Frederick W. McLean

Expression of matrix metalloproteinase (MMP-1) and tissue inhibitor of MMP in serosal tissue of intraperitoneal organs and adhesions

OBJECTIVE To compare expression of matrix metalloproteinase (MMP-1) and tissue inhibitor of MMP (TIMP-1) in serosal tissue of intraperitoneal organs and adhesions. DESIGN Prospective and cross-sectional study. SETTING Academic research centers. PATIENT(S) Patients undergoing abdominal or pelvic surgery. INTERVENTION(S) MMP-1 and TIMP-1 expression. MAIN OUTCOME MEASURE(S) Expression of messenger ribonucleic acid (mRNA) and protein was measured by using quantitative reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay. RESULT(S) Serosal tissue of intraperitoneal organs and adhesions express MMP-1 and TIMP-1 mRNA and protein at levels that are consistently varied with 10- to 10,000-fold and 2- to 10-fold higher TIMP, mRNA and protein, respectively. Parietal peritoneum, fallopian tubes and ovaries express higher MMP-1 mRNA levels compared with uterus and adhesions; the lowest expression is found in small and large bowels, subcutaneous tissue. and omentum. Expression of TIMP-1 mRNA was less variable; the highest level was found in the uterus and the lowest in subcutaneous tissue and small bowels. There was less variability in MMP-1 and TIMP-1 protein content than mRNA expression; ovaries and adhesions contained the highest MMP-1 and TIMP-1 levels, respectively, and peritoneum contained the lowest. The MMP-1 and TIMP-1 content and ratios further indicate limited MMP-1 proteolytic activity. Although tissues from premenopausal women express more MMP-1 and TIMP-1, expression did not differ by sex or age. CONCLUSION(S) Because MMP-1 and TIMP-1 expression varies consistently among the serosal tissues of peritoneal organs and adhesions, and because tissue injury alters their expression, site-specific variations in expression of these substances may predispose a particular organ to develop more adhesions.

Relationship between the oral contraceptive and folic acid metabolism: serum folate concentrations.

Abstract A study of women who developed severe megaloblastic anemia while receiving oral contraceptive agents prompted a hematologic investigation of individuals taking such drugs. A group of patients receiving two different oral contraceptives has been evaluated and compared to a control series. No subjects became folate deficient. There does not appear to be any significant relationship between the duration of therapy and the serum folate level. The exact interaction between folic acid and estrogen remains to be determined.

Normal Fetus After Cytosine Arabinoside Therapy

Excerpt To the editor: Cytosine arabinoside (ARA-C) induces remissions in a significant number of patients with acute granulocytic leukemia (1-3). Although there are observations on the effects of ...

Angiomyofibroblastoma of the vulva: a case report of a pedunculated variant and review of the literature.

Objective Angiomyofibroblastoma (AMF) is a benign mesenchymal tumor usually found in the vulva. We reviewed 70 cases of vulvar AMF that have been reported in the English-language literature and report 1 case of a pedunculated variant. Our case brings the total reported to 71 and is only the fourth pedunculated variant reported. Methods This 50-year-old woman presented to our gynecology clinic with a 1-year history of a left labial mass. It began as pea-sized, and rapidly grew to 12 cm in diameter. Physical examination demonstrated a 12-cm pedunculated soft mass arising from the left labia majora. The clinical diagnosis was aggressive angiomyxoma, and a simple excision was performed. The final pathology demonstrated AMF. The patient remains free from tumor at 4 years of follow-up. Results Seventy-one cases were summarized. The mean age at presentation was 45 years. The lesions were equally distributed between the left (52%) and right (48%). The most common clinical diagnosis was a Bartholin gland cyst (46%) or lipoma (15%). The mean duration of the lesion before seeking treatment was 29 months, and the mean diameter at presentation was 5.9 cm. All of the patients were treated with simple excision. The mean duration of follow-up was 37 months. There was 1 report of sarcomatous transformation 2 years after initial treatment. Conclusions Angiomyofibroblastoma is a rare benign tumor that most often occurs in the vulva. Differential diagnosis may include aggressive angiomyxoma, Bartholin cyst, or lipoma. The treatment of choice is simple total excision, which is usually curative.

Vulvar lymphangioma circumscriptum: a report of 3 cases, 2 associated with vulvar carcinoma and 1 with hidradenitis suppurativa.

Vulvar lymphangioma circumscriptum is a rare, benign proliferation of the lymphatic system that presents a diagnostic and management challenge. It may be confused with condyloma acuminata, molluscum contagiosum, or other vulvar disorders. Treatment options include observation, surgical excision, laser ablation, or sclerosing therapy. We report 3 cases, 2 associated with vulvar squamous cell carcinoma and 1 with hidradenitis suppurativa.

Ferrokinetics in pregnancy: I. Fetus and newborn

Abstract Ferrokinetic studies of the goat fetus in utero are presented and are compared to studies in the newborn goat at 24 and 48 hours of age. The hematocrit, serum iron, and plasma iron disappearance half-time have been determined. Based on the observation of a markedly elevated serum iron concentration and shortened radio iron disappearance in the fetus, the major finding is that of a greatly increased plasma iron turnover of the fetus in utero as compared to that of the newborn goat.

Vaginal Bleeding Due to an Infantile Hemangioma in a 3-Year-Old Girl

BACKGROUND Infantile hemangiomas may cause vaginal bleeding in prepubescent girls. CASE A 3-year-old girl was referred for evaluation of painless vaginal bleeding. Her initial evaluation was nondiagnostic. The girls physical examination was remarkable only for an infantile hemangioma of her right hand. A vaginoscopy was performed and a hemangioma of the anterior vaginal wall was identified. The patient was managed conservatively. Her bleeding has decreased in amount and frequency. SUMMARY AND CONCLUSION Infantile hemangiomas are a potential cause of vaginal bleeding in young girls and should be suspected if a child has a hemangioma on another part of their body. Most infantile hemangiomas resolve without therapy.

Lack of pathologic clot lysis following gynecologic surgery

Abstract Blood samples from 34 patients who had been subjected to gynecologic surgery were studied to determine if increased fibrinolytic activity was present within the immediate postoperative period. As measured by the whole blood clot lysis time and the thrombin time, there is no change elicited in the fibrinolytic system within two hours after surgery. Any alteration in either the whole blood clot lysis time or the thrombin time in the postoperative period cannot be attributed to the procedure itself. There was a tendency toward delayed clot lysis in a small number of patients undergoing dilatation and curettage. However, this is of no clinical significance.