Pregnancy after medical management of a uterine arteriovenous malformation. A case report.

BACKGROUND: The natural history of conservatively managed uterine arteriovenous malformations is largely unknown, and the risks associated with subsequent pregnancy and vaginal delivery have not been established. CASE: A multiparous woman with a previously reported history of uterine arteriovenous malformation was monitored throughout pregnancy and vaginal delivery. Serial ultrasound studies were performed prior to a successful induction of labor for severe preeclampsia at 34 weeks' gestation. CONCLUSION: To our knowledge, this is the first report of pregnancy and vaginal delivery in a woman with a prior history of a medically managed uterine arteriovenous malformation. Noninvasive treatment of uterine arteriovenous malformations is rare, and the potential long-term risks of this approach, including pregnancy, remain uncertain.

Outpatient minilaparotomy for ovarian cysts.

OBJECTIVE: To design an operative procedure for the ambulatory management of ovarian cysts using classical surgical techniques. STUDY DESIGN: One hundred consecutive patients 55 years old or younger with 115 persistent or complex ovarian cysts less than 10 cm in diameter were managed as outpatients by minilaparotomy. Minilaparotomy is defined as a transverse or vertical incision 3-5 cm in length. The procedure and anesthetic were dictated by each clinical situation. Bupivacaine HCl with epinephrine was injected in the wound preemptively, and ketorolac was administered systemically perioperatively. Operative times, complications and pathology were determined for each case. RESULTS: The procedures (unilateral cystectomy, 65; bilateral cystectomy, 9; unilateral salpingo-oophorectomy, 20; and bilateral salpingo-oophorectomy, 6) were performed under general endotracheal anesthesia in 89, laryngeal mask anesthesia in 5 and spinal block in 6. Mean operative time was 46 minutes. Estimated blood loss in 96% of cases was < 50 mL, and none was > 100 mL. Pathology in two cases revealed adenocarcinoma of borderline malignancy. Remaining histology included endometrioma, 40; dermoid, 25; serous cystadenomas, 14; hemorrhagic corpus luteum, 9; mucinous cystadenoma, 8; cystadenofibroma, 7; follicular cyst, 3; fibrothecoma, 2; and peritoneal inclusion cyst, 1. Ninety-six of 100 patients were discharged on the day of surgery. Two were admitted for urinary retention, one for severe nausea and vomiting, and one for diabetes control. CONCLUSION: Minilaparotomy is a safe, rapid procedure for the management of ovarian cysts on an ambulatory basis. It can be performed under regional anesthesia, avoids intraperitoneal spill and requires only basic operative techniques and instrumentation. Minilaparotomy is also a cost-effective technique for outpatient management of ovarian cysts.

Skin manifestations of mitochondrial DNA syndromes: case report and review.

Mitochondrial DNA syndromes are an emerging class of diseases that can present at any age. Clinical findings are legion and may include renal tubulopathy, growth retardation, myopathy, seizures, and ophthalmoplegia. Mitochondrial DNA syndromes have presented with symmetric cervical lipomas, poikiloderma, and anhidrosis. We describe a child with a novel mitochondrial DNA syndrome who had poikiloderma on sun-exposed areas. We also reviewed 274 patients with mitochondrial DNA disorders for skin findings. Symmetric cervical lipomas were consistently associated with myoclonic epilepsy as part of 1 syndrome. With the exception of lipomas, skin findings were reported in 16 patients.

The noninvasive diagnosis and management of a uterine arteriovenous malformation.

BACKGROUND: Successful nonsurgical therapy of uterine arteriovenous malformations is rare, with most cases being diagnosed at hysterectomy. CASE: A uterine arteriovenous malformation was diagnosed by Doppler ultrasound, and its resolution after 1 week of treatment with methylergonovine maleate was observed. CONCLUSION: Although there are case reports regarding treatment of uterine arteriovenous malformations by embolization performed by interventional radiology, to our knowledge, the noninvasive long-term management of a uterine arteriovenous malformation has not been reported.

Use of multiple reporting sources for perinatal hepatitis B surveillance and follow-up.

The New York State Perinatal Hepatitis B Prevention Program was implemented in New York State (excluding New York City) as a surveillance and control program in 1988. This report describes and evaluates the program and provides data from 1991 regarding hepatitis B surface antigen (HBsAg)-positive mothers and their infants' subsequent hepatitis B vaccination. The program was created using multiple existing surveillance and data collection systems. Completeness of case-ascertainment was estimated by means of the Chandra Sekar-Deming method (J Am Stat Assoc 1949; 44:101-15). An audit of hospital medical records and follow-up by local health departments were used to validate reporting accuracy. Of 158,273 live births in 1991, 363 (0.2%) were born to confirmed HBsAg-positive mothers. Estimated completeness of case-ascertainment was 96%. Thirty-five percent of HBsAg-positive mothers did not report risk factors for hepatitis B, confirming the need for universal testing. Of the infants, 83% received hepatitis B immune globulin and three doses of vaccine within one year of birth. By using existing data collection systems, the program was established quickly, and start-up funding and training requirements were simplified. Multiple reporting increased case-ascertainment to almost 100%. The program effectively identifies and ensures prompt vaccination of infants born to HBsAg-positive mothers.

Carcinoma of ovarian and other origins in effusions. Immunocytochemical study with a panel of monoclonal antibodies.

One of the more difficult challenges in cytopathology may be distinguishing malignancy from reactive conditions in effusions. Furthermore, it is frequently impossible to determine the primary site of the tumor on the basis of cellular morphology alone. In the present study we sought to construct a panel of antibodies that might distinguish carcinoma of the ovary from other metastatic tumor types as well as aid in the distinction between benign and malignant effusions. One hundred twenty-four cases of effusions (80 malignant and 44 benign) were examined with seven monoclonal antibodies (MAbs) (Ber-EP4, OV-TL3, OV-TL23, ID-3, SH9, H23 and D-14). Sensitivities for the seven MAbs ranged from 11% to 75%, with specificity of 43-100%. No single antibody could reliably distinguish carcinoma from reactive conditions, but Ber-EP4 combined with H23 detected 87% of malignant effusions, with a false-positive rate of 2%. Although these antibodies did not differentiate ovarian carcinoma from other types of malignancies, when used together they are highly accurate in distinguishing benign from malignant effusions.

Effects of mutagenesis of C912 in the streptomycin binding region of Escherichia coli 16S ribosomal RNA.

Four different mutations were produced at position 912 of Escherichia coli 16S rRNA in the multicopy plasmid pKK3535. Cells transformed with the mutant plasmids were assayed for growth in steptomycin. The U912 mutant conferred low level streptomycin resistance as reported originally by Montandon and co-workers (EMBO J 1986; 5:3705-3708). The G912 mutant also gave low level resistance but, unlike U912, caused significant retardation in growth rate and tended to select for fast-growing revertants. The A912 mutant was without effect on growth rate or streptomycin sensitivity, while deletion of C912 was lethal. Cells with U912 were selected for increased streptomycin resistance (MIC up to 160 micrograms/ml) and then cured of the plasmid. The cured cells retained a higher level of streptomycin resistance (MIC: 80 micrograms/ml) than the original wild type strain (MIC: 10 micrograms/ml), but sequencing by reverse transcriptase showed no evidence of U912 in the cellular 16S rRNA. Thus, recombination of the plasmid-coded U912 mutation into host rrn operons was not the mechanism by which increased streptomycin resistance occurred. The plasmid with U912 was transformed into three different streptomycin-dependent strains to determine whether the rRNA mutation, which presumably alters streptomycin binding, was compatible with S12 mutations which require bound streptomycin in order to function properly. In one strain, no transformants could be isolated, indicating that the plasmid was lethal. The two other streptomycin-dependent strains were transformed, but ribosomes containing the mutant rRNA were non-functional.

Rocky Mountain spotted fever in New York State.

Clinical and laboratory data provided in 214 Rocky Mountain spotted fever (RMSF) case reports received by the New York State Department of Health during 1977-1988 were analyzed to determine recent trends of this disease observed infrequently, but continuously, in New York State residents. Age, sex, geographic exposure, onset, symptoms, laboratory test, treatment, and hospitalization data are presented. Despite a 69% decrease of disease incidence from 1977 (0.368 cases per 10(5) population) to 1980 (0.114 cases per 10(5) population), case incidence rates in New York State since 1980 have averaged 0.118 cases/10(5) population with a 5.2% case fatality rate. RMSF was reported more frequently in males (58.9%) and in the total 10-19-year-old age group (28%) than in any other age group. Of 156 reports including confirming laboratory data, 60.3% relied upon the microimmunofluorescence or indirect immunofluorescent antibody procedure, as opposed to 32.7% with Proteus-OX, 4.5% with complement fixation, or 1.9% with latex agglutination, microagglutination, or indirect hemagglutination procedures. Of 164 reports providing therapy data, 79% included the use of tetracyclines alone or in combination with other drugs, as opposed to 21% using chloramphenicol or other drugs. Of 44 patients in the 1-9-year-old age group, 32 (73%) received tetracyclines for RMSF therapy despite risks of staining the permanent teeth. One hundred and thirty patients (61%) required hospitalization, with the highest rate in the 30-39-year-old age group (19/24 = 79%).

Development and evaluation of classroom tests: a practical application.

This manuscript describes the concerns of a 15-member faculty group in a team-taught undergraduate nursing course regarding the quality of its classroom tests. A process of systematic evaluation spanning several semesters resulted in changes both in testing and, subsequently, in the grading policy. The primary goal of the changes was to strengthen the validity and reliability of tests which, in turn, would increase test fairness for the students. Discussion areas include 1) reliability and validity; 2) difficulty and discrimination indices; 3) effects of poor-item elimination; and 4) determination of cut scores. Explanations of how testing and measurement principles were applied occurs in each area.