Rectal administration of misoprostol for the management of retained placenta--a preliminary report

BACKGROUND

Retained placenta is one of the serious complications of childbirth, and misoprostol is known to be a potent uterotonic agent. Therefore, we proposed that rectal misoprostol also may facilitate placental separation in women with retained placenta by its ability to increase uterine contractility.

METHODS

The placenta was diagnosed as retained if it was not expelled within 40 minutes after vaginal birth. Then, 800 microg of misoprostol was inserted rectally and the patient observed thereafter.

RESULTS

A total of 18 parturients who had retention of the placenta were studied; all the placentas were spontaneously expelled within 35 minutes. The side effects involved included nausea 17%, vomiting 11%, diarrhea 22%, shivering 33%, and pelvic cramping pain 44%. All these discomforts resolved within 24 hours.

CONCLUSIONS

Our study demonstrated that misoprostol per rectum is a safe and effective technique and may be a useful alternative to manual removal of retained placentas.

QSAR study of steroid benchmark and dipeptides based on MEDV-13

A molecular electronegativity distance vector based on 13 atomic types, called MEDV-13, is a descriptor for predicting the biological activities of molecules based on the quantitative structure-activity relations (QSAR). The MEDV-13 uses a modified electrotopological state (E-state) index to substitute for the relative eletronegativity (q) of non-hydrogen atoms in the molecule of interest in the MEDV and a topological distance for the relative distance (d) in the MEDV. For an organic molecule containing several chemical elements such as C, H, O, N, S, F, Cl, Br, I, and P, the MEDV-13 includes at best 91 descriptors. Then it is essential to employ a principal component regression (PCR) technique to derive a QSAR model relating the biological activities to the MEDV-13. The MEDV-13 is used to study the QSAR of the corticosteroid-binding globulin (CBG) binding affinity of the steroids and the activity inhibiting angiotensin-converting enzyme (ACE) of dipeptides, and resulting models have a comparable quality to the current three-dimensional (3D) methods such as CoMFA though the MEDV-13 is a descriptor based on two-dimensional topological information.

Preeclamptic pregnancy is associated with increased sympathetic and decreased parasympathetic control of HR

Previous work from our laboratory using heart rate variability (HRV) has demonstrated that women before menopause have a more dominant parasympathetic and less effective sympathetic regulations of heart rate compared with men. Because it is still not clear whether normal or preeclamptic pregnancy coincides with alternations in the autonomic functions, we evaluated the changes of HRV in 17 nonpregnant, 17 normotensive pregnant, and 11 preeclamptic women who were clinically diagnosed without history of diabetic neuropathy, cardiac arrhythmia, and other cardiovascular diseases. Frequency-domain analysis of short-term, stationary R-R intervals was performed to evaluate the total variance, low-frequency power (LF; 0.04-0.15 Hz), high-frequency power (HF; 0.15-0.40 Hz), ratio of LF to HF (LF/HF), and LF in normalized units (LF%). Natural logarithm transformation was applied to variance, LF, HF, and LF/HF for the adjustment of the skewness of distribution. We found that the normal pregnant group had a lower R-R value and HF but had a higher LF/HF and LF% compared with the nonpregnant group. The preeclamptic group had lower HF but higher LF/HF compared with either the normal pregnant or nonpregnant group. Our results suggest that normal pregnancy is associated with a facilitation of sympathetic regulation and an attenuation of parasympathetic influence of heart rate, and such alterations are enhanced in preeclamptic pregnancy.

Asymptomatic uterine incarceration at term gestation: a case report

Uterine incarceration is a rare event complicating pregnancy. Herein, we present a unique case of an asymptomatic term pregnancy with uterine incarceration; this patient had had an anterior myomectomy 3 years earlier. She had an asymptomatic antenatal course and incidental identification of uterine incarceration during cesarean section. We also address the importance of early recognition and appropriate management regarding this circumstance.

Psychosocial risk factors of teenage pregnancy in eastern Taiwan

BACKGROUND

Teenage pregnancy is a growing worldwide problem, associated with adolescents' social and health problems and poor perinatal outcome. This study was conducted to investigate psychosocial factors predisposing to the high teenage pregnancy rate in Hualien, eastern Taiwan.

METHODS

A regional hospital-based study was conducted with a retrospective analysis of hospital records and questionnaires to collect personal and family data regarding the perinatal outcome of 100 pregnant teenagers and 100 pregnant adults, who had normal deliveries at the Buddhist Tzu-Chi General Hospital between 1994 and 1995.

RESULTS

A significantly higher percentage of teenage mothers were of aboriginal origin than adult mothers (63% vs 25%; p < 0.05) and lived in rural areas (80% vs 19%; p < 0.05). There was also a higher incidence of late antenatal care (31% vs 11%; p < 0.05) drinking (36% vs 9%; p < 0.05) and a greater history of smoking (34% vs 7%; p < 0.05) among teenage mothers. About 86% of teenage mothers did not use any contraception. The preterm birth rate was not significantly higher in the adult group, but teenage mothers tended to have significantly lower birth weight infants (19% vs 9%; p < 0.05) and a decreased incidence of cesarean section (19% vs 33%; p < 0.05). About 20% of the teenage mothers had their first coitus before the age of 13, while none of the adult mothers had sexual coitus before the age of 13.

CONCLUSIONS

In this hospital-based study, teenage mothers tended to be of aboriginal origin, lived in rural areas, had early sexual exposure without contraception, had drinking and smoking habits, were late seeking antenatal care and gave birth to low birth weight infants.

Laparoscopic loop ligatures for bladder repair during laparoscopic surgery

In this paper, we report a case where a bladder perforation occurred during a laparoscopically assisted vaginal hysterectomy and was repaired by laparoscopic loop ligatures. This is the first case report of using the laparoscopic loop ligatures to close the bladder perforations. The loop ligature is an easy and quick procedure, which can be performed by most surgeons who take the time to learn the endoscopic suturing techniques.

Hysteroscopic endometrial ablation without endometrial preparation

OBJECTIVE

To study the effectiveness of endometrial ablation by hysteroscopic resection without prior medical preparation for the treatment of women with persistent menorrhagia.

METHOD

From January 1996 to January 1997, a total of 170 women with persistent menorrhagia and/or dysmenorrhea and who underwent hysteroscopic endometrial resection were included in the study. A thorough suction curettage was done before the procedure. The operation was conducted through a continuous flow hysteroscopic resectoscope with electrosurgery while the patient was under intravenous general anesthesia. The distention fluid used was 5% dextrose with a gravity feed infusion system consisting of a 2-1 bag between 1 and 1.5 m above the uterine cavity. After the procedure, the patients' conditions were followed for at least 6-18 months by telephone interview or at our clinic.

RESULTS

A total of 127 women were available for a follow-up period of at least 6 months. Operative complications were 3%; three women had fever and received oral antibiotics; no uterine perforation occurred; one case of post-operative bleeding was controlled by intrauterine balloon inflation; the average operation time was 21 min; The mean fluid deficit was 435 ml. Ninety-nine out of 127 women (78%) had adequately controlled menorrhagia (18.1% had amenorrhea, 42.5% hypomenorrhea and 17.3% had normal menstrual flow), while 27 women (21.2%) were failed due to unchanged or heavier menstrual flow after surgery. Eleven (40%) out of the 27 failed cases had myoma with menorrhagia, whereas only five women (5%) out of the 99 adequately treated women had myomas (P < 0.05). Thirty-eight (54%) out of the 70 women with severe dysmenorrhea reported either lessening dysmenorrhea or no dysmenorrhea after the surgery. A total of 76 women (60%) were satisfied with the procedure. A second surgical procedure, either a resection or hysterectomy, was necessary in 13 women (10%) after ablation (seven received repeated ablations and six underwent hysterectomy).

CONCLUSION

Endometrial ablation without endometrial suppression is a cheap, effective and acceptable procedure for treatment in women with persisted persistent menorrhagia.

Transcervical embryoscopic diagnosis of conjoined twins in a ten-week missed abortion

Embryoscopic diagnosis of conjoined twins presenting with a missed abortion has never been reported. The morphological and pathological examinations, and the exact time of death in the conceptus of a missed abortion are seldom clearly delineated. The newly developed field of embryoscopy has created a new frontier in early embryonic/fetal visualization and is able to confirm the sonographic diagnosis. In this report, we used a transcervical endoscope to verify conjoined twins (thoraco-omphalopagus) in a 10-week missed abortion. Based on the size and the external features of the dead embryo, which exhibited developmental arrest at nine weeks and three days of menstrual age, we estimated that the embryo had died four days before examination. The whole procedure proceeded smoothly without any immediate complications.

Neonatal gastric aspirates as a predictor of perinatal hepatitis B virus infections

OBJECTIVE

To elucidate possible routes and predictors of perinatal transmission of hepatitis B virus (HBV).

METHOD

This was a prospective follow-up study. One hundred and forty-seven out of 1762 pregnant women who were screened in the antenatal clinic of a university teaching hospital were HBsAg carriers. Enzyme immunoassay was used for determination of hepatitis B markers. Occurrence of HBsAg in newborns' gastric aspirates, newborns' and infants' blood, and maternal milk samples were determined. Their relationship with delivery routes and duration of the first stage of labor were analyzed by chi square test.

RESULTS

The presence of HBsAg in newborns' gastric aspirates was strongly associated with the acquisition of HBsAg by the babies. There was no correlation between the rate of infant antigenemia and the duration of the first stage of labor, nor did cesarean section decrease the rate of vertical transmission of HBV.

CONCLUSIONS

This is the first report to provide direct evidence for the major role of the oral route in vertical transmission of HBV during delivery. In addition to maternal serum HBeAg, HBsAg status in newborn's gastric aspirates is another important determinant for vertical transmission of HBV.

Extensive thrombophlebitis with reactive thrombocytosis in a high risk Chinese parturient associated with retained placenta increta: a case report

Postpartum thrombophlebitis is an infrequent disorder in Chinese women. A case is reported of extensive postpartum thrombophlebitis involving 23 cm of the femoral and pelvic veins. This 25-year-old splenectomized victim of beta-thalassemia was bedridden for 12 weeks because of threatened premature labor before Cesarean delivery. During the operation, placenta increta with massive bleeding was encountered. To save the uterus, ten percent of the placenta was retained. Duplex color Doppler imaging was performed for the diagnosis and follow-up of the thrombosis and vigorous anticoagulation therapy successfully cured this patient.

Postcoital hemoperitoneum without identifiable bleeding source: a case report

Spontaneous intra-abdominal bleeding has been called abdominal apoplexy. It has been so named because its nature and spontaneity closely resemble those of its more common cerebral counterpart. The bleeding source commonly came from a ruptured branch of celiac axis or superior mesenteric artery. Rarely, hemoperitoneum occurs spontaneously post coitus without evident vaginal injury. There were only twelve cases reported in the medical literature to date. Nearly, all of them showed injury of pelvic organs including round or broad ligaments, ovarian cysts or adhesion bands. A case of massive hemoperitoneum after coitus, with no definite bleeding source, is reported.

Transcervical flexible endoscopy for first trimester embryonic/fetal evaluation

OBJECTIVE

The aim of the study was to investigate the efficacy of flexible embryofetoscopy for visualization of the first trimester human embryo and fetus.

METHOD

Twelve pregnant women scheduled for legal termination of pregnancy at 6-12 weeks' gestation were included in the study. A flexible fiber optic endoscope with an eyepiece connected to a monitor was used. The sterile endoscope was passed transcervically under ultrasound guidance through the chorion into the chorionic cavity. Embryos/fetuses were observed directly through the intact amniotic membrane.

RESULT

Successful embryofetoscopies with clear visualization of the embryo or fetus were accomplished in 50% of cases. There were no procedure-related complications.

CONCLUSION

Preliminary experience employing transcervical flexible embryofetoscopy for direct visualization of the first trimester human embryo and fetus suggest that this technique may be used for the early identification of congenital anomalies suspected by ultrasound and is expected to offer opportunities for embryo/fetal tissue sampling as well as for gene and cell therapies.

Overexpression of the proto-oncogene c-jun in association with low-risk type specific human papillomavirus infection in condyloma acuminata

Infection with different types of human papillomavirus (HPV) is associated with neoplasia at different anatomic sites. The "low-risk" HPVs (LR-HPV) are responsible for benign genital lesions such as condyloma acuminata. In order to clarify the tumorigenic mechanism of LR-HPV, the HPV infection status was investigated and the expression of the c-jun proto-oncogene in different HPV-related skin and genital lesions analyzed. Of the 17 condyloma specimens analyzed by Western blotting, 13 cases (76.5%) exhibited overexpression of the c-jun gene. All 13 cases harbored high copy numbers of the LR-HPV genome with an average of 926 copies per cell, whereas the other four cases had an average of 12 copies of LR-HPV per cell (P < 0.001). Further typing of HPV by Southern blotting revealed that HPV-6 and HPV-11 infections predominated in c-jun positive cases. The c-jun protein was detected much less frequently in cervical cancers (three of 29, or 10.3%) and skin warts (one of 10), and was not detected in five genital polyps or in five normal cervical tissues. These findings suggest a type 6/11-specific induction of c-jun gene expression in HPV-related neoplastic lesions.

Resistance to insulin-mediated glucose uptake and hyperinsulinemia in women who had preeclampsia during pregnancy

Plasma glucose and insulin responses to a 75-g oral glucose load, and the steady-state plasma insulin (SSPI) and glucose (SSPG) concentrations after an infusion of somatostatin, insulin, and glucose, were determined 2 months after delivery in 26 women; 13 who had a normal pregnancy and 13 who developed preeclampsia. The plasma glucose response to oral glucose was not different in the two groups, but the plasma insulin response was significantly greater (P < .02) in those who had been preeclamptic. Although the mean (+/- SE) SSPI concentrations during the infusion study were similar in the two groups (51 +/- 2 v 56 +/- 2 microU/mL), the SSPG concentrations were significantly higher (P < .02) in those who developed preeclampsia (160 +/- 17 v 119 +/- 17 mg/dL). Thus, when studied 2 months after delivery, women who developed preeclampsia were relatively insulin resistant and hyperinsulinemic when compared to those who had an uncomplicated pregnancy.

Characterization of mullerian inhibiting substance binding on cervical carcinoma cells demonstrated by immunocytochemistry

Müllerian inhibiting substance (MIS) is a glycoprotein released from Sertoli cells or follicular cells of gonads, responsible for the regression of Müllerian ducts and/or Müllerian-derived tumor cells. Binding of MIS to target cells is essential for initiating regression. A human cervical carcinoma CaSki cell was examined by quantitative immunocytochemistry detected by anti-avian MIS antibody for MIS binding ability. Various treatments of WGA-peroxidase conjugate, enzyme digestion, sodium periodate or exogenous estrogen before antibody recognition were performed. It was found that the WGA partially blocked MIS binding to CaSki cell surfaces. Protease digestion of CaSki cell surfaces prior to addition of MIS or an anticervical carcinoma monoclonal antibody 1H10 (MAb 1H10), blocked the binding of MIS but not MAb 1H10 to cell surfaces. Sodium periodate and overnight exposure of CaSki cells to estrogen or diethylstilbestrol before or after fixation of the cells, did not influence MIS binding ability in vitro. MIS binding was higher on avian Müllerian duct compared with MIS binding to CaSki cells by quantitative immuno-gold labeling analysis. MAb 1H10 immuno-gold complexes binding to CaSki cells was also obtained and compared with MIS immuno-gold bindings. MIS binding site could be a polypeptide which survived sodium periodate treatment. The 'critical window' period, in which developing Müllerian ducts respond to exogenous estrogen protection from MIS regression, is possibly lost in CaSki cell.

Elective cesarean section for macrosomia?

BACKGROUND

Fetal macrosomia is associated with increased risk of dystocia and birth trauma. Elective Cesarean section has been recommended for macrosomic fetus to prevent the associated complications. However, the cost/benefit ratio of such practice should be known before it can be considered appropriate.

METHODS

The record of 6230 women delivered consecutively at Tri-Service General Hospital were reviewed retrospectively. The occurrence rates of dystocia and birth trauma were compared between normal birthweight group (2500-3999 gm) and macrosomic group (> or = 4000 gm). The complication rates were calculated specifically among those macrosomic infants delivered vaginally.

RESULTS

Of the 6230 singleton pregnancies, 207 had an infant weighing at least 4000 gm. One hundred and three macrosomic infants were delivered by Cesarean section. The indication for Cesarean section was dystocia in 25, estimated fetal macrosomia in 30 and other, 48. If only those pregnancies with macrosomic infant allowing an adequate trial of labor were considered, the frequency of Cesarean section for dystocia was 19.1% in the 4000-4999 gm group and 21.4% in the 4500 gm group, compared with 4.4% in the normal birthweight group. No birth trauma occurred in the macrosomic infants delivered by Cesarean section. Of those macrosomic infants delivered vaginally, the frequency of clavicle fracture was 11.8% in the 4000-4499 gm group and 18.2% in the > or = 4500 gm group, compared with 1.2% in the normal birthweight group. Two infants (18.2%) weighing greater than 4500 gm sustained brachial plexus injury.

CONCLUSIONS

Elective Cesarean section on macrosomic infants to prevent dystocia is not recommended because most of them can be delivered vaginally. For the very macrosomic infants (> or = 4500 gm), elective Cesarean section is suggested to prevent birth trauma.

Genital human papillomavirus infections in Taiwan

OBJECTIVES

Identification and typing of HPV infections in genital condyloma and normal cytological cervix.

METHODS

Cervical cells from 289 Pap cases with normal cytological findings were examined for HPV infection by slot blot hybridization. Fifteen condyloma biopsy specimens were studied by Southern blot hybridization.

RESULTS

Thirty-six cases (12.5%) with normal cervical cytology were HPV positive. The predominant HPV type in women with normal cytology is HPV-16. Risk factors for HPV infection in women with normal cytology depend on age and history of pregnancies. Twelve cases (80%) of condyloma contained HPV-6 or -11 sequences. The predominant HPV type in genital condyloma is HPV-11.

CONCLUSIONS

HPV detection in population-based screening programs for cervical neoplasia can be an important tool in identifying women who are at risk of developing dysplasia and cervical cancer.

Identification and typing of human papillomavirus in cervical cancers in Taiwan

BACKGROUND

Although human papillomaviruses (HPV) are associated with cervical cancer, it has yet to be determined if specific HPV types have clinical or prognostic significance.

METHODS

Identification and typing of HPV were done by polymerase chain reaction (PCR) and restriction fragment length polymorphism.

RESULTS

Of the 43 cases of cervical cancer, 31 (72%) were HPV positive. The results of HPV typing in 40 cases of squamous cell carcinoma of the cervix revealed the presence of HPV-16 in 20 cases (50%), HPV-18 in 2 cases, HPV-11 in 1 case, HPV-33 in 1 case, HPV-52 in 1 case, HPV-58 in 1 case, and unidentified HPV types in 5 cases. Neither HPV-31 nor HPV-42 were present in our study. One case of squamous cell carcinoma had HPV-11 integration. Chi-square analysis revealed significant correlation between HPV genotypes and squamous cell patterns, no significant correlation between HPV genotypes and clinical stages, and cell differentiation of squamous cell carcinoma of cervix.

CONCLUSIONS

These findings may contribute to understanding the role of HPV in cancer and the value of typing as a prognostic indicator.

Characterization of a human cervical carcinoma-associated antigen by lectin binding and immuno-electron microscopy

The specific binding and nature of the epitope recognized by monoclonal antibody (Mab) 1H10, which binds an antigen expressed on human cervical tumors, was characterized by enzyme digestion, lectin competition assay and immuno-electron microscopy. Membrane homogenates of CaSki cervical carcinoma cells were digested with various enzymes, then analysed by SDS-PAGE and immunoblotting. Cells grown on coverslips were treated with various enzymes and in situ binding of Mab 1H10 to cells was analysed by electron microscopy. The ability of lectin-conjugates to block Mab 1H10 binding to CaSki cells was also examined. Treatment of samples with sodium periodate abrogated antigen recognition by Mab 1H10. Neuraminidase and hyaluronidase digestion decreased but did not eliminate Mab 1H10 binding to cells in situ. Chondroitinase ABC digestion, in contrast, removed Mab 1H10 binding sites both in vitro and in situ. Trypsin and chymotrypsin digestion of cell membrane homogenates decreased the molecular weight of the Mab 1H10 antigen but did not decrease the binding intensity. Wheat germ agglutinin (WGA) strongly bound to CaSki cells and partially blocked Mab 1H10 binding, indicating that the antigen contains N-acetyl-galactosamine residues at or near the epitope recognized by Mab 1H10. Ricinus communis agglutinin (RCA) exhibited a similar binding pattern to WGA. However, concanavalin A bound only weakly to CaSki cells and was ineffective at blocking Mab 1H10 binding. The tumor-associated antigen recognized by Mab 1H10 is concluded to be a chondroitin sulphate glycoprotein or proteoglycan rather than a mucopolysaccharide or lipoprotein.

[A clinical study on 268 patients with cervical carcinoma]

Cancer is the leading cause of death in Taiwan with cervical carcinoma having the highest incidence rate (29.65 per 100,000) of all cancers among women. In the present study, we collected 268 consecutive cases of cervical carcinoma, seen in Tri-Service General Hospital from January 1983 to December 1984. The evaluation included a review of the case data including demographic features, symptoms, stage of cancer, reproductive history, pathology, and survival time (product limit method for survival). Results showed that in situ cervical carcinoma was diagnosed in 31 (11.5%) patients with a mean age of 47.7 years. Two hundred and thirty-seven patients (88.5%) with a mean age of 55.6 years were noted to have invasive carcinoma, showing stage I 22.4%, stage II 46.6%, stage III 10.1% and stage IV 9.3%. The ratio of invasive carcinoma to carcinoma in situ was 7.7:1. Ninety-two percent of patients were symptomatic on admission with vaginal bleeding (78%), vaginal discharge (16%) and abdominal pain (16%) being the most common, and the majority of these patients were symptomatic before cervical carcinoma was pathologically proved. Survival analysis showed five-year survival rates of 100%, 84.6%, 63.2%, 54.1% and 13.2% for stages O, I, II, III and IV, respectively. Low cervical carcinoma survival rates seemed clearly related to progression of the disease the presence of more extensive disease. The average age at the time of diagnosis was older and the clinical stage of disease was more advanced when compared with most developed countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix: light and electron microscopic observations in two cases

Small cell carcinomas are rare in cervical cancers and appear to be a heterogeneous group of tumors. Neuroendocrine carcinoma of the cervix, one subtype of small cell carcinomas of the cervix, can be identified by characteristic light and electron microscopic criteria. Two cases of neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix are reported in which electron microscopic studies were performed. The presence of small dense-core membrane-bound granules (120 to 160 nm) in cytoplasmic process under electron microscopic observation confirmed the diagnosis of neuroendocrine carcinoma of the cervix. The coexistence of electron dense-core membrane-bound granules, abundant tonofibrils, and desmosomes within the cancer cells, suggests that these tumors may have derived from the multipotential precursor cells with neuroendocrine and squamous differentiation. Because neuroendocrine carcinomas appear to have the highest incidence of recurrence and the poorest prognosis, it is necessary to distinguish these neoplasms from squamous cell carcinomas of the cervix. Literature about neuroendocrine carcinomas of the cervix is also reviewed.

The role of aggregation of platelets in pregnancy-induced hypertension: a comprehensive and longitudinal study

Plasma 6-keto-prostaglandin F 1 alpha and thromboxane B2, the metabolites of prostacyclin and thromboxane A2 respectively, were measured in 12 women with pregnancy-induced hypertension, 12 age-matched normotensive pregnant women and 8 non-pregnant women as controls. Pregnancy was divided into 3 stages, namely: 22-27, 28-32 and 33-39 weeks. The concentrations of thromboxane B2 in the plasma of women with pregnancy-induced hypertension was 1.4-1.7 times greater than normotensive pregnant subjects at the same gestational stage, and 2 times higher than controls. Plasma levels of 6-keto-prostaglandin F 1 alpha in normotensive pregnant women was 1.8 times greater than in those with pregnancy-induced hypertension at 28-32 and 33-39 weeks, and was significantly higher than control. The ratio of thromboxane B2 to 6-keto-prostaglandin F 1 alpha was markedly increased in the group of patients with pregnancy-induced hypertension at 28-32 and 33-39 weeks gestation. The ratio of the two metabolites in normotensive patients at each stage of gestation was similar to the control group. The ratio of circulating aggregated platelets in subjects with pregnancy-induced hypertension was significantly lower than in normotensive pregnant subjects at 33-39 weeks, implying increased turnover of platelets in pregnancy-induced hypertension. There was no significant difference in count of platelets, adenosine diphosphate threshold concentration and variables of platelet aggregation induced by adenosine diphosphate among the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Reproductive performance following ectopic pregnancy

The reproductive performance subsequent to operative removal of ectopic pregnancy was examined in 132 women. They represent 44.6% of 296 women admitted for ectopic pregnancy between 1981 and 1989. The follow-up period ranged from 6 months to 9 years, averaging 3.6 years. During the follow-up period, 69 (52.3%) pregnancies occurred. Among them, 60 (87%) were intrauterine and 9 (13% of the pregnant women) were repeated ectopic pregnancies. Full-term delivery was obtained in 73.9% of the pregnant patients. Forty of the 132 patients received conservative surgery and 92 patients received radical surgery for ectopic pregnancy. The operation method had no influence on subsequent fertility in women with an intact contralateral tube, who had significantly higher pregnancy (p less than 0.005) rate (3.8%) than women with an affected contralateral tube (39.5%, 47% and 41%, respectively). Compared with parous women (13.3%), the risk of repeated ectopic pregnancy was similar to nulliparous women (12.5%), but the nulliparous women had a slightly lower conception rate (40%) than parous women (54.8%). Unruptured ectopic pregnancies comprised 41.6% of our cases. There was no significant difference in fertility rate between ruptured and unruptured ectopic pregnancies in our study.

No decline in preterm birth rate over three decades

Low socioeconomic status has been associated with risk of preterm delivery. During the past 30 years, Taiwan has had tremendous economic growth and people have attained higher levels of education and living. It is thus not unreasonable to presume that the rate of preterm delivery would decline in response to these changes. The birth registry of Tri-Service General Hospital from 1957 to 1987 was reviewed. The rate of preterm delivery remained stable over the past 30 years, unaffected by these country-wide social changes.

Comparative study of Filshie clip and Pomeroy method for postpartum sterilization

A prospective randomized comparison of the peri-operative complications and long-term sequelae between the Filshie clip and Pomeroy methods was undertaken in 200 postpartum women at Tri-Service General Hospital, Taipei, Taiwan. The peri-operative complications in either group were mild and infrequent. One pregnancy in the Pomeroy group was reported after follow-up for 24 months. No significant difference between the two groups was found in respect to long-term sequelae.

Pregnancy in patients with systemic lupus erythematosus

Ten pregnancies in patients with systemic lupus erythematosus were reviewed. Preterm delivery occurred in 4 cases (40%), fetal growth retardation in 2 (20%) and intrauterine death in 2 (20%). Preeclampsia developed in one case, which was the only found maternal complication. The most important factor associated with poor outcome was lack of antenatal care. Most of the SLE-complicated pregnancies can anticipate a favorable outcome if, and only if, there is a well-planned management with close cooperation among the patient, obstetrician, rheumatologist and neonatologist.

Lectin bindings and diethylstilbestrol effects on the recognition of mullerian inhibiting substance (MIS) on chick mullerian ducts by MIS-antiserum

A high intensity of lectin bindings was demonstrated on the epithelial cells and serosa cells of the regressing right Mullerian ducts (Mds) in the female chick embryos. The strong lectin bindings occurs on, or in the regressing Md cells along with marked surface MIS bindings at the age of day 13. However, at the age of days 5-7 1/2, bindings of lectins were weak. Neither Wheat-germ agglutinin (WGA) or Concanavalin A (Con-A) labelings before MIS-antiserum (MIS-Ab) incubation can block antibody recognitions to the antigens, including MIS and growth hormone at the age of day 13. Our previous studies indicated that after WGA labeling on the surfaces of Md epithelial cells prior to the incubation of MIS-Ab at day 10 did not prevent the recognition of MIS-Ab (Wang 1989). On the contrary, at day 7 1/2, the specific binding of MIS was eliminated after preincubations with lectins and prenatal diethylstilbestrol (DES) treatment at the age of day 5. It is suggested that DES provides a protection to the Mds from MIS-induced regression by preventing the MIS binding to its specific membrane receptors. An increase of extra- and intracellular glycoproteins or carbohydrates of regressing Md epithelial cells were suggested. Internalization of WGA but not MIS molecules was found in Md epithelial cells. The Golgi saccules were negative of lectin bindings.

Unsuccessful treatment of fetal immunologic thrombocytopenia with dexamethasone

Corticosteroid therapy near term for mothers with immunologic thrombocytopenia has recently been suggested as a clinically useful method to prevent neonatal thrombocytopenia. The unreliability of this approach is illustrated by the case of an infant with a low platelet count delivered after the maternal administration of dexamethasone.