[Pregnancy after uterine artery embolization in uterine myoma]

OBJECTIVE

To report a case of successful pregnancy outcome after embolization treatment of symptomatic leiomyoma.

DESIGN

Case report.

SETTING

Department of Gynaecology and Obstetrics of University Hospital, Hradec Králové.

SUBJECT AND METHOD

A 41-year old primigravida who had previously undergone uterine artery embolization and myomectomy had successful course of the spontaneously conceived pregnancy terminated per sectionem cesarean. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: spontaneous abortion (22%), malpresentation (17%), hypotrophy (7%), premature delivery (28%), caesarean section (58%) and postpartum hemorrhage (13%).

CONCLUSION

Whether this procedure is safe for women desiring future fertility is controversial. There are very few data regarding the outcomes of pregnancies after embolization.

Cardiac troponin T in pregnant women having intravenous tocolytic therapy

We studied drug-induced cardiotoxic effects in 22 pregnant women having tocolysis with intravenous fenoterol and verapamil. Because CK-MB is released from the uterus and placenta, we used the determination of cardiac troponin T (cTnT) as it is one of the most sensitive and specific indicators of myocardial necrosis. Cardiac troponin T levels were within physiological range (0.08 +/- 0.01 microgram/l) in all healthy pregnant women tested between 32 and 36 weeks of gestation (control group). In the pregnant women having tocolysis cTnT levels started to increase slightly during the first day of treatment (0.10 +/- 0.03 microgram/l) and were significantly higher (p < 0.05) during the third day (0.35 +/- 0.14 microgram/l) of tocolytic therapy. The cTnT levels in cord blood (0.13 +/- 0.03 microgram/l) did not correspond with maternal cTnT concentrations.

The influence of latent hyperprolactinaemia on the levels of LH, FSH, E2 and T in the midfollicular phase of the cycle

The metoclopramide test for latent hyperprolactinaemia was done on 174 randomly chosen infertile women in the midfollicular phase of the cycle. 54 women had latent hyperprolactinaemia which was defined as a PRL level of at least 150 ng/ml after metoclopramide. Just before the metoclopramide was given, blood was taken to measure the levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), 17-beta estradiol (E2) and total testosterone (T). Women with latent hyperprolactinaemia had significantly lower levels of LH (p < 0.01) and E2 (p < 0.001) and higher levels of T (p < 0.05) in the midfollicular phase when compared with women without this condition. FSH levels showed no statistically significant difference.

Herpes simplex virus type 1 envelope subunit vaccine not only protects against lethal virus challenge, but also may restrict latency and virus reactivation

A subunit vaccine containing the main antigenic components of herpes simplex virus 1 (HSV-1) was tested in Balb/c mice and albino rabbits. The mice were completely protected against challenge with 10 LD50 of the highly pathogenic SC16 strain given by intraperitoneal (ip) route when immunized with 1000 antigen units (ELISA) corresponding to 110 micrograms of protein. The animals were protected against lethal disease when immunized with 1-33 micrograms of protein per dose. Immunization of rabbits with 3000 antigen units prior to inoculation of strain Kupka into right scarified cornea limited the establishment of latency in the trigeminal ganglia. Both the number of animals in which latency had been established as well as the number of homolateral sensory ganglion cells which had become virus carriers were reduced. However, the effect of immunization was less striking at preventing HSV reactivation in rabbits vaccinated after infection. When shedding of reactivated HSV was elicited by repeated epinephrine iontophoresis to cornea, there was no quantitative difference between the immunized and mock-immunized groups, only the period between stimulation and the onset of virus shedding was prolonged in immunized rabbits (from 3.6 to 5.6 days, p < 0.05). But if the corneas were stimulated by a single iontophoresis procedure, the duration of virus shedding was significantly reduced from 5.6 days in the mock-immunized rabbits to 1.7 days in the immunized ones (p < 0.025). In the latter experiment, the total number of positive swabs during 14 days of the post-stimulation period was higher in the mock-immunized animals (31 of 171, 18.1%) than in the immunized ones (12 of 162, 7.4%; p < 0.025).

Regions US6 and US7 of herpes simplex virus type 1 DNA encoding glycoproteins D and I may influence neuroinvasivity

Recombinants were prepared by replacing a 1931 bp region of the BamHI J fragment (0.906-0.920) of the pathogenic ANGpath DNA-coding for glycoprotein D (gD) and a part of glycoprotein I (gI)--by the corresponding sequence of nonpathogenic KOS DNA (Kaerner et al., 1991) and tested in DBA/2 mice. The strain ANGpath and the control recombinant ANGpath/gD-gIpath, prepared by back transfer of the given ANGpath DNA fragment into ANGpath/gD-gIdellacZ+ DNA, were pathogenic after intraperitoneal inoculation. In contrast, mice infected with the strain KOS and the low-pathogenic recombinant ANGpath/gD-gIKOS survived peripheral virus administration. Both the strain KOS and the low-pathogenic recombinant ANDpath/gD-gIKOS spread by bloodstream to spleen, liver and adrenal glands but did not multiply in spinal cord. Nevertheless, the antigen of low-pathogenic recombinant ANGpath/gD-gIKOS was found in retroperitoneal vegetative nerves and ganglia. On the other hand, the strain ANGpath and the pathogenic recombinant ANGpath/gD-gIpath multiplied in cerebrospinal nerves and spinal cord causing typical hind leg paralysis.

Replacement of glycoprotein B gene in the herpes simplex virus type 1 strain ANGpath DNA by that originating from nonpathogenic strain KOS reduces the pathogenicity of recombinant virus

Herpes simplex virus type-1 (HSV-1) strain ANGpath and its recombinants, in which the 8.1 kbp BamHI G restriction fragment (0.345-0.399) containing the glycoprotein B (gBpath) gene (UL27) or its subfragments-coding either for cytoplasmic or surface domains of gB-had been replaced with the corresponding fragments from nonpathogenic KOS virus DNA (gBKOS), were tested for their pathogenicity for DBA/2 mice and rabbits. The recombinant ANGpath/B6KOS prepared by transferring the 2.7 kbp SstI-SstI subfragment (0.351-0.368) of the BamHI GKOS fragment still had the original sequence of ANGpath DNA coding for the syn3 marker in the cytoplasmic domain of gB and was pathogenic for mice as well as for rabbits. Virological and immunohistological studies in DBA/2 mice infected with the latter pathogenic recombinant and with ANGpath showed the presence of infectious virus and viral antigen at inoculation site (epidermis, subcutaneous connective tissue and striated muscle in the area of right lip), in homolateral trigeminal nerve and ganglion, brain stem, midbrain, thalamic and hypothalamic nuclei. In contrast, nonpathogenic recombinants ANGpath/syn+B6KOS (prepared by transferring the whole BamHI GKOS fragment) and ANGpath/syn+KOS (prepared by transferring the 0.8 kbp BamHI-SstI subfragment of the BamHI GKOS fragment) showed limited haematogenous and neural spread, but no evidence of replication in CNS; thus, their behaviour resembled that of the wild type strain KOS. The recombinant ANGpath/syn+KOS, which was not pathogenic for mice, still remained pathogenic for rabbits, a phenomenon indicating the presence of an additional locus in the gB molecule participating on virulence. Sequencing the 1478 bp SstI-SstI subfragment of the BamHI G(path) fragment (nt 53,348-54,826 of UL segment) showed the presence of at least 3 mutations as compared to the KOS sequence, from which the change of cytosine to thymine at nt 54,251 altered the codon for arginine to that for histidine (amino acid 515) in the gB polypeptide chain.

The glycoprotein B gene and its syn3 locus of herpes simplex virus type 1 are involved in the synthesis of virus-associated growth factor (HSGF-1)

A putative growth factor (HSGF-1) associated with herpes simplex virus type 1 (HSV-1), which is similar to PRGF associated with pseudorabies virus, and/or HSGF-2 associated with HSV-2, was described. Experiments with four syncytial (syn) and four nonsyncytial (syn+) HSV-1 strains showed that the ability of this virus to produce HSGF-1 in infected cells is associated with the syn+ phenotype. Double infection of cells with syn+ and syn strain resulted either in enhancement or complete inhibition of HSGF-1 production, depending on the chosen pair of syn+ and syn strains. The studies with the recombinants between the syn+ strain KOS and syn strain ANGpath in the gene for glycoprotein B (gB) and syn3 locus revealed that the gB gene and its syn3 locus play a role in the HSGF-1 synthesis.

Antireticulin antibodies in sera of children with insulin-dependent diabetes mellitus

Sera from 125 children (mean age 9.5 +/- 3.9; range 0.5-18 years) with newly diagnosed insulin-dependent diabetes mellitus were examined for the presence of antireticulin antibodies (ARA). Fifty-four of these children were followed up over a period of 150-400 days after the onset of the disease with respect to their serum ARA. The indirect immunofluorescence method on human and rat tissue was used to detect autoantibodies. In each serum, the level of islet cell antibodies (ICA) was determined. The prevalence of ARA in our diabetic children (16%) was significantly higher than in normal population (P less than 0.05). In sera of newly diagnosed ICA-negative children, ARA were more frequent than in ICA-positive patients (P less than 0.025). The difference in ARA prevalence was even higher when patients were divided into two groups one with less and one with more than 30 JDFu (P less than 0.005). On the contrary, sera sampled 150-400 days after the manifestation of IDDM revealed neither a positive nor a negative association between ICA and ARA. Thus, the negative association of ARA with ICA in the early stages of IDDM may suggest the role of an autoimmune response to reticulin in part of the IDDM patients, and gives further evidence to the heterogeneity of IDDM.

A novel quasi-viral agent, MaTu, is a two-component system

MaTu is a quasi-viral agent presumably derived from a human mammary tumor. In some respects it resembles classical viruses and in some the "slow viruses," and in others it is different from both. Using monoclonal antibodies (Mabs), we showed that it is a two-component system. One part of the complex, MX, is exogenous; it is manifested by a protein, p58X, which is a cytoplasmic antigen and it reacts with some natural sera of man and of various animals. The other component, MN, is endogenous to human cells. This is manifested by a twin protein(s), p54/58N, localized on the cell surface and in the nucleus. This protein is absent in rapidly growing, sparse cultures of HeLa, but it is inducible either by keeping the cells in dense cultures or, more efficiently, by infecting them with MX. Both inducing factors are synergistic. Only p54/58N is associated with virions of vesicular stomatitis virus (VSV), reproduced in MaTu-infected HeLa. This suggests that MN is responsible for complementation of VSV mutants and for the formation of the VSV (MaTu) pseudotype. Both p54/58N peptides are glycosylated and they form oligomers linked by disulfidic bonds; p58X is not glycosylated and it does not form S-S-linked oligomers.

Pathogenicity and latency competence for rabbits of the herpes simplex virus type 1 ANGpath gC and gE defective mutants

A total of 139 rabbits was infected to the right scarified cornea with HSV type 1 strains Kupka, ANG, ANGpath and their gE defective (ANGpathI2-4), gC defective (ANGpathgC18), gC/gE negative (ANGpathCI-8) and gC/ICP4 deletion (ANGpathY1) mutants. Strains ANG, ANGpath, ANGpathgC18 and ANGpathY1 were, in contrast to the two gE negative mutants, highly lethal, but 79% of rabbits infected with the non-encephalitogenic Kupka strain survived. Strain Kupka and strain ANGpath gE-negative mutants I2-4 and gCI-8 were tested for their latency competence. While Kupka established latency in the homolateral trigeminal ganglia from 80% of infected rabbits, I2-4 did so in one of 10 animals only, and the gC/gE mutant gCI-8 was not harboured in any of infected animals in an inducible form. Significant correlation was found between shedding into the culture fluid of reactivated virus from the explanted ganglion and brain stem fragments at one hand and the presence of the viral DNA in these organs on the other hand as judged by spot blot hybridization with the HSV-1 strain 17 Kpn I fragments h and i to DNA extracts prepared from these organs. Hybridizations were predominantly negative with the DNA from the corresponding non-cultured organs, except in a few cases of non-cultured ganglion and brain stem from rabbits previously infected with the gE deletion mutants which displayed positive hybridization, although no virus reactivation could be observed in corresponding explants.

Type-common and type-specific monoclonal antibodies to herpes simplex virus types 1 and 2

Seventeen monoclonal antibodies (Mabs) reacting specifically with the cells infected with herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) were characterized by a variety of immunological tests such as radioimmunoprecipitation, immunoblotting and virus-neutralization. The majority of Mabs was directed against glycoprotein B (anti-gB), six reacted with glycoprotein C (anti-gC) and one with glycoprotein G (anti-gG). Six anti-gB Mabs reacted with both types of HSV (anti-gB-1,2), two anti-gB and all the six anti-gC Mabs have been specific for HSV-1 (anti-gB-1 and anti-gC-1). The remaining two anti-gB Mabs and the anti-gG have been specific to HSV-2 (anti-gB-2 and anti-gG). Only three out of the seventeen examined Mabs neutralized the virus.

Cytoplasmic islet cell antibodies in children with type I diabetes

In a group of 72 type I juvenile diabetics we investigated the prevalence of islet cell antibodies (ICA). Their occurrence rate was followed up over 1-3 years. In 66 patients also neutralizing antibodies and IgM antibodies to Coxsackie B viruses were determined. ICA positivity was recorded in 21 out of 38 Coxsackie positive diabetics (55%), compared to 13 out of 28 Coxsackie negative diabetics (46%). ICA were found in a total of 73% of diabetic patients. The postinitial course of diabetes, assessed according to partial remissions, did not differ substantially between ICA positive and ICA negative patients. ICA persisted over a longer period of time in children who had suffered from Coxsackie B virus infection than in children who had not experienced this virus infection (p less than 0.05). The concurrent action of Coxsackie B virus infection before the manifestation of diabetes may contribute to the heterogeneity of autoimmune processes in some juvenile diabetics.