Laser-assisted tubal anastomosis.

OBJECTIVE: To determine if laser-assisted anastomosis is superior to microsurgical anastomosis and laser welding for tubal reconstruction. STUDY DESIGN: Sixty uterine tubes from 30 rabbits were transected and then anastomosed with a microsurgical technique, laser welding and laser-assisted anastomosis using a microscope. The rabbits were mated one month postoperatively and examined for implantation sites and adhesion formation three to seven days postpartum. RESULTS: The amount of time required to perform laser-assisted anastomosis as well as laser welding was significantly shorter than for microsurgery. All the tubes withstood the distension pressure of pregnancy with the exception of 1 of the 20 laser-welded tubes, which had 30% of its circumference dehisced. There was no difference in the number of implantation sites per tube between the different groups. The anastomotic sites were well healed and were nonidentifiable except for holding stitches and microsurgical sutures. CONCLUSION: Laser-assisted anastomosis and laser welding took less time to perform than microsurgery. Laser-assisted anastomosis resulted in excellent healing, as did microsurgery. With the protection of serum albumin, laser-assisted anastomosis did not cause any thermal damage, and the anastomotic sites could tolerate the distension pressure of pregnancy and parturition without problems. Laser welding without protection of serum albumin could cause thermal damage and dehiscence. The implantation and pregnancy rates were comparable The implantation and pregnancy rates were comparable with all three types of procedure.

Quantification of human amniotic fluid constituents by high resolution proton nuclear magnetic resonance (NMR) spectroscopy.

We have investigated the ability of high-resolution proton NMR spectroscopy to provide a biochemical constituent screening of human amniotic fluid (AF). Proton NMR spectra were obtained at 300 MHz on AF from patients undergoing amniocentesis in the mid-trimester. Only AF from normal pregnancies (normal fetal karyotype, normal alpha-fetoprotein levels, normal birth outcome) was used in this study. The AF supernatant was lyophilized and resuspended in deuterated water containing 0.1 mM phosphate buffer and 6.02 mM disodium maleate. Identification of low molecular weight compounds was confirmed by two-dimensional NMR spectra (primarily correlated spectroscopy, or COSY) and standard addition techniques. A broad profile of compounds were 'NMR visible' in a single proton spectrum, including creatinine, glucose, organic acids (acetate, citrate, and lactate) and several amino acids (alanine, histidine, leucine, phenylalanine, tyrosine and valine). The proton spectrum was unaffected by prior freezing/thawing of AF samples. We were able to quantify compounds by comparison with an added concentration standard (maleate) at concentrations as low as 30 microM. Good agreement with literature values based on other analytical techniques was obtained.

Comparison of laser-assisted anastomosis, laser welding, and microsurgical anastomosis of rabbit uterine tubes.

OBJECTIVE: To assess laser-assisted anastomosis in fallopian tube reconstruction. METHODS: Fifty-two rabbit uterine tubes were transected and subjected to laser welding or to microsurgical or laser-assisted anastomosis in a randomized paired design, and compared with the contralateral side. The time required for the procedure, patency of the uterine tubes, amount of adhesion formation, and quality of scar tissue (grossly and histologically) were evaluated 4 weeks after surgery. RESULTS: Traditional microsurgical procedures required significantly longer operative time than laser-assisted anastomosis (64.4 +/- 2.2 versus 41.3 +/- 2.2 minutes) or laser welding (47.8 +/- 3.0 versus 24.5 +/- 3.0 minutes). Patency was established in all 52 uterine tubes. Adhesion formation was animal-dependent rather than procedure-dependent. All scars healed well and most were not visible beyond residue suture. Inflammatory cells were noted around the suture sites; however, gross observation revealed that all mucosal surfaces over the scars were smooth. One of 18 laser-welded uterine tubes developed dehiscence, whereas there was no dehiscence in laser-assisted or microsurgically anastomosed uterine tubes. CONCLUSION: Laser-assisted anastomosis is superior to laser welding or microsurgical anastomosis in rabbit uterine tubes. Laser-assisted anastomosis has potential use in fallopian tube reconstruction.

Model for the genetic evolution of human solid tumors.

A conceptual model is proposed for the genetic evolution of many human solid tumors that is based on the observations that cancer cells may spontaneously double their chromosome number; that cells with excessive chromosome numbers may be cytogenetically unstable, both losing chromosomes randomly during subsequent cell divisions, and often developing structural abnormalities in the chromosomes that are retained; and that some structural chromosome abnormalities may activate growth-promoting genes. The sequence of tetraploidization with chromosome loss can occur repeatedly in a given tumor. The available evidence supporting the model is reviewed. A computer simulation system that embodies these concepts is described and the model is used to generate distributions of chromosome number/cell under various simulated conditions and in a variety of simulated biological settings. A simulation of the time course of changes in chromosome number per cell that accompany the spontaneous neoplastic transformation of mouse fibroblasts in vitro is described. The best fit to the data was obtained when provision was made for the activation of at least two growth-promoting genes. The conditions for generating discrete aneuploid peaks in cytogenetic and flow cytometric studies were explored; our modeling studies suggest that the activation of a growth promoting gene is required in order to produce a discrete aneuploid peak. Our modeling studies suggest that the overrepresentation of individual oncogene-bearing chromosomes in aneuploid cell lines may require the activation of gene dose-dependent growth-promoting genes and is not likely to occur in cell lines in which at least two copies of each normal chromosome are required for cell survival. Overall, the results obtained using the model are consistent with a wide variety of flow cytometric and cytogenetic studies in human solid tumors.

Karyotypic evolution of a human undifferentiated large cell carcinoma of the lung in tissue culture.

Serial cytogenetic studies were performed on a cell line derived from a pleural effusion from a patient with undifferentiated large cell carcinoma of the lung. The initial sample had a broad range of chromosome numbers per cell, with a hypodiploid/pseudodiploid stem line and a hypotetraploid sideline. A sequence consisting of a doubling of chromosome number per cell followed by chromosome loss was observed repeatedly during 40 culture passages. The presence of metaphase spreads showing evidence of endoreduplication suggested this as a likely mechanism for the doubling of chromosome number per cell. Eleven marker chromosomes were observed in the cells of the primary sample; these markers persisted through all subsequent passages. Chromosomes 1, 2, 6, 7, 8, 11, and 16 were consistently overrepresented; each of these chromosomes was involved in marker formation. Chromosomes 4, 5, 9, 10, 19, 21, and 22 were consistently underrepresented. Every chromosome, either in its normal form and/or as part of a marker, was represented on the average by at least one copy per diploid cell. Eighteen new marker chromosomes were observed during the course of cell cultivation; one of these evolved into a clonal marker over the course of six cell passages. Of the new marker chromosomes that were formed during the observation period, the majority were found in hypotetraploid cells.

Balanced translocation karyotypes in patients with repetitive abortion. Case study and literature review.

Cytogenetic studies were conducted upon 100 consecutive couples with abortions. Eight balanced carrier translocation karyotypes were discovered (8%): three cases of Robertsonian translocations and five reciprocal translocations. Two structural variant karyotypes and a poly-X mosaic were also found. A review of the literature on repetitive abortion revealed 82 balanced translocations in 1,331 couples, a rate of 6.2%. Cytogenetic studied should be routine for patients with repetitive abortion. In the pooled series, 3.7% of couples with translocation had wastage, including some with normal offspring; 9.2% had malformed offspring; 62% of the carrier couples lacked the malformation history. Seventy-four percent of the translocations were reciprocal; risk rates for imbalanced progeny were undefined for 90% of the carrier couples. Only 11 imbalanced conceptuses were demonstrated cytogenetically in 262 pregnancies of the carrier group.

Maternal transport.

Maternal transport offers the following distinct advantages over newborn transport: 1. The mother at risk may receive the highest level of obstetric expertise and technology available in the area. 2. The newborn is assured of immediate intensive paediatric evaluation and support. 3. The reduced equipment needs increase the speed and efficiency of the transport operation. 4. Mother-infant bonding may be enhanced. Maternal transport can never replace newborn transport for there will always be unexpected deliveries of compromised or malformed infants. Thus, in an effective regional perinatal care system, obstetric and neonatal transport programmes should complement each other. Experience to date would indicate that, when such efforts are co-ordinated, one can expect a further decline in perinatal morbidity and mortality for the region.

Polyamines in amniotic fluid, plasma, and urine during normal pregnancy.

Polyamines have been implicated as markers of cell kinetic parameters. Putrescine and spermine were elevated in the urine of women with normal pregnancies. Particularly striking was the over 75-fold increase in spermine excretion. Putrescine was more than twofold that found for normal women. In several patients followed serially during pregnancy to assess the temporal pattern of the urinary excretion of polyamines, it was found that the highest levels of all three polyamines occurred at 12 weeks of gestation. In amniotic fluid, putrescine was higher prior to 30 weeks of gestation whereas spermidine was significantly higher at or beyond 30 weeks of gestation. Spermine was relatively high in both groups. Studies are ongoing to assess whether alterations from these normally elevated patterns will occur in the fluids of pregnant women at high risk for abnormal fetal development.

Improved neonatal survival through maternal transport.

Data on outcome from 239 consecutive infants requiring neonatal intensive care following in utero maternal transport to a regional perinatal center were contrasted with those of 642 infants born in outlying hospitals and consecutively transported as newborns to regional intensive care centers during the same 30-month period (January 1974 through June 1976). Neonatal mortality was lower for maternal transport than for newborn transport infants in comparable groups of mortality risk (based on birthweight and gestational age), reaching levels of significant difference (P less than .05) for groups of premature infants weighing less than 1500 g and born prior to 34 weeks' gestation. A high-risk maternal transport system developed subsequent to a well established newborn transport and intensive care system broadens the scope of patients afforded neonatal intensive care and further reduces neonatal mortality and morbidity in the region it serves.

The association of maternal and neonatal thrombocytopenia in high-risk pregnancies.

In this study of 136 women with pre-eclampsia, eclampsia, placenta previa, or abruptio placentae, 21 mothers were noted to have thrombocytopenia. Seventeen of the 21 were in the pre-eclampsia group. Of the 21 thrombocytopenic mothers, nine were associated with thrombocytopenia in the children, seven children had normal platelet counts, and five had no counts performed. Eight of the nine thrombocytopenic neonates were associated with pre-eclampsia in the mother, and five of these were not believed to have disseminated intravascular coagulation as the etiology of the platelet defect. The results suggest that thrombocytopenia is common in high-risk pregnancies in both the mother and the baby. However, the etiology of the platelet defect cannot be easily explained on the basis of a hypercoagulable state.

Successful treatment of acute leukemia during pregnancy. Combination therapy in the third trimester.

Aggressive treatment with cytarabine, vincristine sulfate, and prednisone for acute myelogenous leukemia, administered from the 31 st week of pregnancy, resulted in both sustained complete remission of the leukemia and delivery of a normal infant with a normal birthweight and a normal male karyotype. It is concluded that chemotherapy with cytarabine combinations can be administered in the third, and probably the second, trimester of pregnancy without risk of serious damage to the developing fetus.

X-short arm deletion gonadal dysgenesis in two siblings due to unique translocation (Xp-;16p+).

A family demonstrating short arm deletion of the X chromosome as a consequence of X-16 balanced translocation in the mother is reported. The two Xp- sisters exhibit clinical signs of gonadal dysgenesis, while the balanced carriers are phenotypically normal. To our knowledge this represents the only example of both the balanced carrier state for an X translocation and its genetic consequence occurring in the offspring, as well as the involvement of X-16 interchange. Literature data of 37 additional cases of verified X translocations are discussed.