The EcoRV genetic polymorphism of human monoamine oxidase type A is not associated with Parkinson's disease and does not modify the effect of smoking on Parkinson's disease.

We previously observed an association with Parkinson's (PD), and modification of the effect of smoking on PD, by a polymorphism of the monoamine oxidase B (MAO-B) gene. The A form of monoamine oxidase (MAO-A) shares with MAO-B many characteristics that could be relevant to PD, especially proneuroxicant bioactivation and dopamine metabolism. MAO-A is also inhibited by tobacco smoke, which bears an apparent protective effect on PD. We investigated the possibility that MAO-A genetic variants may also be involved in predisposition to PD and in modification of the effect of smoking. Three-hundred and seventy-one subjects--145 idiopathic PD cases and 226 age/gender-matched controls--were genotyped for the EcoRV polymorphism of MAO-A gene which has been related to increased enzyme activity. MAO-A EcoRV polymorphism was neither significantly associated with PD nor did it modify the inverse relationship with smoking. These results suggest that the EcoRV polymorphism of MAO-A is not an important biomarker of PD risk.

VEGF stimulates tyrosine phosphorylation of beta-catenin and small-pore endothelial barrier dysfunction.

The purpose of this study was to test the hypothesis that tyrosine phosphorylation signaling events and protein kinase C (PKC) activation mediate vascular endothelial growth factor-A(165) (VEGF)-induced endothelial cell (EC) proliferation and barrier dysfunction in bovine pulmonary artery EC monolayers. A size-selective permeability assay showed that VEGF stimulated a delayed, prolonged (6-45 h), concentration-dependent (50-200 ng/ml, approximately 1-4 nM) increase in the number of predominantly small-"pore" transport pathways (<60 A) across EC monolayers. The tyrosine kinase inhibitor herbimycin A (HA) and the selective PKC inhibitor bisindolylmaleimide (BIM) prevented this phenomenon. After 6-24 h, VEGF-treated monolayers displayed an HA- and BIM-sensitive reorganization of beta-catenin adherens junctions with fingerlike projections and the loss of beta-catenin at sites of small paracellular hole formation. HA and BIM prevented the VEGF-induced increase in EC growth. HA blocked the VEGF-induced rapid and prolonged (10 min-45 h) increases in the phosphotyrosine (PY) contents of VEGF receptor 2, phospholipase C-gamma1, paxillin, and beta-catenin as well as approximately 140- and 128- to 117-kDa proteins, whereas BIM inhibited only the tyrosine phosphorylation of beta-catenin. These data suggest that VEGF initiates increased EC growth and chronic, small-pore endothelial barrier dysfunction by PY signaling through beta-catenin that depends on PKC.

Symptomatic liver hemangioma with intra-tumor hemorrhage treated by angiography and embolization during pregnancy.

BACKGROUND: Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast majority are small (less than 4 cm) and asymptomatic, but there have been a few reported cases of these lesions leading to severe pain and even spontaneous fatal hemorrhage. Estrogen may cause the growth of liver hemangiomas, but there is a paucity of information concerning the effect of pregnancy upon these lesions. CASE: A patient presented at 18 weeks' gestation with the acute onset of vomiting and epigastric pain. A right upper-quadrant ultrasound scan found a 9-cm hypodense lesion within the liver, and magnetic resonance imaging (MRI) suggested a hemangioma. The lesion was believed to be inoperable, and selective catheterization of the common hepatic artery was performed. An angiogram demonstrated a round vascular mass 12 cm in diameter occupying much of the left side of the liver, with the vascular supply from the middle hepatic artery and to a lesser extent from the left hepatic artery. Embolization was performed, and a post-embolization image demonstrated satisfactory occlusion of the vessels treated. The patient's epigastric pain resolved after the procedure. The lesion was observed with monthly ultrasound and regressed to about 50% of its original size. The patient was scheduled for an elective primary cesarean delivery at 39 weeks to avoid possible rupture of the hepatic hemangioma during the second stage of labor. Her cesarean and postpartum course were uncomplicated. CONCLUSION: A symptomatic liver hemangioma with intratumor hemorrhage can be successfully treated with embolization during pregnancy. Because of the paucity of reported cases, it is uncertain whether vaginal birth is contraindicated in these patients.

Prenatal care, screening, and complications.

Articles are reviewed that give the clinician new guidelines to diagnose neural tube defects without using amniocentesis. Cervical measurement using ultrasound as a tool to objectively evaluate and follow patients at risk for premature labor and incompetent cervix are reviewed. The utility of transabdominal versus transvaginal ultrasound is discussed. Two papers are presented that look at the use of aspirin in preeclampsia. One study looks at metabolic degradation of the prostaglandins associated with pregnancy-induced hypertension and shows that there is a heterogeneity in response to aspirin therapy. However, once the patient has pregnancy-induced hypertension, aspirin does not seem to be effective. A paper is presented that looks at the safety of autologous blood donation for both the mother and the baby and confirms its usefulness in obstetrics as in the nonpregnant patient.

Management of the pregnant patient with a cerebral venous angioma: a report of two cases.

Though there is a large body of knowledge regarding the management of pregnant women with arterial lesions in the central nervous system, little information is available on venous malformations. We report our experience with two pregnant patients with cerebral venous angiomas. These lesions are usually asymptomatic and only rarely cause seizures or subarachnoid hemorrhage. Based on our experience and literature review, we suggest that patients with venous angiomas without a history of hemorrhage can safely undergo labor and vaginal delivery.

Intrapartum course of fetuses with isolated hypoplastic left heart syndrome.

Once considered universally fatal, the hypoplastic left heart syndrome is now being surgically treated in the newborn period. To help formulate an appropriate management plan for the labor and delivery of these patients, we reviewed the intrapartum course and immediate neonatal outcome of 13 fetuses with known hypoplastic left heart syndrome. Eleven of 13 patients underwent labor, and only one had an abnormal fetal heart pattern. There were no cases with meconium staining of the amniotic fluid. All patients with spontaneous or induced labor were delivered vaginally. There were no Apgar scores less than 8 at 5 minutes, and all umbilical cord blood pH values were greater than or equal to 7.20. All infants survived to undergo initial reconstructive surgery. We conclude that labor does not appear to be a high-risk situation for the fetus with this disorder. Routine intrapartum fetal heart rate monitoring can be used, oxytocin can be used as indicated, and cesarean section should be reserved for traditional obstetric indications.

Preeclampsia, trisomy 13, and the placental bed.

Genetic predisposition and abnormal trophoblastic function are thought to contribute to the development of preeclampsia. A multipara developed severe preeclampsia and subsequently delivered a live growth-retarded infant with trisomy 13. Biopsy of the placental bed taken immediately after delivery demonstrated inadequate trophoblastic remodeling of the maternal uterine vasculature, with an absence of normal physiologic changes in the spiral arteries. This case suggests that fetal trisomy 13 can be associated with preeclampsia in multiparous women and that abnormal trophoblastic invasion may contribute to the pathophysiology.

Cost-effective approach to office screening for gestational diabetes.

Gestational diabetes is a common problem during pregnancy. There are numerous screening programs, all of which are costly and time consuming. During a 6-month period, 50 patients were screened for gestational diabetes with a standard 50-g oral glucose load, and 1 hour later a capillary blood specimen was evaluated by means of a reflectance meter and a venous sample was evaluated in the hospital laboratory. We found that the capillary blood glucose determination was accurate, but we recommend that specific cutoff values for each meter be established for each facility. By using the glucose reflectance meter, 90% of patients will not require laboratory studies, which results in significant cost savings. Besides cost savings, the immediate results obtained by a reflectance meter allow for prompt identification of an abnormal screen and prompt scheduling for further evaluation of glucose intolerance during the pregnancy.

Safety of predeposit autologous blood donation in the third trimester of pregnancy.

The option of predeposit autologous blood donation (PABD) before elective surgery has been gaining popularity as a means of eliminating the transmission of the acquired immune deficiency syndrome and hepatitis. It also prevents potential antigen sensitization and transfusion reactions. The use of PABD in pregnant women has been described, but its safety for both mother and fetus, especially in the first and third trimester, has not been established. After studying 16 third-trimester pregnant women with antenatal surveillance techniques and continuous fetal monitoring, we concluded that PABD is a safe procedure for both mother and fetus.

Nephrotic syndrome due to preeclamptic nephropathy in a hydatidiform mole and coexistent fetus.

A case study and review of the literature of 2 uncommon obstetric events associated with each other is presented. The diagnosis, treatment, and evaluation of a case of nephrotic syndrome due to preeclamptic nephropathy in a hydatidiform mole and coexistent fetus is presented. Cytogenic studies and appropriate follow-up therapy are discussed. The complete remission of renal and hypertensive complications with evacuation of the pregnancy and lack of malignant transformation is stressed and is found to be characteristic of "partial" mole.