcarboxamides (30) which are highly potent orally active NK1 antagonists. Among the compounds synthesized, N-[3,5-bis(trifluoromethyl)benzyl]-7,8-dihydro-N,7-dimethyl-8-oxo-5- (substituted phenyl)-6-pyrido[3,4-b]pyridinecarboxamides (30a,f,g) showed excellent antagonist activities with IC50 values (in vitro inhibition of [125I]-BH-SP binding in human IM-9 cells) of 0.21-0.34 nM and ED50 values (in vivo inhibition of capsaicin-induced plasma extravasation in guinea-pig trachea, iv) of 0.017-0.030 mg/kg. These compounds exhibited significantly potent activity upon oral administration with ED50 values of 0.068-0.17 mg/kg. Conformational studies on 30g indicated that the two stable conformers of 30g are quite similar to those of CP-99,994.

A case of nondiabetic macrosomia with Simpson-Golabi-Behmel syndrome: antenatal sonographic findings

The incidence of macrosomic infants weighing 5,000 g or more is rare. We experienced a case of nondiabetic macrosomia, in which the fetus weighed more than 5,000 g. The newborn was diagnosed as having Simpson-Golabi-Behmel syndrome. We discuss antenatal ultrasonographic findings in the case.

High-performance liquid chromatographic separation of penicillamine enantiomers labelled with N-[4-(6-dimethylamino-2-benzofuranyl)phenyl] maleimide on a chiral stationary phase

Penicillamine enantiomers derivatized with N-[4-(6-dimethylamino-2-benzofuranyl)phenyl]maleimide (DBPM) were separated and determined by high-performance liquid chromatography. A fluorogenic reagent, DBPM easily reacted with D- or L-penicillamine to give each two kinds of strong fluorescent derivatives (D1-, D2-, L1- and L2-DBPM), which could be separated on a Pirkle-type chiral stationary phase using an eluent of 75% aqueous methanol solution containing 0.15 M CH3COONH4 and 0.05 M tetra-n-butylammonium bromide. Two of the peaks (D1- or L1-DBPM), having a shorter retention time than the others, had almost the same retention times (25 min for D1-DBPM and 25.7 min for L1-DBPM). The retention times of the peaks eluted later were 28 min and 31.6 min for D2- and L2-DBPM respectively. Linear calibration curves over the range of 2-50 pmol per injection were obtained for D- and L-penicillamines with a detection limit of 290 and 350 fmol at respectively at a signal-to-noise ratio of 3. Using the proposed method, the absence of contamination of L-penicillamine in a commercially available D-penicillamine preparation (capsule) was confirmed.

[The predictive factor of postpartum impaired glucose tolerance in pregnant women with abnormal glucose tolerance]

To determine factors predictive of impaired glucose tolerance (IGT) in the postpartum period, we examined the maternal and perinatal characteristics of fifty-eight women with abnormal glucose tolerance during pregnancy. A 75g oral glucose tolerance test (OGTT) was performed on the women again around 4 weeks after delivery. Forty women who had a 2-hour plasma glucose level of 140mg/dl or more were defined as IGT in postpartum (group IGT), and the other eighteen women with a 2-hour plasma glucose level lower than 140mg/dl were defined as having normalized glucose tolerance (group N). The women in group IGT weighed more during pregnancy than those in group N (p < 0.05). Insulin secretion during the antepartum OGTT was lower in group IGT than in group N. On the basis of the prepregnant body mass index (BMI) for the obese group (BMI > or = 24), the women in group IGT weighed much more during pregnancy than those in group N (p < 0.03). In the non-obese group, the women in group IGT had higher glucose levels and lower insulin responses than those in group N. We concluded that, in obese women, excessive weight gain during pregnancy is predictive of postpartum IGT, while in non-obese women, the severity of glucose intolerance during pregnancy is related to poor postpartum prognosis.