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Lack of effect of pregnancy on outcome of melanoma
154
Citations from the Literature
more useful. We thus studied late second-trimester and early third-trimester (24 to 36 weeks’ gestation) maternal serum ofetoprotein levels with the same enzyme immunoassay we use to evaluate routine second-trimester (I 5 to 20 weeks’ gestation) levels. Values Variance was as to preclude women with
rose up to 32 weeks and fell slightly thereafter. greater than at I5 to 20 weeks but not so great clinical usefulness in the third trimester. Of 279 a normal (0.4 to 2.49 multiples of the median)
maternal serum o-fetoprotein value at I5 to 20 weeks’ gestation, 270 (96.8%) showed levels in the same range later in gestation; however, none of six singleton pregnancies with unexplained maternal serum a-fetoprotein levels > 2.50 multiples of the median at I5 to 20 weeks’ gestation showed maternal serum cr-fetoprotein levels in this range at 24 to 36 weeks’ gestation. The relationship between second- and thirdtrimester maternal serum a-fetoprotein levels in abnormal pregnancies remains to be elucidated in a large sample. Thus we are conducting not only cohort but also cross-sectional studies. Preliminary findings suggest that women with preterm premature rupture of membranes or with premature labor show elevated late second-trimester and early third-trimester maternal serum cr-fetoprotein levels; however, larger sample sizes are necessary. Cardiac function in fetuses of type I diabetic mothers Rizzo G: Arduini D; Romanini C ISI Cl Obstetrica e Ginerologica. Universita Cattolica S Cuore, Largo A Gemelli, 8. 00168 Roma, ITA AM J OBSTET GYNECOL 1991, l64/3 (837-843) Cardiac function was cross-sectionally studied by means of M-mode and Doppler echocardiography in 40 fetuses of mothers with well-controlled insulin-dependent diabetes at 20 to 38 weeks of gestation. These variables were measured: interventricular septal thickness, ratio between the peak velocities during early passive ventricular filling and active atrial tilling at the level of the atrioventricular valves’ peak velocities, and the time to peak velocity at the level of the ascending aorta and the pulmonary artery. The values obtained were compared with our reference limits for gestation. A significant increase of interventricular septal thickness that was unrelated to maternal glycosylated hemoglobin levels was evidenced. Early passive ventricular tilling/active atrial filling ratios were significantly lower in fetuses of diabetic mothers than in control fetuses. These differences were significantly related to interventricular septal thickness. No significant modifications were found in either aortic or pulmonary peak velocities or in time to peak velocity values. These findings suggest that in spite of an adequate metabolic control an interventricular septal hypertrophy that affects cardiac diastolic function, develops in fetuses of diabetic mothers. Aggravation of subclinical diabetes insipidus during pregnancy lwasaki Y; Oiso Y; Kondo K; Takagi S; Takatsuki K; Hasegawa H; lshikawa K; Fujimura Y; Kazeto S; Tomita A First Department of Internal Medicine. Nagoya University School of Medicine, 65 Tsurumai-rho, Showa-ku, Nagoya 466, JPN NEW ENGL J MED 1991, 324/8 (522-526) Background. Transient polyuria and polydipsia during Inr J Gynecol Obstet 37
pregnancy
are rare, and their cause is not entirely
clear. Pos-
sible explanations include the exacerbation of preexisting abnormalities in the secretion or action of vasopressin and abnormally large increases in plasma vasopressinase activity. Methods. We studied two women in whom overt polyuria and polydipsia developed during the third trimester of pregnancy and disappeared after delivery. The secretion and action of vasopressin were studied both when the women had polyuria and polydipsia and later, when their water intake and urine volume were normal. Results. One patient had partial nephrogenic diabetes insipidus. She had little increase in urine osmolality in response to water deprivation. hypertonic-saline infusion. and vasopressin injection and no response to desmopressin acetate (I-deamino-8-D-arginine vasopressin) during the immediate postpartum period. Her basal and stimulated plasma vasopressin concentrations were high (16.5 to 203.4 pmol per liter) before and during hypertonic-saline infusion 30 months post partum. The other patient had neurogenic diabetes insipidus. She had subnormal basal vasopressin concentrations, a subnormal increase in the vasopressin level and a subnormal decrease in urine
partial plasma plasma flow in
response to the administration of vasopressin. and a normal response to desmopressin. After pregnancy, when her urine volume was normal, she had no increase in plasma vasopressin in response to hypertonic-saline infusion, but she had a normal rise in the plasma vasopressin level and a normal renal response to vasopressin administration. Conclusions. Pregnancy may unmask subclinical forms of both nephrogenic and neurogenic diabetes
insipidus.
This exacerbation
creased vasopressinase siveness to vasopressin.
activity
may result from both in-
and diminished
renal respon-
Lack of efiect of pregnancy on outcome of melanoma MacKie RM; Bufalino R; Morabito Cascinelli N Department of Dermatology, University Cl2 8QQ, GBR
A;
Sutherland
of Glasgow,
C;
Glasgow
LANCET 1991, 33718742 (653-655) To determine the effect of pregnancy on prognosis in melanoma we investigated 388 women treated for stage I primary cutaneous disease during their childbearing years. 85 women had been treated before any pregnancy, 92 during pregnancy, I43 after they had completed all pregnancies, and 68 between pregnancies. Women who had received treatment while pregnant had primary tumours of significantly greater thickness than did those in the other three groups (p = 0.002). Other possible confounding factors (site, age, parity) did not difter between the groups. Once tumour thickness was controlled for, survival rate of women in whom melanoma was diagnosed and treated while they were pregnant did not differ from that in the other three groups. Cox regression analysis showed no differences between the three groups of women who were not pregnant at diagnosis. Women with melanoma should be advised about pregnancy on the basis of thickness and site of tumour and evidence of vascular spread, and not hormonal status.
Citations from the Literature
more useful. We thus studied late second-trimester and early third-trimester (24 to 36 weeks’ gestation) maternal serum ofetoprotein levels with the same enzyme immunoassay we use to evaluate routine second-trimester (I 5 to 20 weeks’ gestation) levels. Values Variance was as to preclude women with
rose up to 32 weeks and fell slightly thereafter. greater than at I5 to 20 weeks but not so great clinical usefulness in the third trimester. Of 279 a normal (0.4 to 2.49 multiples of the median)
maternal serum o-fetoprotein value at I5 to 20 weeks’ gestation, 270 (96.8%) showed levels in the same range later in gestation; however, none of six singleton pregnancies with unexplained maternal serum a-fetoprotein levels > 2.50 multiples of the median at I5 to 20 weeks’ gestation showed maternal serum cr-fetoprotein levels in this range at 24 to 36 weeks’ gestation. The relationship between second- and thirdtrimester maternal serum a-fetoprotein levels in abnormal pregnancies remains to be elucidated in a large sample. Thus we are conducting not only cohort but also cross-sectional studies. Preliminary findings suggest that women with preterm premature rupture of membranes or with premature labor show elevated late second-trimester and early third-trimester maternal serum cr-fetoprotein levels; however, larger sample sizes are necessary. Cardiac function in fetuses of type I diabetic mothers Rizzo G: Arduini D; Romanini C ISI Cl Obstetrica e Ginerologica. Universita Cattolica S Cuore, Largo A Gemelli, 8. 00168 Roma, ITA AM J OBSTET GYNECOL 1991, l64/3 (837-843) Cardiac function was cross-sectionally studied by means of M-mode and Doppler echocardiography in 40 fetuses of mothers with well-controlled insulin-dependent diabetes at 20 to 38 weeks of gestation. These variables were measured: interventricular septal thickness, ratio between the peak velocities during early passive ventricular filling and active atrial tilling at the level of the atrioventricular valves’ peak velocities, and the time to peak velocity at the level of the ascending aorta and the pulmonary artery. The values obtained were compared with our reference limits for gestation. A significant increase of interventricular septal thickness that was unrelated to maternal glycosylated hemoglobin levels was evidenced. Early passive ventricular tilling/active atrial filling ratios were significantly lower in fetuses of diabetic mothers than in control fetuses. These differences were significantly related to interventricular septal thickness. No significant modifications were found in either aortic or pulmonary peak velocities or in time to peak velocity values. These findings suggest that in spite of an adequate metabolic control an interventricular septal hypertrophy that affects cardiac diastolic function, develops in fetuses of diabetic mothers. Aggravation of subclinical diabetes insipidus during pregnancy lwasaki Y; Oiso Y; Kondo K; Takagi S; Takatsuki K; Hasegawa H; lshikawa K; Fujimura Y; Kazeto S; Tomita A First Department of Internal Medicine. Nagoya University School of Medicine, 65 Tsurumai-rho, Showa-ku, Nagoya 466, JPN NEW ENGL J MED 1991, 324/8 (522-526) Background. Transient polyuria and polydipsia during Inr J Gynecol Obstet 37
pregnancy
are rare, and their cause is not entirely
clear. Pos-
sible explanations include the exacerbation of preexisting abnormalities in the secretion or action of vasopressin and abnormally large increases in plasma vasopressinase activity. Methods. We studied two women in whom overt polyuria and polydipsia developed during the third trimester of pregnancy and disappeared after delivery. The secretion and action of vasopressin were studied both when the women had polyuria and polydipsia and later, when their water intake and urine volume were normal. Results. One patient had partial nephrogenic diabetes insipidus. She had little increase in urine osmolality in response to water deprivation. hypertonic-saline infusion. and vasopressin injection and no response to desmopressin acetate (I-deamino-8-D-arginine vasopressin) during the immediate postpartum period. Her basal and stimulated plasma vasopressin concentrations were high (16.5 to 203.4 pmol per liter) before and during hypertonic-saline infusion 30 months post partum. The other patient had neurogenic diabetes insipidus. She had subnormal basal vasopressin concentrations, a subnormal increase in the vasopressin level and a subnormal decrease in urine
partial plasma plasma flow in
response to the administration of vasopressin. and a normal response to desmopressin. After pregnancy, when her urine volume was normal, she had no increase in plasma vasopressin in response to hypertonic-saline infusion, but she had a normal rise in the plasma vasopressin level and a normal renal response to vasopressin administration. Conclusions. Pregnancy may unmask subclinical forms of both nephrogenic and neurogenic diabetes
insipidus.
This exacerbation
creased vasopressinase siveness to vasopressin.
activity
may result from both in-
and diminished
renal respon-
Lack of efiect of pregnancy on outcome of melanoma MacKie RM; Bufalino R; Morabito Cascinelli N Department of Dermatology, University Cl2 8QQ, GBR
A;
Sutherland
of Glasgow,
C;
Glasgow
LANCET 1991, 33718742 (653-655) To determine the effect of pregnancy on prognosis in melanoma we investigated 388 women treated for stage I primary cutaneous disease during their childbearing years. 85 women had been treated before any pregnancy, 92 during pregnancy, I43 after they had completed all pregnancies, and 68 between pregnancies. Women who had received treatment while pregnant had primary tumours of significantly greater thickness than did those in the other three groups (p = 0.002). Other possible confounding factors (site, age, parity) did not difter between the groups. Once tumour thickness was controlled for, survival rate of women in whom melanoma was diagnosed and treated while they were pregnant did not differ from that in the other three groups. Cox regression analysis showed no differences between the three groups of women who were not pregnant at diagnosis. Women with melanoma should be advised about pregnancy on the basis of thickness and site of tumour and evidence of vascular spread, and not hormonal status.