Androgenic adult granulosa cell tumor in a 13-year-old prepubertal patient: a case report and review of the literature.

We report the clinicopathologic findings of an unusual case of adult granulosa cell tumor with androgenic manifestation in a 13-year-old prepubertal girl. The patient had never had a menstrual period and presented with a 1 year history of hirsutism. Physical examination was only remarkable for an increase in facial and abdominal hair, both with a male pattern of distribution. A pelvic ultrasound demonstrated a 6.0 cm right adnexal cyst. Plasma testosterone and 17-hydroxyprogesterone levels were elevated. The patient initially was treated with monophasic oral contraceptive pills for 3 months and owing to lack of response, she underwent an exploratory laparotomy in which a left ovarian tumor, 7.0 cm in greatest dimension, and a 6.5 cm right paratubal cyst were found. A wedge biopsy of the left ovary and subsequent left oophorectomy with right salpingectomy were performed. No gross evidence of disease outside the ovary was noted. Microscopic examination of the left ovarian tumor revealed the typical features of an adult granulosa cell tumor. No tumor was seen outside the ovary. Six days after surgery, plasma testosterone and 17-hydroxyprogesterone levels were in the normal range. Nine months postoperatively, the patient shows no evidence of disease. To our knowledge, this represents the first case of a prepubertal patient with an adult granulosa cell tumor with androgenic manifestations reported in the English literature.

Misoprostol embryotoxicity: clinical evaluation of fifteen patients with arthrogryposis.

We report on clinical evaluations of Brazilian patients with misoprostol-induced arthrogryposis. All 15 patients had growth retardation, underdeveloped bones, short feet with equinovarus, rigidity of several joints with skin dimples and webs, decreased movement of legs stemming from neurologic impairment, bilateral symmetrical hypoplasia or atrophy of limb muscles, and absent tendon reflexes. Of the 15 patients, five had upper limb deformities in addition to lower limb involvement, and one had spinal cord disruption leading secondarily to segmental sensory loss and neurogenic bladder and bowel. Electroneuromyography of five patients indicated that the abnormalities were of neurogenic origin and suggestive of anterior horn cell defects. All of their mothers took 400-4,800 mcg of misoprostol orally or vaginally at 8 to 12 weeks of pregnancy. Our observations support a previously stated caution with regard to the embryotoxicity of misoprostol.

Application of an autoregressive process to estimate genetic parameters and breeding values for daily milk yield in a tropical herd of Lucerna cattle and in United States Holstein herds.

The objectives of this study were to estimate from test day records the genetic and environmental (co)variance components, correlations, and breeding values to increase genetic gain in milk yield of Lucerna and US Holstein cattle. The effects of repeated observations (within cow) were explained by first-order autoregressive processes within and across lactations using an animal model. Estimates of variance components and correlation coefficients between test days were obtained using derivative-free REML methodology. The autoregressive structure significantly reduced the model error component by disentangling the short-term environmental effects. The additional information and the more heterogeneous environmental variances between lactations in the multiple-lactation test day model than in the first lactation model provided substantially larger estimates of additive genetic variance (0.62 kg2 for Lucerna; 14.73 kg2 for Holstein), heritability (0.13 for Lucerna; 0.42 for Holstein), and individual genetic merit. Rank correlations of breeding values from multiple lactations and from first lactations ranged from 0.18 to 0.37 for females and from 0.73 to 0.89 for males, respectively. Consequently, more selection errors and less genetic gain would be expected from selection decisions based on an analysis of first lactation only, and greater accuracy would be achieved from multiple lactations. Results indicated that substantial genetic gain was possible for milk yield in the Lucerna herd (34 kg/yr). Estimates of genetic variance for Holsteins were larger than previously reported, which portends more rapid genetic progress in US herds also; under our assumptions, increases would be from 173 to 197 kg/yr.