Prenatal diagnosis of and midtrimester pathology with karyotype 46,XY,del(4)(q22q26). A case report.

A prenatal diagnosis of an interstitial deletion with chromosome 4,46,XY,del(4)(q22q26) was obtained on amniotic fluid cells drawn at 19 weeks' gestation from a 35-year-old gravida. Counseling on the basis of unusual or tenuous data is always difficult, but comparisons with similar deletions in 4q suggested a substantial risk of anomalies. A comparison of the postabortal autopsy findings with those from other reported cases of interstitial deletions of chromosome 4q suggested different pathology with this area of deletion than previously reported for other areas of 4q.

Intramural ectopic pregnancy implanting in adenomyosis.

The clinical course of this 33-year-old gravida presenting at 16 weeks' gestation with hemoperitoneum was typical for suspected uterine rupture. Pathologic examination of the hysterectomy specimen supports the diagnosis of intramural pregnancy, representing the 15th case reported to date in the literature. Furthermore, there was histologic evidence of adenomyosis both within the sinus tract leading to the implantation site and throughout the myometrium. Documentation of implantation and development of ectopic pregnancy in adenomyotic myometrium should alert the clinician to the possibility of this rare pregnancy complication.

Different secretory immunoglobulin A antibody responses to cholera vaccination in Swedish and Pakistani women.

The capacity of subcutaneous cholera vaccination to induce an antibody response in milk and saliva was studied in lactating Swedish and Pakistani women, since secretory immunoglobulin A (SIgA) antibody responses in these secretions may reflect intestinal immunity. Before immunization, most of the Pakistani women had significant titers of specific SIgA antibodies against Vibrio cholerae lipopolysaccharide in milk, whereas only a few of the Swedish women had measurable, low titers. In the Pakistani women a single subcutaneous injection of cholera vaccine gave rise to a significant SIgA titer rise in 70% of the milk and 45% of the saliva samples. The Swedish women, on the other hand, did not respond with a significant antibody response of any immunoglobulin class in milk or saliva, either after a single or after a booster dose 14 days later. In serum, however, the vaccination induced significant titer rises, mainly of IgG antibodies, also in the Swedish women, but these rises were of lower magnitude than those in the Pakistani group. The results suggest a significant difference in the capacity of parenterally administered cholera vaccine to stimulate SIgA antibody formation in naturally primed and nonprimed individuals.

Boosting of secretory IgA antibody responses in man by parenteral cholera vaccination.

The occurrence of specific antibodies to Vibrio cholerae lipopolysaccharide in serum, milk, and saliva of Pakistani women from a very low socioeconomic group was studied before and after a single subcutaneous cholera vaccination. Before immunization all women had low levels of specific antibodies in serum, primarily of IgM class, and in many cases cholera IgA angibodies were found in milk and saliva as well, indicating earlier natural exposure. The vaccination consistently induced a marked rise in serum antibody titer, and notably also produced significant titer increases in 70% of the milk and in 45% of the saliva samples. Whereas the serum antibodies induced were predominantly of the IgG class, secretory IgA was responsible for most of the titer increase in the secretions. The results indicate that parenteral cholera vaccination can boost local secretory IgA antibody responses in intestinally primed individuals.