Granulosa cells as a source and target organ for tumor necrosis factor-alpha.

Tumor necrosis factor (TNF-alpha), a 17 kDa cytokine, is a product of activated macrophages which was recently shown to be produced by rat and bovine granulosa cells. In the present work, human granulosa cells derived from preovulatory follicles were used. It was demonstrated that human granulosa cells produce TNF-alpha (5-10 units/300,000 cells per 15 h). This production was increased by addition of follicle-stimulating hormone or by a combination of human chorionic gonadotrophin and CSF to the culture media. TNF was also found in bovine follicular fluid and the concentration was higher in the periovulatory than mid-cycle follicles. TNF-alpha was found to increase prostaglandin F-2 alpha production by human granulosa cells (P less than 0.001). We conclude that granulosa cells are both a source and target organ for TNF-alpha.

Multifetal pregnancy reduction in cases of threatened abortion of triplets.

OBJECTIVE: To investigate the course of pregnancy and fetal outcome after first-trimester multifetal pregnancy reduction (MFPR) in patients with triplet pregnancies and uterine bleeding. DESIGN: Case series of patients with threatened triplet pregnancies considered for MFPR. SETTING: Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tiqva, Israel. PATIENT(S): Forty-two patients with triplet pregnancies and first-trimester uterine bleeding. INTERVENTION(S): At 10-15 weeks' gestation, MFPR with intracardiac injection of potassium chloride was performed. The procedures were performed 7-10 days after cessation of bleeding (9-13 weeks) or in the presence of minimal uterine bleeding (14-15 weeks). In patients with heavy uterine bleeding, MFPR was postponed. MAIN OUTCOME MEASURE(S): Early- and late-pregnancy complications related to the procedure, pregnancy outcome, and fetal survival. RESULT(S): Performance of MFPR at 14-15 weeks was associated with a higher abortion rate (38.5%), lower mean gestational age at delivery (30.6 weeks), and lower mean twin birth weight (1,376+/-218 g and 1,014+/-202 g) than was performance of MFPR at 10-13 weeks (18.8%, 33.2 weeks, and 1,720+/-245 g and 1,596+/-170 g, respectively). Abortion occurred in four of the five patients with moderate to heavy uterine bleeding who did not undergo MFPR; the fifth patient gave birth prematurely at 28 weeks, and two of the newborns died. CONCLUSION(S): Pregnancy outcome and fetal mortality and morbidity in triplet pregnancy after MFPR are directly correlated with duration and amount of first-trimester bleeding.

Concurrent genital and rectal prolapse: two pathologies--one joint operation.

This study is a prospective assessment of a joint operation to repair concomitant genital and rectal prolapse, including 10 women treated for concomitant genital and rectal prolapse from 1991 to 1995. Joel-Cohen vaginal hysterectomy was used to correct the genital prolapse, followed by the Altemeier procedure (transperineal rectosigmoidectomy) to correct the rectal prolapse. The post-operative course was uneventful in all cases and there were no recurrences of prolapse in the three year follow up period. Improvement of sphincteric tone was shown in all cases by transrectal manometry, and bladder and rectal continence was maintained. The combined surgical procedure for concurrent genital and rectal prolapse is easy to perform and safe and efficient in terms of recurrence and continence. It is hoped this report will increase multidisciplinary awareness of an effective solution for a potentially debilitating problem.

Evaluation of low serum vitamin B(12) in the non-anaemic pregnant patient.

Low serum vitamin B(12) concentrations in pregnancy may not indicate true megaloblastic anaemia. In the present study we compared biochemical indices of vitamin B(12) deficiency (serum homocysteine and urine methylmalonic acid) in non-anaemic pregnant women with and without low serum vitamin B(12) concentrations. The groups were matched for age, parity and gestational age. No differences were found, and all values were within normal range. These results suggest that the measurement of low serum B(12) concentrations in pregnant women should be followed by analysis at the biochemical level before vitamin B(12) injections are started.