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The article discusses research into gynecologists' opinions and practice patterns regarding patients who consume alcohol during pregnancy. The majority of respondents from the American College of Obstetricians and Gynecologists indicated that they ask their pregnant patients about their alcohol consumption during the initial prenatal visit and most recommend total abstinence from alcohol during pregnancy. They also noted that there were inadequate referral resources available for pregnant women.

Alcohol use among women of child-bearing age is prevalent in the United States, with approximately 1 in 5 non-pregnant women reporting binge drinking (5 or more drinks on any one occasion) and 1 in 25 pregnant women reporting binge drinking. Alcohol use during pregnancy results in a spectrum of adverse outcomes known as fetal alcohol spectrum disorders. Fetal alcohol syndrome (FAS) is one of these disorders. Fetal alcohol syndrome is characterized by specific facial abnormalities and significant impairments in neurodevelopment and physical growth. Early identification of children with FAS has been shown to enhance their long-term outcomes, in an effort to improve clinical recognition of children with this condition, Centers for Disease Control and Prevention (CDC) was directed by Congress in 2002 to lead the development of uniform diagnostic criteria for FAS and other prenatal alcohol-related conditions. The purpose of this commentary is to provide clinicians a summary of the report released by CDC describing the current diagnostic criteria for FAS. In addition, advancements have been made in screening and brief interventions for alcohol use disorders in women who have the potential to make significant strides in the prevention of FAS spectrum disorders. Knowledge of the diagnostic criteria for FAS can lead to increased identification of the syndrome in infants and children and the provision of appropriate medical and support services. Screening for and intervening with women at risk for an alcohol-exposed pregnancy can prevent FAS and other fetal alcohol spectrum disorders. [ABSTRACT FROM AUTHOR]

Endometrioid carcinoma with histopathologic resemblance to cutaneous pilomatrix carcinoma with mutations in the gene encoding beta-catenin, CTNNB1 are rare. There are minimal numbers of reports of high-grade tumors with this divergent differentiation in the literature. We report the case of a 29-yr-old female with an unusual presentation of endometrial cancer with overall histologic appearance indicative of a recently reported aggressive subtype of Federation of Gynecology and Obstetrics (FIGO) IVB grade 3 endometrioid carcinoma with features resembling cutaneous pilomatrix carcinoma. She was treated with a primary chemotherapy regimen with an initial significant response to treatment before developing symptomatic brain metastasis for which she underwent whole-brain radiotherapy. We discuss the unusual histologic and radiologic presentation as well as her individual management throughout this case report. The apparent association with morular metaplasia and atypical polypoid adenomyoma suggests that this rare carcinoma is within a spectrum of lesions associated with aberrant beta-catenin expression/beta-catenin mutation. Its aggressive nature highlights the importance of early recognition of this rare lesion., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 by the International Society of Gynecological Pathologists.)

Objective: To identify an index population of Gulf War couples with burning semen syndrome and to determine whether burning semen syndrome was secondary to seminal plasma hypersensitivity., Methods: Questionnaire surveys, screening laboratory testing for underlying medical disorders, including sexually transmitted diseases and immunoglobulin G and E immunoassays specific for seminal plasma protein, were performed. If subjects met the criteria for seminal plasma hypersensitivity, the Gulf War male veteran's seminal plasma proteins were used to desensitize his female sexual partner., Results: Eighty-nine percent (188 of 211) of respondents had either personally experienced burning after contact with their own semen or had a sexual partner who had burning after contact with their semen. Asymptomatic female partners (three of five) of Gulf War veterans who exhibited specific immunoglobulin E skin and antibody responses to seminal plasma proteins responded successfully to rapid desensitization. Treatment results were confirmed by a provocative office challenge, consisting of instillation of whole seminal fluid into the female's vaginal vault and, if negative, subsequently by natural coitus., Conclusion: The results of this study indicate that seminal plasma hypersensitivity may present as burning semen syndrome in a subpopulation of Gulf War couples. Proper screening of Gulf War couples with clinical features of burning semen syndrome should include assessment for seminal plasma hypersensitivity reactions, as seminal plasma protein desensitization may induce remission of burning semen syndrome.

Introduction: Proinflammatory cytokines may play a pivotal role in the pathogenesis of insulin-dependent diabetes mellitus (IDDM). In vitro, the formation of nitric oxide (NO) catalyzed by inducible NO synthase (iNOS) has been shown to be involved in the cytotoxic effects of cytokines on pancreatic beta cells. Cytokines have also been shown to cause the expression of inducible cyclooxygenase (COX-2) in isolated islets., Aims: To describe a novel in vivo model that allows investigation of the effects of direct cytokine administration to the pancreas., Methodology and Results: By using this method, we demonstrate that administration of interleukin-1beta and interferon-gamma to rat pancreas results in the generation of NO in the treated pancreata as detected by NO trapping and electron paramagnetic resonance spectroscopy. Beta cells were identified as the source of the formed NO. Reverse transcription and polymerase chain reaction analyses showed that administration of cytokines to the pancreas leads to the expression of iNOS and COX-2 mRNA in the pancreas tissue as well as the islets isolated from such tissues. The compound phenyl N-tert-butylnitrone, which protects mice against streptozotocin-induced IDDM, inhibits NO formation and downregulates both iNOS and COX-2 mRNA levels.

Tumor necrosis factor-alpha (TNF alpha) is thought to play a physiological role in the brain. These studies were performed to determine whether a diurnal rhythm of TNF alpha exist in the rat brain. Samples were collected from hippocampus, hypothalamus, cerebral cortex, cerebellum, pons and midbrain at light onset and at 6 h intervals thereafter over a day. A TNF alpha bioassay was used to measure TNF alpha in each area. TNF alpha was highest at light onset in the hypothalamus, hippocampus and cerebral cortex. Levels at light onset were about 10-fold greater than minimal night-time levels. Changes in TNF alpha activity in other brain areas were also evident, but smaller. These results support the hypothesis that TNF alpha has physiological roles in the brain.

Oxygen free radicals may play a pivotal role in the development of the shock-induced inflammatory response syndrome. Hydroxyl free radicals (.OH) react with salicylate (SA) to form 2,5- and 2,3-dihydroxybenzoic acid (DHBA) products. We utilized salicylate hydroxylation to investigate .OH formation during intestinal ischemia/reperfusion injury in male Sprague-Dawley rats. After administering salicylate, the superior mesenteric artery was occluded for 45 min and then allowed to reperfuse for 90 min after declamping. No significant changes in plasma 2,3- and 2,5-DHBA/SA ratios were observed in sham-operated or in animals given intestinal ischemia without reperfusion. A significant increase (p < .05) in arterial, venous, and portal venous 2,5-DHBA/SA ratios occurred 5 min after reperfusion. This increase was prevented by allopurinol as well as by dimethylthiourea (.OH scavenger) pretreatment. 2,3-DHBA was significantly increased (p < .05) in venous and portal venous blood after 30 min of reperfusion, but was not detectable in plasma of allopurinol- and dimethylthiourea-treated rats. These results indicate that hydroxyl free radical formation as reported by SA hydroxylation appears to be important in intestinal ischemia/reperfusion-related tissue injury.

Prenatal diagnosis of monoamnionicity is necessary for optimal care of a twin gestation. When the fetuses are discordant for a lethal anomaly, unequivocal confirmation is imperative. Ultrasound evaluation of our patient revealed a twin gestation discordant for anencephaly and with possible monoamnionicity. When sonography was inconclusive, CT amniography confirmed a single amniotic cavity, permitting appropriate parental counseling and pregnancy management. CT amniography is a useful adjunct to ultrasound in evaluating twins discordant for a lethal anomaly when monoamnionicity is suspected.

Radionuclide angiocardiography (RNA) provides noninvasive measurements of left ventricular function during rest and exercise, which appear to reflect the magnitude of fibrosis and ischemia in patients with coronary artery disease. This investigation evaluated the usefulness of these measurements for providing prognostic information, useful in selecting therapy. The RNA study group included 278 patients with a low resting ejection fraction and coronary artery disease documented by angiography. Patients were followed for up to three years to define survival and incidence of complete pain relief. The 172 patients treated medically had less favorable survival and pain relief than the 106 surgically treated patients. In the medically treated patients, a positive RNA defined a subgroup of 113 patients, with a 20% lower 3-year survival than the 59 patients with a negative RNA. Moreover, comparison of patients receiving medical and surgical therapy following a positive RNA documented a clear improvement in both survival and pain relief for those who showed significant ischemia during exercise and subsequently underwent coronary bypass procedures. In patients with a negative RNA, medical and surgical therapy resulted in a similar survival rate and little difference in pain relief. Calculations comparing the maximal potential increase in survival and complete pain relief, using multiple criteria known to provide prognostic information, identified the exercise response on RNA as the single most important variable for selection of therapy. Therefore, the left ventricular response to exercise provides important prognostic information in patients with low resting ejection fractions, and the results of this procedure can be used to define subgroups of patients who will and will not benefit from coronary artery bypass grafting.

We have carried out a quantitative analysis of the force-interval relationship of the human left ventricle and compared it to previous studies done in both intact subjects as well as isolated muscle. The characteristics of the force-interval relationship of the normal patient resembed those of normal isolated mammalian muscle (except when exposed to high levels of catecholamines). The relationship in group 2 (patients with increased left ventricular dimensions and normal pressure indices) resembled those obtained from isolated muscles from hypertrophied hearts. The relationship from group 3 (patients with increased left ventricular EDDs and depressed pressure indices, two of whom were in clinical heart failure) resumbled those induced in normal muscles exposed to high levels of catecholamines, and those obtained from experimentally induced heart failure. The force-interval relationships of the four patients who fell into the third group were strikingly different from the other groups. This suggests that the force-interval relationship may be useful to describe changes in the inotropic state of the patient's heart.

The relationships between the administered dose, clearance, and the toxicity spectrum of 5-fluorouracil (5-FU) administered as 72-hour constant infusion have been studied in 21 patients with advanced cancer. This was done as a pilot study for possible future combination using 5-FU as a radiosensitizer. Individual patients tolerated up to 65 mg/kg/24 hours, but serious toxicity appeared once as low as 35 mg/kg. Limiting toxicity proved to be "mixed" with upper intestinal symptoms (nausea and vomiting), stomatitis, and central nervous system signs all occurring in various patients. Central nervous system effects (both cerebellar and vomiting) proved as troublesome as stomatitis. There was only a general link between the administered dose and the subsequent toxicity grade, but a reasonably quantitative relationship emerged when the serum 5-Fu levels obtained and the degree of patient toxicity were compared. The clearance of 5-FU was confirmed to be nonlinear over the entire dose range studied (25-65 mg/kg/24 hours), consistent with a two-compartment model of drug metabolism. One compartment appears to be systemic (extra-hepatic) metabolism (probably anabolic removal) which is saturated at just below 15 mg/kg/day. Doses above that level lead to drug accumulation. No steady state was reached, contrary to previous reports. At the higher infusion rates, clearance progressively approaches that predicted by the assumption that the second compartment is splanchnic blood flow and catabolism. While 5-FU can be administered as a 72-hour infusion as one possible schedule for use as a single agent or for combined modality studies, CNS effects are quite troublesome in comparison to longer infusions to toxicity.

Pancreatic lipolytic enzyme activities and plasma lipids were measured in three age groups of female Fisher 344 rats (3 months [young], 12 months [adult], and 27 months [old]) in order to evaluate age-related changes and a possible correlation of these parameters. Cholesterol esterase activity was measured in pancreas homogenate, while the lipase activity was further fractionated into heparin-Sepharose unretained (lipase I) and retained (lipase II) fractions. In analogy to the lipolytic enzymes of the human pancreas, lipase I corresponds to pancreatic lipase and lipase II corresponds to pancreatic carboxylesterase. Plasma triglyceride and cholesterol levels were significantly higher in old as compared with adult and young rats. There was no significant correlation between plasma lipid and pancreatic enzyme activity levels. Cholesterol esterase and pancreatic lipase (lipase I) activity did not show any consistent change with age. Pancreatic carboxylesterase (lipase II), on the other hand, was consistently lower in adult and old animals. Although the importance of pancreatic carboxylesterase for triglyceride hydrolysis remains to be established, our results suggest that this enzyme is under long-term metabolic control. We suggest that early in life, high levels of this enzyme may be needed to supplement pancreatic lipase in order to optimize digestion of dietary fat required for optimal growth.