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Newborn identification by foot- or finger-printing presents serious drawbacks. This study proposes an alternative method based on DNA analysis of blood-spots taken from the newborn child. CSF1PO, TPOX and TH01 microsatellite loci were chosen to develop a fast and reliable protocol to be applied in cases where it is suspected that newborn children have been exchanged. The advantage of these loci is that one can simultaneously amplify them by PCR multiplex reaction and determine their alleles, thereby reducing the time needed for identification tests. Moreover, the amplification products of these loci are very small (< 350 bp) and so can be analyzed in samples with degraded DNA. We have been able to prove that it is possible to obtain results in blood-spots taken from newborns up to 13 years before and kept at room temperature. Thus the protocol proposed here can be applied in long-term post-natal identification cases.

Pregnancy is related to an increased frequency of arrhythmias in asymptomatic patients with Wolff-Parkinson-White syndrome, which might lead to sudden death. A 40-year-old woman, with Wolff-Parkinson-White syndrome which was not diagnosed until pregnancy, presented in the 34th week with an atrial fibrillation, with high risk criteria for ventricular fibrillation. Intravenous ajmaline was given to convert the tachyarrhythmia to sinus rhythm. We obtained an excellent maternal control with no maternal or fetal adverse effects.

This study is to analyze the effect of delayed childbearing on pregnancy outcome among nulliparous women. A hospital-based study was conducted with prospectively collected data from the computerized perinatal data base that includes information about all patients delivered in our Hospital. We studied 17,230 nulliparous women who were > or = 20 years of age with a singleton gestation delivered between 1987 and 1992. We assessed the rates of low birth weight (< 2500 g), preterm delivery (< 37 weeks), small for gestational age, perinatal death (> 500 g and 28 days of life), and selected complications of pregnancy and delivery (ante partum complications, meconium, labor abnormal fetal heart rate, cesarean section, breech presentation, Apgar score, umbilical cord-pH, and rates of neonatal admission). Compared with women aged 20-29 years, women aged > or = 35 years had no significantly higher odds ratio (OR) of low birth weight < 2500 g (OR = 1.3); preterm delivery < 37 weeks (OR = 1.2); small for gestational age (OR = 1.0); and perinatal death (OR = 1.7). In contrast, we found a significantly higher rates of specific antepartal complications (OR = 1.9); cesarean section (OR = 2.5); breech presentation (OR = 1.4); and higher rates of admission to the newborn intensive care unit (OR = 1.4); but excluding infants delivered before 37 weeks of gestation, we found no significantly higher odds ratio of neonatal admission (OR = 1.4). Delayed childbearing is associated with an increased risk of complications of pregnancy and delivery although neonatal outcomes were not appreciably different from those among infants of younger women.

In order to evaluate the influence of mode of delivery on perinatal morbidity and mortality in vertex infants weighing less than 1500 g (VLBW), we made a retrospective study of 152 singleton newborns, in vertex presentation, with a birthweight of less than 1500 g, delivered in the Cruces Hospital (Vizcaya, Spain), a major perinatal referral center, between 1 January 1987 and 31 December 1989. Twins and infants with lethal congenital anomalies or gross intrauterine growth deviations were excluded from the study (n = 71). Of the infants studied (n = 81), 37 were delivered by cesarean section (mean weight 1120 +/- 206 g, range: 680-1495 g) and 44 were delivered vaginally (mean weight 1029 +/- 283 g, range: 530-1475 g). The patients were divided into four groups: Group A: 500-749 g (n = 10); Group B: 750-999 g (n = 21); Group C: 1000-1249 g (n = 27); and Group D: 1250-1499 g (n = 23). The percentages of cesarean sections in each group were 10%, 42%, 66% and 39%, respectively. A comparison within each group of immediate perinatal outcome (Apgar score and umbilical vein cord pH), as well as mortality and sequelae up to 1 year of age did not yield any significant differences between cesarean and vaginal birth. We conclude that cesarean delivery does not appear to offer improved outcome over vaginal delivery in live births without congenital anomalies. For this reason, we believe that fetal weight should not be the only obstetrical variable considered when deciding whether or not to perform a cesarean section in these circumstances.

Two groups of primiparous women with single fetus in cephalic presentation were prospectively randomized at the end of pregnancy to receive epidural analgesia with 0.25% bupivacaine, either single (n = 102) or associated with 0.05 mg of phentanyl (n = 102). Phentanyl significantly reduces the period of development of analgesia and increases the interdose period. The quality of analgesia is significantly better when fentanyl is associated with bupivacaine. The evolution of delivery (dilatation and expulsion) and the perinatal results (cord pH and vitality of the newborn as assessed by the Apgar test) were similar in both groups. We conclude that the association of phentanyl with bupivacaine has advantages for epidural analgesia during delivery, as the quality of analgesia is improved, its duration is prolonged and there are no adverse effects on the evolution of delivery or on the newborn.

The authors present a rare case of pruritic urticarial papules and plaques of pregnancy in a 25-year-old caucasian primigravida admitted to our department because of pruritus in the third trimester of gestation. Recommendations for management are discussed.

In the present paper we have studied the quantitative variations in estrogen (ER) and progesterone receptor (PR) content of breast cancer induced by tamoxifen. In addition to receptors, hormonal levels of estradiol, progesterone, prolactin, FSH, LH and testosterone were also measured. The cases included in our study were consecutively selected among those breast cancers in which an aliquot of the tissue sample sent for analysis of the steroid receptors was positive for cancer and also found to have at least one of the steroid receptors positive, not only in the biopsy but also in the surgical specimen. Following this criterion, we finally collected 14 cases of breast cancer treated daily with 30 mg of tamoxifen during an interval of 3 weeks from the initial biopsy to the final surgery. From our results we can conclude that tamoxifen reduced significantly the ER concentration while no changes were observed in PR values. Concerning hormones, while in premenopausal patients tamoxifen induced a rise in plasma estradiol, in postmenopausal women the only modification observed was a decrease in plasma FSH. The variation in steroid receptor content under tamoxifen therapy may also contribute to the evaluation of the hormone dependency of gynecologic malignancies.

The purpose of this paper is to describe the formation of periovarian adhesions after ovarian bilateral wedge resection or laparoscopic biopsy. Twelve patients with polycystic ovaries and infertility had bilateral ovarian wedge resection and second-look laparoscopy after a mean of 33 months. On the other hand, twenty-four patients with various menstrual disorders had laparoscopic ovarian biopsy and subsequent second-look after a mean of 8.8 months. Ninety-two per cent of the patients who had wedge resection had some periovarian adhesions, and in three cases the adhesions were extensive enough to produce mechanical infertility. Pregnancy occurred in four patients despite the presence of filmy or moderate adhesions. The patients who had laparoscopic ovarian biopsy were found to be free of periovarian adhesions during the second-look ovarian visualization. We conclude that ovarian resection should be reserved for nonresponders to a nonsurgical approach of anovulation, and ovarian biopsy when properly done is not followed by periovarian adhesions.

Twenty-nine patients underwent clinical, hormonal, endoscopic, and cytogenetic studies to determine the cause of primary amenorrhea or delayed sexual development. In 19 of them (mean age 17.6 years), the X chromosome was either missing or anomalous. In ten patients (mean age 25.5 years), the chromosomal complement was normal, 46 XX in six patients and 46 XY in four patients. Those with abnormal chromosomal complements were shorter (mean height, 141.9 cm) than patients with normal complements (158.7 cm). Somatic stigmas were observed more frequently in patients with chromosomally abnormal primary gonadal failure. In 23 patients (79.3%), the gonads were streaks, with fibrous stroma devoid of either follicles or tubules containing germ cells. In three patients the ovaries were hypoplastic, with few primordial follicles. Gonadoblastoma was present in two patients with XY and mixed XX/X/XY gonadal dysgenesis. In every patient with streak gonads and lack of germ cells, serum gonadotropin levels were elevated. Karyotype, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) assays, and eventually laparoscopy and gonadal biopsy are important in the management of patients with primary gonadal failure.

The authors present a very infrequent case of invasive placenta in a 33-year-old caucasian primigravida, admitted in our Department because of labor. In the course of a cesarean section performed for failure of progress, the presence of a highly adherent placenta located in the anterior part of the lower uterine segment which affected the posterior vesical wall was discovered. Recommendations for management are discussed.