Morphometry of Proximal Femur in Indian Population.

INTRODUCTION: Total hip arthroplasty is a commonly performed surgery now-a-day. There are regional and racial variations in the stature of the population worldwide. So there is always need of population specific data for making best fit prosthesis. AIM: The present study was done to measure the parameters of proximal femur and to analyse their correlation by using standard statistical analysis. MATERIALS AND METHODS: Ninety one dry bones (44 left and 47 right) were used. Femur Head Diameter (FHD), Femur Neck Length (FNL), Femur Neck Diameter (FND), Femur Neck Thickness (FNT), Cervicodiaphyseal Angle (CDA) was directly measured with the help of anthropometric instruments. Femur Head Offset (FHO) and Vertical Offset (VO) were measured in the anteroposterior digital photographs. RESULTS: Normally distributed variables were compared using Student's t-test (Unpaired data) to analyse significant effect. There was a significant difference between right and left side of FND and CDA. Pearson correlation coefficient was used to analyse the relationship among variables. FHO had high correlation with the VO (0.687, p<0.001). CONCLUSION: These parameters can be used for designing the prosthesis and plates for hip joint reconstructive surgeries suitable for Indian population.

Dorsoscapularis triangularis: embryological and phylogenetic characterization of a rare variation of trapezius.

The muscle trapezius shows considerable morphological diversity. Variations include an anomalous origin and complete or partial absence of the muscle. The present study reported, a hitherto undocumented complete bilateral absence of the cervical part of trapezius. Based on its peculiar origin and insertion, it was named dorsoscapularis triangularis. The embryological, phylogenetic and molecular basis of the anomaly was elucidated. Failure of cranial migration of the trapezius component of the branchial musculature anlage to gain attachment on the occipital bone, cervical spinous processes, ligamentum nuchae between 11 mm and 16 mm stage of the embryo, resulted in this anomaly. A surgeon operating on the head and neck region or a radiologist analyzing a magnetic resonance imaging of the cervical region would find the knowledge of this morphological variation of trapezius useful in making clinical decisions.

Anatomical Consideration and Potential Complications of Coronary Sinus Catheterisation.

INTRODUCTION: Coronary venous catheterisation has been used for performing various cardiologic interventions. The procedure might become complicated due to obstruction offered by the valve of coronary sinus (Thebesian valve) the acute bend of the Great Cardiac Vein (GCV). The present study sought to expound the anatomical considerations of coronary venous catheterization and to elucidate the potential causes of obstruction and the complications of this procedure. MATERIALS AND METHODS: In this cross-sectional observational study, coronary sinus and GCV were dissected in 40, formalin fixed, adult cadaveric human hearts. Course, length, diameter and angle of bend of GCV, length of coronary sinus and its diameter at its ostium in right atrium were recorded. Thebesian valve morphology and percentage coverage of coronary sinus ostium was recorded. Relation of the coronary sinus and GCV with their neighbouring arteries was described. RESULTS: Coronary sinus: near its termination was directly related to the left atrium. Length: 35.35±4.43 mm (1 SD). Diameter: 11.75 ± 2.66mm. Diameter of CS ostium was more in hearts where Thebesian valve was absent. GCV travelled superficial or deep to the left diagonal artery and crossed circumflex artery superficially. Length: 96.23 ±22.52mm. Diameter: 5.99 ±1.02mm. Angle of bend: 107 ±6.74 degrees. Thebesian valve: Absent in 3 hearts. Various morphologies were observed: thin band, thin band with fenestrations, broad band with fenestrations, well developed semilunar valve (Thin/thick). In five hearts, valve covered more than 50% of coronary sinus ostium. CONCLUSION: Coronary sinus and GCV diameter will help cardiologists and cardiothoracic surgeons to choose an appropriate sized catheter and their length will decide the length of catheter advancement. Thebesian valve may cause obstruction to the catheter due to an extensive coverage of coronary sinus ostium, which is seen in 12.5% cases. The obtuse angle of GCV has to be negotiated in order to enter this vessel. Arteries lying deep to coronary sinus and GCV might be compressed leading to myocardial ischemia.

Anatomical considerations of percutaneous transvenous mitral annuloplasty: a novel procedure for treatment of functional mitral regurgitation.

Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1-6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.

Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver.

BACKGROUND: The pattern of drainage in the right posterior lobe of liver varies considerably. The knowledge of this variation is very important while performing various surgeries on the right posterior lobe. AIM: A study was conducted to see the variations in the pattern of drainage of posterior segment of the right lobe of liver. The aim was to see the variations of right hepatic vein and small accessory hepatic veins draining the posterior segment, the presence of which led to modifications in drainage of posterior segment. MATERIAL AND METHODS: Sixty formalin fixed adult human liver specimens were dissected manually. RESULTS: According to the pattern of drainage of tributaries of right hepatic vein, the right hepatic vein was classified into type I, type II, type III and type IV. According to presence of inferior right hepatic vein, three types of drainage of posterior lobe were seen: Type I, (76.36%) right hepatic vein was large, draining wide area of posterior segment. A small inferior right hepatic vein drained the small area of posterior segment. In Type II, (19.92%) both right hepatic and inferior right hepatic veins were medium sized draining the posteroinferior segment of the right lobe concomitantly. In Type III, (32%) accessory veins, the middle right hepatic vein drained the posterosuperior (VII) as well as the posteroinferior (VI) segment. In one specimen, there were numerous middle right hepatic veins draining the right posterior segment. The knowledge of anatomic relationship of veins draining right lobe, is important in performing right posterior segmentectomy. CONCLUSION: For safe resection of the liver, the complex anatomy of the distribution of the tributaries of the right hepatic vein and the accessory veins have to be studied prior to any surgery done on liver.

Obstructive Thebesian valve: anatomical study and implications for invasive cardiologic procedures.

Thebesian valve is the embryological remnant of the right sinoatrial valve, guarding the coronary sinus (CS) ostium. Advanced invasive and interventional cardiac diagnostic and management tools involve cannulation of the CS ostium. The presence of obstructive Thebesian valves has been reported to lead to unsuccessful cannulation of the CS. We studied the morphology of the Thebesian valve and CS ostium to assess the possible impact of these structures on invasive cardiological procedures. One hundred fifty randomly selected human cadaveric heart specimens fixed in 10% formalin were dissected in the customary routine manner. The Thebesian valves were classified according to their shape as semilunar/fenestrated/biconcave band like and according to their composition as membranous/fibromuscular/fibrous/muscular, and the extent to which the valve covered the CS ostium was also noted. An obstructive Thebesian valve that could interfere with the cannulation of the CS was defined as non-fenestrated (semilunar/biconcave band like) and non-membranous (fibromuscular/fibrous/muscular) valves covering >75% of the CS ostium. Thebesian valves were present in 118 (79%) heart specimens, of which 27 (18%) met the criteria of being obstructive. Semilunar was the most common type of Thebesian valve in terms of shape and was observed in 65 (65/118; 55%) hearts. This type was associated with the least mean craniocaudal (7.9±0.6 mm) and mean transverse (6.25±0.6 mm) diameters of the CS ostium. The mean craniocaudal diameter of the CS ostium (9.4±2.1 mm) was significantly larger (p=0.004) than the mean transverse diameter (7.15±1.5 mm) in specimens with Thebesian valves, and the cranial margin of the CS ostium was free from any attachment of the Thebesian valve in all the types observed (in terms of shape). Hence, attempts to direct the tip of the catheter toward the cranial margin of the CS ostium under direct vision may lead to successful cannulation of the same when conventional techniques have been unsuccessful because of the presence of an obstructive Thebesian valve.

Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study.

AIM: To determine whether maternal serum placental growth factor (PlGF) estimation in early second trimester (20-22 weeks of gestation) can predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction (IUGR). MATERIAL AND METHODS: A prospective cohort study was conducted on 722 women with singleton pregnancies, screened from the antenatal clinic, and serum PlGF levels were estimated at 20-22 weeks of gestation. A cut-off value of <155 pg/mL for serum PlGF was determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia and/or early onset IUGR. Preeclampsia and IUGR were classified as early onset when diagnosed by 32 weeks of gestation. Univariate logistic regression analysis was used to analyze the association between serum PlGF level <155 pg/mL and the two outcome measures (i.e. early onset preeclampsia and early onset IUGR) and odds ratio (OR) was computed. P-value < 0.05 was considered statistically significant. RESULTS: Maternal serum PlGF level <155 pg/mL at 20-22 weeks of gestation had a strong association with early onset preeclampsia (OR 8.35; 95% CI 1.79-18.94; P = 0.007) and with early onset IUGR (OR 10.73; 95% CI 4.08-20.23; P = 0.000). The sensitivity of serum PlGF < 155 pg/mL for predicting early onset preeclampsia and early onset IUGR were 82 and 84, respectively. CONCLUSION: Maternal serum PlGF level estimation in early second trimester (20-22 weeks of gestation) may be useful in predicting the occurrence of early onset preeclampsia and/or early onset IUGR.

Serum placental growth factor as a predictor of early onset preeclampsia in overweight/obese pregnant women.

The purpose of this study was to analyze whether maternal serum placental growth factor (PlGF) could predict early onset preeclampsia (<32 weeks of gestation) in overweight/obese pregnant women, and whether it could do it more effectively than in normal/underweight pregnant women. A prospective cohort study was conducted on 1678 pregnant women with singleton pregnancies, who were grouped as underweight, normal, overweight, and obese on the basis of body mass index, followed by serum PlGF estimation at 20 to 22 weeks of gestation. A cut-off value of <144 pg/mL for PlGF was determined by Receiver Operating Characteristic curve analysis to identify risk of early onset preeclampsia. Univariate logistic regression analysis revealed significantly stronger association between PlGF <144 pg/mL and early onset preeclampsia in overweight/obese pregnant women (odds ratio 7.64; 95% confidence interval 5.34-10.12; P = .000) than in normal/underweight pregnant women (odds ratio 2.95; 95% confidence interval 1.74-4.26; P = .007). Weight and PlGF levels in study women had a significant negative correlation (r = 0.663; P = .002). Serum PlGF in early second trimester could be an effective predictor of early onset preeclampsia in overweight/obese pregnant women and may be more effective than in normal/underweight pregnant women.

Right sided descending and sigmoid colon: its embryological basis and clinical implications.

Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.

Is serum placental growth factor more effective as a biomarker in predicting early onset preeclampsia in early second trimester than in first trimester of pregnancy?

PURPOSE: To determine whether maternal serum placental growth factor (PlGF) is more effective as a biomarker in predicting the occurrence of early onset preeclampsia in first trimester or early second trimester of pregnancy. METHODS: A prospective cohort study was conducted on women with singleton pregnancies, screened from the antenatal clinic. Serum PlGF estimation was done at 11-14 weeks of gestation on 1,244 women and at 22-24 weeks of gestation on 1,206 women from the initial study population. A cut-off value of <228 pg/ml for serum PlGF at 11-14 weeks of gestation and <144 pg/ml for serum PlGF at 22-24 weeks of gestation were determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia (<32 weeks of gestation). Univariate logistic regression analysis was used to analyze the association between serum PlGF < 228 pg/ml at 11-14 weeks of gestation and <144 pg/ml at 22-24 weeks of gestation with the occurrence of early onset preeclampsia and odds ratio (OR) was computed. P value < 0.05 was considered statistically significant in this study. RESULTS: Maternal serum PlGF <144 pg/ml at 22-24 weeks of gestation had a stronger association (OR 18.83; 95 % CI 12.08-22.24; p = 0.000) than serum PlGF <228 pg/ml at 11-14 weeks of gestation (OR 2.76; 95 % CI 1.29-3.94; p = 0.007) with the occurrence of early onset preeclampsia. The sensitivity and specificity of serum PlGF <144 pg/ml at 22-24 weeks of gestation (84 and 78, respectively) were much higher than those of serum PlGF <228 pg/ml at 11-14 weeks of gestation (58 and 66, respectively) in predicting early onset preeclampsia. CONCLUSION: Maternal serum PlGF may be more effective as a biomarker in early second trimester than in first trimester of pregnancy, in predicting the occurrence of early onset preeclampsia.

Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study.

Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso-planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63-0.92) and that of medio-lateral width was 0.78 (95% CI, 0.62-0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso-plantar thickness is >12.8 mm and medio-lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected.

Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study.

OBJECTIVE: To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20-22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia. STUDY DESIGN: Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20-22 weeks' gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05. RESULTS: Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3-7.2; p=0.000) and serum PlGF<188pg/ml (OR 3.6; 95% CI 1.95-6.5; p=0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF<188pg/ml at 20-22 weeks had a very poor association (OR 1.1; 95% CI 0.3-3.8; p=0.938) with the occurrence of pre-eclampsia, as the 95% CI values encompass 1 and p is >0.05. CONCLUSION: UADV and maternal serum PlGF estimation at 20-22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.

Serum PLGF as a potential biomarker for predicting the onset of preeclampsia.

PURPOSE: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality. Till date despite years of research into the condition, predicting the onset of preeclampsia remains a problem. Placental growth factor is one of the many angiogenic factors, which shows significant altered levels in preeclampsia compared to normal pregnancy. The present study aims to analyze whether estimation of serum PLGF levels in late second trimester can act as a predictor of preeclampsia. METHODS: A total of 150 nulliparous pregnant women admitted in antenatal wards or attending antenatal clinic were included in the study. They were divided into three groups: 30 women being normotensive and 60 each with diagnosed mild and severe preeclampsia, respectively. Serum samples collected from the study groups were subjected to ELISA, and serum PLGF level was calculated in all the samples. RESULTS: Mean serum PLGF levels were found to be significantly low in mild and severe preeclampsia as compared to normal pregnancy. Serum PLGF levels were highest at 26-28 weeks and were lowered at 28-30 and 30-32 weeks of gestation within each of the three study groups. Cutoff value of serum PLGF levels for predicting mild and severe preeclampsia was calculated statistically from the analyzed data. CONCLUSION: Estimation of serum PLGF levels at 26 weeks of gestation in nulliparous pregnant women can be used as a screening test to identify women at risk for the development of preeclampsia with very high sensitivity.

Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study.

OBJECTIVES: To determine the association between PlGF (placental growth factor) estimation in early second trimester (22-24weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage. STUDY DESIGN: A prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24weeks of gestation and a cut-off value of <122pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05. MAIN OUTCOME MEASURES: Proportion of study population developing postpartum hemorrhage. RESULTS: Logistic regression analysis showed the association of serum PlGF <122pg/ml at 22-24weeks (Odds ratio 8.9516; 95% CI, 5.0728-15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573-4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant. CONCLUSION: Maternal serum PlGF level <122pg/ml at 22-24weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.

Communication between median and musculocutaneous nerves in the forearm hooking around the origin of the median artery: a rare variation.

Variations of the musculocutaneous and median nerves at the level of axilla and arm are well described in the literature. We encountered a rare variation during dissection in undergraduate medical classes. The left arm of a 55-year-old male cadaver showed a communicating nerve arising from the musculocutaneous nerve 10.6 cm above the cubital fossa. This nerve joined the median nerve 4.6 cm distal to the elbow joint in the forearm after winding around a persistent median artery arising from the ulnar artery. Such communication between musculocutaneous and median nerves in the forearm is a very rare finding.

Incidence, morphology and clinical relevance of bony canals and vascular grooves in the paracondylar region of adult human skulls.

Most features of the skull are well described in standard anatomy textbooks. There may, however, be variations in the form of minor grooves, canals and foramina that merit documentation. In the present study, morphological diversity in the form of osseous tunnels was seen adjacent to the occipital condyles. These canals were present in the paracondylar region (lateral to the occipital condyle) and are therefore termed paracondylar canals. A total of 304 dry adult human skulls (608 sides) of Indian origin were examined and paracondylar canals were found in 59 of these. Thirty-six (11.8%) were bilateral and 23 (7.6%) unilateral. Vascular grooves were found leading to the canals in 52 sides (15.8%). This may result from normal developmental processes and could be a peculiarity confined to the Indian population, as it has not been reported previously. This variant may serve as a valuable anthropological marker. The results of surgical procedures in this area, such as the paracondylar approach (which is directed through the area lateral to the occipital condyles) and the far lateral supracondylar approach, could be impacted upon by this variation.

The role of aspirin versus aspirin and heparin in cases of recurrent abortions with raised anticardiolipin antibodies.

BACKGROUND: The present study was undertaken to compare the role of aspirin versus aspirin plus heparin combination in pregnant women with poor obstetric history and raised anticardiolipin antibodies IgG (IgG(acl)). MATERIAL/METHODS: The study was conducted on 550 pregnant women, 450 with a history of two or more spontaneous abortions forming the study group, while 100 women with one or more live births and no history of abortion were controls. Their blood was tested to assess the level of IgG(acl) by enzyme-linked immunosorbent assay (ELISA). The test was strongly positive in 72 (16%) patients of the study group, who were randomized to receive either low-dose aspirin (80 mg/day) or a combination of low-dose aspirin (80 mg/day) and 5000 IU of unfractionated heparin subcutaneously 12 hourly under hospital surveillance. The pregnancy outcomes were statistically compared. RESULTS: Of the 39 patients treated with low-dose aspirin, 24 (61.5%) gave birth to live issues compared with 28 (84.8%) of the 33 women given a combination of aspirin and heparin (p<0.05), an overall success rate of 72.2%. Mean birth weight of the babies given treatment with heparin and aspirin was 3.21+/-0.33 kg compared with 2.77+/-0.14 kg achieved with aspirin alone (p<0.001). Both treatments were well tolerated. CONCLUSIONS: The study provides evidence that in cases of recurrent abortions with raised IgG(acl), treatment with a combination of aspirin and heparin showed better outcome than treatment with aspirin alone.

Prevalence of anticardiolipin antibody IgG in recurrent first trimester abortions and the role of aspirin in its prevention.

BACKGROUND: Approximately 10% of all human pregnancies end in spontaneous abortions. In the majority of such cases the etiology remains unknown, but anticardiolipin antibodies are gaining recognition as potential causes of recurrent miscarriage. MATERIAL/METHODS: The prevalence of anticardiolipin antibody IgG (IgGacl) in 60 pregnant patients with recurrent first trimester abortions and 60 pregnant controls of comparable age with no history of abortion were examined to find a possible relation between IgGacl and spontaneous abortion. The assay for IgGacl was done by Enzyme Linked Immunosorbent Assay (ELISA). Positive test results were considered 'strongly elevated' with IgGacl levels exceeding 36 GPL units. Aspirin (80 mg per day) was prescribed for patients with recurrent first trimester abortion and strongly elevated levels of IgGacl. RESULTS: Strongly elevated levels of IgGacl were detected in a total of 18 patients (30%) with recurrent abortions, and none of the controls (p<0.001). Of all the patients with strongly elevated levels, 16 patients had unexplained abortions and 2 had explicable abortions. The relative risk for strongly elevated IgGacl was 3.78. These 16 patients with unexplained abortions were treated with aspirin, 80 mg per day, and a successful pregnancy outcome was observed in 10 patients, while 2 patients were in the third trimester of pregnancy. CONCLUSIONS: IgGacl is strongly associated with first trimester recurrent abortions and increases the risk approximately 4-fold. Aspirin is beneficial in patients with recurrent first trimester abortions and strongly elevated levels of IgGacl.