Three Cases of Severe Placental Abruption as a First Symptom of Preeclampsia.

Placental abruption is often referred to in the literature as a complication of preeclampsia. We report 3 recent cases where the first symptom of preeclampsia was placental abruption. All women were previously healthy and in their first ongoing pregnancy. All had been seen by obstetricians for regular pregnancy checkups. None of the patients had a preexisting diagnosis of preeclampsia. Only one of the patients had risk factors for preeclampsia and occasional hypertension. In all cases, laboratory signs of preeclampsia were abnormal intra- or immediately postpartum. One fetus died in utero, and the other two pregnancies fortunately showed a favourable outcome.

District health board of residence, ethnicity and socioeconomic status all impact publicly funded insulin pump uptake in New Zealand patients with type 1 diabetes.

AIMS: Insulin pump therapy (CSII) is becoming increasingly common for those living with type 1 diabetes (T1D), and has been publicly funded in New Zealand since 2012. The aim of the current study was to examine national uptake of publicly funded pumps from 2012 to 2016, with a focus on the proportion of patients using pumps analysed according to district health board (DHB) as well as demographic characteristics. METHODS: Data from nationally held data collections including the New Zealand Virtual Diabetes Register were used to calculate the overall and subgroup proportions using pumps. Logistic regression analysis was then used to estimate the independent contributions of DHB of residence and sociodemographic characteristics to variations in pump use. RESULTS: Between 2012 and 2016, CSII for those living with T1D (n=17,338) increased from 1.6 to 11.3% overall. However, speed of uptake differed by DHB of residence, ethnicity, degree of deprivation, age and gender. A four-fold difference in uptake between highest and lowest using DHBs was seen after adjusting for known confounders. CONCLUSIONS: From 2012 to 2016 there has been a steadily increasing uptake of CSII. Despite publicly funded access, disparities in use appear to exist, including by DHB of residence as well as traditionally described socio-demographic barriers to healthcare. Efforts to understand and reduce these disparities are required.

Pregnancy Complicated by Maternal MODY 3 and Paternal MODY 2 Diabetes and Subsequent Rapidly Falling Insulin Requirement.

Background. 'Maturity-Onset Diabetes of the Young' (MODY) or monogenic diabetes accounts for approximately 1-2% of diabetes and is frequently misdiagnosed as type 1 or type 2 diabetes. Here we report a case of a 19-year-old pregnant woman with a MODY 3 diabetes expecting a child to a father with MODY 2 diabetes. Possible inheritance scenarios are described and the implications of these scenarios on the pregnancy and infant are discussed. In addition, the pregnancy was complicated by drastically falling insulin requirements in the mother in the 3rd trimester as well as preterm labour and delivery at 33+4 weeks of gestation.

A 41-Year-Old Patient with a Rare Cause of Severe Abdominal Sepsis Misdiagnosed as PID.

Infectious pelvic inflammatory disease is a common condition and a frequent cause of abdominal pain in a young female patient. In a patient who has not completed family planning, the diagnosis is often made with a low threshold and treatment started on a low suspicion of diagnosis to avoid a negative impact on fertility. Here, we present a case of a 41-year-old woman who was misdiagnosed with infectious pelvic inflammatory disease and treated ineffectively with antibiotics when the underlying condition of her persistent abdominal pain was a midgut neuroendocrine tumor that had caused bowel perforation and formation of an abscess in the pouch of Douglas.

21-Year-Old Pregnant Woman with MODY-5 Diabetes.

The term "Maturity-Onset Diabetes of the Young" (MODY) was first described in 1976 and is currently referred to as monogenic diabetes. There are 14 known entities accounting for 1-2% of diabetes and they are frequently misdiagnosed as either type 1 or type 2 diabetes. MODY-5 is an entity of monogenic diabetes that is associated with genitourinary malformations and should be considered by obstetricians in pregnant women with a screen positive for diabetes, genitourinary malformations, and fetal renal anomalies. Correct diagnosis of monogenic diabetes has implications on managing patients and their families. We are reporting a case of a 21-year-old pregnant woman with a bicornuate uterus, fetal renal anomalies, and a family history of diabetes that were suggestive of a MODY-5 diabetes.

Direct crosstalk between cancer and osteoblast lineage cells fuels metastatic growth in bone via auto-amplification of IL-6 and RANKL signaling pathways.

The bone microenvironment and its modification by cancer and host cell interactions is a key driver of skeletal metastatic growth. Interleukin-6 (IL-6) stimulates receptor activator of NF-κB ligand (RANKL) expression in bone cells, and serum IL-6 levels are associated with poor clinical outcomes in cancer patients. We investigated the effects of RANKL on cancer cells and the role of tumor-derived IL-6 within the bone microenvironment. Using human breast cancer cell lines to induce tumors in the bone of immune-deficient mice, we first determined whether RANKL released by cells of the osteoblast lineage directly promotes IL-6 expression by cancer cells in vitro and in vivo. We then disrupted of IL-6 signaling in vivo either via knockdown of IL-6 in tumor cells or through treatment with specific anti-human or anti-mouse IL-6 receptor antibodies to investigate the tumor effect. Finally, we tested the effect of RANK knockdown in cancer cells on cancer growth. We demonstrate that osteoblast lineage-derived RANKL upregulates secretion of IL-6 by breast cancers in vivo and in vitro. IL-6, in turn, induces expression of RANK by cancer cells, which sensitizes the tumor to RANKL and significantly enhances cancer IL-6 release. Disruption in vivo of this auto-amplifying crosstalk by knockdown of IL-6 or RANK in cancer cells, or via treatment with anti-IL-6 receptor antibodies, significantly reduces tumor growth in bone but not in soft tissues. RANKL and IL-6 mediate direct paracrine-autocrine signaling between cells of the osteoblast lineage and cancer cells, significantly enhancing the growth of metastatic breast cancers within bone.