R. Matorras

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.

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.

Sequential vacuum extractor and forceps delivery

SummaryEighty deliveries in which a combination of vacuum extractor and forceps procedures was used for delivery were analysed retrospectively. The previous vacuum extractor delivery and the previous forceps delivery in the record books were used as controls. The vacuum extractor—forceps deliveries were due to a vacuum extractor failure in 76 per cent of the cases and deliberate use to draw down the fetal head and permit a low forceps delivery in the remaining 24 per cent. In the vacuum extractor-forceps group there were increased incidences of post-dates pregnancies, induced labour, difficult applications and malrotations. Mean birth weight and mean newborn head circumference were higher than in the controls. The perinatal results were poorer (5 minute Apgar scores < 7 in 6 per cent of cases versus 1 per cent in the control cases; mean umbilical cord pH 7.15 ± 0.08 (s.d.) versus 7.20 ± 0.10 and 7.22 ± 0.08). Admissions to the neonatal unit occurred in 21 per cent of the newborn delivered with the vacuum ...