O-201 Prenatal and postnatal outcome of mosaic embryo transfers: multicentric study of one thousand mosaic embryos diagnosed by preimplantation genetic testing with trophectoderm biopsy

Study question

To explore the effect of chromosomal mosaicism detected in preimplantation genetic testing (PGT-A) on prenatal and postnatal outcome of mosaic embryo pregnancies

Summary answer

No significant difference between euploid and mosaic embryos was observed in terms of weeks of gestation, average weight, and developmental defect of the babies born

What is known already

Mosaic embryos have the potential to implant and develop into healthy babies. Transfer of these embryos is now offered as an option for women who undergo IVF resulting in no euploid embryos. While, prenatal diagnosis has shown the depletion of chromosomal mosaicism in mosaic embryos, several concerns remain. For instance, the direct effects of different kind of mosaicism on prenatal/postnatal outcome and the possibility that intra-biopsy mosaicism in the TE is a poor predictor of the ploidy status of the ICM. Thus, there is certainly a need for comprehensive analyses of obstetrical and neonatal outcome data of transferred mosaic embryos.

Study design, size, duration

Compiled analysis from multicenter data on transfers of mosaic embryos (n = 1,000) and their outcome, with comparison to a euploid control group (n = 5,561). To explore the effect of embryonic mosaicism on newborns, we matched mosaic embryos resulting in a birth with a euploid embryo by a series of parameters (maternal age, embryo morphology, and indication for PGT-A). Prenatal tests and birth characteristics of > 200 neonates from mosaic embryo transfers were compared to > 200 euploid embryos.

Participants/materials, setting, methods

PGT-A was performed on blastocyst-stage embryos with 24-Chromosome whole genome amplification (WGA)-based Next Generation Sequencing (NGS). In accordance with established guidelines, embryos were categorized as mosaic when PGT-A results indicated 20-80% aneuploid content. Prenatal testing where performed in 30% of pregnancies with amniocentesis, 4% did an extra analysis for potential UPD for the suspected mosaic chromosome, and an additional 16% performed chorionic villus sampling (CVS) and 9.5% performed noninvasive prenatal testing (NIPT).

Main results and the role of chance

Of the 465 mosaic embryos that implanted, about 20% miscarried, and out of those, 75% were early spontaneous abortions. Of the pregnancies, 3 out of 368 were stillborn (2 out of them were twins that were extremely premature at 23 weeks, and the other died during pregnancy from a heart defect). The remaining 99% of those have been born or are late ongoing pregnancies at the time of analysis. Prenatal tests were performed in > 200 pregnancies and the vast majority tested normal. All 5 abnormal cases were amniocentesis tests showing microdeletions or insertions of sizes smaller than the resolution used during PGT-A, so they were unrelated to the mosaicism detected with PGT-A. In fact, in none of the cases did the prenatal test reflect the mosaicism detected at the embryonic stage. Matching each of the 162 mosaic embryos resulting in a birth with a euploid embryo, we found that the length of gestation was similar on average, and so was the average weight of the babies at birth. We also gathered information on the routine physical examination performed on babies at birth, and of those 162 babies from mosaic embryo transfers, none had obvious developmental defects or gross abnormalities.

Limitations, reasons for caution

Even though newborns resulting from mosaic embryo transfers in this study invariably appeared healthy by routine examination, concerns for long-term health cannot yet be entirely dispelled. The question must therefore be carefully considered by each clinic and patient situation.

Wider implications of the findings

Prenatal testing of > 200 pregnancies from mosaic embryo transfers showed no incidence of mosaicism that matched the PGT-A findings, indicating the involvement of self-corrective mechanisms. Pregnancy and obstetric data indicates that mosaic embryos prevailing through gestation and birth have similar chromosomal and physiological health compared to euploid embryos.

Trial registration number

none

Role of the progesterone receptor for paclitaxel resistance in primary breast cancer

Paclitaxel plays an important role in the treatment of primary breast cancer. However, a substantial proportion of patients treated with paclitaxel does not appear to derive any benefit from this therapy. We performed a prospective study using tumour cells isolated from 50 primary breast carcinomas. Sensitivity of primary tumour cells to paclitaxel was determined in a clinically relevant range of concentrations (0.85–27.2 μg ml⁻¹ paclitaxel) using an ATP assay. Chemosensitivity data were used to study a possible association with immunohistochemically determined oestrogen and progesterone receptor (ER and PR) status, as well as histopathological parameters. Progesterone receptor (PR) mRNA expression was also determined by quantitative RT–PCR. We observed a clear association of the PR status with chemosensitivity to paclitaxel. Higher levels of immunohistochemically detected PR expression correlated with decreased chemosensitivity (P=0.008). Similarly, high levels of PR mRNA expression were associated with decreased paclitaxel chemosensitivity (P=0.007). Cells from carcinomas with T-stages 3 and 4 were less sensitive compared to stages 1 and 2 (P=0.013). Multiple regression analysis identified PR receptor status and T-stage as independent predictors of paclitaxel chemosensitivity, whereas the ER, N-stage, grading and age were not influential. In conclusion, in vitro sensitivity to paclitaxel was higher for PR-negative compared with PR-positive breast carcinoma cells. Thus, PR status should be considered as a possible factor of influence when designing new trials and chemotherapy protocols.

Genetic and environmental contributions to plasma C-reactive protein and interleukin-6 levels – a study in twins

Elevated baseline levels of acute-phase proteins such as C-reactive protein (CRP) or cytokines like interleukin-6 (IL-6) are known risk factors for atherosclerosis and cardiovascular disease (CVD) events. However, until today, there is only controversial information about the contribution of genetic and environmental factors. Therefore, we performed an open prospective study in 108 monozygotic (MZ) and 60 same-sex dizygotic (DZ) twin pairs to analyse the genetic and environmental contributions to plasma CRP and IL-6 levels. Heritability of IL-6 was 0.61, indicating that plasma IL-6 levels are to a major part influenced by genetic determinants; however, for CRP, heritability was only 0.22, pointing to a moderate genetic influence. Plasma CRP levels were strongly influenced by female gender, older age and especially the body mass index. Our data underline the central role of IL-6 in low-grade inflammation contributing to atherosclerosis and CVD.

Microtubule-associated protein tau and in vitro paclitaxel sensitivity in primary breast cancer

20088

Background: Paclitaxel has an important role in the adjuvant therapy of primary breast cancer. Recently, microtubule-associated protein tau was described as a marker of paclitaxel sensitivity. We attempted to validate these findings in vitro utilizing the ATP tumorchemosensitivity assay (ATP-TCA). Methods: The in vitro drug sensitivity to paclitaxel was evaluated in 48 fresh primary breast cancer specimens using the ATP-TCA. ATP-TCA results were analysed using the area under the curve (AUC) of growth inhibition. These results were correlated with the expression of tau mRNA measured by quantitative RT-PCR (Spearman’s correlation coefficient). Tau was also compared between progesterone receptor (PgR) positive and negative and estrogen receptor (ER) positive and negative tumors, respectively (Wilcoxon test). Results: The correlation of tau with the AUC for paclitaxel was weak (r = −0.20) and disappeared when considering PgR positive and negative tumors separately (r = −0.004 and r = −0.048, respectively). Tau was found to be differentially expressed between PgR positive and negative as well as between ER positive and negative tumors (p < 0.0005 in both tests). Conclusions: The expression of tau does not show independent predictive value for the in vitro paclitaxel sensitivity in primary breast cancer.

No significant financial relationships to disclose.

Mammadiagnostische Zweitbefundung in der Radiologischen Klinik: sinnvoller Mehraufwand oder Ressourcenverschwendung?

PURPOSE

To assess the effect of a second diagnostic reading of breast imaging at a university department of radiology.

MATERIAL AND METHODS

The diagnostic reports of first readers from different private radiology practices and the reports of second readers from the university department of radiology were compared with the histological results (n = 214) and outcome of follow-ups for 4 years (n = 74) in 236 patients (mean age 55 years). BI-RADS categories were used for this purpose. The initial examinations had been performed because of symptoms (n = 117), early detection outside an organized screening program (n = 102), evaluations following breast cancer therapy (n = 13) and unknown primary tumors (n = 4). In addition, the number of complementary examinations and the influence of a second reading on patient management were evaluated.

RESULTS

A total of 140 lesions were malignant and 148 were benign. Of the 288 lesions, 49 % were classified identically in the second reading; 36 % (79/217) of the lesions initially classified as BI-RADS 4 and 5 were downgraded to benign; and 41 % (29/71) of the lesions classified as BI-RADS 1 to 3 were upgraded as suspected of being malignant. The kappa value between the first and second readers was 0.34 with respect to each BI-RADS category separately and 0.18 with respect to categories 1 to 3 (benign) versus 4 and 5 (malignant). A second reading increased the sensitivity from 81 % (114/140) to 96 % (135/140) and the specificity from 30 % (45/148) to 78 % (116/148). Second readers detected 23 additional malignant lesions, changed two lesions correctly classified as malignant to benign categories and caused 6 additional false-positive findings. In all, 38 surgical biopsies could be prevented, one biopsy was erroneously delayed and three unnecessary excisional biopsies were initiated. In the study group, 49 MRI examinations revealed 5 additional malignant lesions and positively influenced surgical planning in 28 patients. In addition to these MRI examinations, 221 patients were examined using ultrasonography, 62 patients using complementary mammography, and 7 using galactography.

CONCLUSION

The benefit of a second reading outweighs the expenditure.

Einfluss eines gest�rten Glukosestoffwechsels auf Manifestationen und Prognose der Atherosklerose in verschiedenen Gef��regionen

Patients with cardiovascular disease have a poorer diagnosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions.

METHODS

In a prospective study we included 906 patients (72.5% men, mean age 62 +/- 9 years) preceding heart catheterization. All patients were evaluated for the presence of peripheral stenosis by carotid duplex sonography (pathologic: stenosis >50%) and evaluation of the ankle-brachial index (pathologic <0.9). Blood samples were drawn from each subject after an overnight fasting period and serum glucose was evaluated.

RESULTS

Patients were compared with regard to the presence of DM (known DMor fasting glucose > or =126 mg/dL, N = 283, 31.2%) or IFG (fasting glucose >110 and <126 mg/dL, N = 89, 9.8%). Patients with IFG and DM had a higher prevalence of atherosclerotic manifestations in the coronary, carotid and peripheral vessels. Diabetics had the highest prevalence of atherosclerotic manifestations in multiple vascular regions (=advanced atherosclerosis). Cardiovascular events (death, myocardial infarction and stroke) after a median follow-up of 4.1 years were evaluated in 901 patients (99.4%). Presence of IFG and DM significantly increased the incidence of cardiovascular events (event rate: no DM 10.9%, IFG 13.6%, DM 23.4%, P < 0.0001). Moreover, patients with advanced atherosclerosis suffered significantly more often from cardiovascular events (event rate: no stenosis 4.1%, coronary artery disease without peripheral stenosis 9.7%, advanced atherosclerosis 23.9%). Prognosis was worst in patients with DM and advanced atherosclerosis with an event rate of 35%.Patients with cardiovascular disease have a poorer prognosis if they are diabetic. The risk for cardiovascular events is already increased in individuals with impaired fasting glucose (IFG). The aim of this study was to evaluate the impact of diabetes mellitus (DM) and IFG on the incidence of atherosclerotic manifestations and on the long-term prognosis of patients with atherosclerosis in various vascular regions.

p53 expression and resistance against paclitaxel in patients with metastatic breast cancer

PURPOSE

Paclitaxel is an important agent in the pharmacological treatment of metastatic breast cancer. Despite its efficacy in selected patients, the majority of patients have a resistance against paclitaxel. The aim of this study was to identify the responding patients and hence prevent the other patients from ineffective treatment. Identifying these patients could spare them an ineffective treatment and could in turn characterize a subgroup of patients with a higher response rate.

MATERIAL AND METHODS

Thirty-three patients with metastatic breast cancer received paclitaxel 175 mg/m(2 )either as first- (15 patients) or as second-line (18 patients) treatment. Immunohistochemistry was performed on the blocks of the primary tumors with monoclonal antibodies against p53, HER-2/ neu, P-glycoprotein, Glutathione-S-Transferase-pi, and beta-tubulin II. The expression of those factors was then correlated with the objective response to paclitaxel.

RESULTS

Ten of 33 patients had an objective response to treatment. A significant correlation with the objective response was found for the expression of p53. None of the tumors with p53 expression ( n=11) responded to paclitaxel. In contrast, 10 of the 22 patients without p53 expression showed an objective response ( P=0.013). Expression of HER-2/ neu, P-glycoprotein, Glutathione-S-Transferase-pi, and beta-tubulin II did not show a correlation with the response to paclitaxel.

CONCLUSION

The immunohistochemical detection of p53 characterizes patients with metastatic breast cancer unlikely to respond to paclitaxel.

Effects of combined therapy of clopidogrel and aspirin in preventing thrombus formation on mechanical heart valves in an ex vivo rabbit model

BACKGROUND

The aim of our study was to investigate the efficacy of the combination of clopidogrel and aspirin in the prevention of thrombus formation on artificial heart valves in an experimental rabbit model as compared to anticoagulation with warfarin.

METHODS

Studies were performed after oral administration of clopidogrel and aspirin in group I (n=9) for 5 days, after 5+/-2 days treatment with warfarin in group II (n=9) and without medication in group III (n=9). Leaflets from Sulzer Carbomedics bileaflet valves were placed in a flow chamber. The flow chamber was filled with blood in a continuous circulation between the carotid artery and the jugular vein.

RESULTS

In group III, the flow chamber was clotted after a median of 15 min of circulation. Weight analysis before and after 1 h of perfusion showed that the median thrombus weight was 9.1 mg in group I, 14.4 mg in group II and 33.7 mg in group III. Further analysis by electron microscopy showed fewer platelets and erythrocytes on leaflets in group I than on leaflet surfaces in group II.

CONCLUSION

Clopidogrel and aspirin were more effective than warfarin in preventing thrombus formation on artificial heart valve leaflets in our investigation. This rabbit model with a high dosage of clopidogrel and aspirin, and a short-time exposure of the heart valve leaflets to rabbit blood under laminar flow, should be further evaluated with respect to whether it can give information about antithrombotic regimens in patients after mechanical heart valve replacement.

Determinants of urinary incontinence in a population of young and middle-aged women

BACKGROUND

Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population-based sample of young and middle-aged women.

METHODS

Of 641 eligible women aged 20-59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus.

RESULTS

The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased from 1 to 3.5 with increasing age and from 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PFMS to 3.4 in the group unable to contract their pelvic musculature. In addition, women with cystocele and/or absence of the urethrovesical crease had a 2.5-fold increased OR of incontinence (95% CI 1.5-4.2), smoking increased the OR 1.9 times (95% CI 1.1-3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4-5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non-significant correlations with performed hysterectomy and the woman's weight.

CONCLUSIONS

Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.

Cough-induced leak-point pressure--a valid measure for assessing treatment in women with stress incontinence

BACKGROUND

Presently available urodynamic methods are of little use for assessing the severity of urinary stress incontinence or for evaluating of treatment, Cough-induced leak-point pressure may prove to be a more useful urodynamic method in these respects. A vaginal anti-incontinence device was used to validate this new urodynamic method.

AIM

The primary aim was to determine the extent to which cough-induced leak-point pressure was affected by the vaginal device. Secondary aims were to study the short-term effects of the vaginal device on leakage and urinary flow, and to relate the change in cough-induced leak-point pressure to the change in leakage as expressed by a short-term pad test.

METHODS

In a prospective study of 22 women with a history of stress incontinence, the effect of a new vaginal anti-incontinence device (Conveen Continence Guard) on cough-induced leak-point pressure, a short-term pad test and urinary flow was studied.

RESULTS

Cough-induced leak-point pressure increased from 99.9 to 138.9 cm H2O, while leakage, measured by a short-term pad test, decreased from 22.7 to 3.3 g when using the device. Urinary flow was not significantly reduced by the device.

CONCLUSIONS

Cough-induced leak-point pressure is a valid, quantitative, dynamic measure of urethral closure function which can be used to study the effects of treatment in patients with stress incontinence. The vaginal device is effective for treatment of stress incontinence in the short-term, without reducing urinary flow.

[Implementation and evaluation of supportive approach of the psychiatric nurse specialist and psychiatric community health nurse. Part III]

The psychiatric community nurse takes on the role of an expert in her interaction with the psychiatric patient and others because she feels unprepared to manage therapeutic interaction. She measures her own abilities against the patient's progress and this makes it important for therapeutic interaction to succeed. This is accomplished when she exercises control over the interaction, manipulates the interaction by describing or reformulating the negative experiences or meanings verbalised by patients. She also distances herself from the psychiatric patient by stigmatising the psychiatric patient or if she feels that she cannot solve the problem, she refers the psychiatric patient to an external resource. The above narration indicates that this action by the psychiatric community nurse is not facilitative for patient interaction. In order to facilitate patient interaction, a supportive approach was generated and described by Van Wyk (1995: 99-116) whereby the advanced psychiatric nurse (a person with a masters degree or an advanced diploma in psychiatric nursing), creates a context where the psychiatric community nurse can sacrifice her objective observing position for an observed position where she forms part of the story of interaction between herself and the psychiatric patient. The objective of this study was to describe the implementation and evaluation of Van Wyk's (1995: 99-116) supportive approach to the psychiatric community nurse in interaction with the psychiatric patient by utilizing multiple descriptive case studies.

A population study of urinary incontinence and nocturia among women aged 20-59 years. Prevalence, well-being and wish for treatment

BACKGROUND

The aim was to study urinary incontinence (UI) and nocturia in a female population; prevalence, effect on well-being, wish for treatment and result of treatment in primary health care.

METHODS

A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor.

RESULTS

Of the included 641 women, 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%), 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type.

CONCLUSIONS

Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it, only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.

Pad weighing tests: the best way to quantify urine loss in patients with incontinence

This article reviews the literature on pad weighing tests composed to measure urinary incontinence. The tests can be divided into short-term tests (one to two hours) performed in a clinic or laboratory, or long-term tests (12 to 48 hours) performed by the patient at home. The short-term tests, apart from practical disadvantages, have low negative predictive value and require retrograde filling of the bladder to reach acceptable reproducibility. The long-term tests have practical advantages, better sensitivity and acceptable reproducibility. Pad weighing tests have no value for the purpose of differential diagnosis. The validity of the long-term test as a measure of the symptom of urinary incontinence is obvious whereas it is unclear what the short-term test measures.

Frequency/volume chart: the basic tool for investigating urinary symptoms

BACKGROUND

This article reviews the literature on the frequency/volume chart. The frequency/volume chart is the systematic registration of point of time of voiding and voided volume done by the patient in her own environment for a specified period of time, usually 24 or 48 hours. The chart can be supplemented with the registration of incontinence episodes. Measurements obtained from the frequency/volume chart include total voided volume/24 hours, frequency of micturition, mean voided volume, largest single voided volume and range of voided volumes.

RESULTS

Normal values for these measurements as well as values for patients with stress incontinence and detrusor instability are presented.

CONCLUSIONS

The frequency/volume chart is a simple and inexpensive way of recording basic data, some of which can be obtained in no other way, e.g. total voided volume. The frequency/ volume chart has acceptable reproducibility but limited diagnostic capacity. It provides a basis for instituting treatment in many patients and provides the best tool for following the result of treatment in patients with the urge syndrome.

Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence

The aim of the study was to test the reproducibility of a new method of determining cough-induced leak-point pressure (CILPP). A cough-induced increased in intra-abdominal pressure was recorded vaginally in 26 women with stress incontinence and urinary leakage was detected electronically. CILPP determinations and short-term pad tests were carried out on two different occasions. Reproducibility is expressed by a coefficient of repeatability as limits of agreement. These indicate that, for 95% of the cases, a repeat measurement of CILPP will be between 0.72 and 1.28 times the first measurement. The coefficient of variation was 11.2%. There was a moderate inverse correlation between pad-test data and CILPP. It was concluded that the new method allows for an accurate determination of CILPP, which represents a quantitative and dynamic assessment of urethral function. The reproducibility of the method appears to be better than that of pad tests and standard urodynamic parameters. The correlation with pad-test data gives support to the validity of the method.

Expanded gold standard in the diagnosis of Chlamydia trachomatis in a low prevalence population: diagnostic efficacy of tissue culture, direct immunofluorescence, enzyme immunoassay, PCR and serology

OBJECTIVE

To evaluate the diagnostic efficacy of chlamydia culture, direct immunofluorescence (DFA), direct enzyme immunoassay (EIA), polymerase chain reaction (PCR) and serology by defining positive culture or at least two positive non-culture tests as true positive.

SETTING

Three gynaecological departments located in separate areas of Sweden.

PATIENTS AND DESIGN

All pregnant women requesting abortion during a six month period were included. In cases with unconfirmed non-culture tests, reculture with multiple passage and PCR on the culture transport medium was performed for confirmation. Serum was analysed for chlamydial antibodies type IgG, IgM and IgA using microimmunofluorescence.

RESULTS

18 of 419 (4.3%) patients were positive for chlamydia according to the defined criteria. Twelve of 419 (2.9%) were positive in standard culture (primary inoculation). The sensitivity of standard culture, DFA, EIA and PCR were 66.7%, 77.8%, 64.7% and 71.4% respectively. The specificity 100% (by definition), 99.5%, 100%, 100% respectively. The positive predictive value 100% (by definition), 87.5%, 100%, 100% respectively. Negative predictive value 98.5%, 99.0%, 98.5%, 98.9% respectively. Serum IgG titre of > or = 64 and > or = 1024 gave positive predictive values of 10% and 21% respectively.

CONCLUSIONS

When an expanded gold standard is used, the specificity and positive predictive value of the non-culture tests used are comparable with that of standard culture even in this low prevalence population. Standard culture underestimated the chlamydia prevalence by 33%. The prevalence found represents a decrease from 10 to 2.9% of culture verified chlamydia during four years in comparable populations. Chlamydial antibodies of certain immunological classes are not necessarily present in cases with chlamydia.

New York State screening program for fragile X syndrome: a progress report

New York State has established a program to screen post-pubertal mentally retarded males for the fragile X [fra(X)] syndrome. The goal of the program is to identify affected males and inform their families of the diagnosis. Females in these families who are at risk for inheriting the mutation will then be able to determine their carrier status and consider that information in making reproductive decisions. Males were evaluated for 10 features of the syndrome by physicians and nurses throughout the state; cytogenetic analysis was carried out on a subset of this population. A total of 1332 males has been screened and chromosome studies have been completed for 489. Forty-three (9%) were positive for fra(X), and an additional 11 other chromosome abnormalities were identified. The 43 patients belonged to 38 families. Of the 24 families who were informed of the diagnosis, 12 consulted genetic counseling centers for follow-up studies and 12 did not.

Diagnosis and prevalence of persistent chlamydia infection in infertile women: tissue culture, direct antigen detection, and serology

Specimens for chlamydial culture, direct fluorescent antibody (DFA) test, two enzyme immunoassays (EIA) for antigen detection, and serum for chlamydial antibodies were collected from 256 infertile women. Specimens were taken from the tubes during tuboplasty and from the cervix and endometrium during laparoscopy or tuboplasty. Antibodies to Chlamydia trachomatis were found four times more often in patients with signs of prior pelvic inflammatory disease (PID) than in infertile women with normal pelvic findings. Only 48 (37%) of 131 patients with signs of prior PID had a history of PID. Ten or more C. trachomatis elementary bodies (EBs) per smear were found in 21 (8.2%) of 256 patients. Six patients had a positive culture or a positive antigen EIA test. All six had high numbers of EBs in the DFA test. We conclude that routine culture and EIA antigen tests detect only a minority of persistent chlamydia infections in this population, but subjective factors in the interpretation of DFA methods must be considered.

Pad weighing test--a simple method to quantitate urinary incontinence

This paper reviews the litterature on pad weighing tests designed to measure urinary incontinence. These can be divided into short-term (one to two hours), as suggested by the International Continence Society, or long-term (12 to 48 hours). Apart from practical disadvantages the short-term tests have a low sensitivity and require retrograde filling of the bladder to reach acceptable reproducibility. The long-term tests have practical advantages, better sensitivity and acceptable reproducibility. The validity of the long-term test as a measure of the symptom of incontinence is evident, whereas it is unclear what the short term test measures. An evaluation of the value of pad-weighing tests in different kinds of incontinence is lacking.

Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass

Plasma levels of two oral contraceptive gestagens were studied during 24 hour oral challenges in seven morbidly obese women after jejunoileal bypass comparing the results to unoperated normal controls. To study binding and transport of the gestagens, sex hormone binding globulin levels were determined in these patients, in normal-weight controls, and in unoperated morbidly obese patients. The unoperated morbidly obese patients had significantly decreased levels of sex hormone binding globulin, compared to normal-weight controls and to the jejunoileal bypass patients, whose levels were similar to the controls. The jejunoileal bypass patients had a reduced capacity to absorb oral contraceptive gestagens, although the plasma levels were of the same magnitude found in normal subjects using lower doses of gestagens. However, the gestagen to sex hormone binding globulin ratio was lower in jejunoileal bypass patients, implying reduced biologic activity and thus reduced contraceptive efficiency of the gestagen. There were no enzymatic or morphologic signs of liver dysfunction. No correlations were found between plasma gestagen levels and number or volume of stools, fecal fat excretion, or intravenous C-cholic acid load. It is concluded that caution must be exercised in prescribing oral contraceptives to jejunoileal bypass patients.

A simple patient-administered test for objective quantitation of the symptom of urinary incontinence

A pad-weighing test for the quantitation of urinary loss, performed by the patient during 48 hours of daily activities, was evaluated. All patients (n = 46, age 21-73 years) were able to perform the test. The precision of their weighing was good and the reproducibility of the results equal or better than that of previously published tests. There was no correlation between the results of the 48-hour test and a standardized one-hour test, indicating that these two tests measure different aspects of incontinence. Of the two tests the 48-hour test likely gives a more valid measure of the symptom of urinary incontinence. Other advantages over the standardized short term tests are that no hospital staff is involved in the testing and that the test is independent of the physical capacity of the patient.

Absorption of an oral contraceptive gestagen in ulcerative colitis before and after proctocolectomy and construction of a continent ileostomy

Plasma 1-norgestrel (1-Ng) levels after administration of a common oral contraceptive in fertile women (mean age 29 +/- 5 yrs) with mild ulcerative colitis before or after proctocolectomy with a conventional ileostomy or a continent ileostomy reservoir were determined and compared to those of a group of healthy volunteers serving as controls. Before operation, peak and 10-hour levels of 1-Ng were not statistically different from control. Levels in patients with either type of ileostomy were slightly lower than controls, but were only statistically significantly lower in patients with continent ileostomy (p less than 0.05). In a subgroup of patients studied both before and after proctocolectomy with construction of a continent ileostomy, there was a slight reduction in peak and 10-hour levels compared to control. After administration of the pill directly into the reservoir, significant levels of 1-Ng in plasma were found with peak and 10-hour levels approximately one-half of those achieved after oral administration. Although the material is small, it suggests that patients with mild ulcerative colitis and with small ileal resections (8.8 +/- 8 cm) can use combined contraceptive pills containing 1-norgestrel with confidence. Caution should be exercised, however, in prescribing "mini-pills" to patients after proctocolectomy and ileal resection.