Cultures of ovarian surface epithelium from women with and without a hereditary predisposition to develop female adnexal carcinoma

AIM: Conflicting evidence exists on whether in vivo morphological characteristics can distinguish Ovarian Surface Epithelium (OSE) of ovaries obtained from women with and without a predisposition to develop female adnexal (ovarian and fallopian tube) carcinoma. This study aims to detect differences in growth potential and morphology that are maintained or specifically expressed in vitro. STUDY DESIGN: Ovarian surfaces were scraped to retrieve OSE cells from 56 women at hereditary high risk for female adnexal carcinoma, of whom 33 are BRCA1 and four are BRCA2 mutation carriers (Predisposed OSE, POSE) and from 26 women without such risk (Non Predisposed OSE, NPOSE). Number of passages and total cell yield until last passage, as well as morphology was compared between both groups. To confirm morphology, the expression of epithelial, mesothelial, and fibroblast markers was assessed. RESULTS: Both POSE and NPOSE cultures displayed similar growth potential and morphology. The expression of epithelial markers cyto-keratins 7 and 8 was similar between both groups. Only in cultures in which cells did not uniformly exhibit these markers, the percentage of cells expressing these markers was significantly lower at last passage when compared to the initial culture. In these latter cultures, cells that were morphologically indistinguishable from fibroblasts were observed. Mesothelial marker calretinin was expressed in 75% of cells of both POSE and NPOSE cultures and correlates with cyto-keratins 7 and 8 expression. CA 125 expression was equally low in POSE and NPOSE cultures (4.3%). Fibroblast markers FSM and vimentin were expressed in 100% and collagen IV was expressed in 16% of cells in all cultures. CONCLUSION: OSE cells derived from women with a hereditary predisposition to develop female adnexal cancer possess similar in vitro characteristics as OSE from women without this predisposition. On basis of our results, it seems advisable to study only 100% cyto-keratins 7 and 8 positive OSE cultures, since contamination of fibroblasts in some primary OSE cultures cannot be ruled out.     

Fetal weight estimation in diabetic pregnancies and suspected fetal macrosomia

OBJECTIVE: To review the literature on the accuracy of sonographic estimated fetal weight (EFW) in diabetic pregnancies, specifically on its role in the prediction and clinical management of fetal macrosomia. METHODS: An English language literature search of Medline listings was performed to review the recently published data on sonographic fetal weight estimation in diabetic pregnancies and suspected fetal macrosomia. RESULTS: Ultrasound biometry used to detect macrosomia is characterized by low sensitivity, low positive predictive value, and high negative predictive value. Serial sonographic measurements and the use of additional examiners can increase the positive predictive value. Regardless of the formula used, the accuracy of the sonographic estimate decreases with increasing birth weight. Three-dimensional ultrasound and magnetic resonance imaging techniques are still investigational. To date, none of the management algorithms developed for selective interventions that are based on the sonographic EFW have demonstrated any efficacy in reducing the incidence of either shoulder dystocia or brachial plexus injury. CONCLUSIONS: The true value of ultrasonography in the management of fetal macrosomia may be its ability to rule out the diagnosis. Ultrasound-derived fetal weight estimates alone are not sufficient grounds for deciding the route of delivery. To assess the risk of macrosomia, other known risk factors should also be taken into account. To determine the mode of delivery, the clinical fetal weight estimate, subjective maternal weight estimate, and clinical assessment of pelvic capacity should be added to the sonographic fetal weight estimate, with consideration of the risk factors for macrosomia.     

Induction of labor with prostaglandin E2 in women with previous cesarean section and unfavorable cervix

OBJECTIVE: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. METHODS: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. RESULTS: There were no significant differences between the study and control groups in mean (+/-S.D.) maternal age (30.9 +/- 4.7 years versus 31.2 +/- 4.8 years, P = 0.6), gestational age at delivery (39.2 +/- 1.8 weeks versus 39.3 +/- 1.6 weeks, P = 0.36), overall rate of cesarean section (36% versus 37.3%, P = 0.8), rates of low 5-min Apgar score < or =7 (3.1% versus 3.7%, P = 0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P = 0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). CONCLUSION: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.     

Women's attitude toward analgesia during labor--a comparison between 1995 and 2001

OBJECTIVE: To compare the attitude of gravid women towards analgesia during labor in 1995 and 2001, in Israel. METHOD: Women in the third trimester of pregnancy were asked to complete an antepartum questionnaire regarding the mode of analgesia they preferred during their labor. The questionnaire was distributed twice, once in 1995 and again in 2001, in order to study changing attitudes. RESULTS: Study participants included 114 women in 1995 and 125 in 2001. There were no differences between the groups in maternal age, gestational age, gravity, parity, or level of education. In 1995, 57% of the women were interested in having epidural analgesia during labor, compared to 66% in 2001 (P < 0.001). The preference for opioids decreased from 31.5% in 1995 to 18.5% in 2001 (P < 0.001). In 1995, none of the women questioned opted for avoiding all kinds of analgesia, whereas in 2001, 8% did so. CONCLUSION: Women's attitudes to analgesia during labor have changed over the last 6 years. Epidural block has become very popular, while opioids use lost its popularity; at the same time, there has been an increase in the number of women who prefer to avoid all kinds of analgesia during labor.     

Neurophysiologic monitoring and pharmacologic provocative testing for embolization of spinal cord arteriovenous malformations

BACKGROUND AND PURPOSE: Embolization of a spinal cord arteriovenous malformation (SCAVM) is still considered risky. We evaluated the efficacy and reliability of pharmacologic provocative testing with neurophysiologic monitoring in the embolization of SCAVMs. METHODS: We retrospectively analyzed results of 60 provocative tests during 84 angiographic procedures (in 52 patients) with intended endovascular embolization. Tests included 47 sodium amytal and 56 lidocaine injections. All procedures were performed with general anesthesia and monitoring of cortical somatosensory evoked potentials (SEPs) and transcranial motor evoked potentials (MEPs). For provocative testing, 50 mg of amytal and 40 mg of lidocaine were consecutively injected through a microcatheter placed at the position of intended embolization. If SEPs and MEPs did not change, embolization was performed with N-butyl-cyanoacrylate (NBCA). If SEPs or MEPs changed, NBCA embolization was not performed from that catheter position. RESULTS: One false-negative result occurred, with an increase in spasticity after embolization. Nineteen positive results occurred: four after amytal injection and 15 after lidocaine injections. Seven injections in a posterior spinal artery feeder resulted in loss of SEPs or MEPs. Eleven injections in the anterior spinal artery feeder and one in the posterior inferior cerebellar artery feeder resulted in loss of MEPs. CONCLUSION: Provocative testing with amytal and lidocaine combined with neurophysiologic monitoring had a high negative predictive value and was a useful adjunct for SCAVM embolization. Both amytal and lidocaine should be used as provocative agents, and both SEPs and MEPs should be monitored.     

Secondary reconstruction of the extensor mechanism using part of the quadriceps tendon, patellar retinaculum, and Gore-Tex strips after proximal tibial resection

Competence of the extensor mechanism is the major determinant of functional outcome of patients after proximal tibia resection. A method of secondary reconstruction of the extensor mechanism using the middle third of the quadriceps tendon and the patellar retinaculum augmented with Gore-Tex strips and gastrocnemius flap is described. Between 1981 and 1997, 7 patients with extension lag greater than 20 degrees at least 1 year after the initial surgery underwent secondary reconstruction of the extensor mechanism. All patients were followed up for a minimum of 2 years. Full extension to an extension lag of 10 degrees was achieved in three patients, and an extension lag between 10 degrees and 20 degrees was achieved in 4 patients. All patients had good to excellent functional outcomes and reported no limitations in daily life activities.     

Tracheal mucormycosis presented as an intraluminal soft tissue mass

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.     

Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: Is it justified?

BACKGROUND: Dissection of levels II-IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. METHODS: The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II-IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. RESULTS: Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. CONCLUSIONS: Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged.     

Three common neuralgias. How to manage trigeminal, occipital, and postherpetic pain

The pain experienced by patients with trigeminal, occipital, or postherpetic neuralgia is often severe, chronic, and difficult to treat. In this article, Drs Ashkenazi and Levin outline the pathologic mechanisms of pain in these common neuralgias and discuss individually tailored pharmacologic and surgical approaches to their treatment.     

An in vivo functional genetic screen reveals a role for the TRK-T3 oncogene in tumor progression

Over the past decades, much has been learnt about the genes that contribute to oncogenic transformation of primary cells in vitro. However, much less is known about the genes that contribute to the later stages of tumor progression, in which cells of ever increasing malignancy arise through clonal selection in vivo. To search for genes that confer a tumor progression phenotype in vivo, we have used a functional genetic approach. We used adenovirus-transformed mouse embryo fibroblasts, which are tumorigenic in immunodeficient nude mice, but not in immunocompetent mice, due to strong cytotoxic T-cell-mediated immune rejection. We infected these cells in vitro with several high-complexity retroviral cDNA expression libraries and selected rare variants that formed tumors in immunocompetent mice. Using this approach, we identify here the TRK-T3 oncogene as a tumor progression gene. TRK-T3 does not inhibit T-cell reactivity towards the tumor cells. Instead, we find that cells expressing TRK-T3 enhances in vivo growth rate, most likely by stimulating anchorage-independent proliferation in growth factor-limiting conditions. Our data indicate that cDNA expression libraries can be used to identify tumor progression genes in vivo that cannot be readily identified using in vitro cell culture systems.