Visual interpretation of the effect of maternal betamethasone administration on the fetal heart rate pattern.

This study was performed to interpret visually the effect of maternal betamethasone administration on the fetal heart patterns in women at risk for preterm delivery. These effects had previously only been described using computer analysis. It was a retrospective study of 54 women who had received two doses of betamethasone 12 hours apart and had fetal heart tracings before, and on the first and second days after steroid administration. The primary outcome measure was change in short-term variability and secondary outcome measures were change in long-term variability, baseline fetal heart rate, accelerations and decelerations. Inter-observer variation of fetal heart rate variability was also measured. Betamethasone caused a significant reduction in short-term variability 1 and 2 days after administration. There was no effect on baseline fetal heart rate or on variable decelerations. A transient decrease in fetal heart rate accelerations was observed on the first day after steroid administration but not on the second day. Inter-observer variability was good between the two observers (GJH and BVI). In most clinical settings, surveillance of fetal wellbeing is achieved most commonly by visual inspection of the fetal heart tracings and not by computer analysis. Clinicians should be aware of the effects of betamethasone on these tracings when considering interventions and/or other tests of fetal wellbeing.

Lessons learned from infertility investigations in the public sector.

OBJECTIVES: To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector. DESIGN: A retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility. RESULTS: Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests. CONCLUSIONS: Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.

Large-cell neuroendocrine carcinoma of the uterine cervix--a clinicopathological study of five cases.

OBJECTIVE: The present study describes 5 cases of large-cell neuroendocrine carcinoma (LCNEC) of the uterine cervix, evaluating their clinical features and pathological profiles. METHODS: Clinical data were obtained from the patients' clinical files at the combined gynaecological-oncology unit of Johannesburg Hospital and the University of the Witwatersrand Medical School, Johannesburg, South Africa. A histopathological diagnosis was obtained after biopsy material from all 5 patients was examined microscopically and subjected to immunohistochemical staining with MNF116 (pankeratin) synaptophysin and chromagranin A, all of which are neuroendocrine markers. Two patients received pelvic radiotherapy only. None of the 5 patients in this series received chemotherapy or underwent surgery. RESULTS: All 5 patients were adult females, with an average age of 57.3 years. The majority were multiparous, with the most common presenting complaint being vaginal bleeding. Three of the 5 patients presented with advanced-stage cervical carcinoma, with evidence of metastases in 2 of them. Treatment responses and long-term survival in our series proved to be disappointing as 3 of the 5 patients died in less than 6 months. On histopathological examination, all 5 tumours showed features of a high-grade poorly differentiated malignant neoplasm with ulceration and extensive tumour necrosis including trabecular and organoid growth patterns. All 5 neoplasms also showed strong immunoreactivity for MNF116, while their endocrine nature was confirmed by staining for synaptophysin in all cases. None of the tumours showed positive straining for chromagranin A. CONCLUSIONS: LCNECs are rare tumours and distinct from other neoplasms of the uterine cervix. The results of this study reaffirm the biologically aggressive nature of this uncommon tumour and its very unfavourable prognosis.

Genome analysis of Marek's disease virus strain CVI-988: effect of cell culture passage on the inverted repeat regions.

The genomes of different derivatives of Marek's disease virus (MDV) strain CVI-988, a low oncogenic isolate of a serotype 1 MDV, were analyzed by restriction enzyme analyses to detect whether alterations occurred after passages in cell culture. DNA molecules of strain 988 isolated directly from blood cells contained mainly two copies of the 132-bp repeat sequence previously reported within BamH1-H and -D fragment as previously reported for more virulent MDV strains. Although a minority of virus particles showed repeat amplification was already at the fifth passage level, amplification mainly occurred between passages 17 and 34 in cell culture. In addition, a 400-bp deletion was detected within the BamH1-A fragment of two derivatives of CVI-988, 988C and 988C/R6.

Open reading frame L1 of Marek's disease herpesvirus is not essential for in vitro and in vivo virus replication and establishment of latency.

Two mutant CV1988 Marek's disease virus (MDV) strains were developed in which a part of ORF L1 was replaced by lacZ with the SV40 early promoter. These mutant strains, CVIL1LacZ-A and -B, were inoculated into chickens to test the hypothesis that ORF L1 is involved in the induction and/or maintenance of latency. Mutant virus could be reisolated from lymphocytes obtained from chickens during both the lytic and latent phase of infection, indicating that ORF L1 is not essential for the induction and/or maintenance of latency or the reactivation from latency. Beta-galactosidase-positive lymphocytes were detected during the latent infection demonstrating that the SV40 early promoter can be active in recombinant MDV strains during latent infection. Although the insertion of lacZ was stable in cell culture, recombination within lacZ and the BamHI-L fragment was observed during in vivo infection.

Comparison of the protective efficacy of recombinant pseudorabies viruses against pseudorabies and classical swine fever in pigs; influence of different promoters on gene expression and on protection.

The glycoprotein E (gE) locus in the genome of pseudorabies virus (PRV) was used as an insertion site for the expression of glycoprotein E1 of classical swine fever virus (CSFV). Transcription of E1 in the recombinants M401, M402 or M403 was regulated by the gD promoter of PRV, the immediate early gene promoter of human cytomegalovirus, or the gE promoter of PRV, respectively. Groups of four pigs were vaccinated once intramuscularly with 10(6) plaque forming units (p.f.u.) of the recombinant viruses and challenged intranasally with 100 50% lethal doses of virulent CSFV and with 10(5) p.f.u. of virulent PRV. All pigs vaccinated with M402 were fully protected against both classical swine fever and pseudorabies.

Detection of herpes simplex virus DNA in spontaneous abortions from HIV-positive women using non-isotopic in situ hybridization.

The purpose of this study was to determine the prevalence of Herpes simplex virus (HSV) endometritis in spontaneous abortions in HIV-positive women using non-isotopic in situ hybridization (NISH). Post-abortal endometrial curettings from 18 HIV-positive women were investigated for the presence of HSV-1 and HSV-2 DNA with NISH. In addition, 18 unselected post-abortal endometrial curettings in HIV-negative women were used as controls, together with samples of normal proliferative and secretory endometrium. Thirteen of the 18 specimens (72 per cent) from the HIV-positive study group demonstrated the presence of HSV DNA, while 2 of the 18 HIV-negative group (11 per cent) showed a positive signal. Although the prevalence of HSV endometritis in the HIV-positive group was significantly higher than in the HIV-negative group (P < 0.05), a causal role for the virus in inducing the abortion remains to be determined. In addition, the significance of HSV endometritis with regard to the clinical management of HIV-positive patients is as yet uncertain.

Recurrent spontaneous abortion: histocompatibility between partners, response to immune therapy, and subsequent reproductive performance.

PROBLEM: Immunological factors may account for previously unexplained cases of recurrent abortion. METHOD: After screening 76 couples for causes of recurrent spontaneous abortion and measuring maternal antipaternal immunity, 23 primary spontaneous recurrent aborters were immunized once with their husbands' leukocytes. Testing for antipaternal cytotoxicity was repeated in 21 couples. Seroconversion was significantly less frequent in couples who shared more than one human leukocyte antigen [one of five (20%) versus 13 of 16 (81%), P < .02]. RESULTS: Twelve of 16 women (75%) who became pregnant had live children and five of those have had a second live child. All 12 women who achieved successful pregnancies had become antipaternal cytotoxic antibody-positive after immunization, whereas all four patients who had repeat abortions had failed to seroconvert (P < .001). However, this relationship is not necessarily causative, as the successful group also tended to have fewer previous abortions and less human lymphocyte antigen sharing. CONCLUSION: Except for transient illness after immunization, one moderately small for gestational age baby and one premature labor at 32 wk, no complications were observed after immunization.

Retrospective analysis of platelet numbers and volumes in normal pregnancy and in pre-eclampsia.

OBJECTIVE: To determine the distribution of platelet volumes and numbers through pregnancy, and to compare these to changes in platelet volumes and numbers in women with pre-eclampsia. SUBJECTS: Four hundred twenty-eight women with normal pregnancy from whom four or more platelet measurements were available were identified. 74 women with pre-eclampsia (blood pressure > or = 140/90 mmHg, at least 0.5 g protein/24 h urine collection) from whom platelet measurements were available between 27 and 30 weeks of gestation were identified. RESULTS: Mean platelet volume and platelet number remained constant in normal pregnancies between the first trimester and the end of pregnancy. A persistent increase of > or = 0.8 fl (> or = 90th centile) in mean platelet volume was found in 14 out of 15 pre-eclamptic patients between 24 weeks and 38 weeks of gestation and in only 13 of 428 normal pregnant individuals. Platelet numbers were decreased by > or = 50 x 10(9)/l (i.e. to less than the 10th centile) in 12 of the 15 patients with pre-eclampsia. 10% of the normal pregnant population showed a similar decline in platelet numbers showing that changes in platelet numbers may be a less accurate assessment of the development of pre-eclampsia. CONCLUSION: We suggest that longitudinal determination of platelet volumes may be of use in identifying those women at risk of pre-eclampsia.

Application of the polymerase chain reaction to the detection of bovine viral diarrhea virus infections in cattle.

We used the polymerase chain reaction (PCR) technique to detect bovine viral diarrhea virus (BVDV) infections in cattle. Of 120 cattle screened in this study, 29 were scored positive for BVDV with both PCR and conventional virus isolation. Ninety cattle were negative in both assays. One cow was scored positive for BVDV with the PCR but was negative with virus isolation. In dilution experiments PCR analysis was at least 10 times more sensitive than BVDV isolation.

Recurrent spontaneous abortion--aetiological factors and subsequent reproductive performance in 76 couples.

A diagnostic screening programme identified a possible aetiological factor in 32 of 76 couples (42%) evaluated for recurrent spontaneous abortion (three or more consecutive abortions). The abnormalities most commonly observed were endocervical infections (18%), cervical incompetence (11%) and uterine abnormality (9%). Hypothyroidism was present in 3 women and chromosomal abnormality in 2. None were positive for lupus anticoagulant. Treatment of uterine abnormality and cervical incompetence was associated with 75% and 86% success rates, respectively, whereas treatment of infective causes resulted in a 44% successful pregnancy rate, much the same as the 42% rate that occurred in women who had not been thus treated.

Pulmonary oedema after hexoprenaline administration in preterm labour. A report of 4 cases.

Despite the widespread use of beta-sympathomimetic agents for preterm labour there appears to be a limited appreciation of the need for cardiovascular monitoring in the mother. Four patients in whom pulmonary oedema developed during tocolysis with hexoprenaline are described and the aetiological factors and pathogenesis of this potentially lethal complication discussed. Guidelines for the safe use of hexoprenaline in preterm labour are suggested.

Conservative approach to the management of pelvic inflammatory disease.

Clinical criteria and treatment protocols are outlined for 663 cases of mild, moderate and severe pelvic inflammatory disease (PID). Data on 176 patients requiring admission to hospital and who were treated conservatively with antibiotics are analysed. Criteria for operative intervention are outlined; only 1 patient required surgical intervention. The study suggests that, provided strict criteria are adhered to, conservative management of PID is both safe and effective and offers outlying hospitals and rural practitioners a plan of management that can be safely followed before resorting to referral to major centres.

Endocrine profile associated with estrogen and progesterone receptors in leiomyoma and normal myometrium.

In leiomyoma and normal myometrium estrogen receptors act independently at low or high levels of the normal serum steroid range in the menstrual cycle. It might be an inherent characteristic of leiomyomas, which results in their progressive growth in the absence of any abnormal stimulation. In the secretory phase of the menstrual cycle, serum progesterone suppresses estrogen receptor concentrations in leiomyoma. In the present study serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) showed direct as well as inverse correlations with estrogen and progesterone receptors in different phases of the menstrual cycle.

Ethnic variation in estrogen and progesterone receptor concentration in leiomyoma and normal myometrium.

The total content of 17-beta estradiol and progesterone receptors in human uterine leiomyoma and normal myometrium in a Caucasian population was determined. Estrogen receptor concentrations in leiomyoma and myometrium were not significantly different (p = 0.1401). The concentration of progesterone receptors in leiomyoma was higher than in myometrium (p = 0.0303). Negroid and Caucasian ethnic groups did not differ with respect to estrogen (p = 0.7040) or progesterone (p = 0.8494) receptor concentrations in leiomyoma, but estrogen (p less than 0.005) and progesterone (p less than 0.005) receptor concentrations in normal myometrium were significantly higher in Caucasian than in negroid patients. Leiomyoma in negroid and Caucasian patients appears to be histologically similar, but the biochemical pathway of its pathogenesis seems to differ. Genetic predisposition probably acts as an initiation factor in the myometrium of both ethnic groups, then estrogen receptor levels in negroids and alterations in steroid metabolism in Caucasians promote the growth of leiomyoma.

Immunologic investigation of recurrent pregnancy loss and consequences of immunization with husbands' leukocytes.

A significant association was found between absence of cytotoxicity to husbands' lymphocytes and of MLC suppression, both of which were absent more commonly in primary than secondary abortion. Following immunization with husbands' leukocytes, systemic side effects were common and cytotoxicity became positive in all but two of eight women tested, both of whom also failed to develop MLC suppression.

Absence of a functional vagina. A report of 2 cases and a review.

The congenital and acquired conditions in which a functional vagina is absent are given briefly and modern-day treatment reviewed with reference to its history. Two case reports illustrate the difficulty in choosing the most suitable form of treatment. Some guidelines to management are suggested.

Oestrogen and progesterone receptor concentrations in leiomyoma and normal myometrium.

The content of cytoplasmic 17 beta oestradiol and progesterone receptors in human uterine leiomyoma and normal myometrium in the Negroid population was determined. Eighteen women of reproductive age, at various stages of the menstrual cycle, were included in the study. The serum oestrogen and progesterone concentrations were also measured. This is the first report in the literature in which oestrogen and progesterone receptors in leiomyoma are significantly higher than in normal myometrium (P = 0.0002). The steroid dependence of the growth of leiomyomas may be related to the steroid receptor level. The presence of persistently high concentrations of oestrogen and progesterone receptors in leiomyoma should be helpful in the treatment of this benign tumour.

Vaginal tumors in pregnancy. Case report and review of the literature.

A young patient with a vaginal tumor in early pregnancy is presented. The difficulty in diagnosis and subsequent management is discussed. Vaginal tumors with special reference to vaginal leiomyoma are reviewed and a differential diagnosis is presented.

Primary choriocarcinoma of the fallopian tube. Report of a case with survival and postoperative delivery. Review of the literature.

A patient is presented with primary choriocarcinoma of the fallopian tube arising from a tubal pregnancy. Treatment consisted of an initial operation including adnexectomy and resection of bilateral ovarian thecalutein cysts, followed by chemotherapy. The patient delivered a healthy infant 2 years later, and is alive and well 5 years after the event.