Pretreatment study of P53 overexpression for selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma: a randomized-controlled study.

PURPOSE: To study the value of pretreatment testing of P53 overexpression in selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma. PATIENTS AND METHODS: This prospective randomized clinical study included 38 patients with histologically confirmed endometrial carcinoma and staged clinically as stage I. Immunohistochemical staining of the tumor specimens obtained by dilatation and curettage with P53 monoclonal antibodies was done. The patients were randomized into two groups according to the planned surgical treatment: hysterectomy group and hysterectomy plus pelvic lymphadenectomy group. RESULTS: There was no significant difference in mean age, parity, medical status, surgical stage, histologic types, grade of differentiation, and myometrial invasion between the two groups. The survival rate in the hysterectomy group in our study was 82.4% and the recurrence rate was 17.6%, while in hysterectomy and lymphadenectomy group the survival rate was 81.0% and the recurrence rate was 19%. Adding pelvic lymphadenectomy was found to be associated with prolonged recurrence time in the P53-positive patients (24.07 vs. 17.8 months for group A). CONCLUSION: Pretreatment testing of P53 expression is recommended to help with other prognostic factors in the selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma.

Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology.

The aim of this randomised prospective study was to assess the efficacy of early thromboprophylaxis with low-molecular weight heparin (LMWH) in women with a history of recurrent first trimester spontaneous abortion or miscarriages without identifiable causes vs no treatment. The study comprised of 340 women with unexplained spontaneous recurrent miscarriages. Patients in group A were prescribed LMWH (Enoxaparin sodium 0.2 ml, 20 mg, once daily subcutaneously) from the time of confirmation of fetal viability by ultrasonography until 34 weeks' gestation, and folic acid tablets 0.5 mg daily until 13 weeks' gestation. Patients in group B were given folic acid tablets 0.5 mg daily until 13 weeks' gestation. Termination of pregnancy was the primary outcome. There was a significant difference in the incidence of both early (4.1% vs 8.8%) and late miscarriages (1.1% vs 2.3%) in group A than in group B, respectively. There were no differences between both groups as regards the occurrence of pre-eclampsia, placental abruption, caesarean delivery, intra-partum bleeding or ecchymosis at operative wounds. There were no differences in most of the neonatal values between both groups. However, the mean birth weight was significantly higher in group A. LMWH seems to be a safe drug and effective in significantly reducing the incidence of recurrent miscarriages of unknown aetiology when given in the first trimester and continued throughout pregnancy.

Can a single serum CA125 assay predict the outcome of threatened abortion?

Earlier work suggested that high levels of CA125 could be detected in the sera of women with threatened abortion. In this study, we used CA125 as a method of anticipating outcome in cases of threatened abortion and compared the results with ultrasonic findings. Three groups of patients were studied.(1) 57 women who threatened to abort, but whose pregnancy continued.(2) 43 women with a threatened abortion, who subsequently aborted, and (3) 50 normal women who had no bleeding in early pregnancy. There was a highly significant increase in serum CA125 in women who aborted compared with the other two groups (P<0.001). The results compared well with conventional ultrasound and serum CA125 may be developed as a cheap, sensitive and specific predictor of outcome in cases of threatened abortion.

Transplacental transmission of hepatitis C virus in HIV-negative mothers.

The aim of this work was to evaluate transplacental transmission of hepatitis C virus (HCV) in HIV-negative pregnant women who were HCV-PCR-positive, and also to determine the serotypes of the virus in these cases. Therefore, 767 pregnant women were screened for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and anti-HIV antibodies. HCV PCR was performed for HCV-positive women. Those who were PCR-positive were tested for anti-HCV IgM. Neonates of PCR-positive mothers were tested for virus transmission by the PCR test. Virus serotyping was done for mothers and neonates. Anti-HCV antibodies were detected in 105 out of 767 (13.7%) pregnant women. PCR was positive in 18 out of 67 HCV-positive women (26.9%). Transplacental transmission occurred in 11.1% of HIV-negative pregnant women. HCV type 4 predominates in Egypt (83.3%). Mothers who are PCR-positive and have high aspartate aminotransferase and positive anti-HCV IgM are most likely to transmit HCV to their babies.

Detection of pregnant women at risk of cervical incompetence by transvaginal sonography during straining.

OBJECTIVE: To evaluate the ability of transvaginal sonography (TVS) undertaken, during straining to detect incompetent cervix in pregnant women at risk. METHOD: Forty-seven pregnant women with risk factor(s) for cervical incompetence and 22 pregnant women (control) were evaluated for cervical changes detected by TVS during rest, transfundal pressure and during the stress induced by straining. RESULTS: The control group demonstrated no cervical changes. The changes were more significant during straining than with transfundal pressure. In the group with risk factor(s), 48.9% showed negative response and 51.1% demonstrated positive response. The pregnancy outcome was more favourable in the group with negative response (full term pregnancy 82.6% vs 70.8%, preterm delivery 13% vs 16.7% and pregnancy loss 4.4% vs 12.5%). CONCLUSION: TVS during straining can be applied as a stress test in women at risk for cervical incompetence.

Bladder stone: a complication of intravesical migration of Lippes loop.

We report on a woman in whom an intrauterine contraceptive device (Lippes loop) migrated from the uterus to the bladder with formation of a calculus. Eight years elapsed between intrauterine insertion of the device and its retrieval with the calculus from the bladder.

Electrophoretic separation of two Aedes caspius Pallas forms from Egypt.

Isozyme banding patterns of the recently recognized autogenous stenogamous and anautogenous eurygamous sexually isolated Aedes caspius forms were investigated using horizontal starch gel electrophoresis of 5 enzymes. The esterase assay clearly separated in 2 forms, a faster band being characteristic of autogenous individuals. Other tested enzymes were encoded by 5 loci that were highly polymorphic. The "malic" enzyme locus was unambiguously diagnostic, specific, non-overlapping alleles at that locus were revealed in each form. Other enzyme loci screened exhibited at least 2 alleles common to both forms, allelic frequency differences at least loci could not separate the 2 forms except at the cathodal MDH-1 locus (malate dehydrogenase assay). Probability of correct diagnosis at the MDH-1 locus was as high as 93% so that it may be used as a confirmatory test.