The role of cervical cultures to guide perioperative antibiotics in cervical cerclage - a retrospective analysis of 65 consecutive cases.

OBJECTIVE: The objective of this study is to examine results of bacterial cultures of the cervix prior to cerclage placement and how these may be used to guide prophylactic antibiotics. METHODS: All patients undergoing cerclage between 2000 and 2003 in a single, large community hospital were evaluated for indication for cerclage, signs and symptoms on presentation, transvaginal ultrasound cervical length findings, type of cerclage placed, type of anesthesia used, cervical culture taken, tocolytics given, gestational age at delivery, and complications surrounding delivery. RESULTS: Sixty-five cerclages were performed between 2000 and 2003, 13 (20%) prophylactic, 47 (72%) therapeutic, and five (8%) emergent. Cervical cultures were obtained in 85% of patients, of which 40% were negative resulting in no antibiotics given. In the remaining 45%, one or more pathogens were isolated and antibiotics were given according to sensitivities reported. Fifty-five of 65 patients (84%) delivered after 32 weeks gestation and a latency > 60 d was seen in 84%. The incidence of chorioamnionitis and PPROM was low. CONCLUSION: Bacterial cultures of the cervix prior to cerclage show variable colonization and antibiotic sensitivities and, there is no single antibiotic, chosen empirically, that will cover all pathogens.

Identification of L1CAM, Jagged2 and Neuromedin U as ovarian cancer-associated antigens.

In order to identify tumor-associated genes of ovarian carcinoma, we have investigated the transcriptional profile of 11 ovarian tumor cell lines and 2 immortalized ovarian surface epithelial cell lines (IOSE) derived from normal ovarian epithelium with Affymetrix GeneChip technology. We have analyzed the expression profile of 12652 genes. A total of 136 genes were up-regulated and 165 were down-regulated in at least 7 out of 11 ovarian tumor cell lines in comparison to the transcriptional profile of the IOSE cell lines with a change factor of +/-2 as the threshold level. We have focused on up-regulated genes encoding for transmembrane receptors and secreted proteins as possible markers for diagnosis and targets for therapy of ovarian carcinoma. We have identified the transmembrane Notch ligand Jagged2, cell adhesion molecule L1CAM and the secreted polypeptide Neuromedin U as possible candidates. Immunohistochemical analysis revealed expression of L1CAM predominantly in ovarian carcinomas, in borderline tumors to a lesser extent, and very rarely in ovarian non-epithelial types of cancer. Further analysis of L1CAM revealed that a splice variant lacking exons 2 and 27 is predominantly expressed in ovarian carcinoma cell lines DW and GG. Functional investigation of stable Delta(2,27)L1CAM transfectants of the ovarian tumor cell line OV-MZ-2 revealed significantly stronger adhesion to laminin in comparison to mock transfectants.

Immune responses to murine monoclonal antibody-B43.13 correlate with prolonged survival of women with recurrent ovarian cancer.

OBJECTIVE: We evaluated the therapeutic efficiency of the murine monoclonal antibody-B43.13 in the treatment of patients with recurrent ovarian cancer. STUDY DESIGN: This was a retrospective study of immune responses and survival in 44 patients who were treated with technetium 99m-labeled monoclonal antibody-B43.13, a murine monoclonal antibody that is directed against the tumor-associated antigen CA125. Most patients were pretreated heavily. Biologic activity was quantified by the assay of immune responses to the human anti-murine antibodies against the monoclonal antibody-B43.13 variable region (Ab(2)) and antibodies that target the CA 125 antigen itself (anti-CA 125 antibody). RESULTS: More than one half of patients (56.8%) survived for >12 months after the first dose of monoclonal antibody B43.13; 34.1% of the patients survived >24 months. To date, 6 of the 44 patients are alive, with survival times of 4 to 7.5 years after the start of the antibody treatment. More than 60% of the evaluable patients met predefined criteria for robust, treatment-emergent human anti-murine antibodies and Ab(2) responses, and these responses were associated with improved survival rates. Median survival time increased approximately 3-fold for human anti-murine antibody responders (22.6 months) versus nonresponders (7.2 months; P <.0016, log-rank test) and 2-fold for Ab(2) responders (18.3 months) versus nonresponders (9.3 months). No serious drug-associated adverse events were reported. CONCLUSION: The associations between multiple types of immune response and improved clinical outcomes suggest that monoclonal antibody-B43.13 should be further evaluated for potential use as an immunotherapy for CA125-expressing malignancies.