Cheryl K. Walker

Human fetal antibody-dependent cellular cytotoxicity to herpes simplex virus-infected cells

ABSTRACT: Human fetal antibody-dependent cellular cytotoxicity (ADCC) has not been reported previously. Most investigations have failed to document any cytolytic activity among fetal lymphocytes. The purpose of this study was to investigate ADCC activity in the human fetus and identify and characterize the effector cell populations in the fetus. Fetal spleen cells were separated into single-cell suspensions and assayed with 51Cr-labeled herpes simplex 1-infected Chang liver target cells. Significant ADCC activity was detected in 19 of 26 (73%) of freshly assayed fetal spleen cell preparations from fetuses of 17–24 wk gestational age. This activity, however, was significantly less than concurrently run adult peripheral blood mononuclear cells. After plastic adherence the fetal spleen ADCC activity from nonadhcrent cells was not significantly different from whole spleen preparations. Surprisingly, ADCC activity in nonadherent fetal cells dropped signifi- cantly after exposure to latex beads, an effect not seen in nonadhcrent adult lymphocytes. Thus, either fetal monocyte-derived (macrophages) fetal spleen cells do not efficiently adhere to plastic or a unique nonadherent population of latex-sensitive immunocytcs is capable of mediating ADCC activity in the fetus. We suspect the former conclusion to be the more plausible; however, fluorescence-activated cell sorter staining of fetal cells was not sufficient to confirm these suspensions by fluorescence-activated cell sorter analysis.

Pregnancy and pediatric HIV infection

An estimated 1 million individuals in the United States are infected with the human immunodeficiency virus. Over 200,000 acquired immunodeficiency syndrome cases have been reported to the Centers for Disease Control as of January 1992. While only 10% of reported cases have been in women, this proportion is steadily growing. Among women with acquired immunodeficiency syndrome, over 80% are of reproductive age. Thus, great concern has been raised over perinatal transmission of human immunodeficiency virus, which is the major cause of pediatric acquired immunodeficiency syndrome.

Pelvic inflammatory disease: Key treatment issues and options

among whites and more common among formerly married women than among those currently married. Design We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. Sample The survey was conducted with a multistage probability sample of 8450 women. Results The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. Conclusion PID is still a widely prevalent condition among American women; PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae.

Diagnosing pelvic inflammatory disease: A comprehensive analysis and considerations for developing a new model

OBJECTIVEn--To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model.nnnDATA SOURCESn--Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed.nnnSTUDY SELECTIONn--Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis, and other measures.nnnDATA EXTRACTIONn--Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data. Data were classified by quality rating.nnnDATA SYNTHESISn--Historical findings were usually not statistically significant predictors of pelvic inflammatory disease, and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously.nnnCONCLUSIONSn--No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators.

Anti-infective drugs in obstetrics and gynecology

Prophylactic and therapeutic options for reproductive infections are continually shifting. In this review, highlights from the recent literature of anti-infective drugs in obstetrics and gynecology are presented. Several articles offer new insights into the basic pathophysiology of common infections. Others provide novel strategies in prophylaxis for women with recurrent infections and for those undergoing surgical procedures. In the therapy arena, refinements in dosing schedules favor lower doses and shorter courses for some infections. Intriguing data regarding infrequently discussed infectious processes are presented. Finally, as new, more sophisticated agents flood the market, they are compared against the gold standards of treatment.

Chlamydia trachomatis infection and pregnancy outcome

in connection with termination of pregnancy induced in 23 women by sulprostone, a derivative of prostaglandin Esub 2. A rapid decrease in PRA was observed during and after infusion of 1000 mug or 1500 mug sulpostrone. PRA returned to the initial values at 24 h after drug administration. The lowest levels of PRA were 36% and 51% of the initial values (P < 0.001) in the two drug concentration groups. No significant changes were observed in the control group. The value for plasma CAMP did not correspond completely to the changes in PRA. Serum concentrations of oestradiol, progesterone and chorionic gonadotrophin showed a gradual decrease during drug administration. The changes in serum potassium, sodium and calcium were minimal. The decrease in PRA associated with sulprostone is very surprising. Our finding elucidates in part the still rather poorly known mechanism and function of renin-angiotensin system in pregnancy.