Twin pregnancy consisting of 46, XY heterozygous complete mole coexisting with a live fetus.

Complete hydatidiform mole and coexistent fetus (CMCF) is a rare occurrence and is associated with an increased risk of persistent gestational trophoblastic diseases. The aim of this study was to reveal a potential risk factor and to determine optimum management of CMCF cases. Molar tissues are cytogenetically divided into two types, homozygous and heterozygous. The molar tissue of our case showed a 46, XY heterozygous complete mole. Genomic DNA was analyzed by the polymerase chain reaction using sets of unlabelled forward and Cy-5-labelled reverse primers for DNA marker loci. The patient developed persistent trophoblastic disease (PTD) with lung metastasis. Since 1980 there have been 13 reports (including our case) that cytogenetically revealed CMCF and clarified the clinical outcome. Nine of the 16 CMCF cases before 21 weeks of gestation and seven of the 12 CMCF cases after 22 weeks of gestation developed PTD. The incidence of PTD from CMCF was not related to the gestational age at termination or delivery. There were 10 case reports that analyzed the zygosity of a mole, heterozygous or homozygous. Two of six homozygous and three of four heterozygous moles in CMCF cases developed PTD. A heterozygous mole is thought to be a high risk factor for the incidence of PTD. Cytogenetic study is clinically useful for the optimum management of CMCF cases.

Promotion of OTC products within a network-model HMO.

The drug benefits of most health plans do not include reimbursement for over-the counter (OTC) drugs. However, one PMB found that significant savings could be obtained if the OTC option was encouraged.

Qualitative evaluation of uterine contractions recorded by a double guard-ring tocodynamometer.

Qualitative characteristics of uterine contractions in various labors were evaluated by a double guard-ring tocodynamometer, according to the percentages of concurrent and synchronous contractions of two contraction curves when compared with overall contractile activity. For term and preterm labors, percentages of both concurrent and synchronous contractions were significantly higher than those of Braxton Hicks contractions; however, the concurrent and synchronous percentages of preterm labor were lower than those of term labor. Synchronous percentage in groups under maintenance therapy or active treatment in preterm labor were nearly the same; however, the percent concurrent under maintenance therapy was significantly lower than that during active treatment. Both concurrent and synchronous percentages were significantly higher during the active phase of labor than those during the latent phase. The percentages in the latent and active phases of spontaneous contractions were nearly the same; however, they increased significantly during the active phase of augmented contractions, as compared with the latent phase. When the percentages of concurrent and synchronous contractions at each cervical dilatation were retrospectively examined, both values increased significantly between 5 and 6 cm of cervical dilatation. The results suggest that this method can provide important information for understanding the quality of the contraction if attention is paid to the percentages of concurrent and synchronous contractions of two contraction curves and will aid in determining whether oxytocin or tocolysis should be given in term or preterm labor.

Clinical features of long contraction wave recorded by an external tocodynamometer.

Clinical features of a long contraction wave, lasting 3 minutes or more, recorded on an external tocodynamometer were studied. The long wave was observed in 50 out of 1,050 pregnant women. Clinical significance was not indicated by the shape of each wave which was either a long relaxing type or a fused type, but by the frequency of occurrence. Vaginal delivery and its close relation to oxytocin administration were significantly more frequent in the sporadic type, in which the long wave was observed once within a week, and fetal distress and a low Apgar score were more frequently observed in the frequent type, in which long waves occurred twice or more within a week. The results suggest that the obstetric prognosis is normal unless the long wave occurs sporadically and its recovery is good, and that it is ominous when long waves are observed twice or more within a week. Careful observation is needed in that case.

[The obstetric prognosis and neonatal outcome of pregnant women with psychiatric disorders].

Obstetric prognosis and neonatal outcome of pregnant women with psychiatric disorders were retrospectively investigated. 1. Out of 1.472 deliveries at Saga Medical School from April 1983 to July 1988, there were fourteen cases (0.95%) involving psychiatric disorders-six of epilepsy, one of anxiety neurosis and seven of schizophrenias. 2. Total blood loss was relatively great in four epileptic patients. However, the general prognosis for each was good and the neonatal outcome was uneventful. 3. As for schizophrenic patients, six out of seven cases grew worse during the pregnancy and four in the postpartum period. Three cases underwent cesarean section due to their mental illness. 4. We made inquiries about the postpartum life of schizophrenic mothers and children, and received five answers (70.1%). It was found that schizophrenic mothers could not bring up the baby by themselves; they needed the help of their husbands and their own mothers. It is concluded that consistent management by both psychiatrist and obstetrician from the antepartum period to postpartum life are required for psychotic mothers and their children to obtain a favorable prognosis, and a follow-up system is desirable for the physical as well as the mental growth of the infants.

Activation of CMP-N-acetylneuraminic acid:lactosylceramide sialyltransferase during the differentiation of HL-60 cells induced by 12-O-tetradecanoylphorbol-13-acetate.

We previously reported that the synthesis of NeuAc(alpha 2-3)Gal(beta 1-4)GlcCer (GM3) ganglioside was preferentially enhanced during the differentiation of HL-60 cells into a monocyte/macrophage lineage induced by 12-O-tetradecanoylphorbol-13-O-acetate (TPA). Since exogenously added GM3 ganglioside was shown to be able to induce the differentiation of HL-60 cells into the monocyte/macrophage lineage in a synthetic medium, the functional role of the GM3 ganglioside increase during the differentiation of HL-60 cells has become the subject of much interest. In the present study, we investigated the activity of CMP-NeuAc:lactosylceramide sialyltransferase, which catalyzes the synthesis of GM3 ganglioside from lactosylceramide, in cells undergoing differentiation induced by two different reagents, TPA and 1 alpha,25-dihydroxy-vitamin D3, which induce the differentiation of HL-60 cells into the monocyte/macrophage lineage through different modes of action. We showed that the activation of CMP-NeuAc:lactosylceramide sialyltransferase and the increase in GM3 ganglioside were not related to the differentiated lineage but to the specific action of TPA, i.e. activation of protein kinase C.