Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate.

OBJECTIVE: To evaluate the efficacy of a predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate in order to select the best cases for the medical treatment. METHOD: Our study included 40 patients. The inclusion criteria were: hemodynamic stability; adnexal mass < or = 3.5 cm; desire of future pregnancy; and a written permission to participate in the study. All patients were treated with a single dose of methotrexate (50 mg/m2 i.m.). A predictive score was elaborated based on four parameters: initial levels of beta-hCG, aspects of the image at ultrasound (hematosalpinx, tubal ring or live embryo), size of the mass, vascular flow of the color Doppler. Each parameter received a grade from 0 to 2. Grade 0 represented an unfavorable situation, grade 1 a borderline situation and grade 2 a favorable situation. RESULTS: The success rate with a single dose of methotrexate was 75% (30/40). In the present study the cut off grade was 5, because the majority of patients with grade > or = 5 were treated successfully (29/30 - 97%), while those with grade < 5 failed. CONCLUSION: The predictive score helps us to indicate the best cases for the medical treatment. Therefore, we do not advise it when the grade is < 5. However, we can predict a good evolution of the treatment when the grade is > or = 5. Federation of Gynecology and Obstetrics.

["Single-shot" antibiotic prophylaxis in thoracic surgery; reduction of the postoperative infection rate]. / "Single-shot"-Antibiotikaprophylaxe in der Thoraxchirurgie; Senkung der postoperativen Infektionsrate.

A prospective, controlled and randomised trial was started to detect the effectivity of a "single-shot" antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecutively scheduled for major thoracic surgery except endoscopic procedures or mediastinoscopy were enrolled in this study and randomized into either the control group (no antibiotics perioperatively; n = 100) or the prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction of anaesthesia; n = 100). Clinical signs correlated with infection, radiological findings and the results of repeated microbiological examinations were recorded and a comparative statistical analysis was done. Compared to controls the prophylaxis group had fewer (not significant) infections of the wound, the pleural cavity and the urinary tract and fewer patients of this group showed "pronounced infiltration" in daily taken chest roentgenograms (significant), clinical signs for pneumonia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, isolated from tracheal aspirates, immediately taken after intubation disappeared more often. Specimens of pleural fluid taken postoperatively were less often positive for bacteria. Fewer patients were treated with antibiotics in the postoperative course and the courses were shorter in the prophylaxis group compared to controls. Considering the risk factor "positive microbiological culture" in preoperative tracheal aspirates, patients of the prophylaxis group showed much more seldom new radiological "infiltration" (statistically highly significant) and, in addition, had lower white blood cell counts (significant) and lower mean maximal body temperatures. The results of our trial confirm the preventive effect of "single-shot" antibiotic prophylaxis in thoracic surgery against infections.

Chromosomes and large bowel tumors.

As a variety of chromosome banding techniques are applied in the systematic study of large bowel neoplasms coupled with new approaches in cell and molecular biology, one can anticipate much new knowledge in this area. This report will present a synopsis of recent work from our laboratory. Chromosomal changes in large bowel neoplasms can be classified into those involving an abnormal number of chromosomes and those involving structural changes.

Marker chromosomes in direct preparations of human large bowel tumors.

A survey of 257 marker chromosomes in 48 primary human large bowel adenocarcinomas showed that 44% were markers with recognized patterns. Chromosomes #1, #3, #5, #8, #9, #13, and #17 were involved most frequently. Markers related to chromosomes #7 and X were not seen in any recognizable form. The unidentified chromosomes were classified as markers with abnormal banding regions. In correlating tumor location and stage of invasion with markers, there were fewer markers in tumors from the right side. However, there was little difference in the number of markers seen in the left-sided tumors, irrespective of histopathologic stage, suggesting that function and microenvironmental conditions between various parts of the colon may be related to these differences. The most striking observation is that 21% of all tumors analyzed were without any obvious markers.

Chromosomal banding patterns in human large bowel adenomas.

Chromosome studies were performed on direct preparations of 38 benign human large bowel adenomas by fluorescent banding techniques. Five adenomas had a normal diploid karyotype line. Six adenomas had numerical abnormalities, and seven polypoid lesions exhibited structural and numerical changes. In 20 adenomas without analyzable metaphases, it was presumed that the cells were dividing at a lower rate. Mosaics were observed in 25% of cases. The most common finding was trisomy of 7, 8, or 13.

Chromosome 6q- in metastatic melanoma involving the large bowel.

Chromosome banding analysis was performed on a metastatic melanoma involving the large bowel. The complex karyotype contains a 6q- chromosome, which has been seen in a variety of other neoplasms.

Chromosomes in human large bowel tumors. A study of chromosome #1.

Chromosome studies on 49 patients with large bowel adenocarcinomas showed abnormalities of chromosome #1 in 19 cases (39%). One had monosomy, 13 showed trisomy, and 5 cases had structural abnormalities. Eighteen patients had tumors on the right side of the colon; of these, only 3 had an abnormal #1 (17%); 16 of 28 tumors (57%) located on the left side had abnormalities of #1. The regions of consistent duplication of 1q were q24----q44? The presence or absence of changes of chromosome #1 may be useful as a prognostic indicator in large bowel cancer.

Karyotypic findings in a colonic villous adenoma.

Chromosomes from a patient with a villous adenoma of the colon were examined in detail with fluorescent banding. Of the cells analyzed, 73% had a modal chromosomal number of 48-52. The karyotypic findings show clonal evolution, an additional chromosome #8 being the most frequent abnormality, suggesting that this may be the primary chromosomal change, but other changes such as loss of a Y chromosome and the presence of marker chromosome #1 with duplication of the long arm also were observed. Previous cytogenetic data on large-bowel tumors is summarized. We hypothesize that this chromosomal evidence suggests that tubular adenoma, villous adenoma, and adenocarcinoma may be interrelated steps of a growth disorder.

Human large-bowel cancer: correlation of clinical and histopathological features with banded chromosomes.

Clinical and histopathological features were correlated with cytogenetic banding studies on direct preparations from 31 large-bowel tumors. An interesting relationship between the site and the karyotypes of the tumors was observed. There appears to be a progressive increase in chromosomal number and/or structural rearrangement as one progresses from proximal to distal large bowel. We suggest that these observations may be related to differences in function and micro-environment within different areas of the colon. Although it is not known what factors favor cytogenetic variability and instability on the left side or the presence of fewer abnormalities on the right side of the colon, it is evident that clonal karyotypic evolution may be important in the progression of large-bowel cancer. The brevity of follow-up precludes conclusions regarding the influence of karyotype on survival.

Chromosomal banding patterns in human large bowel cancer.

Cytogenetic banding studies were performed on direct preparations from 31 large bowel tumors. Twenty-eight of these were from primary sites and three from metastases. Some distinctive patterns were observed. The 31 tumors were separable into four groups: (1) Tumors with normal karyotypes (three cases); (2) tumors with simple gains of chromosomes (three cases); (3) tumors with gains, losses and structural aberrations (ten cases). Groups 1, 2 and 3 were all in the diploid range; and (4) tumors with hypotriploid-hypotetraploid karyotypes (15 cases). Non-random gains of several chromosomes, especially No. 8 and non-random losses of No. 17 were seen in this series. Thirteen cases had sex chromosome abnormalities. The most prominent structural abnormalities involved chromosomes No. 1 and No. 5. Marker chromosomes were sometimes absent, but when present ranged from simple translocations to the most complex rearrangements. Doubling of chromosome and/or marker chromosomes were prominent in Group 4. Double minutes were seen in all three metastatic tumors and three primary cancers. Premature chromosome condensation was observed in three cases in the hypotriploid-hypotetraploid group.

Premature chromosome condensation in human large bowel cancer.

Two patients with large bowel cancer are described in whose tumors the presence of cells with premature chromosome condensation (PCC) was encountered. The percentage of PCC In the tumors was 6.9 and 6.6%. We hypothesize that the near tetraploid chromosome number present in the tumor cells in both patients may be the product of fusion of two near diploid malignant cells. Also it is speculated that some colorectal tumors with chromosomes ranging from the hypotriploid to the hypotetraploid levels may be the result of cell fusion.

Double minutes in human large bowel cancer.

Two patients with large bowel carcinoma are described in whose tumors the presence of double minutes was observed. In one of these, the first such patient to be reported, double minutes were present in 100% of metaphases examined in both the primary tumor and its liver metastasis. The number of double minutes varied from 6 to 93 per metaphase. In the second patient, double minutes were seen only in two metaphases. The literature on double minutes is summarized, and it is concluded that double minutes are found in a wide spectrum of tumors, including human large bowel cancer and are not confined to tumors of neurogenic origin as suggested by earlier workers. In additon, evidence is suggestive of an association between the lack of differentiation and the presence of double minutes, but further data are required to substantiate this.

[Noonan syndrome: differential diagnosis with Turner's syndrome]. / Síndrome de Noonan; diagnóstico diferencial con el síndrome de Turner.

Clinical and laboratory evidences assure an unequivocal identity to the syndrome described by Noonan. We believed that the terminology used by many authors has contributed to maintain confusion with Turner's syndrome from which it is clearly differenciated. The signology of both syndromes was confrontated in order to delineate the syndrome. Emphasis was made to point out the signs which are proper to each syndrome and the signs which are common to both of them stressing those that, occur with equal or significant difference. Two new signs are described in Noonan syndrome: alopecia of the hund portions of the eyebrows and keratosis rubra pilaris (Ulerythema ophriogenes).

Dermatoglyphic differences between 45,X and other chromosomal abnormalities of Turner syndrome.

The dermatoglyphic findings in 87 patients with Turner syndrome are summarized. Comparisons are made between the 50 cases with 45,X karyotypes and the remaining 37 with different chromosomal abnormalities including 19 patients with an X long arm isochromosome cell line. The results indicate differences between the 45,X patients and the other chromosomal types which are in the same direction as the changes reported between Turner syndrome and normal controls.

Chromosomal and clinical findings in 110 females with Turner syndrome.

One hundred and ten patients with abnormal karyotypes who were referred to the Department of Medical Genetics with the possible diagnosis of Turner syndrome were reviewed. The frequency of chromosomal abnormalities and clinical findings in the different chromosomal types are summarized.