Comparative study between sublingual and vaginal misoprostol for induction of labor in post term pregnant patients with unfavourable cervix

Background: Pharmacological studies suggest that sublingual route might be the optimal route of administration for PGE1 analogue misoprostol because the avoidance of the first pass hepatic circulation would yield bioavailability like that achieved with the vaginal route along with an earlier onset of action and a prolonged activity

Objective: The aim of this study was to compare the efficacy and the safety of vaginal misoprostol with sublingual misoprostol for induction of labor in post-term pregnancy

Subjects and Methods: This study included 50 cases, each with a singleton post-term pregnancy and a live fetus requiring induction of labor were allocated to sublingual and vaginal administration of misoprostol. Outcome measures related to labor and maternal and fetal side effects were compared between the 2 groups and evaluated using Chi square test

Results: The sublingual route of misoprostol was associated with a reduced risk of failed induction, reduced time from initiation to induction, reduced induction to delivery interval and a higher incidence of maternal and fetal side effects. However, the differences were not statistically significant

Conclusion: The sublingual route of administration of misoprostol is comparable in efficacy and safety to the vaginal route for induction

Expression of Ki67 and P53 in primary squamous cell carcinoma of the larynx.

We studied a series of untreated laryngeal carcinomas in an attempt to determine the relationship between Ki67 and p53 expression and clinicopathological findings. The relationship between expression of these markers in non-tumoral tissue was also evaluated in order to investigate the possible role of immunohistochemistry as a diagnostic aid in evaluating laryngeal biopsies. Materials and Methods: Samples from 54 patients with laryngeal squamous cell carcinoma (SCC) were analyzed retrospectively. The uninvolved vocal cord was evaluated as a non-tumoral sample. Paraffin sections of tumors were immunohistochemically stained for p53 and Ki67 expression. Results: Overall, p53 expression was found in 35 (64.8%) of the patients. There was a significant correlation among tumoral p53 expression and tumor location, tumor stage and lymph node involvement. Most grade I tumors had a Ki67 labeling index <50% and a labeling index ≥50 was found mainly in high-grade tumors. Tumoral Ki67 expression correlated significantly with tumor grade and mitotic count. There was no correlation between Ki67 labeling index and tumor region. In non-tumoral tissue, 95% of high-grade pre-neoplastic lesions revealed a high expression of Ki67. Non-tumoral p53 expression did not correlate with histological findings. Conclusion: p53 and Ki67 expression in tumoral tissue may be a prognostic marker in patients with laryngeal SCC. Evaluation of the proliferative index in biopsy samples of dysplastic laryngeal mucosa is potentially useful for predicting the progression toward carcinoma.