In-vitro secretion of proinflammatory cytokines by human amniochorion carrying hyper-responsive gene polymorphisms of tumour necrosis factor-alpha and interleukin-1beta.

The identification of polymorphisms in genes encoding proinflammatory cytokines that affect transcription or the secretion rate has opened new ways to understand the variation in responses to infection during pregnancy. In this study, human amniochorion carrying hyper-responsive alleles of tumour necrosis factor-alpha (TNF-alpha: TNF*2 at -308) and interleukin-1beta (IL-1beta: IL-1*2 at +3953) were stimulated in vitro with bacterial lipopolysaccharide (LPS) and compared with tissues carrying the common alleles (TNF*1 and IL-1*1). Fetal membranes carrying the TNF*1 allele displayed an identical dose-response pattern to tissues carrying a TNF*2 allele, except at the highest dose of LPS tested (50 ng/ml) there was a significantly greater production of TNF-alpha in the presence of a TNF*2 allele. Membranes carrying the IL-1*2 polymorphism secreted IL-1beta in a dose-response curve that was different from IL-1* tissues when challenged with 5, 10 and 50 ng/ml LPS. These observations support the hypothesis that reproductive tissues carrying hyper-responsive proinflammatory cytokine genes may over-respond to intrauterine infection secreting higher amounts of cytokines, which in turn, may lead to adverse pregnancy outcomes.

[Comparative evaluation of bone mineral density in Mexican women using x-ray bone densitometry and ultrasound]. / Evaluación comparativa de la densidad mineral ósea en mujeres mexicanas entre el osteodensitómetro de rayos X y de ultrasonido.

With lifestyle changes in women, smoking and use of beverages with caffeine, and sedentarism increasing, so the risk factors for decalcification, increase; which is a public health problem by the higher incidence of osteoporotic fractures, as the age advances, specially in the postmenopause woman, which means a greater secondary morbidity-mortality; an important cause of physical disability, which directly affects psychoemotional wellbeing in women. In this study two methods of bone densitometry, were used; one of x ray, and other with ultrasound in 138 women during postmenopause with an average index of corporal mass of 29. Both results were compared of bone density, T measurement with osteopenia and osteoporosis. Double densitometry, was done in the 138 patients of lumbar spine with DEXA equipment, and of calcaneum with DTU-one equipment, by the same technician, finding the difference of T punctuation in this double study.

Evidence of endothelial cytotoxic compounds in placental extracts from preeclamptic women.

OBJECTIVE: To determine whether placenta and plasma of preeclamptic women contain factors that cause endothelial cell damage. METHODS: Placental extracts and plasma from preeclamptic and normotensive women were added to cultures of normal human umbilical vein endothelial cells and their effect on their viability, was determined by MTT reduction and 51chromium release. RESULTS: Placental extracts from normotensive and preeclamptic women were cytotoxic to endothelial cells, but not the plasma from both groups. Mean +/- standard deviation values of cytotoxicity index in preeclamptic and normotensive placental extracts using the MTT reduction were 70.3 +/- 6.76% and 51.4 +/- 8.81%, respectively, showing a significant difference (P < .0001). Using the 51chromium-release assay, preeclamptic placental extracts showed cytotoxic effects of 87.6 +/- 13.47% compared with 17 +/- 20.60% in control patients. The cytotoxic activity decreased after trypsin digestion and heat treatment in both groups. CONCLUSIONS: A cytotoxic factor to endothelial cells in placental extracts of preeclamptic women was identified. This compound is thermolabile and sensitive to trypsin digestion.

[Shock in obstetrics. Institutional experience]. / Choque en obstetricia. Experiencia institucional.

Shock is one of the most difficult problems an obstetrician can face. Hemorrhage is the main reason of shock. A descriptive and retrospective research was conducted at Instituto Nacional de Perinatología, from January 1992 to May 1996, including all patients admitted to the intensive care unit with diagnosis of shock. There were found 90 cases with diagnosis of shock, 82 were hipovolemic, and 8 cases had the septic kind of shock. The average of age was 32.2 years, with a gestational age between 6.2 to 41.4 weeks . There were 71 healthy patients, hypertension was associated to pregnancy in 9 cases, infertility in two, myomatosis in 2, and diabetes in 2 more patients. Other 5 cases reported different pathologies. The most frequent cause for hipovolemic shock resulted to be placenta acreta (40 cases), followed by uterine tone alterations in 37 patients, ectopic pregnancy in 7, uterine rupture or perforation in 4, and vaginal or cervical lacerations in 2. The estimated blood loss varied from 2200 cc to 6500 cc, and the minimal arterial pressure registered during shock was between 40/20 mmHg to 90/60 mmHg. Medical initial assistance consisted in volume reposition with crystalloids, globular packages, and plasma expansors in 73 patients (81.1%). The rest of the patients received in addition coloids, platelets and cryoprecipitates. A total of 76 patients required surgical intervention consisting in total abdominal hysterectomy. In 5 cases the previous surgical procedure was done and ligation of hypogastric vessels was needed. Salpingectomy was performed in 5 patients, and rupture or perforation repair in 3. The average surgery time was 2 hours and 33 minutes. The observed complications were 7 cases with abscess of the cupula, consumption coagulopathy in 2, 1 vesical quirurgical injury, 1 intestinal occlusion, and 11 vesico-vaginal fistula. The average days of hospitalization resulted to be 5. The most frequent kind of shock seen by obstetricians is the hipovolemic type, followed by septic shock, Volume reposition and restoration of adequate tissue oxygenation is the main goal in treatment, and so the rapid and opportune decision for surgery shall prevent the patients decriment and maternal mortality.

[The efficacy of sulbactam-ampicillin in preventing postoperative infections in gynecology and obstetrics. A comparative open study]. / Eficacia de Sulbactam/Ampicilina en la profilaxis de infecciones postquirúrgicas en gineco-obstetricia. Estudio abierto comparativo.

An open comparative and multicentric trial was carried out to assess the activity of sulbactam ampicillin combination against no treatment, as a prophylactic agent of post-surgical infection in ob-gyn practice. 100 patients were included in the trial and distributed in two groups. sulbactam/ampicillin 0.5/1.0 g, i.v. was administrated during the surgery and the dose was repeated 6 h. later. No cases of post-surgical infection was detected in the group of sulbactam/ampicillin, while 4 cases were observed in the no treatment group. Sulbactam/ampicillin is an effective and well tolerated antimicrobial agent in the prophylaxis of post-surgical infections.

[Cirrhosis and pregnancy. Presentation of a case]. / Cirrosis y embarazo. Presentación de un caso.

Our service received a thirty-year old female patient, primigravida, with 32.1 weeks of gestational age, severe toxemia and icteric. Initial treatment consisted of hydralazine, nifedipine and magnesium sulfate. Stabilization was obtained interrupting pregnancy. Laboratory tests showed hyperbilirubinemia and prolonged blood coagulation tests. Radiologic, endoscopic and other special diagnostic procedures were not conclusive. Histopathology gave a definitive diagnosis. A team approach management was required.

[Peri-intraventricular hemorrhage in pre-term newborns weighing less than 1,000 g., and its possible relationship with way of delivery]. / Hemorragia peri-intraventricular en neonatos de pretérmino con peso inferior a 1,000 g., y su posible relación con la vía de nacimiento.

The Cerebral ultrasonographic study of 20 preterm newborns under 1,000 g. is presented. Two groups were formed: 15 by vaginal via, and 5 by section. There was a higher frequency of cerebral hemorrhage among pre-term newborns by vaginal via than in products obtained through cesarean section. The causes for higher vulnerability to cerebral hemorrhage in the brain of the pre-term products, are mentioned. The changes in conduct for the birth of pre-term products should wait for more experience.

[Morbidity and mortality in pregnant patients with lupus erythematosus]. / Morbimortalidad en la paciente lúpica embarazada.

The clinical records of 14 patients with proved diagnosis of sistemic lupus erythematosus (SLE) associated to pregnancy, seen between november 1986, and july 1988 at the "20 de Novembre" Hospital in Mexico City, were studied. The following variables were evaluated: maternal age, of beginning of SLE, lupus criteria present at the moment of the acute phase of the disease, obstetric history, prenatal care, age of pregnancy, laboratory studies, therapy before, during and after delivery, children's findings, and maternal complications, 50% of the patients had history of previous abortions; there was a high incidence of preterm deliveries (42.86%); 71.42% of the patients suffered hypertension; 64.31% had anemia. Therapy was based on corticosteroids and antihypertensive drugs. There was a significant relationship between low hemolitic complement levels and product's weight.