Genetic heterogeneity of platelet glycoproteins Ia and IIIa is associated with in vitro fertilisation implantation failure.

Thrombophilic genetic factors have been shown to play an important role in implantation outcome after in vitro fertilisation (IVF). In this pilot study we investigated the frequencies of glycoprotein Ia (GpIa)-C807T and GpIIIa-PlA1/PlA2 polymorphisms in 60 nulligravidae women with a history of unexplained IVF implantation failures and compared them with 60 healthy fertile women. We found statistically significant associations between the GpIa-C807T and GpIIIa-PlA1/PlA2 polymorphisms and IVF implantation failure (odds ratio [OR] = 3.45, 95% confidence interval [CI]: 1.63-7.30, p = 0.001; and OR = 2.86, 95% CI: 1.27-6.45, p = 0.010, respectively) with the risk being higher for combined carriers of GpIa-807T and GpIIIa-PlA2 alleles (OR = 10.13, 95% CI: 2.85-35.99, p < 0.001), suggesting a synergistic effect of the two polymorphisms. The above associations were strongest for the youngest age group. Our results indicate that GpIa-807T and GpIIIa-PlA2 may be susceptibility alleles for IVF implantation failure.

Successful pregnancy with the use of vaginal pessary in a patient with a very short cervix. A case report.

Preterm birth is one of the causes of perinatal morbidity and mortality. The traditional treatment for a short cervix has been the cerclage in addition with the progesterone administration. Recently, the idea of using vaginal pessaries as a new less invasive method of treatment for the same indication is under discussion. The case of a 29-year-old pregnant woman with an extremely short cervix and the treatment, she underwent during her second pregnancy, is presented. In order to avoid a preterm delivery the patient was treated with the use of a vaginal pessary. After the placement of the pessary and its removal after 37 weeks of gestation, a full term delivery was performed. The pessary was symptom free throughout. In conclusion, the cervical pessary may offer a safe and easy alternative to cerclage for the treatment of cervical insufficiency and prevention of preterm birth.

Effects on the immune system and toxicity of carboplatin/paclitaxel combination chemotherapy in patients with stage III-IV ovarian and non small cell lung cancer and its role in survival and toxicity.

PURPOSE: To examine the impact of paclitaxel and carboplatin combination chemotherapy on the parameters of the immune system in patients with non small cell lung cancer (NSCLC) and with ovarian cancer before, during and after chemotherapy, and the effect of this combination on the overall patient survival. METHODS: 24 patients with NSCLC and 20 with ovarian cancer (all in stage IIIb-IV) treated with 6 courses of paclitaxel and carboplatin combination chemotherapy were separated into two groups according to their survival group A: long survival (> 12 months for NSCLC; > 30 months for ovarian cancer) group B: short survival (<12 months for NSCLC; <30 months for ovarian cancer). At the same time we studied some immunological parameters (CD3, CD4, CD8, CD56, CD34, IL-3, IFN-γ) in relation with the induced toxicity during chemotherapy. The results were analysed using the ANOVA method. RESULTS: We observed a statistically significant difference of CD4 and CD4/CD8 after chemotherapy between groups A and B (p<0.001 and p< 0.006 respectively), implying that the further increase of T-helper cells after chemotherapy had a positive impact on survival. In addition, statistically interesting was the difference in values of IFN-γ between patients of groups A and B before and after chemotherapy (p< 0.039 and p< 0.027, respectively). Patients with high IL-3 had little chance of toxicity. CONCLUSION: Our findings support that with carboplatin/ paclitaxel combination chemotherapy, important parameters of the immune system (IFN-γ, CD4, CD4/CD8) can be used as prognostic factors for survival, while others (IL-3) as indicators of toxicity.

Pregnancy and Waldmann disease.

We present a case of a woman with intestinal lymphangiectasia and pregnancy. She had been treated with albumin transfusions beginning from the age of 2 years. No major complications were caused to the pregnancy. During pregnancy she was given albumin transfusions at regular intervals, while measuring total proteins, albumin and calcium concentrations in the serum. Due to the increasing needs in proteins as the pregnancy went on, the interval between each transfusion went decreasing. Finally, at 39 weeks of gestation she gave birth by cesarean section due to placenta previa to a healthy female fetus. A worsening of hypoproteinemia and edema was noted during puerperium and lactation. Weaning improved her clinical status. The baby was followed by pediatricians and found her in good health. Summing up, normal pregnancy is compatible with the condition. A strict maternal and fetal care during pregnancy and puerperium is recommended.

Relationship between Helicobacter pylori seropositivity and hyperemesis gravidarum with the use of questionnaire.

AIM: The aim of the present study was to investigate the relationship between Helicobacter pylori (HP) infection and Hyperemesis gravidarum (HG) by using a questionnaire. METHODS: Twenty-five pregnant women with HG and 85 asymptomatic pregnant women (aged 14-40) of matching gestational age were enrolled between October 2004 and January 2006. Anti-HP immunoglobin G (IgG) serum antibody was tested to establish seropositivity. In our study we used a multi variable questionnaire (name, age, gravida, number of vomits daily etc.). The results were analyzed using chi squared and Mann-Whitney U- test. RESULTS: The prevalence of HP infection was 56% (14 of 25) among patients with Hyperemesis gravidarum and 48.2% (41 of 85) among control subjects (P>0.05, chi squared test). In the same study the HP seropositivity is not related to age of the woman (50%, 55 of 110 were HP positive, P>0.05 chi squared test) but there was a significantly association between number of deliveries and HP seropositivity (primigravida [+] 34.2% versus 65.8%, multigravida [+] 6.1% versus 38.9%, P<0.05 chi squared test). The history for gastrointestinal problems of the tested women and their husbands is not related to HP seropositivity(38.1% positive for HP and with gastrointestinal disorders she/he or both versus 61.8% positive and without problems both, P>0.05, Mann-Whitney U- test). Finally there was no relativity between the number of vomits daily and the HP seropositivity (48.2% with HP [+] and 0-3 vomits daily versus 56% with HP [+] and 4-8 vomits daily, P>0.05 chi squared). CONCLUSIONS: Our findings do not support any direct correlation between HP seropositivity and Hyperemesis gravidarum, number of vomits daily, age of woman, history for gastrointestinal problems but only with the number of deliveries.

Familiar hypertrophic cardiomyopathy in association with coarctation of the aorta and coronary artery disease. Importance of family screening. A brief report.

Hypertrophic cardiomyopathy (HCM) is a condition of unknown etiology with thickening of the interventricular septum. It is better defined as a genetic disorder of autosomal dominant inheritance with variable left ventricular hypertrophy and symptoms. HCM has been rarely reported in association with other causes of hypertrophy such as hypertension and aortic stenosis. The combination of aortic stenosis or other arterial stenosis such as coronary artery disease with HCM is unusual. We present a case of a middle aged male with an unusual combination of cardiac diseases. Mild coarctation of aorta, mild aortic stenosis in association with familial HCM and the difficulty in diagnosis are the salient features. The acute change on ECG underscores the presence of coronary artery disease coexistent with the above mentioned diagnosis. The importance of family screening in this situation is highlighted. On the other hand, combined forms of left ventricular outflow obstruction are being recognized with increasing frequency. The importance of recognizing multiple levels of obstruction in such patients is emphasized.