F.J. Rodriguez-Escudero

Human immunodeficiency virus—induced immunosuppression: A risk factor for human papillomavirus infection

In a group of 92 women with genital condylomata, 15 (16.3%) human immunodeficiency virus-positive patients were found, whereas no case was detected in a control group of 100 women. The relative risk was greater than 19.28. Human immunodeficiency-positive status was associated with other parameters: lower age and parity, major frequency of induced abortions, and sexually transmitted diseases. Thus although human immunodeficiency-positive status seems to be a true risk factor in relation to the altered immunologic state, an indirect association cannot be discarded. Such patients should be screened closely for human papillomavirus infection and cervical cancer. Among human immunodeficiency-positive women, a more resistant behavior of human papillomavirus-associated lesions was detected (recurrence-persistence of 41.7% versus 12%), a fact that might also be in relation to the immunodepressed status.

Variations in Estrogen and Progesterone Receptor Levels after Short-Term Tamoxifen Treatment in Breast Carcinoma

The modification of estrogen and progesterone receptor status was prospectively studied in mammary carcinoma after short-term (7 days) administration of tamoxifen citrate (30 mg/day). Seventeen patients fulfilled the stringent criteria required for final evaluation. Tamoxifen was administered to them immediately prior to surgery and receptor status was studied on the surgical specimen. Estrogen receptor levels were significantly (p < 0.05) decreased after treatment, whereas progesterone receptors remained statistically unaltered, although they showed a tendency towards significant increase (p = 0.12). Following these results, short-term tamoxifen treatment seems inadequate for the induction of significant levels of progesterone receptors in mammary carcinoma.

Pruritic urticarial papules and plaques of pregnancy

The authors present a rare case of pruritic urticarial papules and plaques of pregnancy in a 25‐year‐old caucasian primigravida admitted to our department because of pruritus in the third trimester of gestation. Recommendations for management are discussed.

Angiosarcoma of the breast and pregnancy : a new therapeutic approach

A case of angiosarcoma of the breast managed primarily by a chemotherapeutic approach is referred. A 29-year-old patient presented complaining of a painful mass in her right breast. An incisional biopsy carried out under general anesthesia showed a moderately-differentiated angiosarcoma surrounded by fibrofatty tissue. Ruled out distant metastases, a decision was made to initiate neoadjuvant chemotherapy consisting of ifosfamide, vincristine and dactinimycin. After 2 courses of chemotherapy the tumor volume was reduced by 50% and the histologic examination of the mastectomy specimen revealed a well-differentiated angiosarcoma with widespread areas of necrosis probably produced by previous chemotherapic treatment. The patient is clinically free of disease after 24 months of follow-up. Although this is a single case report, and by no means can be considered a guideline for future treatments, we nevertheless feel that the result obtained with the chemotherapeutic approach with this patient is encouraging.

Monitoring endometrial adenocarcinoma with a four tumor marker combination: CA125, squarnous cell carcinoma antigen, CA19.9 and CA15.3

The combined value of four tumor markers, in the follow‐up of endornetrial adenocarcinoma, is analyzed. Cancer antigen 125 (CA 125), squamous cell carcinoma antigen (SCC), carbohydrate antigen 19.9 (CA 19.9) and carbohydrate antigen 15.3 (CA 15.3) were used in 213 evaluations from 105 patients. Sensitivity as regards recurrence or progression of disease was 45% (CA125), 9% (SCC), 51% (CA19.9) and 21% (CA 15.3). Specificities as regards the ‘no evidence of disease’ ranged from 95% to 99%. Single tumor marker efficiency ranged from 90% for CA 125 to 84% for SCC (p = 0.08). With the two tumor marker combination sensitivity increased up to 77% achieved with CA 125‐CA 19.9, but efficiency increased only slightly (92.0% for CA 125‐SCC). In the best three tumor marker combination, a sensitivity of 85% was achieved (CA 125‐CA 19.9‐CA 15.3), and an efficiency of 92.2%. The simultaneous use of the four tumor markers did not improve assay results. The possibility of recurrence or progression of disease in some combinations was very low (4.6% when CA 125 and CA 19.9 negative, 3% when CA125, CA 19.9 and CA15.3 negative), a fact to be considered in order to avoid aggressive management in such cases. The tumor markers were of limited value for the prediction of recurrences. The suggestion of recurrence when the increase in tumor markers was the only finding was confirmed in only 7%, while confirmation was made in 100% when there was another pathological finding.

Repeat pregnancy associated with cardiac pacemaker

Two pregnancies in a patient with a fixed‐rate pacemaker are reported. The first pregnancy was uneventful. The second had no maternal complications either. A moderate tachysystolia was detected during the second period. The newborn was delivered with forceps applied under spinal anesthesia. Newborn infant evolution presented no hazards, but umbilical cord analysis revealed a severe acidosis, in spite of a normal scalp analysis 45 min earlier. Epidural anesthesia is recommended for such patients.

True knots in the umbilical cord: Clinical findings and fetal consequences

SummaryEighty-seven singleton pregnancies with true knots in the umbilical cord were studied, together with a control group. Associated factors were multiparity (62 versus 46 per cent), long cords (7 versus 2 per cent) and the presence of nuchal cords (48 versus 26 per cent). The total incidence of umbilical cord knots was 0–68 per cent of deliveries.Umbilical cord knots were not found to be associated with fetal distress in terms of Apgar scores, or umbilical cord blood analysis. Fetal heart tracings were comparable in both the study group and the control group. Perinatal mortality and neonatal morbidity were also similar in the two groups.In general true knots in the umbilical cord do not have significant repercussions on fetal wellbeing.

Spontaneous Pregnancy in Couples Waiting for Artificial Insemination Donor Because of Severe Male Infertility

OBJECTIVEnTo assess the spontaneous fertility in couples with severe seminal conditions while waiting for artificial insemination donor.nnnSTUDY DESIGNnProspective follow-up during a period of 24 months.nnnSETTINGnUniversity Medical School.nnnPARTICIPANTSnThere were 285 couples in which the male had a very severe seminal pathology: 166 azoospermia, 86 oligozoospermia and 33 severe asthenozoospermia.nnnOUTCOME MEASURESnPregnancy rates after being included on waiting list.nnnRESULTSnThe spontaneous pregnancy rate was 3.2% (9/285), per month spontaneous pregnancy rate being 0.13%. Spontaneous pregnancy rate was 0% in azoospermia (0/166). versus 7.6% (9/119) in non-azoospermia cases. Spontaneous pregnancy rate was 8.5% (4/47) in the group with less than 0.1 million motile sperm/cc, 6.5% (3/46) in the group between 0.1 and 1 million/cc and 7.7% (2/26) in the group with 1-2 million/cc.nnnCONCLUSIONnIn a 2-year follow-up, pregnancy rate among non-azoospermic couples before undergoing artificial insemination was 7.6%. Extramatrimonial pregnancy (based on anamnesis and sperm analysis) seemed to be uncommon. Even in cases with less than 0.1 million of motile sperm/cc there was not a negligible spontaneous pregnancy rate.

Prognostic factors in the management of donor insemination. Analysis of 3227 cycles

SummaryINTRODUCTIONDonor insemination is an accepted method to achieve pregnancy in couples with a male factor infertility or when genetic anomalies are found in the husband. John Hunter was the first to document an artificial insemination in 1799, for a husband with hypospadias. Donor insemination for the treatment of infertile couples with severe male factors has been available since the late 1970s in Spain. During the time 1978 to 1989 we have treated 796 infertile couples. Since 1985 other treatments have been available in our department, decreasing the number of patients requiring donor insemination.