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Inhibin and hydatidiform mole
240
Notes
be contributory, varicella vaccine induces immunity to chicktmpox that is persistent for UP to 6 years even in ~uao~mp~rnis~ ChildEIl. GershonAA(1) ColumbiaUniversity, New York,NY,10032,USA may
Serum and molar tissue were obtained from 7 patients who were newly diagnosed as complete hydatidiform mole. Blood samples were taken both on the day of primary evacuation of molar tissue and 7-10 days thereafter. Serum inhibm was measured by a specific heterologous radioimmunoassay. Molar tissue contained exceptionally high concen~atio~ of h&&m, and serum inhibh ~n~n~tio~ in women with hydati~fo~ mole were significantly (P c 0.005) greater than women at a comparable stage of normal pregnancy. Within only 7 to 10 days after primary evacuation, inhibm concentrations declined significantly (P c 0.02) to values similar to those seen in the follicular phase, whereas human chorionic go~do~ph~ @CCi) were still elevated. ~ost~vacuation serum inhibin levels remained elevated in only 3 patients who developed persistent trophoblastic disease whereas all 4 patients who remained clinically normal had serum inhibin levels of 0.4 U/ml or less. In view of the ral?id decline of serum inhibin levels to normal in those women without persistent ~~hobl~tic die, this report suggests that me~~ment of inhibin may prove to be a superior marker to hCG in the management of trophoblastic disease. Yohkaichiya T (2) MonashUniversity, Victoria, 3168Australia
The incidence of insulin-dependent (Type 1) diabetes mellitus peaks twice during the life-span. One peak occurs in puberty and another in the fifth decade. To evaluate possible differences between classical childhoodand adult-onset ‘Qpe 1 diabetes, we examined cliiical, bio~e~~, autoimmune, and genetic features of $2 children and adolescents aged 1.5-18.2 years, and 44 adults aged 20.0-55.8 years, when they presented with the disease. The metabolic disorder at presentation was of equal severity, and both groups had similar frequency of ketoacidosis (25%). The prodrome period was, however, longer in adults 18 weeks versus 4 weeks) and the adults also had higher serum C-peptide levels compared with children (0.29 f 0.03 vs 0.17 f 0.01 nmol/l; P < O.oOl), suggesting that they had more residual betacell function. There were no significant differences in
(1) N Et@ J i&d (1989) 324 892 (2) BMJ (1989) 298, 1684
sex ratio, blood glucose levels, hemoglobin AI values, degree of metabolic d~ompe~ation, or frequency of Type I diabetes in &st degree relatives. C~oplasmic islet cell antibodies were present in an equal proportion of both groups (81%) at presentation, and the frequency of complement fixing islet cell antibodies was also similar in both groups (60% of the children and 46.2% of the adults). insulin autoantibodies were present at diagnosis in only one of 26 adults versa8 43% of the Colin (P c 0.001). HLA DR3, DR4 or the heterozygous DR314were present in 100% of the children versus 80% of the adults. The proportions of single HLA high risk antigens did not show any difference between the groups, but the heterozygous combination of DR3/4 was present in 36.6% of the children compared with only 12.5% of the adults (P c 0.05). HLA Dw314 was also more common in the children than in the adults (26.6% versus 9.8%; P c 0.05). We conclude that Type 1 diabetes that begins in adulthood is characterised by a longer symptomatic period before diagnosis, better preservation of residual beta-cell function, and lower ftenuencies of insulin autoa~tib~ies and HLA-D3/D4 heterozygosi~ than Type 1 diabetes that begins in childhood or adolescence. KajatainenJ (3) Universityof Oulu, 90220Oulu.Finland
Smoking and pregnancy. Since low birthweight is the most important determinant of perinatal mortality worldwide. an understanding of the factors affecting birthweight is essential for prevention. It is well-~0~ that smokers have smaller babies than non-smokers but the relationships between low birthweight and psychological stress, social disadvantage, alcohol and caffeine intake are less clear. A prospective study of 1513 pregnant women in a London Hospital found that smoking was the most important single factor affecting fetal growth, reducing birthweight by 5%. The study found no evidence that either alcohol or caffeine consumption or psychosocial stress or social disadvantage at the levels experienced by this population had any direct effect on birthweight. The main environmental cause of low birthweight was smoking and if perinatal mortality is to be reduced. then women must be persuaded not to smoke during pregnancy. BrookeOG(4) St Oeorge’sHospital MedicalSchool,London
SW17ORE,UK
(31 N Engt J &fed (1989) 320, 881-6 (4) B&f.!(1989)298, 795
Notes
be contributory, varicella vaccine induces immunity to chicktmpox that is persistent for UP to 6 years even in ~uao~mp~rnis~ ChildEIl. GershonAA(1) ColumbiaUniversity, New York,NY,10032,USA may
Serum and molar tissue were obtained from 7 patients who were newly diagnosed as complete hydatidiform mole. Blood samples were taken both on the day of primary evacuation of molar tissue and 7-10 days thereafter. Serum inhibm was measured by a specific heterologous radioimmunoassay. Molar tissue contained exceptionally high concen~atio~ of h&&m, and serum inhibh ~n~n~tio~ in women with hydati~fo~ mole were significantly (P c 0.005) greater than women at a comparable stage of normal pregnancy. Within only 7 to 10 days after primary evacuation, inhibm concentrations declined significantly (P c 0.02) to values similar to those seen in the follicular phase, whereas human chorionic go~do~ph~ @CCi) were still elevated. ~ost~vacuation serum inhibin levels remained elevated in only 3 patients who developed persistent trophoblastic disease whereas all 4 patients who remained clinically normal had serum inhibin levels of 0.4 U/ml or less. In view of the ral?id decline of serum inhibin levels to normal in those women without persistent ~~hobl~tic die, this report suggests that me~~ment of inhibin may prove to be a superior marker to hCG in the management of trophoblastic disease. Yohkaichiya T (2) MonashUniversity, Victoria, 3168Australia
The incidence of insulin-dependent (Type 1) diabetes mellitus peaks twice during the life-span. One peak occurs in puberty and another in the fifth decade. To evaluate possible differences between classical childhoodand adult-onset ‘Qpe 1 diabetes, we examined cliiical, bio~e~~, autoimmune, and genetic features of $2 children and adolescents aged 1.5-18.2 years, and 44 adults aged 20.0-55.8 years, when they presented with the disease. The metabolic disorder at presentation was of equal severity, and both groups had similar frequency of ketoacidosis (25%). The prodrome period was, however, longer in adults 18 weeks versus 4 weeks) and the adults also had higher serum C-peptide levels compared with children (0.29 f 0.03 vs 0.17 f 0.01 nmol/l; P < O.oOl), suggesting that they had more residual betacell function. There were no significant differences in
(1) N Et@ J i&d (1989) 324 892 (2) BMJ (1989) 298, 1684
sex ratio, blood glucose levels, hemoglobin AI values, degree of metabolic d~ompe~ation, or frequency of Type I diabetes in &st degree relatives. C~oplasmic islet cell antibodies were present in an equal proportion of both groups (81%) at presentation, and the frequency of complement fixing islet cell antibodies was also similar in both groups (60% of the children and 46.2% of the adults). insulin autoantibodies were present at diagnosis in only one of 26 adults versa8 43% of the Colin (P c 0.001). HLA DR3, DR4 or the heterozygous DR314were present in 100% of the children versus 80% of the adults. The proportions of single HLA high risk antigens did not show any difference between the groups, but the heterozygous combination of DR3/4 was present in 36.6% of the children compared with only 12.5% of the adults (P c 0.05). HLA Dw314 was also more common in the children than in the adults (26.6% versus 9.8%; P c 0.05). We conclude that Type 1 diabetes that begins in adulthood is characterised by a longer symptomatic period before diagnosis, better preservation of residual beta-cell function, and lower ftenuencies of insulin autoa~tib~ies and HLA-D3/D4 heterozygosi~ than Type 1 diabetes that begins in childhood or adolescence. KajatainenJ (3) Universityof Oulu, 90220Oulu.Finland
Smoking and pregnancy. Since low birthweight is the most important determinant of perinatal mortality worldwide. an understanding of the factors affecting birthweight is essential for prevention. It is well-~0~ that smokers have smaller babies than non-smokers but the relationships between low birthweight and psychological stress, social disadvantage, alcohol and caffeine intake are less clear. A prospective study of 1513 pregnant women in a London Hospital found that smoking was the most important single factor affecting fetal growth, reducing birthweight by 5%. The study found no evidence that either alcohol or caffeine consumption or psychosocial stress or social disadvantage at the levels experienced by this population had any direct effect on birthweight. The main environmental cause of low birthweight was smoking and if perinatal mortality is to be reduced. then women must be persuaded not to smoke during pregnancy. BrookeOG(4) St Oeorge’sHospital MedicalSchool,London
SW17ORE,UK
(31 N Engt J &fed (1989) 320, 881-6 (4) B&f.!(1989)298, 795