Relevance of declines in serum human chorionic gonadotropin levels to the management of persistent ectopic pregnancy

ABSTRACT
Aim: To evaluate postoperative declines in serum human chorionic gonadotropin (hCG) levels (percentages of preoperative hCG levels) to rule out persistent ectopic pregnancy (PEP).

Methods: A retrospective study was conducted on 50 patients who underwent laparoscopic salpingotomy between April 1995 and March 2008. The postoperative course was divided into four periods: (period A: days 1–2; period B: days 3–4; period C: days 5–6; and period D: days 7–8), and the postoperative serum human chorionic gonadotropin declines in the PEP and control groups (successfully treated patients) were compared. A cutoff value of serum hcg decline to rule out PEP was established by receiver operating characteristic (ROC) analysis.

Results: Ten of the 50 patients (20%) were diagnosed with PEP. There were no differences in clinical findings or preoperative serum hCG levels between the two groups. From period C, the serum hCG decline in the control group was significantly greater than in the PEP group, and all individual serum hCG declines in the PEP group were outside the 95% confidence interval of the control group. Furthermore, analysis by ROC using a 14% decline in postoperative serum hCG as a cutoff revealed that the specificity and sensitivity of the test were equal to 100% from period C.

Conclusion: Declines in serum hcg during period C (days 5–6) constitute an important marker of the presence or absence of PEP. Decisions regarding a second intervention for PEP should be made by this time postoperatively.

Journal of Obstetrics and Gynaecology Research
Volume 35 Issue 5, Pages 961 - 966
Published Online: 23 Oct 2009

Relevance of declines in serum human chorionic gonadotropin levels to the management of persistent ectopic pregnancy
Takashi Abe, Shigeo Akira, Yasuyuki Negishi, Masao Ichikawa, Akihito Nakai and Toshiyuki Takeshita

Efficacy and safety of sorafenib in patients

Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma (HCC): Asia-Pacific (AP) trial subgroup analyses by baseline transaminase (ALT/AST)/-alpha fetoprotein (AFP) levels

Journal of Clinical Oncology, 2009 ASCO Annual Meeting Proceedings (Post-Meeting Edition).Vol 27, No 15S (May 20 Supplement), 2009: 4590

Background: Results of the phase III, randomized, double blind, placebo-controlled AP trial demonstrated that sorafenib is effective and safe for the treatment of advanced HCC in patients from the AP region (Cheng et al, Lancet Oncol, 2009). Hepatic function influences treatment as a measure of organ damage and tumor stage. We performed subset analyses of the AP study dataset according to baseline hepatic function, as indicated by levels of ALT/AST and AFP.

Methods: Patients (N=226) with advanced HCC, ECOG PS 0–2, Child-Pugh class A, and no prior systemic therapy were randomized 2:1 to receive sorafenib 400 mg BID or placebo. Endpoints included overall survival (OS), disease-control rate (DCR; defined as complete/partial response or stable disease by RECIST, maintained for 28 days from first demonstration of response), time to progression (TTP) and safety. Patients were grouped by baseline levels of ALT/AST (normal, mild, or moderate) and AFP (normal or abnormal).

Results: Median TTP, OS and DCR by subset are shown in the table. The most common grade 3/4 adverse events in the sorafenib populations were hand-foot skin reaction and diarrhea.

Conclusions: Sorafenib was effective and safe in patients from the AP region with advanced HCC within a broad range of baseline hepatic enzyme and AFP levels. These results suggest that sorafenib is an effective treatment for HCC, irrespective of baseline ALT/AST or AFP levels

Predictive value of mid-trimester amniotic fluid high-sensitive C-reactive protein, ferritin, and lactate dehydrogenase for fetal growth restriction

Predictive value of mid-trimester amniotic fluid high-sensitive C-reactive protein, ferritin, and lactate dehydrogenase for fetal growth restriction.
Borna S, Abdollahi A, Mirzaei F.

Department of Gynecology and Obstetrics, Tehran University/ Medical of Science, Iran.

BACKGROUND: Fetal growth restriction (FGR) is surprisingly common with placental dysfunction occurring in about 3% of pregnancies and despite advances in obstetric care, FGR remains a major problem in developed countries. AIM: The purpose of this study is to find out the predictive value of amniotic fluid high sensitive C-reactive protein (hs-CRP), ferritin , and lactate dehydrogenase (LDH) for FGR.

MATERIALS AND METHODS: This prospective strategy of this study has been conducted on pregnant women who underwent genetic amniocentesis between 15th and 20th weeks of gestation. All patients were followed up on until delivery. Patients with abnormal karyotype and iatrogenic preterm delivery for fetal and maternal indications were excluded. The samples were immediately sent to laboratory for cytogenetic and biochemical examination. Non-parametric tests and receiver-operator characteristic curve analysis were used for statistical purpose.

RESULTS: A significant correlation between incremental amniotic fluid alpha fetoprotein (alphaFPr) and LDH levels and FGR at gestational weeks 15th-20th was found out. We also found an optimum cut-off value> 140 IU/L for the amniotic fluid LDH concentration with a sensitivity of 87.5% and a specificity of 82.4% for the prediction of FGR.

CONCLUSION: Once the LDH value is confirmed, it could serve as a prediction factor for FGR at the time of genetic amniocentesis at gestational weeks 15-20.

Recombinant human albumin as protein source in culture media used for IVF

Oocytes obtained from 85 women undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment were randomly selected for culture in media containing either human serum albumin (HSA), (n = 42) or recombinant human albumin (rHA), (n = 43). At the time of transfer, the two embryos with the overall best morphology were selected on day 2, 3 or 5. Comparable rates of fertilization, cleavage, blastocyst formation and implantation were observed in both groups. The frequency of pregnancy and early pregnancy loss were also equal. It is concluded that culture media containing rHA seem to produce embryos of high quality comparable to media containing HSA. Therefore, rHA may replace HSA as a protein source in culture media for IVF and may reduce risks of prion contamination and transmission of plasma derived impurities.

Bungum M, Humaidan P, Bungum L.
Fertility Clinic, Skive Sygehus, Resenvej 25, Denmark

Prevalence of metabolic syndrome increases with the increase in blood levels of gamma glutamyltransferase and alanine aminotransferase in Japanese men

BACKGROUND: Gamma glutamyltransferase ( GGT ) or alanine aminotransferase ( ALT) is reported to be an independent risk factor of diabetes and cardiovascular disease and proposed as a component of metabolic syndrome (MS). However, there are few studies examining the direct association between MS and Gamma glutamyltransferase or alanine aminotransferase in Japanese men and women.

METHODS: Direct associations between GGT or ALT and MS defined by revised NCEP criteria for Japanese and between GGT or ALT and Japanese MS (JMS) defined by the Examination Committee for the Criteria of Metabolic Syndrome were examined using medical check-up data from 1,880 men and 1,079 women.

RESULTS: The prevalence of MS and JMS was significantly higher in subjects with the highest quartile of GGT or ALT than the subjects with the lowest quartile of GGT or ALT (p<0.0001 in men and p<0.0001 for MS and p<0.001 for JMS in women). The optimal cutoff points of GGT and ALT for diagnosing MS or JMS were 42 U/L or 41 U/L, respectively for GGT and both 25 U/L for ALT in men and 21 U/L or 23 U/L, respectively for GGT and 20 U/L or 25 U/L, respectively for ALT in women.

CONCLUSION: The prevalence of MS and JMS increases with the increase in blood levels of GGT or ALT even through the normal range of GGT or ALT in Japanese men and women.

Tachikawa Medical Center, Nagaoka

Analysis of urobilinogen and urine bilirubin for intra-abdominal injury in blunt trauma patients

OBJECTIVE: To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury.

METHODS: Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy. We reviewed initial urinalysis results from trauma patients in the emergency department (ED) for the presence of urine hemoglobin, uroblinogen and urine bilirubin . Computed tomography (CT) scan results and operative reports were reviewed from the trauma registry for evidence of liver laceration, spleen laceration, bowel or mesenteric injuries.

RESULTS: There were 73 injuries and 57/516 patients (11%) with intra-abdominal injury. Urinalysis was positive for urobilinogen in 28/516 (5.4%) patients, urine bilirubin in 15/516 (2.9%) patients and urine hemoglobin in 313/516 (61%) patients. Nineteen/forty-seven (4%) subjects had liver lacerations, 28/56 (5%) splenic lacerations, and 15/5 (3%) bowel or mesenteric injury.

Comparing the proportion of patients that had urobilinogen detected in the group with and without intra-abdominal injury, 8/28 (29%) subjects with urobilinogen, 5/15 (33%) subjects with bilirubin and 47/313 (15%) subjects with urine hemoglobin were found to have liver lacerations, spleen lacerations, or bowel/mesenteric injuries. Preexisting liver or biliary conditions were not statistically associated with elevation of urine bilirubin, urine hemoglobin or on initial urobilinogen urinalysis after blunt abdominal trauma. Point prevalence for urobilinogen, urine bilirubin and urine hemoglobin are 5.43% (28/516), 2.91% (15/516) and 60.7% (313/516) respectively.

CONCLUSIONS: The utility of the initial routine urinalysis in the ED for adult blunt abdominal trauma patients should not be used as a screening tool for the evaluation of intra-abdominal injury.

Chronic kidney disease (CKD) is more likely to progress to end-stage renal disease in African Americans

Chronic kidney disease (CKD) is more likely to progress to end-stage renal disease (ESRD) in African Americans while the reasons for this are unclear. The metabolic syndrome is a risk factor for the development of diabetes, cardiovascular disease, and has been recently linked to incident CKD. Historically, fewer African Americans meet criteria for the definition of metabolic syndrome, despite having higher rates of cardiovascular mortality than Caucasians. The presence of microalbuminuria portends increased cardiovascular risks and has been shown to cluster with the metabolic syndrome. We recently reported that proteinuria is a predictor of CKD progression in African American hypertensives with metabolic syndrome. In this review we explore the potential value of including CKD markers--microalbuminuria/proteinuria or low glomerular filtration rate (GFR)-in refining the cluster of factors defined as metabolic syndrome, ie, "cardiorenal metabolic syndrome."

Lea JP, Greene EL, Nicholas SB, Agodoa L, Norris KC.
Department of Medicine, Renal Division, Emory University, 550 Peachtree St., 8th floor, Atlanta, Georgia 30308

Improved outcome for Chinese children with acute promyelocytic leukemia

OBJECTIVE: Acute promyelocytic leukemia (APL) is now highly curable, except in many developing countries. Introduction of current treatment strategies may improve the outcome for children with APL in these countries. METHODS: The diagnosis was based on the FAB classification and detection of PML-RARalpha rearrangement. From December 1999 to September 2004, 16 eligible children were treated with an intensive in-house protocol including high-dose AraC and anthracycline. Subsequently, 14 cases were treated with a less intensive protocol modified from the PETHEMA LPA99. RESULTS: The 3.5 years event-free survival (EFS) was 37.5% (95% CI, 13.8-61.2%) for patients treated on initial protocol. The treatment failures were: six patients abandoned treatment (37.5%), two who died of intracranial hemorrhage at diagnosis (6.3%) and sepsis in remission (6.3%) respectively, and two who relapsed (12.5%). Those treated on modified PETHEMA had a 3.5 years EFS of 79.6% (95% CI, 52.9-106.3%). Treatment failures included: one who died of intracranial hemorrhage at diagnosis (7.1%) and one who relapsed (7.1%). The patients on modified PETHEMA had a significantly higher EFS (P = 0.012), lower frequency of sepsis during treatment (7.7% vs. 77.8%; P = 0.0015), and lower hospitalization cost (median US$ 4,700 vs. US$ 20,000; P < 0.0001) than those on in-house protocol. CONCLUSION: Treatment with the less intensive protocol based on the PETHEMA LPA99 study of childhood APL successfully reduced chemotherapy toxicity and lowered hospitalization costs without increasing relapses. This led to decreases in treatment-related morbidity and the treatment abandonment rate, thus improving overall outcome. Pediatr Blood Cancer

Department of Pediatric, The First Affiliated Hospital of Sun Yat-Sen University, Zhongshan Er Lu, Guangzhou, China.