Khalil A

A familial case of recurrent hydatidiform molar pregnancies with biparental genomic contribution.

Hydatidiform mole is a benign trophoblastic neoplasia characterized by an abnormal development of the embryo and proliferation of placental villi. Using microsatellite markers amplified by the polymerase chain reaction, we have performed a genetic study on eight independent molar tissues occurring in two sisters. Karyotype and genotype data demonstrate a diploid and biparental constitution in seven of the analyzed moles suggesting a common mechanism underlying the etiology of the various molar pregnancies in this family. The data reported here suggest that complete and partial hydatidiform moles are not always separate entities and that women with familial recurrent hydatidiform moles are homozygous for an autosomal recessive mutation.

Ocular toxicity in low-dose tamoxifen: a prospective study

Purpose To look at the incidence, symptomatology, course and reversibility of low-dose tamoxifen ocular toxicity.Methods Sixty-five women with breast cancer, on tamoxifen oral therapy (20 mg/day), and a totally normal eye examination, were prospectively followed up. A full ophthalmic evaluation was done every 6 months, for a median of 30 months (range 4-79 months). Any sign of toxicity in the cornea, lens, retina or optic nerve was looked for, whether associated with a change in visual acuity or not.Results Ocular toxicity was documented in 8 patients, giving an incidence of 12%. Seven patients had keratopathy in the form of subepithelial deposits, whorls and linear opacities. Three of these patients had a concurrent symptomatic bilateral pigmentary retinopathy that warranted discontinuation of therapy. One patient developed bilateral optic neuritis that left her with optic nerve pallor and a decrease in vision. The patients who had the toxicity had a significantly higher tamoxifen cumulative dose (p = 0.03), and were longer on treatment (p = 0.04), than the non-affected ones. The keratopathy changes were reversible upon discontinuation of the drug.Conclusion Prompt reporting of symptoms and yearly ophthalmic examinations are mandatory in patients on tamoxifen to detect toxic effects while these are still reversible.

Recurrent molar pregnancies in a family with extensive intermarriage: Report of a family and review of the literature

Background Familial recurrent molar pregnancies are exceedingly rare. The genetic basis for recurrent moles is not well understood, and its association with major human lymphocytic antigen histocompatibility is debatable. The purpose of this report is to present a family with extensive intermarriage and recurrent molar pregnancies with some emphasis on the result of the human lymphocytic antigentyping. Case Two sisters, both married to first-degree cousins, had three and five pathologically confirmed molar pregnancies, respectively. A second-degree cousin, also married to her first-degree cousin, is also reported to have had five consecutive moles. Chromosomal analysis and human lymphocytic antigen-typing on the two sisters and their spouses was performed. Human lymphocytic antigen-typing was compared to a cross-sectional sample of our population. This showed a high incidence of unusual human lymphocytic antigens in these family members. Conclusion In families with extensive intermarriage and recurrent molar pregnancies, patients and their spouses may have unusual human lymphocytic antigen histocompatibility, which supports the possibility of a strong genetic predisposition expressed at the level of major histocompatibility class I and li gene translation.

Fetal Macrosomia (≥4500 g): Perinatal Outcome of 231 Cases According to the Mode of Delivery

OBJECTIVE: To determine perinatal complications in infants ≥4500 g according to delivery mode.STUDY DESIGN: Records of 231 mothers and live cephalic infants weighing ≥4500 g over a 13-year period were retrospectively reviewed. Maternal and perinatal complications were compared in relation to delivery mode.RESULTS: Vaginal delivery (NVD) was achievable in 168/189 (88.9%) of women allowed to labor, of which 36.9% were operative. The cesarean delivery (CS) rate was 27.3%. The NVD group had a lower incidence of diabetes; however, hypoglycemia and transient tachypnea were more common in the CS group. The frequency of low Apgar scores at 1 and 5 minutes was similar in both groups. A total of 13 (7.7%) major fetal injuries were documented in the NVD group (arm weakness 3, hematoma 3, clavicular fracture 2, and brachial plexus injury 5). Shoulder dystocia was documented in only 7/13 (53.8%).CONCLUSION: Vaginal delivery is achievable in 88.9% of pregnancies with infants ≥4500 g allowed to labor, at the expense of a 7.7% risk of perinatal trauma.

A randomised comparison of patient satisfaction with vaginal and sublingual misoprostol for induction of labour at term

Objective  To compare patient satisfaction with two routes of misoprostol for term labour induction.

Two dose regimens of nifedipine for management of preterm labor: a randomized controlled trial.

We compared two dose regimens of tocolytic oral nifedipine. Women with singleton pregnancies admitted in preterm labor (24 to 34 weeks) were randomized to high-dose (HD) nifedipine ( N = 49; 20 mg loading dose, repeated in 30 minutes, daily 120 to 160 mg slow-release nifedipine for 48 hours followed by 80 to 120 mg daily until 36 weeks) or low-dose (LD) nifedipine ( N = 53; 10 mg, up to four doses every 15 minutes, daily 60 to 80 mg slow-release nifedipine for 48 hours followed by 60 mg daily until 36 weeks). Uterine quiescence at 48 hours (primary outcome); delivery at 48 hours, 34 and 37 weeks; and recurrent preterm labor were similar. Gestational age at delivery was higher in HD (36.0 +/- 2.8 versus 34.7 +/- 3.7 weeks, P = 0.049). Rescue treatment was needed more in LD (24.5 versus 50.9%, odds ratio = 0.3; 95% confidence interval 0.1 to 0.7). Maternal adverse effects, birth weight, intensive care nursery admission, and composite neonatal morbidity were similar. However, neonatal mechanical ventilation was needed less and nursery stay was shorter in HD. HD nifedipine does not seem to have an advantage over LD in achieving uterine quiescence at 48 hours. Further studies should address the optimal dose and formulation of tocolytic nifedipine.

Laparoscopic Unwinding and Cystectomy of Twisted Dermoid Cyst During Second Trimester of Pregnancy

A woman in the sixteenth week of pregnancy experienced acute abdominal pain, and magnetic resonance imaging suggested a dermoid cyst. Laparoscopic unwinding and cystectomy of the twisted cyst was performed successfully.

Tamoxifen and ovarian cysts: a prospective study.

PURPOSE To prospectively follow a group of women with breast cancer on tamoxifen for the development of ovarian cysts. METHODS 72 women were followed every 6 months with pelvic examination and vaginal ultrasound. Chi square and Students t-test were used for statistical analysis. RESULTS The duration of treatment was 31.5+/-20 months. The mean age was 51.2+/-9.8 years. 55.6% were post-menopausal. Out of 72 women, 18 (25%) developed ovarian cysts. The mean age of women who developed ovarian cysts was significantly lower than in those who did not (47.0+/-7.0 and 52.5+/-10.2 years, respectively, P=0.03), however, the mean duration of treatment was not significantly different (33.3+/-17.4 and 29.3+/-20 months, respectively, P=0.45). Out of 32, 14 (43.8%) pre-menopausal and out of 40, 4 (10%) post-menopausal women developed ovarian cysts (P=0.003). They developed the cysts after an average duration of 33.3+/-18 and 50.7+/-6.2 months, respectively (P=0.7). The average diameter of the cysts was 2.8+/-1.2 cm. All cysts were simple except for one pre-menopausal women. All the cysts in post-menopausal women resolved spontaneously. One pre-menopausal patient had a multi-loculated cyst, was operated and had a serious cystadenoma. In nine patients, the cysts resolved spontaneously and in three after discontinuation of tamoxifen, and one patient was lost to follow-up. All cysts were asymptomatic. CONCLUSION Ovarian cysts frequently develop in women with breast cancer on tamoxifen. The majority of the cysts resolve spontaneously, therefore an expectant management with follow-up ultrasonography is recommended.

Mode of delivery for vertex–nonvertex twin gestations

To compare the neonatal outcome of vaginally delivered (VD) to that of abdominally delivered (CS) vertex–nonvertex (Vx/NVx) twins.

Prevalence of hepatitis B surface antigen in pregnant Lebanese women

A cross-sectional study of 558 pregnant Lebanese women attending the antenatal clinics at the American University of Beirut Medical Center in 1993-95 sought to determine the hepatitis B virus (HBV) prevalence in this population. Infants born to mothers who are positive for both hepatitis B surface antigen (HBsAg) and e-antigen (HBeAg) have a 70-90% risk of becoming chronic HBV carriers compared the 10-40% risk among mothers positive only for HBsAg. 16 women (2.9%) were positive for HBsAg and of these only 1 (6.3%) was positive for HBeAg. There were no significant differences between HBsAg-positive and negative women in terms of age education socioeconomic status or HBV risk factors (e.g. blood transfusions intravenous drug use alcohol intake tatooing history of jaundice marriage to a man with multiple sexual partners). The 2.9% prevalence detected in this study places Lebanon among countries with moderate endemicity for HBV. Since known risk factors for HBV were not associated with HBsAg positivity routine antenatal screening as well as universal newborn vaccination against HBV are recommended to prevent perinatal infection and horizontal transmission in the community.