A 10-year follow up of reproductive function in women treated for childhood cancer

Previously, this study group found that female childhood cancer survivors could be at risk of early cessation of fertility. The aim of the present study was to evaluate reproductive function in the same group of survivors 10 years after the initial study. Of the original cohort of 100, 71 were re-examined. Thirty-six survivors reported regular menstrual cycles. When they were compared with 210 controls, they differed significantly in antral follicle count (AFC) (median 15 versus 18, P=0.047) but not in anti-Müllerian hormone (AMH) (median 13.0 versus 17.8 pmol/l). Survivors cured with minimal gonadotoxic treatment had significantly higher AMH and AFC compared with survivors cured with either potentially gonadotoxic treatment or treatment including alkylating chemotherapy and ovarian irradiation (20.0, 5.8 and <3 pmol/l, P<0.001; and 15, 9 and 2, P=0.03, respectively). Thirty-eight survivors had achieved at least one live birth. Complicated second-trimester abortions (n=4) were observed primarily in survivors cured with radiotherapy affecting pelvic organs. In conclusion, childhood cancer survivors have signs of diminished ovarian reserve. However, if the ovarian function is preserved in the early to mid-twenties, it is likely to persist until the mid-thirties, giving a good chance of childbearing.

The mu/kappa agonist nalbuphine attenuates sensitization to the behavioral effects of cocaine

Sensitization refers to an increase in sensitivity to a drug and is believed to play a role in the etiology of substance use disorders. The purpose of the present study was to evaluate the ability of the mixed mu/kappa agonist nalbuphine to modulate sensitization to the locomotor and positive reinforcing effects of cocaine. Rats were habituated to a locomotor activity chamber and treated with saline (1.0 ml/kg, ip), cocaine (10 mg/kg, ip), or cocaine+nalbuphine (10 mg/kg, ip) every day for 10 days. Following locomotor activity testing, rats were implanted with intravenous catheters and cocaine self-administration was examined on fixed ratio (FR) and progressive ratio (PR) schedules of reinforcement. Rats treated with cocaine exhibited a progressive increase in locomotor activity over the 10-day treatment period, and this effect was significantly reduced in rats treated with cocaine+nalbuphine. In self-administration tests, rats treated with cocaine exhibited significantly higher levels of responding at a threshold dose of cocaine (0.03 mg/kg/infusion) on both FR and PR schedules than rats treated with saline. This increase in responding at a threshold dose of cocaine was blocked completely in rats treated with cocaine+nalbuphine. These data suggest that nalbuphine attenuates the development of sensitization to the behavioral effects of cocaine.

Progesterone supplementation during early gestations after IVF or ICSI has no effect on the delivery rates: a randomized controlled trial

BACKGROUND

The aim was to study whether prolongation of luteal support during early pregnancy influences the delivery rate after IVF.

METHODS

Dual centre study including 303 women who achieved pregnancy after IVF or ICSI was used. All were treated with the long protocol using GnRH agonists and given luteal support with 200 mg vaginal progesterone three times daily during 14 days from the day of transfer until the day of a positive HCG test. The study group (n = 150) withdrew vaginal progesterone from the day of positive HCG. The control group (n = 153) continued administration of vaginal progesterone during the next 3 weeks of pregnancy.

RESULTS

The number of miscarriages prior to and after week 7 of gestation was seven (4.6%) and 15 (10.0%) in the study group and five (3.3%) and 13 (8.5%) in the control group respectively. The number of deliveries was 118 (78.7 %) in the study group and 126 (82.4 %) in the control group. The differences were not significant.

CONCLUSIONS

Prolongation of progesterone supplementation in early pregnancy has no influence on the miscarriage rate, and thus no effect on the delivery rate. Progesterone supplementation can safely be withdrawn at the time of a positive HCG test.

Scleredema and smoldering myeloma

A 46-year-old white man had classic findings of scleredema; subsequently, a monoclonal immunoglobulin G lambda light chain was detected in his serum. Findings of a bone marrow biopsy specimen revealed that he had an increased percentage of plasma cells, some of which were atypical. A diagnosis of scleredema and smoldering myeloma was made.

Inflammatory tinea capitis caused by Microsporum gypseum in a five-year-old girl

An otherwise healthy five-year-old girl presented for evaluation of a large patch of erythematous scaling alopecia on the vertex of her scalp. Previous attempts to treat this with various topical agents resulted in no improvement. Our evaluation included examination of fungal cultures, which grew out a colony with characteristic morphology of Microsporum gypseum, supported by lactolphenol blue tease mounts, demonstrating the characteristic conidia for this fungus. Treatment was begun with oral griseofulvin, and evidence of inflammation resolved along with conversion to negative cultures for M. gypseum, although an area of scarring alopecia from the kerion remains. The epidemiologic basis, clinical presentation, differential diagnosis, evaluation, and treatment principles for this important geophilic organism are reviewed. Physicians need to be aware of this agent of tinea capitis, since it is destructive and only responsive to oral therapy.

Multiple adnexal tumors and a parotid basal cell adenoma

A 72-year-old woman had a preauricular mass and several scalp nodules. Her medical history included excisions of multiple cutaneous tumors, including cylindromas, trichoepitheliomas, basal cell epitheliomas, and a trichilemmoma. The parotid mass and a scalp nodule were excised. On light microscopy, the parotid mass and scalp nodule appeared similar. Ultrastructural features revealed by electron microscopic analysis of the tumors allowed diagnosis of a cylindroma of the scalp and a parotid basal cell adenoma. The association of trichilemmoma and membranous basal cell adenoma of the parotid has not been previously described. The pathogenesis of these multiple cutaneous tumors from a common cell of origin is considered.

Acanthosis nigricans and a rectal carcinoid

Malignant acanthosis nigricans is often related to adenocarcinomas of the gastrointestinal tract, but it has also been found to coexist with tumors of the amine precursor uptake and decarboxylation system. It can precede, accompany, or follow the appearance of the underlying tumor. Evaluation of our patient's new-onset acanthosis nigricans led to the discovery of an asymptomatic rectal carcinoid tumor. To our knowledge, this is the first report of acanthosis nigricans associated with a carcinoid tumor of the rectum. It emphasizes the importance of considering underlying malignancy in the evaluation of patients with acanthosis nigricans.