Coriocarcinoma gástrico primario: reporte de caso / Primary gastric choriocarcinoma: case report

El coriocarcinoma gástrico primario (CGP) es un tumor extremadamente raro, altamente invasivo y de rápida diseminación hematógena. Presentamos el caso de una paciente de 57 años que inicia con cuadro de hematemesis y, progresivamente, se le suman episodios de melena, baja de peso y epigastralgia. Es derivada al Instituto Nacional de Enfermedades Neoplásicas en donde se le realizan gastroscopía y biopsia. Así, el análisis histológico reportó patrón sugestivo para CGP; el cual se confirmó al realizarle a la paciente los estudios por imágenes necesarios y llevar a cabo el análisis inmunohistoquímico para gonadotrofina coriónica humana y alfa feto proteína. Posteriormente, a la paciente se le realiza una gastrectomía radical D2 con preservación esplénica y de cola de páncreas. Lamentablemente, su evolución no fue favorable y fallece por la progresión de la enfermedad.

Primary gastric choriocarcinoma (PGC) is an extremely rare and highly invasive tumor with rapid hematogenous spread. We present the case of a 57-year-old female patient who started with hematemesis and progressive episodes of melena, weight loss and epigastralgia. It is derived from the National Institute of Neoplastic Diseases where gastroscopy and biopsy are performed. Histological analysis reported pattern suggestive of PGC; that was confirmed by immunohistochemical analysis for human chorionic gonadotrophin and fetal alpha protein. Subsequently, the patient underwent a radical D2 gastrectomy with splenic preservation and tail of the pancreas preservation. Unfortunately, her evolution was not favorable and died due to the progression of the disease.

Synchronization of estrus in paca (Cuniculus paca L. ): possible impacts on reproductive and productive parameters / Sincronização do estro em pacas (Cuniculus paca L. ): possíveis impactos sobre parâmetros reprodutivos e produtivos

Estrus synchronization is a reproductive biotechnology used to improve artificial insemination or pairing through the manipulation of the estrous cycle at a desirable time. Employing this technique in captive pacas (Cuniculus paca L.) is important because it creates expectation of meeting the demand for paca meat and, consequently, reduces poaching. Thus, this research aims to verify the effect of a progestogen implant associated with two doses of eCG on the synchronization and induction of fertile estrus. Twenty-seven adult pacas were used, 18 non-pregnant females and nine males, divided into three groups. G1 and G2 females groups (treatments) received 1.5 mg Norgestomet and were injected intramuscularly, seven days later, with 0.13 mg of prostaglandin. After 24 hours the implants were removed and the animals immediately received 25 IU and 50 IU of ECG intramuscularly, respectively. The mating of the three groups took place on the same days. G3 females' group (control) showed estrus on different days after D0. Females under treatment displayed estrus only after removing the implant (D8). G1, G2, and G3 pregnancy rates were 100%, 66%, and 50%, respectively. Regarding births per parturition, 100% of G1 and G3 produced one offspring, while 50% of G2 produced two. Progestogen in the form of subcutaneous implants was effective in mimicking the luteal phase of the estrous cycle. After removal, implants favored the occurrence of a fertile estrus. As a conclusion, further studies must be conducted in order to establish in-depth possible association between 50 IU of eCG, and the occurrence of twin pregnancies.(AU)

A sincronização é uma biotécnica reprodutiva que melhora a porcentagem de cobertura por meio da manipulação do ciclo estral. Empregar esta biotécnica em pacas de cativeiro (Cuniculus paca L.) é importante, pois cria-se a expectativa de que a demanda pela carne seja atendida e a caça ilegal diminua. O objetivo da pesquisa foi verificar o efeito de implantes de progestágenos associados a duas doses de gonadotrofina coriônica equina (eCG) na sincronização e indução de cios férteis de pacas. Foram utilizadas 18 fêmeas não prenhas e nove machos, divididos em três grupos. Fêmeas do G1 e G2 receberam implantes com 1,5mg de Norgestomet e, sete dias depois, 0,13mg de prostaglandina via intramuscular (IM). No dia 8 (D8), foram retirados os implantes e G1 e G2 receberam 25 UI e 50 UI de eCG, IM, respectivamente; G3 foi o controle. O pareamento nos três grupos aconteceu nos mesmos dias. As fêmeas do G3 apresentaram cio alguns dias após o dia zero (D0). Fêmeas que receberam tratamento apresentaram cio só após a retirada do implante no dia 8 (D8). As taxas de prenhez de G1, G2 e G3 atingiram 100%, 66% e 50%, respectivamente. Em relação a filhotes por parto, 100% do G1 e G3 produziram uma cria, enquanto 50% do G2 produziram duas crias. O progestágeno do implante foi eficaz em mimetizar a fase lútea do ciclo estral. Após a remoção, o tratamento hormonal favoreceu a ocorrência de cio fértil. Outros estudos devem ser realizados a fim de estabelecer uma possível associação entre 50 UI de eCG e a ocorrência de gestações gemelares.(AU)

Gonadotropina coriónica en flujo vaginal para el diagnóstico de rotura prematura de membranas / Chorionic gonadotrophin in vaginal discharge for diagnosis of premature rupture of membranes

Objetivo: Establecer la eficacia diagnóstica de la determinación de gonadotropina coriónica en flujo vaginal para el diagnóstico de la rotura prematura de membranas. Método: Investigación de tipo prospectiva en muestra de 270 embarazadas que asistieron al Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Los grupos consistieron en pacientes con rotura prematura de membranas (grupo A; n = 135) y embarazadas con membranas integras (grupo B; n = 135), consideradas como controles. Se evaluaron las características generales, valores de gonadotropina coriónica en flujo vaginal y efectividad diagnóstica. Resultados: La edad gestacional al momento de la determinación de las concentraciones de gonadotropina coriónica en flujo vaginal fue de 32,9 +/- 1,6 semanas para el grupo A y 33,1 +/- 1,9 semanas para el grupo B (p = ns). No se encontraron diferencias estadísticamente significativas en la edad materna y la frecuencia de paridad entre ambos grupos de tratamiento (p = ns). Las pacientes del grupo A presentaron concentraciones significativamente más altas de gonadotropina coriónica en flujo vaginal (697,4 +/- 382,4 mUI/mL) comparado con las embarazadas del grupo B (91,4 +/- 47,1 mUI/mL; p < 0,0001). Un valor de corte de 100 mUI/mL presentó un valor por debajo de la curva de 0,96 con una sensibilidad del 97,0 por ciento, especificidad del 51,1 por ciento, valor predictivo positivo del 66,5 por ciento y valor predictivo negativo del 94,5 por ciento. Conclusión: La determinación de las concentraciones de gonadotropina coriónica en el flujo vaginal es una técnica diagnóstica útil para la rotura prematura de membranas.

Objective: To establish the diagnostical efficacy of chorionic gonadotropin in vaginal fluid determination for diagnosis of premature rupture of membranes. Method: A prospective research type was done with a sample of 270 pregnant women who assisted to obstetrics emergency at Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Groups consisted in patients with premature rupture of membranes (group A; n = 135) and pregnant women with intact membranes (group B; n = 135), considered as controls. General characteristics, values of chorionic gonadotropin in vaginal fluid and diagnostic efficacy were evaluated. Results: Gestational age at the moment of determination chorionic gonadotropin in vaginal fluid was 32.9 +/- 1.6 weeks in group A and 33.1 +/- 1.9 weeks in group B (p = ns). There were no significant differences in maternal age and frequency of parity between groups (p = ns). Patients in group A showed significant higher concentrations of chorionic gonadotropin in vaginal fluid (697.4 +/- 382.4 mUI/mL) compared with pregnant women in group B (91.4 +/- 47.1 mUI/mL; p < 0.0001). A cut-off point of 100 mUI/mL showed a under the curve value of 0.96 with a sensitivity of 97.0 percent, specificity of 51.1 percent, positive predictive value of 66.5 percent and negative predictive value of 94.5 percent. Conclusions: Determination of chorionic gonadotropin concentrations in vaginal fluid is a useful diagnosis tool for premature rupture of membranes.

Validación del método de valoración biológica de gonadotrofina coriónica humana / Validation of the biological potency test for human chorionic gonadotropin

Introducción: en el Centro de Investigación y Desarrollo de Medicamentos se cuenta con una serie de ensayos biológicos para el control de calidad que deben ser sujetos a validación, entre ellos se encuentra la valoración biológica de gonadotrofina coriónica humana. Objetivo: evaluar el desempeño del método de valoración biológica de gonadotrofina coriónica humana. Métodos: se evaluaron la exactitud, la precisión y la especificidad como parámetros de validación siguiendo la metodología descrita en la Regulación 41-2007 del Centro para el Control Estatal de la Calidad de los Medicamentos (CECMED) para la Validación de métodos de análisis. Resultados: en el estudio de exactitud no se observaron diferencias significativas entre los valores de peso del útero obtenidos al ensayar la muestra y el material de referencia a las tres dosis administradas. En el estudio de la repetibilidad se alcanzaron coeficientes de variación menor del 50 por ciento. No se observaron diferencias significativas entre las precisiones alcanzadas por dos analistas diferentes en días diferentes. El estudio de especificidad mostró que los excipientes o sustancias auxiliares de la formulación no interfieren en la valoración biológica del producto. Conclusiones: el método biológico validado resultó ser específico, exacto y preciso en el rango de concentraciones estudiadas, lo que corrobora su calidad, teniendo un valor agregado

Introduction: a number of biological tests for quality control used in the Center for Drug Research and Development should be validated. Biological potency test of human chorionic gonadotropin is one of them. Objective: to evaluate the performance of the human chorionic gonadotropin biological potency test. Methods: the accuracy, precision and specificity were evaluated as validation parameters according to the 41-2007 Regulation of the Center for the State Control of Drug Quality (CEDMED) for analysis method validation. Results: in the accuracy test, no significant differences were observed between the uterus weight values from tested sample and the reference material at the 3 tested doses. Variation coefficients were less than 50 percent in the repeatability test. There were no significant differences between the precision values of two different analysts at different times. The specificity test showed that excipients or auxiliary substances in the formulation did not interfere with the results of the biologic potency test of the final product. Conclusions: the validated biological method showed good accuracy, precision and specificity in the range of studied concentrations, all of which proved its quality, so it has added value

Cortisol influence on testicular testosterone secretion in domestic cat: an in vitro study / Ação do cortisol sobre a secreção de testosterona em testículos de gato doméstico: um estudo in vitro

The aim of the present experiment was to investigate the effect of corticosteroids (exogen) on in vitro testosterone secretion after stress by transportation (40 minutes). Feline testes (Felis silvestris catus) were incubated in the following media: TCM 199; TCM 199 + hCG 10_7M; TCM 199 + hydrocortisone 10_7M, or TCM 199 + hCG + hydrocortisone. The animals (n=21) were allocated into three groups: (S) that arrived at 3 h prior to surgery, (A) that remained in the laboratory for 36 h before being submitted to surgical procedure, and (C) that were also allowed to remain for 36 hours in the laboratory before the surgical procedure, but whose testes had been incubated with hydrocortisone prior to incubation in the referred media. The results showed that group S secreted higher levels of testosterone, regardless of the culture media. It is noteworthy that the suppressing action of hydrocortisone sodium succinate led to a reduction in the testosterone concentration, despite the presence of hCG.

O objetivo deste trabalho foi investigar o efeito da hidrocortisona sobre a secreção de testosterona após cultivo in vitro dos testículos, em distintas situações de estresse (transporte) de gatos domésticos (Felis silvestris catus). Testículos foram incubados nos seguintes meios de cultura: TCM 199; TCM 199 + hCG 10_7M; TCM 199 + hydrocortisona 10_7M e TCM 199 + hCG + hidrocortisona. Os animais (n=21) foram alocados em 3 sub-grupos: (S) animal admitido 3 horas antes da orquiectomia, (A) animais orquiectomizados após 36 horas de permanência no biotério e (C) animais que permaneceram por 36 horas no biotério antes da cirurgia e que tiveram seus testículos pré-incubados em hidrocortisona. Os resultados demonstraram que o grupo S secretou maiores valores de testosterona em todas as condições estudadas. É válido mencionar que a supressão promovida pela hidrocortisona também promoveu redução na concentração de testosterona no meio TCM 199, a despeito da presença de hCG.

Experience on triple markers serum screening for Down's syndrome fetus in Hat Yai, Regional Hospital.

OBJECTIVES: To summarize the experience and evaluate the performance of the Hat Yai maternal serum screening (MSS) program. SETTING: The Hat Yai MSS program between 16 February 2003 and 11 March 2004. MATERIAL AND METHOD: The uptake of screening was 999 in 1,040 women (96.0%), between 14 to 20 weeks of gestation with the triple markers: Alpha-fetoprotein (AFP), human Chorionic Gonadotropin (hCG), and unconjugated Estriol (uE3) by Immulite chemiluminescent immunoassay system, Diagnostic Product Corporation (DPC). The risk cut-off for Down 's syndrome is one in 250 or greater, based on software for prenatal Down's syndrome risk calculation, by Prisca 3.5 DPC. RESULTS: There were 119 in 999 cases (11.9%) of the triple test positive. Amniocentesis had been performed on voluntary basis, and the uptake rate of amniocentesis following a positive Down's syndrome screening was 104 in 119 cases (87.3%). Based on clinical diagnosis of Down's syndrome in the newborns of non-amniocentesis mothers, assuming that normal looking babies were not Down's syndrome, the sensitivity (SENS), specificity (SPEC), positive predictive value (PPV), and negative predictive value (NPV) of all chromosomal abnormalities were 85.7%, 88.6%, 5.0%, and 99.8% respectively. The false positive rate was 113 in 992 cases (11.4%). Whereas, the SENS, SPEC, PPV and NPV of Down's syndrome were 100%, 88.4%, 3.4%, and 100% respectively. The false positive rate was 115 in 995 cases (11.6%). The mean level, median level, and multiple of median (MoM) of triple markers were demonstrated. CONCLUSION: The Down's syndrome screening is a systematic application of a test to identify subjects at increased risk of a specific disorder; of course it is not diagnostic, but to benefit making decision regarding further amniocentesis. The sensitivity of Prisca 3.5 software was satisfactory but false positive rate was remarkably high. It needs further standardization with adjusted MoM values.

Association between testicular microlithiasis, testicular cancer, cryptorchidism and history of ascending testis

OBJECTIVE: To prospectively determine the prevalence of testicular microlithiasis in symptomatic patients who were referred for scrotal ultrasound examination and to evaluate the possible association of testicular microlithiasis with testicular cancer and other conditions such as cryptorchidism or history of ascending testis. MATERIALS AND METHODS: 391 men who were referred to our institutions between July 2002 and May 2005 for any type of symptoms from the testicles, underwent physical and scrotal ultrasound examination. The presence of testicular microlithiasis, the number of lesions and the involvement of both testicles in relation to the symptoms as well as the coexistence of other lesions were studied. RESULTS: Eighteen (4.6 percent) of 391 men enrolled into the study had testicular microlithiasis. Two out of the eighteen patients (11 percent) had concomitant testicular cancer, which was confirmed by pathological evaluation of the orchidectomy specimen. One of the patients with testicular microlithiasis presented a rising in biochemical tumor markers (LDH, and HCG) and underwent orchidectomy one year later. Five of the remaining 373 (1.3 percent) patients without microlithiasis were diagnosed with testicular cancer. Thirty six men reported having a history of ascending testis, but none of them was found with testicular cancer. Two cases of testicular torsion in a cryptorchid position had testicular microlithiasis, but the orchidectomy specimen (after surgery) was negative for testicular cancer. The correlation between testicular cancer and testicular microlithiasis found in our study was statistically significant (p < 0.05). CONCLUSION: There seems to be an association between testicular microlithiasis and testicular cancer.

Indução da ovulação em vacas com gonadotrofina coriônica humana (hCG) purificada por cromatografia de afinidade / Induction of ovulation in cows with affinity chromatography-purified Human Chorionic Gonadotropin (hCG)

O objetivo do presente estudo foi purificar o hCG contido em uma preparação comercial (Pregnyl® Organon) por cromatografia de afinidade e avaliar a taxa de ovulação de vacas injetadas com o hormônio purificado. Uma coluna de cromatografia contendo matriz de Concanavalina-A Sepharose (Con-A) foi equilibrada e cem milunidades internacionais (UI) de Pregnyl® foram aplicadas na coluna. Frações de 3,8mL foram colhidas (4 º C) a cada 5 minutos durante 12,5 horas, resultando em um total de 150 frações. Após a fração 76 adicionou-se à coluna solução tampão contendo 0,3M de alfa−metilglicosidase. A concentração protéica das frações foi estimada por espectrofotometria (280nm). Foram observados dois picos de absorbância, um entre as frações 14 e 19 e outro entre as frações 90 e100. As frações 14 a 19 e 90 a 150 foram reunidas seqüencialmente aos pares, concentradas por ultrafiltração e analisadas por SDS-PAGE. O primeiro pico resultou da eluição das proteínas não adsorvidas pela matriz de Con-A, enquanto o segundo representou as proteínas adsorvidas pela coluna, especialmente o hCG. As frações contendo hCG foram reunidas em uma única amostra cuja concentração protéica foi quantificada pelo método de Lowry. Vacas no 5º dia de um ciclo estral sincronizado, apresentando um folículo dominante maior que 8mm de diâmetro, foram injetadas com 0,1, 0,2 ou 0,3mg de proteína contida na amostra purificada. Após 48 horas, a taxa de ovulação observada foi de 0%, 50% e 75%, respectivamente. Foi demonstrado no presente estudo que a técnica de cromatografia por afinidade foi eficiente para aumentar a concentração relativa do hCG preservando sua atividade biológica.

Objective of the present study was to purify hCG contained in commercial preparation (Pregnyl®- Organon) by affinity chromatography and to evaluate ovulation rates in cows injected with the purified hormone. A chromatography column containing concanavalin-A sepharose (Con-A) matrix was equilibrated and one hundred thousand international units (UI) of Pregnyl® were applied to the column. Fractions of 3,8mL were collected (4 degree C) every 5 minutes for 12,5h, to yield a total of 150 fractions. After fraction 76, a column buffer containing 0,3M alpha-methylglicoside was added to the column. Protein concentrations were estimated by espectrophotometry(280nm). Two peaks of absorbance were observed, between fractions 14 and 19, and fractions 90 and 100. Fractions 14-19 and 90-150 were sequentially grouped in pairs concentrated by ultrafiltration andanalyzed by SDS-PAGE. The first peak of absorbance resulted from proteins contained in the commercial product, eluted from the column and not adsorbed by the Con-A matrix. The second peak represented proteins adsorbed by the column, especially hCG. The fractions containing hCG were grouped in a single sample and protein concentration was measured by the Lowry method. Cows in day 5 of the estral cycle, which had a dominant follicle larger than 8mm, were injected with 0,1, 0,2 or 0,3mg protein of the purificated sample. The ovulation rate 48 hours after treatment was 0%, 50% and 75%,respectively. It was demonstrated that relative concentration of hCG can be increased by affinity chromatography and biological activity of purified hCG was satisfactory preserved.

Predictive value of human chorionic gonadotropin in the outcome of early pregnancy achieved by assisted reproductive technology.

This study was undertaken to evaluate the predictive value of the serum human chorionic gonadotropin (hCG) in pregnancies achieved by assisted reproductive techonology (ART). Two hundred and eighty-six pregnancies were studied retrospectively from September 1989 to June 1998. The serum hCG samples at 2-6 weeks after embryo transfer (ET) were analysed by fluoroimmunoassay. Pregnancy status was followed by ultrasonography. There were 100 nonviable pregnancies (NP), 140 viable single pregnancies (VSP) and 46 viable multiple pregnancies (VMP). The sensitivity, specificity, positive and negative predictive value of the D14 hCG (<160 mIU/ml) in distinguishing NP from VSP were 79 per cent, 75 per cent, 68 per cent and 84 per cent, respectively and of the D14 hCG (>350 mIU/ml) in distinguishing VMP from VSP were 82 per cent, 75 per cent, 56 per cent and 91 per cent, respectively. In conclusion, the serum hCG may be used to predict the outcome of early pregnancy achieved by ART.

Serum human chorionic gonadotropin regression pattern in persistent trophoblastic disease during chemotherapy.

The objective of this study was to identify the regression pattern of serum beta-hCG in persistent trophoblastic disease patients after initiating chemotherapy. Eighty-nine women who were diagnosed as persistent trophoblastic disease in King Chulalongkorn Memorial Hospital between January 1985 and December 1998, and received single agent chemotherapy were included. The incidence was 20.2 per cent of total gestational trophoblastic disease patients. Seventy-two (80.9%) from 89 patients were recruited in our study. Sixty-four (88.9%) patients responded to first-line chemotherapy and 8 patients (11.1%) resisted. Suction curettage was done as initial treatment in 61 (84.7%) cases. Most of them (95.8%) received actinomycin-D as first line treatment. Total courses of chemotherapy averaged 4 courses, but increased to 8.5 courses in the resistant group. Mean time of serum beta-hCG to remission was 16.7 and 21.5 weeks in the chemo-sensitive and chemo-resistant group, respectively. Average time to start chemotherapy was in the tenth week, and in the resistant group it was started in the sixth week. Chemotherapy regimen was changed in the fifteenth week. Initial serum beta-hCG levels were not significantly different between the two groups. The reduction rates of beta-hCG were significantly different from the third to the seventh week in the chemo-sensitive and chemo-resistant groups, which was during the second and third course of chemotherapy (P<0.05). In conclusion, by using the reduction rate, the regression pattern of serum beta-hCG level in persistent trophoblastic disease patients was significantly different between the chemosensitive and chemoresistant group from the third to the seventh week after starting chemotherapy.

Study of the relationship between free B-subunit of human chorionic gonadotropin, estradiol and thyroid function in hyperemsis gravidarum

This study was carried out on 40 pregnant women who presented at less than 16 weeks of gestation. They were divided into 2 groups. Group I included 10 normal pregnant women as controls, group II included 30 pregnant women with hyperemesis gravidarum. Results showed a significant elevation of hCG, free beta-subunit of hCG, total T4, total T3, T3 resin uptake, free T4 index, free T3 index and estradiol was found in group II compared with the controls. While, there was a significant decrease in TSH level in group II compared with group I. It was concluded that, hCG and its free beta-subunit play a role in the etiology of hyperemesis, the associated biochemical hyperthyroidism and the elevated serum estradiol

Función de las células de Leydig en estados de hiper o hipoprolactinemia en hombres sanos / Leyding cells function in hyper or hipoprolactinaemic states in healthy men

En el presente trabajo se estudió la función de las células de Leydig, mediante la estimulación con 2000 UI de GCh, en 11 hombres sanos, antes y después de la inducción de hiper o hipoprolactinemia, con sulpiride o bromocriptina respectivamente. La respuesta normal a la estimulación con GCh se caraterizó por un incremento del estradiol sérico a las 24 horas y de la testosterona a las 72 horas, después de la administración de la gonadotropina. Los niveles séricos de FSH disminuyeron durante la prueba. La hiperprolactinemia se acompaño con un aumento de la LH sérica y de un menor incremento del estradiol sérico observado 24 horas después de la administración de la GCh. Por otro lado la hipoprolactinemia disminuyó los niveles séricos basales de testosterona, pero incrementó la respuesta de este esteroide a la GCh. Estos resultados sugieren que la hiperprolactinemia interfiere con la síntesis del estradiol; mientras que la pérdida del efecto trófico de la PRL sobre la esteroidogénesis, en los estados de hipoprolactinemia, disminuye la testosterona sérica basal, pero no altera la respuesta esteroidogénica al estímulo con la GCh. Por ello se concluye que la PRL juega un papel importante en la esteroidogénesis de la células de Leydig en el hombre sano

Evaluación de un test de medición específico de la subunidad beta de la gonadotrofina coriónica humana / Evaluation of a test of specific measurement of human chorionic gonadotropin B-subunit in humans

Se investigó la eficacia de un test de mediación de la subunidad beta de la HCG en orina, en 61 pacientes bajo tratamiento de estrilidad en las cuales se sospechaba el embarazo por el tratamiento que estaban realizando. En 38 casos se obtuvo resultado positivo y en 23 negativo. Se analizan los resultados comparando edades, amenaza de aborto, embarazo ectópico y diferencias entre valores séricos y urinarios de la beta HCG. El test, demostró ser de fácil realización, rápido y confiable en cuanto a sus resultados, no reemplazando a los dosajes cuantitativos en los casos de amenaza de aborto, embarazo ectópico y progresión del embarazo normal

Estado actual del manejo conservador del embarazo ectópico / Present status of conservative management of ectopic pregnancy

El embarazo ectópico (EE) constituye una de las patologías que requiere de mayor acusiosidad diagnóstica, no sólo por la repercusión biológica de su cuadro clínico, sino también por la secuela que su manejo trae en relación a la fertilidad de una pacientes generalmente ya con problemas de esterilidad. El incremento en su frecuencia, por múltiples factores de riesgo, inlcuyendo el manejo de la esterilidad así como las técnicas de reproducción asistida, hacen que el clínico deba estar alerta y disponer de todos los recursos diagnósticos para poder establecer un manejo oportuno y sobre todo conservador de EE sin duda alguna permitirá tener los elementos necesarios para normar una conducta óptima en nuestras pacientes y ofrecer un mejor pronóstico reproductivo con un menor riesgo

Valoración de alfa fetoproteína y gonadotropina coriónica en el diagnóstico de 290 tumores germinales testiculares / Evaluation of alpha-fetoprotein and chorionic-gonadotropin in the diagnosis of 290 testicular germinal tumors

Desde el punto de vista terapéutico y pronóstico, los tumores germinales de testículo se dividen en seminoma puro y no seminoma. El diagnóstico definitivo toma en cuenta la histología, la presentación clínica, y los niveles séricos de alfa fetoproteína (AFP) y fracción beta de gonadotropina coriónica humana (HGC). Objetivo: Correlacionar los valores de AFP y HGC con la variedad histológica y etapa clínica para determinar si cambia el diagnóstico final del tumor. Material y métodos: Se tomó suero en la valoración inicial de 290 pacientes con tumores germinales testiculares determinando niveles de AFP y HGC (ELISA, Quantum II de Abbott). Se revisaron los expedientes para conocer estirpe histológica y estadio clínico. Se consideraron seminomas los tumores con histología de seminoma puro sin elevación de AFP y HGC menor de 500 mUI/ml; los tumores germinales no seminomatosos de testículo (TGNST) presentaron histología de no seminoma o de seminoma con elevación de AFP o HGC mayor de 500 mUI/ml. Resultados: Histológicamente se encontraron 120 seminomas puros y 170 TG-NST. Se reclasificó a 13 casos de seminomas como TGNST ya que 10 presentaron elevación de AFP (tres AFP únicamente y siete AFP más HGC) y tres casos tuvieron elevación de HGC > 500 mUI/ml. La distribución final fue de 107 seminomas y 83 seminomas. Conclusiones: Al analizar los niveles séricos de AFP y HGC con la histopatología se obtiene el diagnóstico definitivo de la estirpe tumoral testicular mejorando la selección del tratamiento

Tratamiento de la neoplasia trofoblastica gestacional de alto riesgo con cisplatino y etopósido / Cisplatin and etoposide in high risk gestational trophoblastic neoplasia

Objetivo: Evaluar la efectividad resultante de la combinación etopósido-cisplatino (E-CDDP) en el tratamiento de la neoplasia trofoblástica gestacional de alto riesgo (NTG-AR). Justificación: La NTG_AR presenta mayor resistencia a quimioterapia. Incrementar índice de respuesta completa con medicamentos que en forma aislada ofrecen provecho, pero que por su sinergia, en combinación mejoran resultados. El tratamiento con E-CDDP es satisfactorio en primera línea. Pacientes y métodos: en la Unidad de Quimioterapia del Hospital General de México, pacientes clasificadas como de alto riesgo, en estudio prospectivo, realizado entre 1991 y 1993 fueron tratadas con la combinación E-CDDP. La fracción beta de la hormona gonadotropina coriónica humana fue monitorizada antes de cada ciclo para evaluar respuesta. Se aplicaron: cisplatino 100 mg/m² día 1 y etopósido 100 mg/m² día 1-5. Resultados: Se trataron siete pacientes con índice pronóstico entre 12 y 20. Se obtuvo respuesta completa en seis (86 por ciento). Una paciente con metástasis cerebrales que logró negativación de marcadores serológicos y de líquido cefalorraquídeo fallecío por sepsis de catéter central. La toxicidad hematológica fue de moderada a intensa pero manejada satisfactoriamente sin emplear estimuladores de colonias. Durante un seguimiento promedio de 24 meses, no se presentaron recaída. Conclusión: En estudio inicial y preliminar, la combinación E-CDDP resultó ser eficaz como esquema de primera línea en el tratamiento de NTG-AR

hormonal profile in ectopic pregnancies

We prospectively investigated the maternal serum level of beta- human chorionic gonadotropin [beta-hCG]progesterone [P], estradiol [E2], human placental lactogen [HPL], alfafetoprotein [AFP] and cancer antigen 125 [CA 125] during the first trimester of normal and abnormal pregnancies. Serum samples were obtained from 20 women with normal intra-uterine pregnancy [IUPs]. Fifteen whose pregnancies were complicated with spontaneous abortion and 31 with surgically and pathologically confirmed ectopic pregnancies [EPs]. The mean serum levels of beta-hCG, E2 and P in patients with EPs [9490.55 +/- 3071.2 mIU/ml, 100.1 +/- 22.09 pg/ml, 4.18 +/- 1.19 ng/ml, respectively] were significantly lower than those measured in normal IUPs [73796.8 +/- 15554.7 mIU/ml, 500.15 +/- 98.84 pg/ml, 19.2 +/- 2.8 ng/ml respectively [p<0.001] and significantly lower than in patients with spontaneous abortion [22524 +/- 6213 mIU/ml, p<0.05, 339.8 +/- 112.16 pg/ml, p<0.01, 10.59 +/- 3.03 ng/ml, p<0.05 respectively]. No significant difference was recorded with respect to serum levels of HPL, AFP and CA 125 among the groups. We also investigated the diagnostic value of simple E2 and P in patients with EPs. We could not identify a discriminatory cutoff value because there was a considerable overlap in serum P and E2 levels between the patients with IUPs and EPs. In conclusion, it is not possible to define a cutoff discriminatory value of P and E2 that completely separates ectopic from IUPs, but the addition of these assays to the workup of a patient with suspected EP may facilitate the earlier diagnosis of EP

Clinical and hormonal response to laparoscopic ovarian cautery in polycystic ovary syndrome

This study was proposed to evaluate the clinical and hormonal response to laparoscopic ovarian cautery in women with polycystic ovarian syndrome [PCOS]. Seven infertile women with positive criteria of PCOS who consistently failed to ovulate with clomiphene citrate [CC] and human chorionic gonadotropin [hCG] were the subjects of this study. Laparoscopic ovarian cautery was performed with the use of a three puncture techniques. Eight to ten cautery points 3 - 4 mm in diameter were created in each ovary. Serum levels of luteinizing hormone [LH], follicle stimulating hormone [FSH], estrone [E1], estradiol [E2], androstenedione [A] and testosterone [T] were estimated before the operation, 4 days after the operation and 6 weeks after the operation. All patients were evaluated clinically for up to 18 months. The results showed significant reduction of A and T [P < 0.01], LH and E1 [P < 0.05] levels 4 days after the operation and 6 weeks after the operation. The level of E2 and FSH did not change significantly. Six of the seven patients [85.7%] ovulated and menses occurred 17 to 36 days after the operation. Five continued to have regular menses and all of these women became pregnant [71.4%]. One patient [14.3%] ovulated only once after operation and then became amenorrheic but she responded to CC 50 mg and is ovulating regularly on this dosage. One patient [14.3%] did not respond and was treated with human menopausal gonadotropins. So, it is concluded that laparoscopic ovarian cautery holds promise for infertile women with PCOS who experience failure of initial medical therapy

Desenvolvimento de um ensaio imunofluorométrico para a medida da molécula inteira da gonaatrofina coriônica (hCG) no soro / Development of an immunofluorometric assay for serum measurement of the whole molecule of human chorionic gonatropin (hCG)

Tendo como base dois anticorpos monoclonais produzidos em nosso laboratório, um específico contra a subunidade beta de hCG/LH (E2P1) e outro específico contra um epítopo descontínuo presente na molécula inteira da hCG (F1P16), desenvolvemos um ensaio imunométrico específico para a molécula inteira de hCG. O monoclonal E2P1 foi adsorvido a placas de microtitulaçåo e o monoclonal F1P16 foi marcado com Európio; o ensaio consta de duas incubaçöes sequenciais de 1h cada e leitura final de fluorescência em fluorômetro tempo-sincronizado. A sensibilidade calculada foi de 1,8 UI/L; o perfil de imprecisåo mostrou erro inferior a 19 por cento entre os valores de 5 a 3000 UI/L; o coeficiente de variaçåo interensaio mostrou-se de 8 por cento para uma amostra de valor médio de 1065 UI/L (n=15) e de 13,9 por cento para outra de valor médio de 28 UI/L (n=15). A comparaçåo com método equivalente (Delphia hCG) nåo mostrou nenhuma discordância em 300 amostras dosadas sequencialmente, sendo que em 1388 amostras onde os valores eram iguais ou superiores a 20 UI/L pelo Delfia, obtivemos alto índice de correlaçåo (r=0,988). Os valores obtidos pelo nosso método mostraram-se discreta, porém, significativamente mais elevados, com medianas de 4610 e 4370 UI/L, respectivamente

Expression of beta-human chorionic gonadotropin (ß-hCG) in non-trophoblastic elements of transitional cell carcinoma of the bladder: possible relationship with the prognosis

Transitional cell carcinoma (TCC) of the bladder is a neoplasm with variability in its clinical behavior. Although there are several studies correlating stage and ABO isoantigen expression with invasiveness, there is no single predictor factor to assess the potential invasiveness, especially in the low grade, non-invasive TCC. In the present study we evaluated the correlation of histological gradeplus stage and the expression of beta human chorionic gonadotropin (ß-hCG); in 100 cases of TCC, with the clinical behavior. These features were correlated with tumor progression in patients with at least two years of follow up. We observed more aggressiveness in G4 group (high grade and invasive) (93 per cents had tumor progression) when comapared to G1 group (low grade and superficial) (11 per cents had tumor progression). However in 25.5 per cents of the TCC cases (groups G2: low grade and invasive and G3: high grade and superficial) the clincial behavior was intermediate, showing some limitation in using grading and staging only, as predictive factor. There was an expression of ß-hCG in 21.4 per cents of the cases in up to 25 per cents of the tumor cells without any trophoblastic morphology. These ß-hCG producing TCC had a strong correlation with aggressiveness: 39.1 per cents and 12.8 per cents of the TCC expressed ß-hCG with and without tumor progression, respectively