Multiple infection of chickens and turkeys with avian oncogenic viruses: prevalence and molecular analysis

The avian herpesvirus, Marek's disease virus (MDV) and several retroviruses, reticuloendotheliosis virus (REV), avian leukosis virus (ALV) (chickens) and lymphoproliferative disease virus (turkeys) are oncogenic and immunosuppressive agents. These viruses were detected either alone, or in various combinations in blood and tumor DNAs of commercial birds using PCR. We present a 5-year retrospective study that included 207 chicken and 52 turkey flocks. Of these, 32 chicken and 18 turkey flocks were negative. Of the positive chicken and turkey flocks 76% and 75%, respectively, had a single, while the rest, 24% and 25%, had a multiple virus infection. In the chickens of the multiple virus-infected flocks, 14% and 17% of the blood and tumor DNAs carry dual MDV and REV and/or ALV sequences, that is about 30% of the PCR-positive, and about 5% of the total DNAs analysed. Multiple virus sequences were detected only in the turkey blood DNAs-11% of 84 samples. Following that quantitation we aimed to analyse the molecular status of the retrovirus sequences in order to determine whether retrovirus sequences were integrated into the herpesvirus genome. We focused on the MDV BamH1-H 132 bp tandem repeat fragment proximity using a combined PCR (cPCR) to identify chimeric PCR products. That included amplification with heterologous combinations of the MDV and retroviral LTR primers. In 13 of 35 DNAs that had both MDV and retrovirus sequences new products were produced. Of 4 MDV + REV chimeric products that were sequenced, one was homologous to the Chicken Repeat element 1 non-LTR type retrotransposon. No evidence for a retrovirus LTR integration was found in the 132 bp repeat proximity, but in two of these products we detected nucleotide stretches of 20 bp and 21 bp with a 70% and 71% homology to the REV-LTR. Also, the amplification of the chimeric products using a retrovirus primer denoted that at least short nucleotide stretches homologous to retroviral LTR primer were present in these DNAs, and that they might resemble ancient retroviral insertions, as previously demonstrated (Isfort et al., 1992).

Intravenous albumin for the prevention of severe ovarian hyperstimulation syndrome in an in vitro fertilization program: a prospective, randomized, placebo-controlled study

OBJECTIVE

To evaluate the efficacy of i.v. administration of human albumin solution for the prevention of severe ovarian hyperstimulation syndrome (OHSS).

DESIGN

A prospective, randomized, placebo-controlled study comparing the effects of i.v. administration of human albumin solution versus sodium chloride 0.9% solution at the time of oocyte retrieval with patients undergoing IVF-ET who are at high risk for the development of severe OHSS.

SETTING

Specialized assisted reproduction unit.

PATIENTS

Thirty-one patients undergoing IVF-ET who had serum E2 levels of 1,906 pg/mL (> 7,000 pmol/L) and multiple follicular development on the day of hCG administration.

INTERVENTIONS

After hCG administration, patients were randomized to receive i.v., either 50 g of human albumin diluted in 500 mL of sodium chloride 0.9% or 500 mL of sodium chloride 0.9% at the time of oocyte retrieval.

MAIN OUTCOME MEASURES

Ovarian size as measured by pelvic ultrasonography, development of ascites, serum E2 concentrations during the luteal phase, and results of the IVF-ET cycles.

RESULTS

Although no patient who had received human albumin solution developed severe OHSS, there were four such cases in the control group. All four were hospitalized with marked ascites and ovarian enlargement. There were no significant differences between the two groups comparing serum E2 levels on the day of hCG administration and during the luteal phase, the number of oocytes retrieved, fertilization, and pregnancy rates.

CONCLUSIONS

Our preliminary results suggest that the administration of human albumin solution may help to prevent the development of severe OHSS in high-risk patients. Further research is needed to assess the potential of this novel approach.

Extraovular PGE2 and oxytocin-implicated uterine rupture during midtrimester termination of pregnancy

A case of uterine rupture caused by extraovular PGE2 in a sequence with intravenous oxytocin during midtrimester termination of pregnancy is presented. It teaches us that when oxytocin is used after prostaglandins in patients having a scarred uterus, the lowest effective dose should be applied.

Vaginal delivery of breech-vertex twins

The safety of vaginal birth for breech-vertex twins has not been addressed directly before. We retrospectively compared the perinatal outcome of two groups of breech-vertex twins: 24 delivered vaginally and 35 delivered abdominally. Vaginal delivery was allowed under the same protocol developed for singletons in breech presentation. Both groups had similar maternal and neonatal characteristics except for a significantly higher rate (P = .003) of pregnancies after infertility in the abdominal delivery group. Intergroup differences in perinatal outcome, as measured by Apgar scores and morbidity and mortality cases, were not significant. Our data suggest that if measures for safe vaginal delivery are taken, this route appears to incur no morbidity and mortality for breech-vertex twins.

Diffuse Lewy body disease with immediate post-partum onset

A previously healthy 27 years-old woman developed psychotic depression and parkinsonism shortly after delivery of her first child. Her neuropsychiatric symptoms progressed to dementia and she died 5 years after onset. Diffuse Lewy body disease was found at autopsy. This case is unusual because of the early age of onset and the abrupt development of symptoms following pregnancy.

The importance of the endopelvic fascia repair during vaginal hysterectomy

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.

Diffuse Lewy body disease and progressive dementia in a young woman

This report details the emergence of a progressive parkinsonian syndrome, dementia and behavioural disturbance in a 33 year-old woman which can be dated to the delivery of her first child. The findings of this case indicate that cortical Lewy body disease should be considered in any patient with temporoparietal dementia and idiopathic Parkinson's disease irrespective of the age of onset.

Aspiration of ectopic pregnancy under guidance of vaginal ultrasonography

This case report describes the treatment of tubal pregnancy by aspiration of the gestational sac content and injection of methotrexate by transvaginal sonographic guidance. The confirmation of the embryo aspiration as indicated by disappearance of the embryo with its heart beat and the resulting 46,XY karyotype, raises the question whether methotrexate injection is necessary.

Perinatal outcome of twin pregnancies complicated with preeclampsia

Twenty-five mild and 19 severe preeclampsia cases in twin pregnancies (12.5%) were compared to 44 matched for gestational age controls. All three groups were similar with respect to maternal age, intertwin birthweight differences, and rates of abdominal deliveries and low (less than 7) 5-minute Apgar scores. The frequency of primiparas in the severe preeclampsia group was significantly higher compared with controls (p less than 0.03). Severe preeclampsia patients delivered at a significantly earlier gestational age (p less than 0.005) and had a significantly lower mean twin birthweight (p less than 0.003) compared with the mild preeclamptic group. The mean twin birthweight of the severe preeclamptic cases was also significantly lower compared with that of controls. All three neonatal deaths occurred in severely discordant second twins born to severe preeclamptic patients. It is concluded that adverse perinatal outcome is associated with severe but not with mild preeclampsia in twin gestations.

Endometrial morphology and hormonal profiles in in vitro fertilization patients

Endometrial biopsy was performed in 27 infertile women participating in the IVF program. Their mean age was 31.8 years, 33% of the women being over 35 years old. The average duration of infertility was 6.9 years. The superovulation protocol consisted of hMG/hCG in 5 cases, of combined GnRH analog/gonadotropin therapy in 20 women, and 2 patients received combined contraceptive pill/gonadotropin treatment. Judging by hormonal profiles, follicular growth rate and number of oocytes retrieved, the response to stimulation was normal. The mean estradiol (E2) levels increased from 132.7 pg/ml on day -5 (SEM = 9.67) to 1272 pg/ml (SEM = 103.7) on the day of hCG administration and to 1813 pg/ml (SEM = 209.6) 1 day later. One day before the hCG application, the mean progesterone and LH levels were 1.34 ng/ml and 8.38 IU/ml, respectively. Only one patient had clinical hyperstimulation syndrome. Ova were harvested in all women, the mean number of oocytes being 7.7 (SEM = 0.83) per patient. In all 27 cases lack of fertilization or faulty ovum cleavage were observed. Thus, an endometrial biopsy (EB) was performed 72 h after oocytes retrieval. The mean estrogen and progesterone levels on the EB day were 610.9 pg/ml (SEM = 78.44) and 45.4 ng/ml (SEM = 7.53), respectively. Histologic examination of the endometrium showed normal secretory endometrium consistent with day 16-17 of spontaneous ovulatory cycle. Two women who received combined contraceptive pills/gonadotropin therapy showed inactive endometrium with subnuclear vacuoles and decidual reaction in the stroma similar to that observed in women on estrogen-progestin birth control medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Invasive papillary serous adenocarcinoma of the endocervix in pregnancy; a case report

A case of invasive papillary serous adenocarcinoma of the endocervix in pregnancy is described. The pure papillary pattern appears rarely, and to the best of our knowledge has never been described previously in pregnancy.

Hormonal profiles following clomiphene citrate therapy in conception and nonconception cycles

The hormonal profiles following clomiphene citrate (CC) administration during a single cycle were compared in infertile women who conceived and in those who did not. Of 41 treated patients, ovulation was assumed to have occurred in 28 and was confirmed by clinical pregnancy in five. In the 28 women who presumably ovulated, two distinct patterns of hormonal secretion were observed. A normal response was exhibited by 17 patients (including the five who became pregnant). The other 11 patients exhibited an abnormal response, characterized by significantly higher luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios than in the normal response group from day 9 until the occurrence of the LH peak (days 9 and 10, P less than 0.05; days 11 and 12, P less than 0.001), and significantly higher oestradiol (E2) levels throughout the cycle (P less than 0.01). In addition, in comparison with the normal response group their LH levels during the follicular phase were significantly higher (P less than 0.05) but their LH peaks at ovulation were significantly lower (P less than 0.02). Moreover, their progesterone levels, in contrast to those in the normal response group, began to increase prior to the LH peak and remained high during the early and mid-luteal phases. None of the women who exhibited this abnormal gonadotrophin response to CC therapy achieved a clinical pregnancy. Exposure to high LH levels in the follicular phase following CC therapy seems to reduce the rate of fertilization and/or to contribute to early embryonic loss.

Clinical aspects of ovarian tumors of low malignant potential

A review of 21 cases of ovarian tumors of low-malignant potential diagnosed in our department over a period of 13 years was undertaken. Ninety percent of the patients presented with stage I disease. The average age at diagnosis (45 years) was younger than commonly found in patients with invasive epithelial cancer. Three patients received postoperative chemotherapy, and all of those were evaluated by second-look laparotomy. One of our patients with stage Ic serous tumor recurred with lung metastases. In two other patients with mucinous tumors, mucocele of the appendix was found. The five year survival in this series was 100%. Our study emphasizes the need for a prospective study to evaluate the value of adjuvant therapy in the various stages of these ovarian neoplasms.

Can premature luteinization in superovulation protocols be prevented by aspiration of an ill-timed leading follicle?

In 12 patients stimulated for in vitro fertilization and embryo transfer (IVF-ET), a single leading follicle developed, whereas the other follicles were 6 mm smaller. In 7 patients chosen at random (group A), the leading follicle was aspirated, whereas in the other 5 the leading follicle was allowed to continue growing (group B). Comparison of the hormonal pattern of both groups showed that a premature luteinizing hormone (LH) surge was avoided only in group A, and only in this group a second follicle aspiration for IVF-ET was done, and two pregnancies were achieved. In group B, aspiration for IVF-ET was canceled because of premature LH surge. It is suggested that aspiration of a single leading follicle during ovulation induction may be an efficient method to avoid premature LH surge enabling other follicles to develop up to the preovulatory stage.

The premenstrual syndrome

PMS is probably a group of entities which include various symptoms that occur during the 7 to 10 days before menstruation and disappear a few hours after the onset of menstruation. The definition of PMS lacks objective criteria. The most common symptoms are irritability, bloating, aggressiveness, mastodynia, and headaches. The prevalence of PMS is estimated at 30 to 40 per cent. PMS is more prevalent among women working outside the home, alcoholics, women of high parity, and women with toxemic tendency; it probably runs in families. The etiology of PMS is no less obscure to us than when it was first described by Frank in 1931. No single theory has been established to explain the entire diversity of PMS symptomatology. The multitude of possible etiologic factors includes psychosocial bases, progesterone deficiency, prolactin excess, thyroid hypofunction, renin angiotensin alternations, antidiuretic hormone excess, decreased colloidosmotic pressure, endorphin activity alternations, serotonin metabolism alternations, prostaglandin action, vitamin deficiency, and such unconventional theories as the ovarian infection or the "yeast overgrowth" theory. A partial resolution of this divergence of hypotheses comes from the biopsychosocial model developed by Keye and Trunnel. According to this model, a biologic, perhaps genetically determined, predisposition to PMS is realized when past and present life experiences, attitudes, beliefs, coping styles, and social forces interact to stress a woman. The diagnosis of PMS is based on establishing a relationship between the luteal phase of the cycle and the symptoms. The evaluation of PMS patients includes the use of a monthly diary to scale the symptoms, a physical examination, and biochemical studies to rule out other disorders. Management includes education, reassurance, and drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Premature rupture of the membranes in a single twin gestational sac. A case report

Premature rupture of the membranes was diagnosed with ultrasound and subsequent injection of dye into the upper sac of a 15-week twin gestation. Because of a history of prolonged infertility, conservative treatment (including bed rest, antibiotics and intravaginal povidone-iodine pessaries) was given. Four weeks later the leakage of amniotic fluid stopped, and at 32 gestational weeks the patient delivered healthy twins by cesarean section. No sign of chorioamnionitis was noted clinically or histologically. It seems that in this unusual case the lower sac was acting as a tampon and at some stage prevented further escape of amniotic fluid as well as ascending infection.

[Ultrasonically-guided aspiration of clear pelvic cysts]

In 33 women aged 13-80, clear pelvic cysts were aspirated. The diameter of the cysts was between 4-11 cm and the aspiration, by either the vaginal or abdominal routes, was ultrasonically guided. In 25 cases (76%) there was no recurrence of a cyst during continuing follow-up. In 8 cases in which a cyst recurred, 4 were operated on and benign tumors were found. Ultrasonically guided aspiration is appropriate treatment for clear pelvic cysts.

Immune modulation exerted by thymic humoral factor (THF-gamma 2), on T-cell subsets and IL-2 production of umbilical cord blood lymphocytes

The effect of a synthetic thymic humoral factor, THF-gamma 2, on the immune competence of T-cells was investigated in vitro on lymphocytes from human cord blood (UCBL). It was found that preincubation of UCBL with THF-gamma 2 caused an increase in the percentage of cells expressing the CD4 or the CD8 differentiation antigens, but did not affect the percentage of CD3 cells. The effect of THF-gamma 2 on PHA-induced IL-2 secretion was also studied and found that a 3hr preincubation with THF-gamma 2, prior to suboptimal PHA stimulation caused an increase in the IL-2 activity of the treated UCBL cultures. This effect was THF-gamma 2 dose dependent with an optimum in the range of 300-600 ng/ml and was not influenced by irradiation of the UCBL. These results indicate that THF-gamma 2, a synthetic octapeptide, modulates the immune state and response of human umbilical cord blood lymphocytes.

Combined diagnostic laparoscopy and follicular aspiration for human in vitro fertilization

Laparoscopic retrieval of oocytes from stimulated follicles for in vitro fertilization and embryo transfer (IVF-ET) was performed at the time of diagnostic laparoscopy in 36 infertile women. Their mean rates of cleavage, embryo transfer and pregnancy did not differ from those obtained in 86 patients (101 cycles) who underwent ultrasonically guided transvaginal oocyte retrieval following diagnostic laparoscopy performed earlier as a separate procedure. In view of the advantages in terms of reduced patient morbidity, time and cost benefits, and the opportunity for oocyte-sperm compatibility testing in vitro, the combined procedure appears to be the best method in patients scheduled to undergo diagnostic laparoscopy.

Development of human embryos in the presence of a copper intrauterine device

This study was designed to examine the teratogenic potential of copper releasing intrauterine contraceptive devices on the developing embryo. The tissues and organs of 11 whole embryos between 7 and 12 weeks of gestation were histologically examined for copper absorption after exposure to a copper intrauterine device in utero. The findings were not significantly different when compared with a control group of 7 embryos. No malformation or copper aggregates were observed in the various organs and placentas. The observations in this small sample would suggest that the copper-releasing intrauterine device has no deleterious effects on fetal development. The question remains whether malformations reported in some cases are associated with copper deposits in the tissues or with free copper ions in the fetal circulation. The implications are discussed.

Recurrent spontaneous twinning

The perinatal outcome of seven recurrent twin deliveries after 28 weeks gestation, was compared to the first twin delivery and to randomly selected controls matched for parity, maternal age and gestational age. The outcome of the recurrent twin gestation was associated with significantly increased gestational age (P less than 0.04) and mean twin birth weight (P less than 0.05) compared to the first twin pregnancy. When compared to controls matched for maternal age and gestational age they were of significantly higher parity (P less than 0.005) but had otherwise similar obstetric characteristics as when compared to controls matched for parity. These data suggest a better outcome for the recurrent compared to the first twin gestation. The frequencies of repeat twinning (0.0165% of all deliveries) and the calculated probability of having by chance a recurrent twin delivery were significantly different (P less than 10(-6)) suggesting that both deliveries may be stochastically dependent events.

Transverse uterine incision for cesarean delivery of the transverse-lying fetus

Low-isthmic transverse uterine incision was performed in 66 patients during Cesarean section indicated for transverse fetal lie. No significant differences were noted in the 1 and 5 min Apgar scores among fetuses delivered before or after rupture of the membranes. In only 5 (7.6%) of these cases was the incision converted into an inverted-T. The 1 min Apgar score was significantly lower in this group (6.0 +/- 1.3) compared to the rest of the group (7.5 +/- 1.7, P less than 0.01), however, the 5 min score showed no significant difference. No significant complications were noted in the post-operative course of mother and fetuses. We concluded that the transverse uterine incision is safe for the Cesarean delivery of the transverse-lying fetus.

Severe ovarian hyperstimulation syndrome: a reevaluated therapeutic approach

During the 10 years 1978 to 1987, 33 patients were hospitalized because of moderate and severe ovarian hyperstimulation syndrome (OHSS) in 39 treatment cycles. Twenty-five treatment cycles ended in moderate OHSS (group A), 7 had severe OHSS without a significant amount of ascites (group B1), and 7 had severe OHSS with ascites (group B2). Groups A and B1 received intravascular volume expander, electrolytes replacement, and indomethacin up to 300 mg/day. The patients in group B2 had significant clinical and biochemical improvement after abdominal paracentesis. Urinary output and creatinine clearance improved significantly, and a decrease in hematocrit, blood osmolarity, and weight reduction were achieved. A strategy for treatment of OHSS based on consecutive ultrasonographic examination, clinical and biochemical evaluation, and abdominal paracentesis in severe OHSS with clinically significant ascites is suggested.

Tamoxifen treatment in women with failure of clomiphene citrate therapy

Fourteen pregnancies were achieved with tamoxifen therapy in 12 women who failed to conceive with clomiphene citrate. There were no side-effects and fewer treatment cycles were required than with clomiphene citrate treatment. Ovulation and cervical score with tamoxifen therapy were significantly higher (p less than 0.005).

Simultaneous tubal and intra-uterine pregnancy following in vitro fertilization and embryo transfer

A case of simultaneous ectopic and intra-uterine pregnancy following in vitro fertilization and embryo transfer (IVF-ET) is described. On day 56 after ET the tubal pregnancy ruptured, with massive hemoperitoneum. Following salpingectomy, the intra-uterine pregnancy continued to term when delivery was carried out by cesarean section owing to non-progress of labor and suspected fetal distress. The pitfalls in diagnosing a simultaneous pregnancy of this kind following IVF-ET are discussed.

Effectiveness of silicone sheeting in preventing the formation of pelvic adhesions

The uterine horns of 35 female rabbits were subjected to injury by cautery. Ten days later the adhesions were scored and lysed, and in 30 animals the lesion on one side was covered with a segment of silicone. The contralateral uterine horn served as an internal control. After 5, 10, or 15 days, the silicone was removed (groups A, B, and C, respectively). Five animals (group D) in which no silicone barrier was introduced served as an external control. The rabbits were killed ten days later, and the pelvic adhesions were scored again. A significant reduction in adhesion formation following lysis was found in groups A, B, and C. The largest difference between the treated and the untreated side was obtained in group A. In each of these groups, the mean adhesions score on the treated side was significantly lower following lysis than in group D.

Lactic dehydrogenase, alkaline phosphatase and human chorionic gonadotropin in a pure ovarian dysgerminoma

Pure dysgerminoma is considered to be a nonsecretary ovarian tumor. In this study serum lactic dehydrogenase, human chorionic gonadotropin, and alkaline phosphatase levels were highly elevated in a 21-year-old woman with unilateral ovarian pure dysgerminoma and fell sharply to normal levels after removal of the tumor. In order to establish the source of these elevated serum enzymes and hormone, the tumor was homogenized and the level of these substances was found to be several times higher than that of normal homogenized ovarian tissue. In addition, the presence of lactic dehydrogenase and alkaline phosphatase in the dysgerminoma cells was shown by histochemical methods. This is the first report providing evidence that pure dysgerminoma contains and secretes enzymes and hormones which may constitute tumor markers useful for the diagnosis and follow-up of patients with this type of neoplasm.

Forskolin-resistant Y1 mutants harbor defects associated with the guanyl nucleotide-binding regulatory protein, Gs

The properties of the adenylate cyclase from forskolin-resistant mutants of Y1 adrenocortical tumor cells was compared with the properties of the enzyme from parental Y1 cells in order to localize the site of mutation. In parental Y1 cells, forskolin stimulated adenylate cyclase activity with kinetics suggestive of an interaction at two sites; in mutant cells, forskolin resistance was characterized by a decrease in enzymatic activity at both sites. Forskolin potentiated the enzyme's responses to NaF and guanyl-5'-yl imidodiphosphate (Gpp(NH)p) in parent and mutant clones, and the mutant enzyme showed the same requirements for Mg2+ and Mn2+ as did the parent enzyme. The adenylate cyclase associated with forskolin-resistant mutants was insensitive to ACTH and was less responsive to Gpp(NH)p than was the parent enzyme. In parental Y1 cells and in the forskolin-resistant mutants, cholera toxin catalyzed the transfer of [32P]ADP-ribose from [32P]NAD+ into three membrane proteins associated with the alpha subunit of Gs; however, the amount of labeled ADP-ribose incorporated into mutant membranes was reduced by as much as 70%. Both parent and mutant membranes were labeled by pertussis toxin to the same extent. The insensitivity of the mutant adenylate cyclase to ACTH and Gpp(NH)p and the selective resistance of the mutant membranes to cholera toxin-catalyzed ADP-ribosylation suggest that a specific defect associated with Gs is involved in the mutation to forskolin resistance in Y1 cells.

Characterization of the growth-discordant twin

A computer-assisted analysis of perinatal variables was undertaken in order to characterize the growth-discordant twin. We studied 124 twin pairs grouped at four degrees of discordancy: over 5, 10, 15, and 20% birth weight difference, using the larger twin as 100%. Twins with birth weight discrepancy below these figures were considered concordant. Highly discordant second twins showed significantly lower birth weight, gestational age, and Apgar scores, and prolonged neonatal hospitalization, as compared with discordant first twins. Complex presentations and a higher cesarean section rate characterize discordant first and concordant twins. It is suggested that a 15% birth weight discordancy be used as the safety limit for birth weight disparity. We also recommend special attention when discordancy seems to increase, especially if the discordant is the second twin.

Vaginal delivery of the second twin in breech presentation

The obstetric performance of 39 vertex-breech twin-pairs was compared with that of 48 vertex-vertex pairs. No difference was found between the two groups in maternal age, parity, gestational age, birth weight, and Apgar scores. The second twin in breech presentation had a higher incidence of very low birth-weight (less than 1500 g), but of borderline significance (P = .05), and a significantly (P less than .03) longer hospitalization period. The cesarean section rate was 7.7 and 10.4% for the breech and vertex second twin, respectively. In our view, breech presentation of the second twin is not an indication for cesarean section.

Indications and results of metroplasty in uterine malformations

During 14 years, 430 women with some type of congenital uterine malformation were discovered by different methods, with a rate of 1 in 137 deliveries. In only 17 was metroplasty indicated, because of very poor reproductive performance; out of 42 desired pregnancies, only 14.3% live births resulted. The abortion rate was 65.2%, and there were 13% premature deliveries. The operations performed included the Strassmann type in 13, the Tompkins technique in three and the Jones operation in one. After the metroplasty, out of 27 completed pregnancies the rate of abortions fell in 14.8% (P less than 0.00003) and the rate of live births rose to 85.2% (P less than 0.00003). There is no doubt that when the indication for metroplasty is strictly imposed, the staff is well versed in the different types of operations and the treatment is done in a center which has acquired competence, the improvement in reproductive performance can be quite impressive.

Pergolide and bromocriptine for the treatment of patients with hyperprolactinemia

A prospective study of 22 women with hyperprolactinemia from various causes was performed with use of bromocriptine in nine patients and pergolide in 13 patients. The administration of 50 micrograms of pergolide followed by 100 micrograms on the second day showed significant decrements (p less than 0.01) in systolic and diastolic blood pressure in either standing or lying position. However, 25 micrograms of pergolide followed by 50 micrograms did not lower blood pressure. Both 25 and 50 micrograms of pergolide induced a maximal and significant (p less than 0.005) inhibition of prolactin at 8 hours and remained suppressed for at least 24 hours. Long-term treatment with either bromocriptine or pergolide was continued for 48 weeks. Both dopamine agonists demonstrated a similar degree of prolactin inhibition throughout time. However, only patients treated with pergolide had higher levels (p less than 0.05) of luteinizing hormone and follicle-stimulating hormone. Resumption of spontaneous menses and cessation of galactorrhea occurred at similar times in both groups. It can be concluded that either dopamine agonist can be safely given to patients with hyperprolactinemia.

Prevention of premature labor by 17 alpha-hydroxyprogesterone caproate

Eighty pregnant women at high risk of giving birth prematurely were divided randomly into two groups. Treatment with either 17 alpha-hydroxyprogesterone caproate, 250 mg by intramuscular injection once a week, or a placebo was given in a double-blind fashion. Imminent premature labor occurred in 29.0% of the treated group and in 59.4% of the control group (p less than 0.025). The rate of premature deliveries was also significantly lower in the treated group (16.1%) than in the control group (37.82%) (p less than 0.05). There were no cases of perinatal death or fetal malformations in either group. The mean birth weight of all infants of the treated group was significantly higher than in those of the control group (3111.9 +/- 905 gm versus 2680 +/- 813.4 gm, p less than 0.05). The results support treatment with progesterone caproate for the prevention of premature labor.

Female pseudohermaphroditism with adrenal cortical tumor in adulthood

Data are presented concerning a case of female pseudohermaphroditism of unknown etiology. The child was born with labioscrotal fusion and clitoromegaly. From the age of 5 to the age of 25 there was no clinical evidence of a hormonal abnormality. At the age of 25 the patient presented with masculinization and Cushing's syndrome, and a left adrenal tumor was removed. The patient was restudied at the age of 29, when 21-hydroxylase deficiency was excluded. Other types of congenital adrenal hyperplasia are considered unlikely. The possible relationship between the ambiguous genitalia present at birth and the virilizing tumor diagnosed at the age of 25 is analyzed.

Endometrial foam cells. Non-estrogenic and estrogenic

Four patients with endometrial foam cells are described. In one the endometrium was obtained after parturition. It showed decidua and endometritis, whereas in the second patient, who had received birth control medication in the past, the endometrium was proliferative. In both cases there was a considerable amount of endometrial hemorrhage. The foam cells in these two patients had little granularity, and their cytoplasm contained hemosiderin. The other two patients received exogenous estrogen and presented with endometrial hyperplasia and adenocarcinoma. In these latter cases the foam cells were more granular, and contained no hemosiderin. Our findings confirm the presence of two types of histologically similar endometrial foam cell: a histiocytic, "non-estrogenic" reactive type capable of phagocytosis, and a stromal, "estrogenic" non-phagocytic type which is associated with hyperplasia or carcinoma and which may also be related to estrogen administration. Staining for hemosiderin may be particularly helpful in differentiating between the two types of foam cell. Such a differentiation is of practical importance because of the biologic significance attached to the "estrogenic" foam-cells which are usually indicative of endometrial hyperplasia or carcinoma.

The obstetrical management of patients with immunologic thrombocytopenic purpura

Pregnant women with immunologic thrombocytopenic purpura (ITP) run the risk of complications during pregnancy and labor, mainly due to the possibility of hemorrhage. Antibodies pass through the placenta, causing a transient, but dangerous thrombocytopenia in the fetus and infant. Four women with ITP, having five deliveries, are presented, showing that the modern treatment of these patients includes corticosteroids during pregnancy, thrombocyte transfusion during labor, and splenectomy being or after the pregnancy in selected cases. Cesarean section is not indicated for the disease per se, and fetal scalp blood sampling for thrombocyte count during labor is not necessary. The newborn needs immediate, careful control and, if necessary, thrombocyte transfusion and even steroids. Prolonged follow-up of the infants is necessary.

The clinical significance of rheometric measurement of cervical mucus properties

Rheometric properties of cervical mucus were studied with the Ovutimer in 26 women. 14 women had regular menstrual cycles, 12 had menstrual irregularities and received treatment to induce ovulation. In 21 women (80.7%) a significant correlation was found between the ovulation time as established by the luteinizing hormone surge, and ovulation time as established by the Ovutimer test. The instrument was found satisfactorily accurate in establishing the day of ovulation in almost all cases.