Intravaginal misoprostol for medical evacuation of first trimester missed abortion.

Objective: To evaluate the safety and efficacy of intravaginal misoprostol for medical evacuation of first trimester missed abortions.Methods: Seven women with a transvaginal ultrasound diagnosis of a first trimester missed abortion were treated with 800 µg of misoprostol. Four 200 µg misoprostol tablets were placed intravaginally, and a repeat dose of 800 µg was repeated if products of conception were not expelled in 12 hours.Results: Five of seven of the medical evacuations were successful. The average gestational age for the patients was 9 weeks with a range of 8 3/7 to 9 3/7 weeks. The average time from insertion to complete passage of products of conception was 18 hours with a range from 5 hours 10 minutes to 50 hours. Only one patient in the successful group required the second dose of misoprostol. One patient completely passed products of conception 2 weeks after the 2 doses of misoprostol and was considered a treatment failure. Another patient passed products of conception within 12 hours following insertion of the misoprostol but required a dilatation and curettage 3 days later and was also considered a treatment failure. Side effects included cramping in all patients, which was noted to be moderate in six and mild in one. One patient also had mild nausea, mild headache, and one episode of diarrhea. The average blood loss was estimated at 434 mL with a range from 171 to 871 mL.Conclusion: Intravaginal misoprostol for medical evacuation of first trimester missed abortions appears to be safe and effective and may be an alternative to dilatation and curettage.

ME491 melanoma-associated glycoprotein family: antigenic identity of ME491, NKI/C-3, neuroglandular antigen (NGA), and CD63 proteins.

BACKGROUND: Numerous monoclonal antibodies (MAbs) have been produced to antigens found in human melanomas. Three of the best characterized melanoma antigens include the melanoma-associated glycoproteins (MAGs) defined by two reagent families--the ME491 family (including ME491, 8-1H, and 8-2A) and the NKI/C-3 family (including NKI/C-3 and NKI/black-13)--as well as the neuroglandular antigen (NGA) defined by MAbs LS59, LS62, and LS140. These three antigens have significant similarities in tissue distribution, biosynthesis, and structure. The ME491 MAG has been cloned, mapped, and sequenced. Numerous non-melanoma-associated proteins (Sm23, CO-029, R2, TAPA-1, CD9, CD37, CD53, and CD63) have recently been shown to have significant homology to this sequence. PURPOSE: We conducted this study to investigate the similarity between the two MAG antigens and NGA. METHODS: Several reagents defining the three different melanoma antigens were compared, using competition immunoprecipitation, immunoassay, and inhibition radioimmunoassay techniques. RESULTS: Immunoassay experiments show that MAbs defining the three melanoma antigens bind to affinity-purified ME491 antigen and inhibit each other from binding in an inhibition radioimmunoassay. Competition immunoprecipitation experiments demonstrate that the ME491 and NKI/C-3 antibodies bind to NGA. Rabbit anti-ME491 idiotype serum recognizes determinants shared by NKI/C-3 and the anti-NGA MAbs. A competition immunoprecipitation experiment also confirms the identity of CD63, as defined by MAb RUU-SP 2.28, with the three melanoma antigens. CONCLUSION: These data indicate that the MAGs defined by ME491 and NKI/C-3 as well as the anti-NGA antibodies are epitopes of the same molecule, which is identical to CD63 by both immunochemical and molecular genetic investigations. IMPLICATIONS: Our results indicate that the data obtained in studies of these three melanoma antigens may be pooled, and we propose that the molecule recognized by these reagents be classified as CD63.

Effect of glycosaminoglycans and enzymes on the integrity of human placental amnion as a barrier to cell invasion.

The effects of glycosaminoglycans and several enzymes on the integrity of the human placental amnion and the consequent effects on the permeability of this structure to virally transformed cells and their parent line were examined. Treatment of the amnion with hyaluronate, heparin, and chondroitin ABC lyase affected the structure of both the epithelium and the extracellular matrix and resulted in a significant increase in tumor cell invasion, but it had no significant effect on the invasion of the parent cell line. These polymers promoted the disorganization of the epithelial cell layer, and their presence resulted both in the matting of collagen fibrils in the stroma and in the loosening of the basement membrane. Pronase treatment removed epithelial cells and stripped collagen fibrils of granules, but it did not promote tumor or parent cell invasion, perhaps as a result of loss of attachment factors. Chondroitin sulfate did not affect the epithelial structure or the rate of tumor invasion and had only slight effects on the structure of the basement membrane and the stroma. These results are consistent with the thesis that the continuity of epithelium is critical to resisting tumor cell invasion and suggest that glycosaminoglycans, in addition to certain enzymes, can alter this integrity.

Glycosaminoglycan production by murine melanoma variants in vivo and in vitro.

Glycosaminoglycan (GAG) synthesis of B-16 melanoma metastatic variants was examined in vivo and in vitro to begin to assess the relationship between the presence of these polymers and the process of primary invasion and metastasis. The variants that were examined for GAG production included the F-1 line that exhibits low metastatic potential, the F-10 line selected for high metastatic potential, and the BL6 line selected for high invasiveness. The F-1 cell line was routinely less invasive than the F-10 and BL6 lines when injected s.c. into the legs of irradiated Swiss Webster mice. All cell lines formed palpable tumors after s.c. injection, but histological sections revealed early and extensive invasion in only F-10 and BL6 tumors. The F-1 tumors were surrounded by a connective tissue capsule and did not begin to invade into host tissue until this structure disappeared approximately 16 days after injection of tumor cells. Some consistent alterations in GAG synthesis, particularly the release of hyaluronic acid and heparan sulfate, were observed among the cell lines in vivo and in vitro, although differences observed in vitro were small and variable. In vivo all tumors were surrounded by a hyaluronic acid-rich zone that was concentrated at the tumor-stromal interface and was transitory. Hyaluronate occurred as a diffuse band around BL6 and F-10 tumors but was confined to a capsule surrounding the less aggressive F-1 tumor. In vitro the BL6 and F-10 cell lines released larger amounts of heparan sulfate and hyaluronic acid than did the F-1 cell line. Differences in release of chondroitin sulfate by the cell lines were not observed. Differences in trypsin-releasable GAG, presumably associated with the glycocalyx, were also not apparent. These results link the release in vitro and organization in vivo of hyaluronic acid and heparan sulfate to invasion and metastasis.