Clinical significance of maternal serum vascular endothelial growth factor (VEGF) level in idiopathic recurrent pregnancy loss.

OBJECTIVE: The aim of this study was to determine whether maternal serum vascular endothelial growth factor (VEGF) levels are associated with unexplained recurrent pregnancy losses (RPLs). PATIENTS AND METHODS: Twenty-one pregnant women with idiopathic RPLs who were selected from 47 cases with RPLs were compared with age-matched 24 control participants. Transvaginal obstetric ultrasonographies were performed and maternal serum samples were collected between 5th and 10th gestational weeks to evaluate serum VEGF and progesterone (P4) concentrations. Enzyme-linked immunosorbent assay technique was used in measurements of VEGF and P4. RESULTS: Prevalence of idiopathic cases among all RPLs was 44.7%. Median serum VEGF value was found statistically higher in RPL group when compared to control group (210.33 ± 108.23 pg/ml vs. 123.91 ± 18.8 pg/ml, respectively). There was no statistical difference between the median values of serum P4 levels in idiopathic RPL group and the control group (19.53 ± 5.79 ng/ml and 20.08 ± 7.85 ng/ml, respectively). Serum VEGF levels did not differ significantly with regard to gestational age within the RPL and control groups (p = 0.72 and p = 0.89, respectively). A positive correlation was found between VEGF levels and the patients' age within RPL group (r = 0.515). CONCLUSIONS: Serum VEGF levels are independent by the gestational age. Serum VEGF concentrations correlate positively with maternal age. Increased maternal age, especially maternal age over 35 years, is related to elevated serum VEGF concentration. Increased maternal serum VEGF concentration is related to recurrent pregnancy loss.

Cord entanglement in monochorionic monoamniotic twins.

Monochorionic monoamniotic twin gestations have been associated with perinatal mortality rates as high as 28% to 47%. Umbilical cord entanglements and knots, twin-to-twin transfusion syndrome, congenital anomalies, prematurity and intertwin locking during labor are responsible for their high perinatal morbidity and mortality. We report here two cases of cord entanglements: One of them was associated with twin-to-twin transfusion syndrome with gross vascular anastomoses and a massive cord entanglement. The other one was associated with cesarean section due to dystocia of cord entanglement of the second fetus after vaginal birth of the first one. There is still no consensus in literature for the management and the mode of delivery of these rarely encountered cases (Fig. 3, Ref. 13).

The effect of immunonutrition on bacterial translocation, and intestinal villus atrophy in experimental obstructive jaundice.

BACKGROUND & AIMS: Spontaneous bacterial infection and septicemia due to increased bacterial translocation (BT) in patients with obstructive jaundice result in significant morbidity and mortality. The present study evaluates the effects of enteral nutrition with immune enhancing feeds on BT and intestinal villus histopathology promoted by obstructive jaundice. METHODS: Fifty male Wistar-albino rats weighing 250-300g were assigned into five equal groups of 10. Animals in Groups I, II, and III were fed with standard chow, those in Group IV were given glutamine 1g/kg/day and the remaining 10 animals in Group V were fed with an arginine, omega-3 fatty acids, and RNA-supplemented enteral diet for (1g/kg/day amino acid and 230 kcal/kg) 7 days preoperatively. Group I underwent sham operation and the remaining animals in all other groups underwent common bile duct ligation. After operation, Group I had standard chow, Groups II and IV had glutamine, Groups III and V had an arginine omega-3 fatty acids, and RNA-supplemented enteral diet for 7 days. All animals were sacrificed on the 8th postoperative day and evaluated both biochemically and histopathologically. Samples from blood, liver, mesenteric lymph nodes and spleen were cultured under aerobic conditions. RESULTS: Significantly less BT was observed in groups fed with an arginine, omega-3 fatty acids, and RNA-supplemented enteral diet or glutamine in pre-and postoperative periods as compared to others (P<0.001). Histologic evaluation also showed significant reduction in villus atrophy in these groups. CONCLUSIONS: Enteral immunonutrition using glutamine or arginine, omega-3 fatty acids, and RNA-supplemented enteral diet during both pre-and postoperative periods seems to reduce BT and decrease atrophy of intestinal mucosal villi in rats with obstructive jaundice.