Increased free fetal DNA levels in early pregnancy plasma of women who subsequently develop preeclampsia and intrauterine growth restriction.

OBJECTIVE: To determine if maternal plasma ffDNA is increased early in pregnancies which subsequently develop preeclampsia (PE) and intrauterine growth restriction (IUGR). METHODS: Blood was obtained at 11-14 weeks and plasma stored. Among those who delivered a male infant and had a birth weight under the tenth centile and/or PE, we divided them into those who delivered before 35 weeks (9) and those who delivered after this gestation (15). A third group with uncomplicated pregnancies was used as controls (24). Real time-polymerase chain reaction (RT-PCR) was carried out to detect the multi-copy Y chromosome associated DSY14 gene. RESULTS: There were no differences between the ffDNA levels in the group delivered after 35 weeks and the control group (2.23ge/mL-1.61ge/mL p = 0.39). However, the levels of ffDNA at 11-14 weeks were statistically, significantly higher in patients that delivered before 35 weeks (4.34ge/mL-1.61ge/mL p = 0.0018). A logistic regression analysis shows that for every unit (1ge/mL) in which ffDNA increases, the likelihood of having PE or a fetus growing under the tenth centile delivered before 35 weeks increases by 1.67 times (CI 1.13-2.47). CONCLUSION: The concentration of ffDNA is significantly higher even during early pregnancy, in patients who subsequently develop PE and/or IUGR and are delivered before 35 weeks.

Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function.

OBJECTIVE: It has been shown that the modified myocardial performance index (Mod-MPI) is associated with higher reproducibility than conventional MPI because it uses mitral and aortic valve 'clicks' to calculate each time period. We aimed to construct normal reference values for the Mod-MPI after 19 weeks' gestation. METHODS: The Mod-MPI was calculated in the left ventricle of 557 normal fetuses at 19-39 weeks' gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) and ejection time (ET) were measured using the Doppler signals (clicks) of the opening and closing of the mitral and aortic valves as landmarks. Mod-MPI was calculated as (ICT + IRT)/ET. RESULTS: Throughout gestation, there was a small increase in the Mod-MPI (at 19 weeks it was 0.35 +/- 0.027 (mean +/- SD); at 39 weeks, 0.37 +/- 0.029; Mod-MPI = 0.33 + 0.001x gestational age (GA) (weeks), r(2) = 0.017). Of the three components, ICT remained constant, IRT increased (IRT = 0.028 + 2.52 x GA (weeks)), and ET slightly decreased (ET = 0.184 - 3.65 x GA (weeks)). Fetal heart rate (FHR) had no effect on the Mod-MPI, but the duration of IRT, ICT and ET decreased by 13-15% when FHR increased from 130 to 160 beats per minute. CONCLUSION: The GA-adjusted reference values for the Mod-MPI and the three time periods used for its calculation can be applied to fetal cardiac evaluation in the presence of pregnancy-associated complications.

Granulosa cell proliferation is impaired in the Igf1 null ovary.

Insulin-like growth factor-I (IGF-I) expression is highly correlated with ovarian follicular growth and granulosa cell proliferation in both pre-pubertal and mature murine ovaries. Igf1 gene deleted mice are infertile, with ovarian follicles arrested at an early stage of development. To elucidate the cause of follicular dysfunction in Igf1 null mice, this study compared granulosa cell proliferation at baseline and in response to exogenous oestradiol (E2) in prepubertal Igf1 null and wild-type (WT) littermate mice. The basal granulosa cell mitotic index was 3.8+/-0.48 in WT and 1.3+/-0.7 in Igf1 null mice (P=0.03). After E2 treatment, WT granulosa mitotic index was 12.7+/-0.0 vs 5.5+/-0.8 for Igf1 null mice (P<0.001). Granulosal BRDU incorporation was also significantly reduced as were cyclin D2 and B1 immunoreactivities in Igf1 null compared with WT mice. The incidence of apoptosis was not increased in Igf1 null follicles, although BAX immunostaining was increased. These data suggest that IGF1 is essential for normal basal and oestrogen-induced granulosa cell proliferation and follicular growth.

Expression of intercellular adhesion molecule 1 (ICAM-1) on the human oviductal epithelium and mediation of lymphoid cell adherence.

The epithelium of the human oviduct expresses the major histocompatibility complex (MHC) class II and shows endocytic properties towards luminal antigens. Therefore, the epithelial cells might behave as antigen-presenting cells, inducing a local immune response. The activation of antigen-specific T cells not only requires presentation of the peptide antigen by MHC class II, but also the presence of co-stimulatory molecules in the antigen-presenting cells. Therefore, the expression of the intercellular adhesion molecule 1 (ICAM-1) was examined in the epithelium of the human oviduct. Most oviducts showed epithelial ICAM-1 expression, as assessed by immunocytochemistry, western blot analysis and RT-PCR assay, and the expression was restricted to the luminal border of ciliated and secretory cells. Interferon gamma, interleukin 1 and lipopolysaccharide treatments increased the percentage of ICAM-1-positive cells in primary cultures, indicating that the expression of ICAM-1 in the oviduct might be upregulated in vivo by inflammatory cytokines or bacterial infections. Binding assays between allogenic phytohaemagglutinin-activated lymphocytes and epithelial monolayers expressing ICAM-1 demonstrated that this molecule stimulated lymphocyte adherence. The presence of ICAM-1, in addition to MHC class II, supports the putative role of the oviductal epithelium in antigen presentation. The exclusive apical distribution of ICAM-1 indicates that T-cell activation would occur in a polarized manner. Binding of lymphoid cells to the surface of the oviductal epithelium may help to retain these immune cells that are required for the clearance of pathogens.

[Coloanal anastomosis (Parks operation) in the treatment of acute radiation rectitis]. / Anastomosis coloanal (operación de Parks) para el tratamiento de la rectitis actínica grave.

AIM: To assess immediate and late results of Parks operation in the treatment of severe radiation rectitis. PATIENTS AND METHOD: Retrospective review of clinical histories of 35 patients with uterine cervical cancer, 5 with endometrial cancer and one with vaginal cancer that received radiotherapy. Two years as a mean after radiotherapy, 14 women had rectal bleeding, 19 fistulae, 7 stenosis and 1 a rectal ulceration. All were initially treated with a discharge colostomy and after a mean interval of 1.6 years, a Parks operation was performed. RESULTS: One patient died after surgery (2.4%) due to peritonitis and sepsis. Early surgical complications were necrosis of descended colon in 2, intra-abdominal abscess in 1, splenic rupture in 1 and postoperative bleeding in 1. Colostomy was closed in 37 patients three months after surgery. During late follow up (ranging from 3 to 64 months) rectal continence has been assessed as good in 30 patients, fair in 5 and bad in 2. Three women required a new colostomy. CONCLUSION: Parks operation is a viable therapeutic alternative for severe radiation rectitis.

[Extrapelvic endometriosis involving the perineum]. / Endometriosis extrapelviana de ubicación perineal.

The ectopic endometriosis in the perineum is very rare (0.2% of ectopic endometriosis). We studied 16 cases of vaginoperineal endometriosis. Fifteen of them were localized in the site of an episiotomy scar and in one there was another focus of a severe endometriosis of multiple localizations. All the patients were submitted to anamnesis, physical, gynecologic and proctologic examination, surgical excition, histopathologic study of the lesion and control. All the patients are asymptomatic after treatment. To cure definitively the disease it is necessary to make a complete ablation of the endometrial lesion. Eventually, hormonal treatments could be use in case there were other endometrial localizations besides the vaginoperineal one.

[Delivery conduction in patients with cicatrix of a prior cesarean section. Pilot study]. / Conducción del parto en pacientes con cicatriz de cesárea anterior. Estudio piloto.

INTRODUCTION: In the clinical practice there is an increasing number of patients with a previous cesarean section. OBJECTIVE: 1. The description of the evolution of patients with previous cesarean section and the possibility of a vaginal delivery. 2. To compare, in patients in labor, a pharmacological approach (ocitocic conduction and peridural anesthesia) vs a spontaneous evolution. METHOD: -a clinical, random and prospective study. We analyze: age, parity, cause of previous cesarean section, obstetrical conditions at the moment of hospitalization, route of delivery, maternal and neonatal complications and days of hospitalization. ANALYSIS: univariable with single frequency and bivariable with contingency table (chi2) and comparison of means (T test). RESULTS: Incoming to the study of 81 cases. Sixteen per cent were operated on without labor. Eighty four per cent (n-68) were separated randomly into two groups: 26 pharmacologically managed and 42, with a spontaneous approach. Within the first group, 84.6% delivered vaginally; the latter group, 88.1%, delivered vaginally. The only variable with a statistically significant difference was the greater cervical dilatation in the spontaneous grop at the moment of hospitalization. CONCLUSION: The probability of vaginal birth after cesarean section is 72.8%, which increases to 86.7% in labor spontaneously initialized. The active management doesn't differ in this study, which has a 10% of power, of spontaneously management.

[Leiomyosarcoma of the inferior vena cava. Presentation of 1 case of autopsy and review of the literature]. / Leiomiosarcoma de la vena cava inferior. Presentación de un caso de autopsia y revisión de la literatura.

This is a clinico-pathological report of a 30 years old male patient that presented with acute epigastric pain. Ultrasound examination showed a retroperitoneal tumor, thrombosis of the inferior vena cava and ascites. CAT scan disclosed thrombosis of hepatic vein and inferior vena cava with right atrium involvement. Necropsy showed a leiomyosarcoma of the inferior vena cava. There are seldom reports of this tumor in the last 5 years and an early diagnosis allows therapeutic interventions associating surgery, radiotherapy and chemotherapy.

[Soft tissue sarcoma. Combined treatment of drug therapy, radiotherapy and conservative surgery]. / Sarcoma de partes blandas. Tratamiento combinado de quimioterapia, radioterapia y cirugía conservadora.

The preliminary results of a prospective and cooperative protocol for the treatment of soft tissue sarcomas of trunk and extremities, stages IB-IIIB are presented. Thirty one patients (17 males, 22 with a tumor larger than 5 cm) aged 16 to 68 years, were treated with one dose of epirubicin 70 mg/m2 i.v. and radiotherapy (3000 rads in 10 fractions) Two or three weeks later an ample surgical complications occurred in 6 patients and were all of infectious origin. The median follow up period has been of 26 months. During this period 5 patients presented late surgical complications (edema in 4 and a pathological fracture in 1), 2 patients had a local tumor recurrence and distant metastases appeared in 7. Actuarial survival was 60% at 48 months. Ninety six percent of surviving patients conserved their extremity. It is concluded that with this treatment modality local recurrence is acceptable, morbidity is low and that the majority of patients do not require amputations or crippling resection.

Development of a computerized system for simultaneous visual discrimination in rats.

In order to automate a simultaneous visual discrimination system, a Sutherland jumping-stand box was modified by adding two lateral alleys which connect the feeder compartment with the starting box. By means of a digital interface, this modified box was connected to an Apple IIe PC. A group of rats (n = 8) was trained. All subjects learned. Advantages relevant to the apparatus design, as well as the benefits derived from the automated procedure are discussed.

[Non-Hodgkin's lymphoma and pregnancy]. / Linfoma no Hodgkin y embarazo.

The coexistence of non-Hodgkin lymphoma and pregnancy is extraordinarily rare. A clinical case is presented and also the description of the epidemiology, the clinical features, the diagnostic methods and the staging. The current guidelines for its managements are analyzed.

[Probable pulmonary damage caused by bleomycin. Communication of 4 cases]. / Probable daño pulmonar por bleomicina. Comunication de 4 casos.

Four patients with advanced germinal cell testicular tumors were treated with cisplatinum, vinblastine and bleomycin. Histopathologic studies revealed pulmonary damage and various degrees of respiratory insufficiency developed in all patients, one of whom died. There was no instance of opportunistic infections in any patient. The pathophysiology relating pulmonary damage to the action of bleomycin is discussed.

Resultados de la cirugía conservadora en el carcinoma invasor de mama precoz / Results of the conservative surgery in the early breast invasive carcinoma

Se analizan los resultados de la cirugía conservadora sin vaciamiento axilar, seguida de radioterapia y la sobrevida en 127 pacientes con cáncer de mama en estadio T1 - T2 No Mo a 144 meses. La población en estudio está constituida por 59 pacientes (46,4%) en T1 y 68 (53,5%) en T2. La edad promedio fue de 53 años para T1 y de 56 años para T2. El 83,2% de las pacientes en T1 tiene una SSEE a 120 meses. La mediana de seguimiento es de 54 meses. La sobrevida total actuarial es de 89,9%. El 11,8% (7/59) fracasaron. Tres (5%) en la zona locorregional y 4 (6,6%) a distancia. El 8% de los fracasos locorregionales lo hicieron en axila, mientras que en mama fue el 1,7%. Dos pacientes tienen fracaso en 2 o más localizaciones simultáneas. El 60,5% de las pacientes en T2 tienen una SSEE a 120 meses. La mediana de seguimiento es de 61 meses. La sobrevida total actuarial es de 77,7%. El 30% (21/68) fracasaron, 4 en la zona locorregional y 17 a distancia. Dos de los fracasos locorregionales fueron en axila y dos en la mama. Seis pacientes tienen dos o más fracasos simultáneos (locorregionales a distancia). Se concluye que en comparación a publicaciones con tratamientos similares, los resultados obtenidos son semejantes; pero al compararlos con los resultados obtenidos con técnicas conservadoras, en que se hace vaciamiento axilar, aquéllos son significativamente superiores, especialmente por los resultados obtenidos en axila

[Anal neoplasms. Treatment with radiotherapy and exclusive chemotherapy]. / Cancer anal. Tratamiento con radioterapia y quimioterapia exclusiva.

We report preliminary results on treatment of anal carcinoma by radiotherapy and chemotherapy. Nine patients (mean age 64, 6 females) were treated with 5-fluorouracil and mitomycin C intravenously, associated to radiotherapy (3000 rads in 10 days). The lesion was located in the anal canal in 4 patients and at the anal margin in 5. Good response was observed in every patient with no evidence of recurrence during a 2 to 30 month follow up period (median 16). A greater number of patients and a longer follow up period is required to establish this as a valid alternative to abdomino-perineal surgery for the treatment of anal carcinoma.

[Unusual sarcomas of the breast. Report of 3 cases]. / Sarcomas inhabituales de la mama. Comunicacion de tres casos.

Non phylloides sarcomas of the breast are infrequent malignant tumors that can be identified only at histologic examination since clinical presentation may not differ from the more frequent phylloides type. In addition to fibrosarcoma, leiomyosarcoma, rhabdomyosarcoma, angiosarcoma and liposarcoma, the stromal sarcoma of the breast has been recently identified. We report 3 such cases with heterologous components of osteosarcoma, chondrosarcoma and liposarcoma. A third case with an anti-sarcoma appearing post radiotherapy for breast carcinoma is also reported.

[Prevalence of esophageal and gastrointestinal symptoms in Chilean adults]. / Prevalencia de síntomas esofágicos y gastrointestinales en adultos chilenos.

We surveyed 300 randomly selected presumable healthy adults for previously defined gastrointestinal and esophageal symptoms. Heartburn was the most common symptom, more frequent in females than in males (p less than 0.01). An association of esophageal symptoms to heartburn but not to smoking habit was found. Constipation was frequent in females and diarrhea in males. We conclude that esophageal symptoms are frequent in presumable healthy individuals.

[Stage II non-seminoma cancer of the testis: combined treatment with surgery and chemotherapy]. / Cáncer testicular no seminoma etapa II: tratamiento combinado con cirugía y quimioterapia.

Fifty-one patients with non-seminoma testicular cancer who underwent retroperitoneal ganglion dissection and 3 support cycles of chemotherapy with Cys-Platin, Vinblastine and Bleomycin. Four patients presented relapses (7.8%). Actuarial survival by 8 years was 87%, with a median of 38 months. The median survival was 43 months. Three of the 4 patients with relapses are currently free of disease after rescue treatment, showing in global terms a control of the disease of 98% during this clinical stage.

Greater efficacy of preweaning than postweaning environmental enrichment on maze learning in adult rats.

In order to assess the behavioural effects of environmental stimulation at different stages of development, two groups of rats were exposed to multisensory enrichment on days 10-24 (preweaning) or 25-39 (postweaning). Both groups had four 25-min sessions per day in a large cage with a variety of stimuli, in addition to 3 min of handling before each session. The mother of the preweaning group remained in the home cage during the stimulation sessions. A third group was maintained in a social condition. Testing in a Hebb-Williams maze started when the rats of the 3 groups were 100 days old. Error, latency and running time scores were lowest in the preweaning group.