Pelvic malignant mixed mesodermal tumor of uncertain origin: a case report.

Extra-uterine, and especially extragenital, malignant mixed mesodermal tumors (MMMT) are very rare. A large intrapelvic tumor resected from a 56-year-old woman was investigated with morphological and immunohistochemical methods. A large, soft and fragile tumor was located in the pelvic space. The tumor showed high cellularity and was biphasic; it consisted of an admixture of adenocarcinoma and various kinds of sarcomas. The latter were comprised of high-grade endometrial stromal sarcoma, pleomorphic sarcoma, and chondrosarcoma. The pleomorphic sarcoma showed a storiform pattern. The periodic acid-Schiff-positive eosinophilic hyaline droplets and globules in multinucleated giant cells revealed a typical ring-like or peripheral staining for alpha-1-antitrypsin and alpha-1 antichymotrypsin. We considered this case to be pelvic MMMT of uncertain origin, heterologous type.

[Fetal hemodynamics assessed by transvaginal color flow mapping during the first and early second trimesters].

The present study has been carried out to evaluate the usefulness of transvaginal color flow mapping in the assessment of fetal hemodynamics during the first and early second trimesters. Forty normal fetuses were examined by transvaginal color flow mapping from 12 to 20 weeks of gestation. Maximum velocity in the transmitral (MVmax), transtricuspid (TVmax), transaortic (AVmax), fetal descending aorta (Vmax) and fetal internal carotid artery (ICVmax) was assessed. The systolic/diastolic ratio and pulsatility index (PI) of umbilical artery was also assessed. The detection rates for the fetal and umbilical flow velocity waveforms were 42.5%-85.0%. In particular, intracardiac blood flow velocity was easy to detect by transvaginal color flow mapping. The Vmax, ICVmax, MVmax, TVmax and AVmax increased significantly with advancing gestation in the normal fetuses. The TVmax was lower than the MVmax during the first and early second trimesters. Transvaginal color flow mapping studies can improve the understanding of the characteristics of fetal blood flow during the first and second early trimesters. Thus it seems to be useful in making an accurate antenatal diagnosis of congenital heart disease earlier.

Combination of epidural morphine and fentanyl for postoperative analgesia.

The rapid onset of epidural fentanyl could be used to cover the latency period of epidural morphine, thus potentiating analgesia during anesthesia regression after short-acting local anesthetics and possibly extending morphine analgesia for longer duration. The object of this study is to determine whether there are clinical advantages or disadvantages of combining epidural morphine and epidural fentanyl for postoperative analgesia. Patients scheduled for gynecologic procedures were assigned to two groups (n = 54 for each): Group 1 receiving 4 mg epidural morphine, and Group 2 receiving 4 mg epidural morphine and 100 micrograms fentanyl 30 minutes before the estimated completion of the surgery using lidocaine epidural anesthesia. Comparisons were made with regard to: (1) times before the first supplemental analgesic for incisional pain, (2) numbers of supplemental analgesic during the first 48 hours postoperatively, and (3) adverse effects. The two groups were comparable. The number of patients requiring supplemental analgesics between the fourth and 17th hours was significantly greater in Group 1 (n = 10, compared to n = 0 for Group 2; p less than 0.05). The mean time before the first supplemental analgesic was significantly longer in Group 2 (p less than 0.05). The number of supplemental analgesics during the first 48 hours was significantly less in Group 2 (p less than 0.01). No significant difference was found regarding adverse side effects. The results obtained confirm the potential desirability of combining epidural morphine and epidural fentanyl for postoperative analgesia.

[Significance of twin to twin transfusion syndrome in the prognosis of twin pregnancies and its prenatal diagnosis by ultrasonography].

The reason why TTS worsen the prognosis of twin pregnancies was discussed with reference to case results for perinatal death, and antenatal diagnostic criteria for TTS by ultrasonography was established. Of 12 perinatal deaths in 71 twin pregnancies, eight fetuses were affected with TTS (1 acardia, 4 donors, 3 recipients). Perinatal mortality rate (39.3%), rate of preterm lobar (62.2%), rate of polyhydramnion (50.0%), mean amniotic fluid volume (3.310 ml) and cord cross section area ratio (2.38) in monochorionic discordant twins were higher than in the other three groups (monochorionic concordant twins, dichorionic discordant twins and dichorionic concordant twins). Eight fetuses among 12 monochorionic discordant twins were affected with TTS. All twins which showed a single GS in early pregnancy were monochorionic twins. Therefore TTS was considered to have a poorer prognosis than usually reported for all TTS, and to find monochorionic discordant twins with a high cord cross section area ratio must be the key in the screening of TTS. Antenatal diagnosis of TTS by ultrasonography is summarized as follows: 1) A single GS in early pregnancy. 2) Estimated body weight difference between the twins/estimated body weight of the larger twins greater than or equal to 0.2. 3) Cord cross sectional area ratio greater than or equal to 2.0.

Interleukin-1-inhibitory IgG in sera from some patients with rheumatoid arthritis.

Inhibition of interleukin-1 alpha (IL-1 alpha) activity was detected in 7 of 41 serum samples from patients with rheumatoid arthritis (RA). These 7 sera inhibited not only IL-1 alpha-induced endothelial cell adherence to neutrophils, but also IL-1 beta-induced endothelial cell adherence, although to a lesser extent. These sera showed no influence on tumor necrosis factor-induced endothelial cell adherence. No inhibitory activity was found in 40 sera from normal control subjects. Studies to further examine these effects included gel filtration analysis of 2 of the RA sera. The inhibitory activity was eluted near Mr 158 kd and above Mr 250 kd. Analysis by protein A affinity chromatography showed that IL-1-inhibitory activity was present in protein A-binding fractions. Purified IgG (by DE-52 column chromatography) from RA patients was found to be as potent an inhibitor as the protein A-binding fractions, which suggests that the major inhibitory activity in RA sera is attributable to IgG molecules. These purified IgG molecules also inhibited IL-1-induced proliferation of mouse thymocytes but did not influence IL-2-dependent proliferation of the CTLL-2 murine T cell line. The 7 patients whose sera showed IL-1-inhibitory activity had mild RA and low titers of rheumatoid factor. The findings, taken together, suggest a possible regulatory role of IL-1-inhibitory IgG in RA disease activity.

[Fetal therapy in utero by blockage of the umbilical blood flow of acardiac monster in twin pregnancy].

We studied a life-saving method for the unaffected twin in two recent patients who had acardiac monster in twin pregnancy. We succeeded in blocking the umbilical blood flow of the acardiac monster in utero as radical treatment for this abnormality in one of the patients. In case 1, tocolysis and amniocentesis with puncture to the cyst of the acardiac monster were performed to prevent premature labor. However, the patient underwent premature labor at 27 weeks of gestation, and the newborn died. In case 2, fetal treatment was given: A steel coil was placed in the umbilical cord close to the abdominal wall of the acardiac monster under ultrasonographic guidance at 23 weeks of gestation to block blood flow. As a result, no enlargement of the acardiac monster was observed, and the cardiac function of the unaffected fetus improved. At 38 weeks of gestation, the patient delivered a normal baby weighing 2,237g and an acardiac monster weighing 110g. There were no complications in either the mother or newborn. There has been no report describing blockage of the umbilical blood flow of an acardiac monster in utero. Our method is considered efficient and less risky to the mother and the unaffected twin.

Non-invasive continuous fetal transcutaneous pO2 and pCO2 monitoring during labor.

Continuous measurements of fetal scalp transcutaneous pO2 (tcpO2) and pCO2 (tcpCO2) monitoring were performed for 49 patients for the purpose of the evaluation of the fetal well-being. The equipment used was transcutaneous pO2/pCO2 monitor Micro Gas 7640 (KONTRON, Switzerland), which was inserted through the vagina and attached to the fetal head with a suction ring. Blood was taken from the umbilical vessels and pO2 and pCO2 values were analyzed. The correlation coefficient between pO2 in the umbilical artery and tcpO2 was 0.78 (p less than 0.01), and that between pCO2 in the umbilical artery and tcPCO2 was 0.79 (p less than 0.01). Relationships between the transcutaneous blood gas analysis and FHR patterns were discussed. Increase of pCO2 and decrease of tcpO2 was observed in the cases of variable deceleration, not observed in the case of early deceleration. FHR patterns don't always indicate fetal condition, for example in the case of fetal arrhythmia, especially fetal bradycardia. But tcpO2 monitoring of the fetus affected fetal arrhythmia during labor aids diagnosis of fetal distress by FHR patterns, especially in the case of fetuses affected by fetal bradycardia.

Interferon-gamma modulates messenger RNA levels of c-sis (PDGF-B chain), PDGF-A chain, and IL-1 beta genes in human vascular endothelial cells.

The authors have investigated the effects of cytokines and lipopolysaccharide (LPS) on mRNA levels of c-sis (platelet-derived growth factor (PDGF)-B chain), PDGF-A chain, and interleukin 1 beta (IL-1 beta) genes in human vascular endothelial cells (EC). IL-1, tumor necrosis factor (TNF), and LPS not only enhanced the accumulation of c-sis mRNA, but also induced IL-1 beta gene expression. Interferon-gamma (IFN-gamma), in contrast, suppressed the accumulation of c-sis mRNA profoundly and PDGF-A chain mRNA to a lesser extent. The cytokine, in addition, suppressed the release of PDGF-like proteins by EC, while maintaining the growth of EC. IFN-gamma, however, augmented the levels of IL-1 beta mRNA in cultured EC in association with LPS or IL-1, suggesting that the suppression of c-sis expression was not mediated through modulation of IL-1 gene expression by IFN-gamma. These results raise the possibility that IFN-gamma may play a novel regulatory role in the pathogenesis of vascular diseases such as atherosclerosis and vasculitis.

[Management of the goat fetus in water using membrane oxygenator by V-A bypass through the cervical vessels--comparison with the A-V bypass method through umbilical vessels].

Fourteen goat fetuses were totally sustained in water by extracorporeal perfusion using a membrane oxygenator. The two groups which underwent perfusion methods may be described as follows: One was an A-V bypass through umbilical vessels which has been reported previously, and the other was a new method, a V-A bypass through cervical vessels. Ten fetuses were perfused by an A-V bypass and the longest survival time was 9 hours. Three fetuses suddenly died shortly after perfusion was started. Four fetuses were perfused by a V-A bypass and the longest survival time was 27 hours. Cardiovascular dynamics were stable from the beginning of perfusion. Autopsy revealed hepatomegaly and bloody ascites in A-V bypassed fetuses but not in the fetuses perfused by a V-A bypass. The A-V bypass through umbilical vessels resembles physiological fetal circulation, and the cannulation technique is not difficult but it needs strict control, especially in the early stages of perfusion. A V-A bypass through cervical vessels doesn't seem to be close to a physiological perfusion for fetuses and the cannulation technique is difficult. But the cardiovascular dynamics are stable, so they are employed for clinical uses in neonatal ECMO. The V-A bypass method seems to be an adequate technique for managing extremely premature fetuses in water.