Relatively normal human lymphopoiesis but rapid turnover of newly formed B cells in transplanted nonobese diabetic/SCID mice.

Human B lineage lymphocyte precursors in chimeric nonobese diabetic/SCID mice transplanted with umbilical cord blood cells were directly compared with those present in normal bone marrow. All precursor subsets were represented and in nearly normal proportions. Cell cycle activity and population dynamics were investigated by staining for the Ki-67 nuclear Ag as well as by incorporation experiments using 5-bromo-2'-deoxyuridine. Again, this revealed that human B lymphopoiesis in chimeras parallels that in normal marrow with respect to replication and progression through the lineage. Moreover, sequencing of Ig gene rearrangement products showed that a diverse repertoire of V(H) genes was utilized by the newly formed lymphocytes but there was no evidence for somatic hypermutation. The newly formed B cells frequently acquired the CD5 Ag and had a short life span in the periphery. Thus, all molecular requirements for normal B lymphocyte formation are present in nonobese diabetic/SCID mice, but additional factors are needed for recruitment of B cells into a fully mature, long-lived pool. The model can now be exploited to learn about species restricted and conserved environmental cues for human B lymphocyte production.

Large ovarian cellular fibroma during pregnancy mimicking a lipid cell tumor.

Lipid cell tumors are extremely rare tumors of the ovary which are usually malignant when larger than eight centimeters. Fibromas, on the other hand, are the most common type of benign ovarian solid tumors. Neither one of these tumors are known to be accelerated by the pregnant state. We report a case of a healthy 15-year-old female who was found to have an ovarian mass during pregnancy. This fibroma weighed more than 3,800 grams and mimicked a lipid cell tumor. Cesarean section and unilateral oophorectomy resulted in a good outcome for both mother and child.

Effectiveness of prostaglandin E2 intracervical gel (Prepidil), with immediate oxytocin, versus vaginal insert (Cervidil) for induction of labor.

OBJECTIVE: Our purpose was to compare the effectiveness of labor induction with use of prostaglandin E2 either as an intracervical gel (Prepidil), with immediate oxytocin, or as a sustained-release vaginal insert (Cervidil) with subsequent oxytocin as needed. STUDY DESIGN: Hospitalized patients at >/=37 weeks' gestation requiring labor induction and having an unfavorable cervix (Bishop score

Successful urgent cerclage in a quadruplet gestation.

Pregnancies complicated by quadruplets are rare but at high risk for premature cervical dilation, premature deliveries, and increased perinatal mortality. This report presents a case of a patient carrying quadruplets whose cervix became 4 cm dilated at 21 weeks even though there were no reported uterine contractions. Despite bed rest and combination tocolytic therapy, the cervix dilated to 6 cm and the membranes protruded. Described here are refinements of an Olatunbosun technique to successfully perform the cerclage. Labor occurred at 32 weeks, and a cesarean delivery was performed before the transvaginal removal of the cerclage. The four appropriately-grown fetuses adjusted well in the intensive care nursery.

Conjoined twins.

Conjoined twins, otherwise known as Siamese twins, have fascinated physicians and laymen alike for centuries. The minimal diagnostic criteria for conjoined twins is the fusion of some portion of mononuclear or monozygotic twins.

Disability from endometriosis in the United States Army.

The impact of endometriosis on the general population has been well documented, and the prevalence rate is quoted as 10%. The records of 6,456 women in the United States Army were reviewed with respect to age, race and active duty status. The active duty records were further evaluated for total sick days from endometriosis-related problems. This evaluation revealed a mean sick time of 15 days per admission per active-duty patient regardless of age or race. The estimate of lost duty time was 21,746 days, considering all active-duty patients in the study (five years of records). The prevalence of endometriosis in the female U.S. Army population was 6.2%. Diagnosis and treatment of endometriosis should be aggressively pursued whenever the disease is suspected.

Computed tomographic pelvimetry in the evaluation of breech presentation.

The purpose of this investigation was to assess computed tomographic (CT) pelvimetry in the evaluation of breech presentation for trial of labor. Thirty-two patients with singleton term breech deliveries formed the study group. Seventeen of the 32 (53.1%) patients fulfilled the criteria for attempted vaginal delivery. Fourteen of the 17 (82.4%) delivered vaginally. All infants so delivered had five-minute Apgar scores greater than or equal to 7. Three of the 17 patients required abdominal delivery: one for fetal distress and two for arrest of dilation. These results compare favorably with studies using conventional x-ray pelvimetry. The advantages of CT over conventional pelvimetry include ease of performance, ease of interpretation, and decreased radiation dose to the fetus.