Stage Ib cervical cancer during pregnancy: planned delay in treatment--case report.

Approximately 0.05% of pregnancies are complicated with cervical cancer. Treatment of this malignancy during pregnancy depends on the stage of disease and gestational age at the time of diagnosis. In women with Stage IB cervical cancer immediate treatment, without regard to the pregnancy, is traditionally advocated in the first and second trimester. A planned delay of treatment, to achieve foetal maturity, may be acceptable if there are no adverse maternal and foetal consequences. We present a case of a Stage IB1 cervical cancer, diagnosed during a twin pregnancy, and treated with a planned delay of 19 weeks. We have reviewed the literature and focused on what is known about planned delay in therapy of Stage IB cervical cancer, diagnosed before 30 weeks of gestational age.

Anti-Müllerian hormone initiates growth of human primordial follicles in vitro.

Survival and growth of follicles in human ovarian tissue is presently only performed with limited success. We evaluated the effect of anti-Müllerian hormone (AMH) and/or testosterone on follicular growth during a 4-week culture period using ovarian cortical tissue from six women in their reproductive years. The cortex of each biopsy was isolated and immediately cryopreserved upon collection and stored in liquid nitrogen. After thawing the tissue was placed in culture. After the culture period all follicles were counted on histological sections and classified for viability and stage of development. Based on evaluation of 6603 follicles it was found that the number of growing follicles significantly increased during the culture period as compared to the uncultured control, irrespective of the composition of the culture medium. Furthermore, significantly more follicles advanced to the primary and secondary stage (p<0.05) in tissue cultured with AMH (54%) as compared to tissue cultured in control medium (41%). The mean diameter of follicles classified as primary follicles was significantly enhanced in tissue cultured in the presence of AMH (p=0.002) and AMH plus testosterone (p<0.001) as compared to that observed in tissue cultured with control medium and medium containing testosterone alone. In contrast the mean diameter of the oocyte and its nucleus remained similar irrespective of culture medium. In conclusion, AMH seems to affect early stages of human follicular development by enhancing recruitment, survival and/or growth during a 4-week culture period.

Comparative genomic hybridization reveals a recurrent pattern of chromosomal aberrations in severe dysplasia/carcinoma in situ of the cervix and in advanced-stage cervical carcinoma.

We analyzed 17 cases of dysplasia/carcinoma in situ (CIS) of the cervix and 29 advanced-stage cervical squamous cell carcinomas by comparative genomic hybridization (CGH). A comparable recurrent pattern of aberrations was detected in both preinvasive and invasive cases, although the total number of aberrations was much higher in the latter category. The most consistent chromosomal gain was mapped to chromosome arm 3q in 35% of preinvasive cases and in 72% of invasive cases. Chromosome aberrations were detected in 13/17 preinvasive cases with a total of 61 involved chromosome arms. In the invasive cases, frequent gains also occurred on 1q (45%), 8q (41%), 15q (41%), 5p (34%), and Xq (34%), and frequent losses were mapped to chromosome arms 3p (52%), 11q (48%), 13q (38%), 6q (38%), and 4p (34%). A recurrent pattern of aberrations has not previously been described in preinvasive lesions of the cervix. Our finding is surprising considering that only few preinvasive lesions are expected to progress to invasive cancer.

Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial.

OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN: Randomised controlled double-blind trial. SETTING: Six obstetric departments in the Copenhagen area. POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.

Immunohistochemical localization of epidermal growth factor in the second-trimester human fetus.

Epidermal growth factor (EGF) is considered to be important in mammalian neonatal growth and development. In order to clarify its developmental role, we have investigated, by immunohistochemistry, the localization of EGF and the time of its first appearance in various organs from a series of 25 midtrimester human fetuses with a gestational age ranging from 13 to 22 weeks. The first detectable EGF immunoreactivity occurred in week 15-16 fetuses in the placenta, the skin, the distal tubules of the kidney, the surface epithelium of the stomach, and the tips of the small intestinal villi, as well as in a few Paneth cells. Glandular structures, such as the glands of the cardia and the pyloric part of the stomach, Brunner's glands of the duodenum, the pancreas, and the submucous glands of the trachea, showed positive EGF immunoreactivity later (week 17). Thus, apart from the kidney, staining of the surface epithelia seems to precede staining of the EGF-producing glandular structures and EGF is not present in the glands before these have already differentiated.

Agenesis of pancreas.

Complete agenesis of pancreas is a rare and lethal condition. Four cases have previously been reported in combination with other malformations, such as severe intrauterine growth retardation, hyperglycaemia and meconium ileus. We report a case of pancreatic agenesis as a single anomaly. The child died when 48 h old with severe metabolic acidosis. The literature is surveyed and the pathogenesis is discussed.

[Chronic radiation enteropathy. A retrospective study]. / Kronisk stråleenteropati. En retrospektiv undersøgelse.

In the period 1968-1989 50 patients, 38 women and 12 men, aged 30-76 years, median 58 years, were referred to the Department of Gastroenterology, Rigshospitalet for severe chronic radiation enteropathy. Most women had received radiation for gynaecological cancer, and most men for urogenital cancer. The initial symptoms of the enteropathy were diarrhoea in 74%, abdominal pain in 62% and weight loss in 52%. Twelve per cent had visible blood in the stools. Ten per cent had fistulas. The symptoms occurred 0-37 years, median ten months after the radiation. The radiation enteropathy had necessitated one or more laparotomies in 35 patients, most often because of subileus/ileus, including resection of the small bowel or the colon in 25 patients, and establishment of an ileostomy or a colostomy in 11. Seven patients developed new fistulas postoperatively. In 32 patients one or more tests for malabsorption were performed as a guidance for therapy: stool mass (26 patients), faecal fat excretion (26 patients), Schilling test (22 patients), lactose absorption (11 patients) and bile acid breath test (seven patients). Half of the patients had diarrhoea, including one third of the patients without intestinal resection. Two thirds had steatorrhoea, including half of the patients without small bowel resection. Three fourths showed decreased absorption of vitamin B12, including half of the patients without ileal resection. All patients studied had abnormal deconjugation of bile acids and more than half of them had bile acid malabsorption. Malabsorption of lactose was found in only one patient. There was no correlation between the radiological and functional abnormalities of the small intestine.(ABSTRACT TRUNCATED AT 250 WORDS)

Five-year follow up of patients with cervical intra-epithelial neoplasia in the cone margins after conization.

Three hundred eighty-five women treated with conization due to repeated CIN I, CIN II or CIN III of the cervix uteri have been followed up for 5 years. All cones were classified according to diagnosis and status of the resection margins. A significantly greater recurrence rate of 16.2% was found in the group with neoplasia in the resection margins, in contrast to 3.9% in the group with normal resection margins. However, 83.8% (75.4-92.2%) of patients with neoplasia in the resection margins can be expected to be free of recurrence after a 5-year postoperative follow-up period. Whether the non-free resection margins were endocervical, ectocervical or both, did not influence the recurrence rate. While the prevalence of non-free resection margins increased significantly with increasing dysplasia, this could not be found with increasing age. The risk of recurrence could not be correlated with the grade of dysplasia. We conclude that neoplasia in the resection margins of the cone represents an increased risk of recurrence. Therefore, we changed the normal smear check-up with a cotton-swab to smear with cyto-brush, supplemented with colposcopy in the non-free resection margin group, but it remains to be proven that this procedure is safer.

Spontaneous pneumothorax following regression of pulmonary metastases.

Spontaneous pneumothorax (SP) caused by necrosis in combination with regression of lung metastases is a rare complication to cancer chemotherapy. Few case reports have previously been presented, and mostly in patients with sarcomas. A patient is presented with spontaneous pneumothorax probably caused by chemotherapy-induced cell necrosis in bilateral lung metastases secondary to an endometrioid cancer. The literature is surveyed. Because of the increasing use of effective chemotherapeutic drugs, it is expected that this rare complication will occur more often.

[Erosion of the splenic artery in acute pancreatitis]. / Arteria lienalis arrosion ved akut pancreatitis.

A patient with bleeding from the eroded distal splenic artery secondary to acute pancreatitis is presented. The pancreatic tail was found to be moderately edematous without cyst, abscess or necrosis at splenectomy. The walls of the artery showed no structural changes. The postoperative course was uneventful.

[Atypical manifestation of extragonadal germinative tumors]. / Atypisk fremtraeden af ekstragonadale germinative tumorer.

Three cases of extragonadal germinative tumours, all with atypical manifestations are presented. All patients were treated as for germinative tumours and all of them were without any signs of recurrence 24 to 60 months after treatment. The literature is surveyed. It is concluded that although the histology of the tumour is uncertain, the location of the tumour and the tumour markers are atypical, younger patients where a germinative tumour cannot be excluded should be treated as for a gonadal germinative tumour with a cisplatinum-based combination chemotherapy.

The receptor for epidermal growth factor is present in human fetal kidney, liver and lung.

In animals a pharmacological doses of the growth-promoting peptide epidermal growth factor (EGF) has an effect on the growth and/or maturation of several organs such as the lung, the kidney, the liver and the gastrointestinal tract. Since EGF elicits its function via binding to specific cellular receptors the presence of these receptors predicts a possible physiological role for EGF and EGF agonists. We have studied the presence of the EGF-receptor on human fetal membrane preparations from the kidney, the liver, the lung and the placenta (gestational age 13-20 weeks). The 4 membrane preparations all bind labeled EGF thus allowing us to calculate the apparent affinity constant and the number of receptors present per mg of membrane protein. The apparent affinity constant (gestational age 13-20 weeks) varies between 0.5 and 3.5 X 10(9) mol-1, median 1.3 X 10(9) mol-1 (n = 40). No difference is observed for the 4 tissues examined, and no difference is found as a function of the gestational age. The number of receptors present per mg of membrane protein (gestational age 16-20 weeks) are (range and (median) 90-220 (130) fmol, n = 10 for the kidney, 80-480 (250) fmol, n = 9 for the liver, 90-690 (300) fmol, n = 10 for the lung, and 2100-4200 (3400) fmol, n = 7 for the placenta. Results for a fetus of gestational age 13 weeks show high values for kidney receptors (240 fmol) and lung receptors (800 fmol) and low values for the placenta receptors (410 fmol).

Cobalamin binding proteins in the human fetus.

Cobalamin binding proteins are synthesized by the fetus from at least 16-19 gestational weeks. Cerebrospinal fluid contained transcobalamin with size and isoelectric points identical to adult transcobalamin. The unsaturated cobalamin-binding capacity in the fetal cerebrospinal fluid was comparable to adult levels, that is 0.01-0.04 nmol/l, median 0.03 nmol/l, n = 4. The unsaturated cobalamin-binding capacity in serum was low compared to adult values (0.02-0.04 nmol/l, median 0.03 nmol/l, n = 4). The unsaturated cobalamin-binding capacity in at term umbilical cord serum was alike for arterial and venous blood. The values obtained was 0.14-1.03 nmol/l, median 0.66 nmol/l, n = 22, which was two thirds of the corresponding values in maternal serum: In the amniotic fluid haptocorrin, intrinsic factor and transcobalamin were identical with the adult binders regarding the size and the isoelectric point.

Nonchromaffin paraganglioma of the retroperitoneum.

We reviewed 37 cases described previously in the literature to provide a patient operated upon for a retroperitoneal nonchromaffin paraganglioma with qualified advice concerning followup examinations and prognosis. This type of tumor apparently grows slowly and metastasizes late. A radical operation is the treatment of choice and provides a good prognosis. We suggested that our patient undergo clinical followup and ultrasound investigations at 3 to 6-month intervals.

CO2-laser treatment of condylomata acuminata.

Fifty-two consecutive patients with condylomata acuminata were treated with CO2-laser under general anesthesia. In many of the cases, previous conventional treatment had failed. The effectiveness of the treatment was found to be between 75 and 87%. It caused few complication or complains. Eighty-three percent of the patients expressed satisfaction with the treatment. Laser treatment of condylomata acuminata is an alternative to conventional treatment in tractable cases and in cases where conventional methods are contra-indicated.