Methotrexate treatment for retained placental tissue.

Three cases of placental polyps not responding to conventional medical and surgical treatment are presented. In all three cases, hCG in serum was negative but despite this a single injection of methotrexate successfully treated the condition. It is suggested that methotrexate acts not only on dividing trophoblastic cells but also has other effects.

The diagnosis of molar pregnancy by sonography and gross morphology.

BACKGROUND: In modern times molar pregnancies are often terminated before classical symptoms have developed. Sonography may not be conclusive and gross macroscopy may not reveal vesicles. If the aborted material is not sent for microscopy adequate follow-up of these patients will not be performed. The objective of this study was to evaluate the percentage of molar cases that potentially will be missed in a setting where material is submitted for histopathology only when sonography and/or gross macroscopy suggest complete- or partial hydatidiform mole. METHODS: Charts from 135 patients with complete hydatidiform mole (75) and partial hydatidiform mole (60) between 1989 1997 were evaluated. RESULTS: In complete hydatidiform mole sonography had been performed in 68 patients. The correct diagnosis had been suspected in 84% of the cases with the aid of sonography and/or gross macroscopy. In partial hydatidiform mole the correct diagnosis was suspected in only 30% of the cases. Three patients with complete mole developed persistent disease despite negative sonography and/or gross macroscopy. One patient with partial mole that was only documented by microscopy also developed sequelae. CONCLUSION: In a setting where material from curettages in early pathological pregnancies are not routinely sent for histopathology 16% and 70% of complete- and partial hydatidiform moles respectively will be missed. Since a subset of these 'discrete' moles will eventually require chemotherapy, this policy could have serious consequences.

Random monoallelic expression of the imprinted IGF2 and H19 genes in the absence of discriminative parental marks.

The IGF2 and H19 genes are genomically imprinted and expressed preferentially from the paternal and maternal alleles, respectively, during human prenatal development. The exact role of the parental imprint(s), however, is not known. To explore this issue in some detail, we have examined human androgenetic cells which by definition should be incapable of allelic discrimination given the paternal origin of both genomes. Allele-specific in situ hybridisation analysis of dispermic complete hydatidiform moles shows that IGF2 and H19 can be found to be transcriptionally active in a variegated manner, which results in the generation of random monoallelic expression patterns. This data shows that imprinted genes can be expressed monoallelically in the absence of discriminating parental marks and raises the question whether or not mechanisms underlying monoallelic expression preceded the acquisition of parental imprints during evolution.

Primary reconstructive surgery with a sliding flap for carcinoma of the Bartholin gland.

Bartholin gland tumours are rare and therefore recommendations concerning management have been based on small series. Although there is a tendency today to perform less radical surgery, meaning hemivulvectomy or a wide local excision, the anatomical position of these tumours often leads to a large postoperative defect. The objective of this report is to present data on three patients but mainly to describe our surgical technique where a sliding flap obtained from the gluteal region is used for primary closure. This surgical procedure offers a functional and cosmetically acceptable vulva which is of importance considering the relative young age of patients with Bartholin gland tumours.

Developmental-dependent DNA methylation of the IGF2 and H19 promoters is correlated to the promoter activities in human liver development.

We have previously shown that the four promoters of the IGF2 gene are under a tight but dynamic control during human liver development, whereby P3 and P1 are reciprocally active before and after birth respectively while the P2 and P4 promoters are constitutively active at a relatively lower level. In this study, we investigated the methylation status of the promoters P1 and P3 of IGF2 and the promoter region of the H19 gene in developing human livers ranging from fetal to late adult. A region of about 300 bp immediately upstream of the IGF2 exon 5 was found to be subjected to a developmental-specific methylation and this may correlate to the P3 promoter activity. The P1 domain of IGF2 was also found to be methylated in a developmentally-specific pattern. The promoter region of the H19 gene displayed different methylation patterns in different development stages showing decreased general methylation with increase of age. Therefore, regional- and developmental-specific DNA methylation is displayed in the promoter regions of the IGF2 and H19 genes. This may be an important factor involved in gene regulation in the developing human liver.

The effect of lignocaine on sperm phagocytosis in the peritoneal fluid from women with or without endometriosis.

The study was undertaken to investigate a possible mechanism for reducing the phagocytosis of spermatozoa by leukocytes in the peritoneal fluid from women suffering from endometriosis. Peritoneal fluids were collected during laparoscopy from women undergoing laparoscopic sterilization or from women under investigation for cause of infertility where the laparoscopic findings were endometriosis. Prepared spermatozoa from one healthy man were incubated in vitro with peritoneal fluid with or without lignocaine. Samples from the incubations were studied daily and the number of viable and dead spermatozoa were counted. The number of free spermatozoa, not adhered to leukocytes, was significantly increased when incubated in human peritoneal fluid supplemented with lignocaine. Thus lignocaine contributes to increasing the number of free spermatozoa and maintaining the possibility of fertilizing an oocyte. For patients with endometriosis, treatment with lignocaine might be a means of increasing the chances of conception. A clinical study is in progress to evaluate this effect in vivo and to search for alternative methods of assisting the fertilization process.

Hydatidiform mole with non-metastatic pulmonary complications and a false low level of hCG.

We present a case of hydatidiform mole with non-metastatic pulmonary complications and stress that termination of the pregnancy will cure the patient. The frequent use of sonography in early pregnancy makes it possible to diagnose pathological pregnancies earlier than was possible before. The fact that molar pregnancies are now being terminated at an earlier stage means that some of the complications associated with advanced moles are seldom encountered today. The case also illustrates the so-called 'high dose hook effect' meaning that an extremely high level of hCG may falsely be reported to be very low by the laboratory.

Aggressive endometrial cancer in a young patient.

An unusually aggressive case of endometrial cancer in a 30 year old woman is presented. The patient experienced abnormal uterine bleeding, at times requiring blood transfusions, for almost half a year before the diagnosis was revealed. For obvious reasons there is a reluctancy to perform invasive examinations in young women. The diagnostic options are discussed.