Cervical cancer in young Japanese women.

This study was performed to determine whether the incidence of cervical cancer in women aged 35 or younger has changed over the last 10 years and to examine the clinical characteristics of the cases. The incidence of cervical cancer in women aged 35 or younger were significantly greater in 1987-1991 than 1992-1996 (p = 0.001). Most new cases were detected by routine cytological screening.

Application of the flow convergence region method to the determination of stroke volume and cardiac output in patients with mitral stenosis.

OBJECTIVE: This study was undertaken to investigate the feasibility and accuracy of determination of stroke volume and cardiac output by calculating transmitral flow volume using the flow convergence region method in patients with mitral stenosis. PATIENTS AND INTERVENTIONS: Fifty-six patients with rheumatic mitral stenosis were studied using imaging and Doppler echocardiography. Aliasing velocities of 20 to 23 cm/s were used to record the flow vonvergence region proximal to the stenotic mitral orifice. The stroke volume (mL) was calculated by multiplying peak transmitral flow rate which was obtained using an angle-corrected hemispheric flow convergence equation, by transmitral velocity time integral (cm) divided by peak transmitral velocity (cm/s) recorded using continuous wave Doppler method. MAIN RESULTS: Stroke volume calculated using the flow convergence region method was not significantly different from that calculated using aortic Doppler two-dimensional echocardiographic method in 39 patients with pure mitral stenosis (75+/-19 [mean+/-1SD] versus 73+/-19 mL, P=0.12), and from that calculated using pulmonic Doppler two-dimensional echocardiographic method in nine patients with mitral stenosis with associated>2+ aortic regurgitation (77+/-12 versus 75+/-14 mL, P=0.49). No significant difference existed between the cardiac output obtained using the flow convergence region method and that obtained using Fick method in 12 patients with pure mitral stenosis. The stroke volume was overestimated by the flow convergence region method when compared with those obtained using aortic Doppler two-dimensional echocardiographic method in patients with mitral stenosis with associated >2+ mitral regurgitation (123+/-40 versus 67+/-15 mL, P=0.001). CONCLUSIONS: The present study provided an alternative way to calculate the stroke volume and cardiac output in patients with mitral stenosis.

Levels of hepatocyte growth factor in maternal serum and amniotic fluid.

OBJECTIVE: The purpose of our study was to investigate hepatocyte growth factor levels in maternal serum and amniotic fluid during pregnancy. We also demonstrated production and secretion of hepatocyte growth factor by placenta and amnion at different stages of gestation. STUDY DESIGN: Hepatocyte growth factor levels in maternal serum (n = 219), cord blood (n = 20), and amniotic fluid samples (n = 90) were measured by an enzyme-linked immunosorbent assay. The secretion of hepatocyte growth factor by placenta and amnion was evaluated by measuring the amount released into the culture supernatant. RESULTS: Most hepatocyte growth factor levels in maternal serum were below the detection limit before 10 weeks of pregnancy. Levels increased significantly thereafter and continued to increase until term. On the other hand, levels in amniotic fluid were significantly higher between 20 and 29 weeks of gestation than after 30 weeks. Hepatocyte growth factor secretion from the placental tissue per weight seemed unchanged throughout pregnancy. Its secretion from amnion was, however, approximately 300 to 400-fold higher in the second trimester compared with that at term. CONCLUSION: Both placenta and amnion produce and secrete hepatocyte growth factor, suggesting its role in fetal growth and the growth and differentiation of placenta.

A novel human monoclonal antibody against cervical cancer: its immunoreactivity with normal tube and ovary and with ovarian tumor tissue.

1-1-2D, a novel human monoclonal antibody (MAb) raised against cervical cancer, was examined for its immunohistochemical reactivity with ovarian cancer. Six of 10 ovarian cancer cell lines showed positive staining, while 3 of 5 cervical cancer cell lines were positive. Among tumor tissues, 15 of 18 (83%) ovarian serous cystadenocarcinomas and 10 of 12 (83%) ovarian clear cell adenocarcinomas were positive. We also performed immunohistochemical staining of the same cancer specimens with OC 125 and compared their reactivity. The frequency of positivity was similar, but the reactivity of the two MAbs was different. 1-1-2D stained the apical surface of the glandular epithelial cells and secretory products of the gland. On the other hand, OC 125 stained the cytoplasm as well as the plasma membrane of the glandular epithelial cells. These results suggest that 1-1-2D MAb recognizes a different antigen from that recognized by OC 125.

[Aggressive management of prolapsed fetal membranes earlier than 26 weeks' gestation by emergent McDonald cerclage combined with amniocentesis and bladder overfilling].

During the period January, 1987-December, 1992, 32 pregnant women (33 fetuses) earlier than 26 weeks' gestation were admitted to our perinatal unit with incompetent cervix and prolapsed fetal membranes through the cervix (hourglassing). Eighteen pregnant women (19 fetuses) were managed aggressively with emergent double McDonald cerclage, which included preoperative amniocentesis and bladder overfilling to decompress and replace prolapsed fetal membranes. Fourteen pregnant women were managed conservatively with bed rest, tocolysis, and antibiotic therapy. The perinatal results of aggressive management were clearly more favorable than those of conservative management when compared: Prolongation of pregnancy 35.2 +/- 39.7 vs. 3.5 +/- 2.6 days (p < 0.01), gestational age at delivery 27.3 +/- 5.3 vs. 24.2 +/- 1.2 weeks' (p < 0.05), birth weight 1,260 +/- 909 vs. 690 +/- 124 grams (p < 0.05), and fetal salvage rates 74(14/19) vs. 7(1/14)%, respectively.

Possible gliclazide-induced water retention with azotemia.

An 80-year-old woman with diabetes mellitus was treated with gliclazide. Prior to the gliclazide administration, her urinary excretion of albumin, serum urea nitrogen and serum creatinine were normal. After the medication, oliguria, edema and azotemia developed. On the twenty-fourth day when the edema was severe and generalized, gliclazide administration was terminated. On the following day urinary volume increased suddenly (5,740 ml/day). Polyuria persisted for five days. Edema improved and urea nitrogen and creatinine were normalized thereafter. Though the mechanism is not known, the clinical course suggests that gliclazide is the principal causative factor in the water retention and azotemia in this patient.

Training: more user friendly.

PIP: China launched its family planning program in 1971 by initially focusing on public information campaigns and providing services to married couples nationwide. It eventually instituted programs to improve maternal and child health/family planning (MCH/FP) through better quality service. Such programs introduced interpersonal communication and counseling to improve quality service. In 1990, with help from UNICEF and the United Nations Population Fund [UNFPA], the Ministry of Public Health (MOPH) implemented a project to improve MCH/FP in 300 of China's poorest counties. Its training activities are chiefly for physicians and emphasize safe motherhood, breast feeding, diarrhea, case management of acute respiratory infection, and FP. Interpersonal communication and counseling has been included in each of these areas. Also with UNFPA assistance, the State Family Planning Commission (SFPC) began a project in 1991, targeting township and village family planning workers, which concentrates on interpersonal communication and counseling in its service delivery system. MOPH and SFPC are China's 2 vertical service delivery systems and they do not cooperate at the central level. At the lower level, however, they work together in interpersonal communication and counseling training. The training uses the participatory training method, which encourages two-way communication. The curriculum addresses motivation; education and counseling; perception, values, and misconceptions; verbal and nonverbal communications; interviewing and listening skills; and how to help the client's decision making. Feedback is very important. The participatory method training class should not exceed 50 participants, but financial constraints make this difficult in China. Short-term benefits of the training are: inspiration to trainers, increased sensitivity to the clients' needs and feelings, and exposure to an international professional work ethic and practice.^ieng

[The amnioinfusion therapy of saline solution for premature rupture of the membranes before 27 weeks' gestational age].

Saline solution amnioinfusion was performed for 12 cases of preterm PROM before 27 weeks gestational age complicated by oligohydramnios in order to suppress chorioamnionitis, prevent fetal pulmonary hypoplasia and delay delivery. The results were as follows. 1. The mean gestational ages at diagnosis of premature rupture of membranes and initiating saline solution amnioinfusion were 23.6 +/- 2.9 weeks and 24.9 +/- 1.5 weeks, respectively. The mean duration of saline solution amnioinfusion was 14.7 +/- 11.9 days. The mean gestational age at delivery was 27.2 +/- 1.7 weeks. The mean birth weight was 1,056 +/- 220g. 2. Saline solution amnioinfusion was effective in relieving oligohydramnios in all cases. No pulmonary hypoplasia was observed in the infants. 3. Clinically saline solution amnioinfusion was effective in suppressing chorioamnionitis in 9 cases out of 12. Histologically the picture of chorioamnionitis was revealed in 10 cases out of 12. no serious infection was observed in the infants. 4. Nine infants out of 12 survived. There were 2 IUFD and one neonatal death. The perinatal survival rate was 75%. 5. It is concluded from the above results that saline solution amnioinfusion is an effective treatment for preterm PROM before 27 weeks' gestational age.