Subsequent reproduction and obstetric outcome after methotrexate treatment of cervical pregnancy: a review of original literature and international collaborative follow-up.

The case reports of 22 patients with cervical pregnancies treated by methotrexate (MTX) administration and published in English literature between 1983 and 1995 were reviewed, by either original paper review or follow-up under international collaboration, to determine the subsequent reproductive performance and obstetric outcomes. Out of 22 cases, 18 (78%) MTX chemotherapy attempts succeeded with complete remission and four (22%) failed. Of the 13 women who wished to conceive and could be followed for at least 3 years, nine succeeded in having live births without congenital malformations, one spontaneously aborted and three suffered infertility. In general, MTX chemotherapy alone or combined with adjuvant methods such as subsequent cervical curettage or cervical tamponade, or intracervical potassium chloride injection, appears to be a convenient and effective method for the treatment of the majority of cervical pregnancies before 12 weeks gestation, and has not been shown to have detrimental effects on subsequent reproductive capacities, obstetric outcomes and progeny health for those cases with successful preservation of the uteri.

Anisodamine causes acyl chain interdigitation in phosphatidylglycerol.

The effect of anisodamine on the structure of the gel phase and the properties of the acyl chain disordering transition of dipalmitoylphosphatidylglycerol (DPPG) has been studied through high-sensitivity differential scanning calorimetry (DSC) and fluorescence polarization measurements of 16-(9-anthroyloxyl)-palmitic acid (16AP) and 3-(9-anthroyloxyl)-stearic acid (3AS), labeling, respectively, the ends and the third carbon of the acyl chains. The non-interdigitated DPPG multilamellar vesicles formed in HEPES buffer show clear fluidity gradient in their acyl chains, whereas the fluidity gradients are completely abolished in the presence of anisodamine. The DSC results showed that the phase transition temperature (Tm) of DPPG is decreased and the enthalpy (delta H) is increased by anisodamine, while the pre-transition vanishes. At 3 mM anisodamine, the delta H of DPPG reaches 9.6 kcal/mol. It can be concluded that DPPG forms an interdigitated gel phase in the presence of anisodamine. A molecular scheme for the interaction of anisodamine with DPPG is proposed.

Effects of fibrin glue on hemostasis.

In order to decrease complications following incomplete hemostasis, we tried to make a safe, efficient and highly concentrated fibrin glue by thawing single-donor fresh frozen plasma. Using a unique animal model, in which arterial bleeding was created, fibrin glue and some related hemostatic agents were tested to evaluate their hemostatic effectiveness. The results demonstrated that: 1) the concomitant use of cryoprecipitate-thrombin tissue glue with adjuvant (aprotinin or calcium chloride) had a better hemostatic effect than the use of cryoprecipitate-thrombin tissue glue alone (p < 0.05); 2) impregnation of fibrin glue with a suitable vehicle was advisable to accelerate the coagulation plug formation and to enhance the mechanical strength of the adhesive plug; 3) Gelform, used as a vehicle to hold the fibrin glue, had a more efficient hemostatic effect than gauze, collagen fleece and Surgicel (p < 0.05); 4) systemic heparinization attenuated the effectiveness of the hemostatic agents and aggravated the bleeding problem, but a low hematocrit level did not; 5) fibrin glue had its own limitations, especially under systemic heparinization, on hemostatic effectiveness in a high-pressure system. Understanding the characteristics of fibrin glue, as mentioned above, definitely improved the hemostatic effectiveness of the glue, especially after failure of the usual methods of controlling bleeding.