Identification of hearing loss after age 18 months is not early enough

Choriocarcinoma arising in the placenta, or intraplacental choriocarcinoma, has seldom been reported, particularly in the absence of maternal metastases. Reluctance to diagnose choriocarcinoma in the presence of chorionic villi can delay diagnosis; however, timely diagnosis of choriocarcinoma is prognostically important, both for the mother and infant. We report the clinicopathologic findings in five mothers and infants in whom choriocarcinoma was identified in the placenta. None of the mothers had a history of gestational trophoblastic disease in previous pregnancies. Three placentas were similar with a single small lesion grossly suggesting a small infarct; microscopically these consisted of infarcted areas surrounded by choriocarcinoma. These three mothers were unusual in that none had metastatic choriocarcinoma; two were treated with chemotherapy and remained disease-free; the third was lost to follow-up shortly following delivery. The remaining two mothers had known pulmonary metastases at time of delivery. One of these latter two placentas contained a large marginal lesion microscopically identified as choriocarcinoma. The fifth placenta had rare microscopic foci of choriocarcinoma, and sheets of necrotic choriocarcinoma were identified in "blood clot" submitted with the placenta. In four of the five cases the choriocarcinoma appeared to be arising from otherwise normal chorionic villi, and in no case was there invasion of the villous stroma. All of the infants survived, and none had evidence of choriocarcinoma. These cases support the concept that choriocarcinoma associated with otherwise normal pregnancy arises in the placenta and may be more common than reported.     

Intradermal and subcutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 41 cases

Superficial leiomyosarcomas are rare tumours. The lesions confined to the dermis, contrary to those involving the subcutis, have been reported to carry a favourable prognosis. A retrospective study of 41 consecutive cases of surgically treated intradermal and subcutaneous leiomyosarcomas was undertaken in order to determine the prognostic factors that may influence the survival of these patients. Seven tumours were predominantly intradermal and 34 involved the subcutaneous tissue. Fifty-four percent of the tumours were located in the lower extremities. All cases stained positively for smooth muscle antigen and 66% for desmin. The tumours were classified with regard to tumour grade I (low grade, 3%), II (intermediate, 12%), IIIA (high grade, 46%) and IIIB (high grade, 39%). In all patients, follow-up information was available. Mean follow-up time was 5 years. The patients with intradermal tumours were all alive without signs of recurrence, whereas 14 of those with leiomyosarcomas involving the subcutis have died with pulmonary metastases. Our study confirms that "pure" intradermal leiomyosarcomas independent of tumour grade behave in a benign fashion, probably due to small tumour size. Tumour size > or = 5 cm, deep localization with fascia involvement, and high malignancy grade (IIIB) were found to deteriorate survival based on a univariate analysis. However, in a multivariate analysis only tumour size was found to be an independent prognostic factor.     

Reiteration frequency of the histone genes in the genome of the amphibian, Xenopus laevis

Although female employment and fertility are generally inversely related in already developed countries, no clear association has been found in the developing economies. The absence of a uniform relationship is related to the problems of measurement for both variable s. Consequently, it is suggested that a better understanding of the relationship between fertility and employment for women can be obtained by giving consideration to: 1) the ecological or individual level of analysis, 2) the life cycle aspects of fertility and labor force participation by means of the use of small age groups in the analysis or cohort data if available, 3) the matching of current or historical perspective on both work and fertility, 4) more complete measures of fertility that consider both the number and spacing of children, and 5) a new approach to measuring the labor force and labor force participation as outlined in the Council of Asian Manpower Studies and the Organization of Demographic Associates approaches. Although there is a need for more data, the most important need is for different data and for different combinations of fertility and work data. It is particularly the labor force data that require a new approach. Both the gainful worker and labor force approaches were designed to measure the work of men in a Western society. These approaches were not designed nor can they be expected to provide useful service for measuring the very different work of women in developing countries, much less in relating work to other variables such as fertility. Thus, it is expected that the relationship between work and fertility will remain elusive under these circumstances. Neither the labor force dimension nor the other dimensions indicated have been generally considered in studies of work and fertility in developing countries. No study has been made using all these suggested dimensions. It is believed that the use of these dimensions is necessary in order to achieve a complete understanding of the relationship between female employment and fertility.     

Cutaneous leishmaniasis in the Libyan Arab Republic: distribution of the disease and identity of the parasite

When mammalian sperm cells are exposed to solutions of albumin there are changes in the membranes of some species that resemble those that normally occur in the uterus prior to fertilization. We have shown that albumin molecules absorb on to the membranes of ejaculated rabbit sperm cells, and that the equilibrium binding constant, K, (1) varies inversely with the albumin concentration, (2) is independent of the sperm cell concentration in the range of 10(6)--10(7) per ml, (3) is independent of the time of exposure of the sperm cells to the albumin solution, and (4) decreases in the presence of Ca++ and Mg++ ions. An unusual aspect of the adsorption is that if the albumin concentration is given the symbol [A], K[A] is a constant in our measurements. This means that for virtually the entire range of [A] studied, the sperm cells bind albumin so that half of the available surface is coated and half remains uncoated. This situation is rather remarkable and it suggests a role that adsorption could play in the physical processes preceding fertilization. In purely physical systems, the optimum for the bridging and flocculation of particles that are coated with adsorbed macromolecular films occurs when half of the available surface is covered. The sperm cell appears to provide the optimal situation for interacting with itself or with another surface.     

Hemodynamic determinants of the time-course of fall in canine left ventricular pressure

The hemodynamic determinants of the time-course of fall in isovolumic left ventricular pressure were assessed in isolated canine left ventricular preparations. Pressure fall was studied in isovolumic beats or during prolonged isovolumic diastole after ejection. Pressure fall was studied in isovolumic relaxation for isovolumic and ejecting beats (r less than or equal to 0.98) and was therefore characterized by a time constant, T. Higher heart rates shortened T slightly from 52.6 +/- 4.5 ms at 110/min to 48.2 +/- 6.0 ms at 160/min (P less than 0.01, n = 8). Higher ventricular volumes under isovolumic conditions resulted in higher peak left ventricular pressure but no significant change in T. T did shorten from 67.1 +/- 5.0 ms in isovolumic beats to 45.8 +/- 2.9 ms in the ejecting beats (P less than 0.001, n = 14). In the ejecting beats, peak systolic pressure was lower, and end-systolic volume smaller. To differentiate the effects of systolic shortening during ejection from those of lower systolic pressure and smaller end-systolic volume, beats with large end-diastolic volumes were compared to beats with smaller end-diastolic volumes. The beats with smaller end-diastolic volumes exhibited less shortening but similar end-systolic volumes and peak systolic pressure. T again shortened to a greater extent in the beats with greater systolic shortening. Calcium chloride and acetylstrophanthidin resulted in no significant change in T, but norepinephrine, which accelerates active relaxation, resulted in a significant shortening of T (65.6 +/- 13.4 vs. 46.3 +/- 7.0 ms, P less than 0.02). During recovery from ischemia, T increased significantly from 59.3 +/- 9.6 to 76.8 +/- 13.1 ms when compared with the preischemic control beat (P less than 0.05). Thus, the present studies show that the time-course of isovolumic pressure fall subsequent to maximum negative dP/dt is exponential, independent of systolic stress and end-systolic fiber length, and minimally dependent on heart rate. T may be an index of the activity of the active cardiac relaxing system and appears dependent on systolic fiber shortening.