Invasive villoglandular adenocarcinoma of the cervix with unusual clinical presentation: A rare case.

The incidence of cervical adenocarcinoma has increased over the last several decades. Villoglandular adenocarcinoma of the cervix (VGA) is a distinct subset of cervical adenocarcinoma, is very rare and occurs in young women. We report an extremely rare case of invasive villoglandular adenocarcinoma of the cervix in a 75 year old woman with unusual clinical presentation.

Seminal LDH-C4 isoenzyme and sperm mitochondrial activity: a study in male partners of infertile couples.

Lactate dehydrogenase isoenzyme patterns were obtained in the seman of 93 male partners of infertile couples and 28 proven fertile subjects as a control group. Sperm mitochondrial activity index (SMAI) alongwith the conventional seminal parameters was studied for all the subjects excepting the azoospermic and vasectomised males. Only LDH-C4, a germ cell specific isoenzyme activity varied with the variation in sperm density. LDH-C4 activity varied significantly (p<0.001) within and between different groups. Lactate dehydrogenase-C4 activity was absent in 17 azoospermic samples, confirming its germinal epithelial origin, as well as in 8 samples of vasectomised males. In one azoospermic sample, there were many immature germ cells along with surprisingly high LDH-C4 activity suggesting more activity of germinal epithelium associated with high LDH-C4 activity. LDH-C4 activity was reduced significantly in oligozoospermic samples in proportion to sperm density, thus confirming strong correlation (p<0.001) between LDH-C4 and sperm density. There was statistically significant correlation between LDH-C4 and percentage sperm motility as well as between LDH-C4 and Sperm Mitochondrial Activity Index (SMAI) (probability varying from p<0.05 to p<0.01 in different groups), but no such correlation was found between LDH-C4 and sperm morphology. The data confirms LDH-C4 as a germinal epithelial marker. Its relationship with percentage sperm motility is suggestive of definite role of LDH-C4 in evaluation of the spermatozoal quality, similarly its relationship with Sperm Mitochondrial Activity Index (SMAI score) suggest the role of LDH-C4 in metabolism of the spermatocytes and sperms, though further studies are required for clear and detailed understanding of its metabolic role in semen.

Acrosome intactness and seminal hyaluronidase activity: relationship with conventional seminal parameters.

Seminal hyaluronidase activity was estimated after liquefaction in semen samples of 100 male partners of infertile couples including 16 azoospermic (no spermatozoon) men and 48 fertility proven men by a method based on measurement of the area of digestion of substrate (hyaluronic acid) in agar plate. Semen samples were also evaluated for Acrosomal Intactness (AI) test except the azoospermics of the studied samples. Seminal hyaluronidase activity was completely absent in azoospermic specimens confirming its cellular origin. Seminal hyaluronidase activity was found to be significantly correlated, statistically, with sperm density (r = 0.708, p < 0.001), % motility (r = 0.6478, p < 0.001) and % normal sperm morphology (r = 0.5724, p < 0.001). Acrosomal Intactness (AI) test scores were also well correlated with sperm density (r = 0.6477, p < 0.001), % motility (r = 0.5965, p < 0.001) and % normal morphology (r = 0.6237, p < 0.001). Both values were higher in semen samples with normal routine parameters (proven fertility and normozoospermic infertile groups) than those compared with abnormal routine parameters (oligozoospermic). We also found very highly significant correlation (r = 0.8442) between seminal hyaluronidase activity and Acrosomal Intactness scores, statistically (p < 0.001). This could be because; normal germinal semineferous epithelium generates abundant number of sperms with normal motility and morphology that are also having intact acrosome. Intact acrosome prevents loss of acrosomal enzymatic activity (e.g. hyaluronidase) until released after liquefaction during seminal analysis and during acrosomal reaction in female genital tract prior to fertilization. Seminal hyaluronidase activity, thus determined, is primarily dependent upon the intact status of acrosome. As each sperm contributes to the seminal hyaluronidase activity, it is directly correlated with sperm density; but at the same time it exhibits goods correlation with % motility and % normal morphology. Therefore AI score and seminal hyaluronidase activity can be considered as good indicators of sperm function.

Effect of exercise on acid-base status and ventilatory kinetics.

The normal respiratory responses and changes in acid base status in twenty normal height, weight and age matched subjects were studied; using Auto Spiro AS 300 spirometer for ventilatory parameters and NOVA stat profile 3 analyser for gas analysis. Each subject performed a progressive incremental treadmill exercise by Bruce protocol to their symptom limited maximum. Minute ventilation (VE), tidal volume (VT) and frequency of respiration (f) increased significantly (P<0.001). Acidosis occured following exercise as pH of arterialized venous blood declined significantly (P<0.05). Gas analysis of arterialized venous blood showed a rise in pO2 (P<0.001) and a fall in pCO2 (P<0.001). Recovery of acid base status as well as gaseous pressure in blood did not occur after 10 min. Expired gas pCO2 declined significantly (P<0.05) and pO2 increase significantly (P<0.05). These pressures returned to resting levels 10 min after exercise. Thus in normal young adults heavy exercise caused an increment in ventilatory kinetics producing hyperpnoea which recovers after a rest of 10 min. Acidosis stimulates the respiratory centre to cause hyperventilation which tries to meet the added metabolic demands of strenuous exercise.

PEFR in pregnancy: a longitudinal study.

Peak expiratory flow rates (PEFR) were measured in 60 pregnant women aged 20-28 years (average 24 yrs) height between 130-160 cm (average 154.5 cm), each month beginning from 3rd month of gestation and also 8-10 weeks postpartum using, Wright's Peak Flow Meter. The PEFR declined from 329.12 +/- 4.40 lpm in 3rd month to 286.22 +/- 3.81 lpm in 9th month of gestation and increased to 347.86 +/- 2.93 lpm in postpartal period. A similar, declining trend is also observed in other Indian studies. However, the values are lower than those observed in Europeans. Also no change in PEFR during pregnancy was observed in an European study. The PEFR in our study regressed at a rate of 6.68 lpm/month of gestation and 5.49 lpm/kg increase in weight throughout pregnancy. The correlation with forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) is non-significant throughout pregnancy. The anaemic pregnant women showed lower PEFR when compared with PEFR of nonanaemic pregnant women, but showed a similar declining trend throughout pregnancy.

A longitudinal study of pulmonary function tests during pregnancy.

The study deals with evaluation of pulmonary function status in fifty normal pregnant women tested monthly. The parameters studied were Vital Capacity (VC) Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1st second (FEV1) using Vitalograph Spirometer; tidal volume (VT), inspiratory capacity (IC) and expiratory reserve volume (ERV) using Expirograph and resting minute ventilation (VE) using Tissot's spirometer. Control values were obtained in the same subject 8-10 weeks after delivery. The increase seen in VT, VE and IC was very highly significant. The small increment in frequency of respiration is significant and the declining trend observed in ERV is very highly significant. VC and FVC were maintained by the rise in IC and a concomitant fall in ERV. Rise in VC is attributed mainly to rise in VT than rise in frequency. The results suggest that though pulmonary function is altered during pregnancy, it is not compromised and hence does not induce any mechanical stress on the respiratory efficiency of the pregnant woman.