The effect of maternal age on fetal and neonatal mortality.

OBJECTIVE: Determine the gestational age at which the risk of fetal or neonatal death associated with delaying delivery by 1 week exceeds the risk of neonatal death associated with immediate delivery, stratified by maternal age intervals. STUDY DESIGN: We conducted a retrospective cohort study of live births, stillbirths and neonatal deaths that occurred in the United States between 2010 and 2013 using birth data. Women were classified into six age categories. Singleton, non-anomalous pregnancies without hypertensive disease or diabetes were included. Relative risks were obtained using a generalized linear model comparing the rate of death associated with immediate delivery to those of expectant management. RESULTS: For all age groups with the exception of women 44 years and older, immediate delivery was associated with lower relative risk of death by 39 weeks. For <25, 25 to 29, 30 to 34, 35 to 39, 40 to 44, odds ratios (OR) and confidence intervals (CI) were 1.0 (0.32 to 3.10), 0.67 (0.19 to 2.37), 0.80 (0.21 to 2.98), 0.67 (0.19 to 2.36) and 0.45 (0.16 to 1.31), respectively. In women 44 years and older, immediate delivery was associated with a lower relative risk of death by 38 weeks (OR: 0.35, CI: 0.14 to 0.90). CONCLUSION: Women greater than 44 years old may benefit from delivery by 38 weeks gestational age to reduce the risk of stillbirth.

An orthotopic model of ductal adenocarcinoma of the pancreas in severe combined immunodeficient mice representing all steps of the metastatic cascade.

INTRODUCTION: Clinically relevant animal models are needed to evaluate new therapeutic strategies against pancreatic adenocarcinoma, which is almost incurable by established treatment. AIMS: To establish and characterize a metastatic orthotopic transplant model for pancreatic ductal adenocarcinoma in severe combined immunodeficient (SCID) mice. METHODOLOGY: Human pancreatic ductal carcinoma cells, PancTu 1, were implanted either subcutaneously or orthotopically into the pancreas. RESULTS: After 4 weeks, orthotopic transplantation resulted in an extensive local tumor growth of an undifferentiated ductal adenocarcinoma with slight to moderate desmoplastic reaction. The tumor growth and spread resembled the situation in humans, including invasion into adjacent organs causing biliary and stomach obstruction. In addition, tumor metastases to regional lymph nodes of the pancreas, lung, liver, mesentery, and diaphragm, and attached to the kidneys, spleen, and reproductive organs were observed. In contrast, no invasion or metastases could be demonstrated by subcutaneous implanted PancTu I cells. Using immunohistochemical analysis, even single human tumor cells could be detected in blood vessels and metastatic organs, providing evidence that the orthotopic transplant model appropriately reflects the entire process of the metastatic cascade. CONCLUSION: This cancer model in SCID mice appears to be a powerful tool to investigate the identity of metastasis-associated genes and to evaluate preclinically the potency of novel antimetastatic agents in ductal adenocarcinoma of the pancreas.

Tumores ováricos, Perfil estadístico

El cancer ovárico ocupa el tercer lugar, en órden de frecuencia, del cancer de las vías genitales. Sin embargo , es el de mayor mortalidad debido al diagnostico tardío. Solamente los cánceres del ovario desubiertos precozmente ofrecen una oportunidad real de sobrevivencia. Los avances en los métodos terapéuticos no han variado el índice de mortalidad debido al estado avanzado del cáncer en el momento de ser aplicados. Los estudios actuales deben orientarse a conocer los grupos de mujeres con mayor riesgo, identificando para ello los principales factores de riesgo. Se realiza una investigación en el departamento de Ginecología y Obstetricia del Hospital "Carlos Andrade Marín" orientada a definir los grupos de alto riesgo para sufrir cáncer ovárico identificando sus principales factores de riesgo, con el fin de aplicar, en aquellos, los exámenes diagnósticos especificos precoz y prioritariamente. Se determinan los tipos de tumores ováricos más frecuentes en nuestra población.

First trimester bleeding and pregnancy outcome in gravidas with normal and low folate levels.

The purpose of this study was to examine whether women with first trimester uterine bleeding and low serum folate have a higher incidence of spontaneous abortions and adverse perinatal outcome compared with women whose folate levels are normal. Serum folate and vitamin B12 levels were obtained on 225 women who presented with first trimester vaginal bleeding; pregnancy outcomes of those whose folate or vitamin B12 levels were low were compared with those with normal levels using the chi-square test. Of the 151 women included, 52 had low folate levels (less than 4.0 ng/ml). Their spontaneous abortion rate and perinatal outcomes were similar to those whose folate levels were normal. We concluded that in pregnancies complicated by first trimester vaginal bleeding, low folate levels do not appear to be associated with an increased risk of pregnancy loss and adverse outcome.

Preeclampsia effect on platelet count.

Thrombocytopenia is well recognized when preeclampsia is complicated by the hemolysis, elevated liver tests, low platelet count (HELLP) syndrome. We studied the effect of preeclampsia on the platelets of women whose platelet count and liver function were within normal range. We prospectively evaluated 67 preeclamptic women, gestational age 30 to 42 weeks, with disease of variable severity. The platelet counts of these patients, obtained within 24 hours preceding delivery, were significantly lower than the platelet counts of 71 control subjects. The platelet counts did not differ significantly between patients with mild and severe preeclampsia. Our findings suggest the existence of subclinical thrombocytopenia in preeclamptic women whose platelet values are within normal range.

The resolution of preeclampsia-related thrombocytopenia.

The average time until the resolution of thrombocytopenia, which as a part of HELLP syndrome accompanies 4-16% of cases of severe preeclampsia, has not been defined previously. We followed 25 patients with severe preeclampsia, platelet counts below 100,000/microL, and elevated liver enzymes until their platelet counts returned to levels above 100,000/microL. Among severe preeclamptics who did not receive platelet transfusions, the average time from delivery to the resolution of thrombocytopenia was 60 hours, and all had platelet counts above 100,000/microL by 95 hours. Seven patients were followed after their platelet counts exceeded 340,000/microL; all showed a rebound phenomenon, with platelet counts reaching values of 413,000-871,000/microL.