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PubMed2002

Predicting the decrease of conjugated bilirubin with extracorporeal albumin dialysis MARS using the predialysis molar ratio of conjugated bilirubin to albumin.

Extracorporeal albumin dialysis with the molecular adsorbent recirculating system (MARS) machine is a new supportive intervention for patients with liver failure. It removes bilirubin and other albumin-bound toxins from the patient and has been shown by preliminary studies of liver failure patients to be beneficial. Our study examines the ability of predialysis molar ratio of bilirubin to albumin to predict the decrease of bilirubin by MARS. We had 5 patients and results from 29 treatments. The results showed a significant correlation between the predialysis molar ratio of bilirubin (total and conjugated) to albumin to the reduction in bilirubin (total and conjugated): R(2) = 0.27 and 0.62 respectively, P <.005 for both. There was no significant correlation with the predialysis molar ratio of unconjugated bilirubin to albumin to the reduction in unconjugated bilirubin. The ratio of change in total bilirubin (micromol/L) to the predialysis molar ratio of total bilirubin to albumin and the ratio of change in conjugated bilirubin (micromol/L) to the predialysis molar ratio of conjugated bilirubin to albumin were 6.2 (+/- 4.2) and 10.8 (+/- 4.3), respectively (mean (+/- SD)). The results enable us to predict the likely reduction in bilirubin (especially conjugated) after each MARS treatment and also suggest to us that albumin infusion before MARS treatment may reduce the efficacy of bilirubin removal. Whether this ratio applies to other albumin-bound toxins remains open for investigation.

Bilirubin↗
PubMed2006

Partial molar volume of n-alcohols at infinite dilution in water calculated by means of scaled particle theory.

The partial molar volume of n-alcohols at infinite dilution in water is smaller than the molar volume in the neat liquid phase. It is shown that the formula for the partial molar volume at infinite dilution obtained from the scaled particle theory equation of state for binary hard sphere mixtures is able to reproduce in a satisfactory manner the experimental data over a large temperature range. This finding implies that the packing effects play the fundamental role in determining the partial molar volume at infinite dilution in water also for solutes, such as n-alcohols, forming H bonds with water molecules. Since the packing effects in water are largely related to the small size of its molecules, the latter feature is the ultimate cause of the decrease in partial molar volume associated with the hydrophobic effect.

Journal Article↗
PubMed2002

Primary wound healing after lower third molar surgery: evaluation of 2 different flap designs.

OBJECTIVES: Wound dehiscences after lower third molar surgery potentially extend the time of postsurgical treatment and may cause long-lasting pain. It was the aim of this prospective study to evaluate the primary wound healing of 2 different flap designs. METHODS: Sixty completely covered lower third molars were removed. In 30 cases, the classic envelope flap with a sulcular incision from the first to the second molar and a distal relieving incision to the mandibular ramus was used, whereas the other 30 third molars were extracted after preparation of a modified triangular flap first similarly described by Szmyd. Wound healing was controlled on the first postoperative day, as well as 1 and 2 weeks after surgery. RESULTS: The overall result was a total of 33% wound dehiscence. In the envelope-flap group, wound dehiscences developed in 57% of the cases. This represents a relative risk ratio of 5.67, with a 95% CI from 1.852 to 12.336. With the modified triangular-flap technique, only 10% of the wounds gaped during wound healing. CONCLUSION: This study confirms evidence that the flap design in lower third molar surgery considerably influences primary wound healing. The modified triangular flap is significantly less conducive to the development of wound dehiscence.

Adolescent↗
PubMedDate not supplied

Molar gestations and hydropic abortions differentiated by p57 immunostaining.

Classification of molar gestations into complete and partial and their differentiation from hydropic abortions traditionally are accomplished by morphology alone. The process sometimes may be inaccurate or inconclusive. With the availability of p57 immunostaining it may be possible to objectively classify these lesions. We used p57 for the differential diagnosis of hydropic abortions and molar gestations and correlated the findings with the clinical outcome of patients in each category. First, 86 cases were originally classified by histomorphology into hydropic abortion (42) and molar gestations (23 complete and 21partial). Based on the pattern of p57 staining the cases were reclassified into 45 hydropic abortions, 15 partial moles and 26 complete moles (3 cases with previous diagnosis of complete mole based on morphology were reclassified as hydropic abortion). Clinical follow-ups ranged from 6-24 months and showed persistent trophoblastic disease in 8 cases (31%) of complete moles and 3 cases (20%) of partial moles (p = 0.47). No hydropic abortion cases demonstrated persistent trophoblastic disease. One patient with partial mole developed choriocarcinoma. This study confirms that p57 objectively distinguishes hydropic abortions from molar gestations (partial and complete moles). This differentiation is clinically relevant since patients with hydropic abortions do not need to be followed while patients with molar gestations do.

Abortion, Spontaneous↗
PubMed1972

Influence of dietary potassium and sodium/potassium molar ratios on the development of salt hypertension.

Among genetically hypertension-prone rats, dietary sodium (chloride) was demonstrably hypertensinogenic and potassium (chloride) antihypertensinogenic. On diets containing the same NaCl but different KCl concentrations, mean blood pressure was greater in rats receiving less dietary potassium, i.e., diets with a higher Na/K molar ratio. On diets with different absolute concentrations of NaCl and KCl, but the same Na/K molar ratios, rats on the higher absolute NaCl intakes had the higher blood pressures. On diets with different absolute concentrations of NaCl and KCl, and different Na/K molar ratios, a group on a lower absolute NaCl intake but with a higher Na/K ratio could have more hypertension than a group on a higher absolute NaCl intake but with a lower Na/K ratio. At equivalent molar ratios, the respective effects of these two ions on blood pressure were dominated by that of sodium. It was concluded that the dietary Na/K molar ratio can be an important determinant for the severity, or even development, of salt-induced hypertension. The mechanism of the moderating effect of potassium on sodium-induced hypertension was unclear.

Analysis of Variance↗
PubMed2000

Relative molar response factors for thermal conductivity detectors

This paper describes an investigation into the universal nature of relative molar response factors for thermal conductivity detectors. Relative molar response factors are measured on multiple gas chromatographs equipped with thermal conductivity detectors, and the values are compared with values in the literature. As was observed previously, relative molar responses obtained on a single instrument for a homologous series vary linearly with respect to the number of carbon atoms in the hydrocarbon chain. However, significant differences are observed for the slope of this line depending on the instrument studied. This contradicts previous literature results that demonstrated an indepedence of the relative molar response with regard to the detector. The current results show that the calibration of thermal conductivity detectors using literature values for relative molar response factors could produce significant errors in the concentrations measured by the laboratory chromatograph.

Journal Article↗
PubMed2004

Low risk of relapse after achieving undetectable HCG levels in women with complete molar pregnancy.

OBJECTIVE: Complete hydatidiform molar pregnancies occur in approximately 1 of 1,000 conceptions. After uterine evacuation of the trophoblastic tissue, women are followed up with serial serum human chorionic gonadotropin (hCG) measurements. Patients are considered to have attained remission when their hCG level spontaneously declines to an undetectable level and remains there during a 6-month follow-up period. This standard effectively detects all disease recurrence; however, it is resource intensive, delays child bearing, and is subject to significant noncompliance. Our objective was to determine the risk of disease recurrence after hCG spontaneously declines to undetectable levels. METHODS: We used a database from the New England Trophoblastic Disease Center to analyze hCG levels in patients with complete molar pregnancies. RESULTS: Among 1,029 women with complete molar pregnancy and complete data, 15% developed persistent gestational trophoblastic neoplasia. The rate of persistent neoplasm among those whose hCG level fell spontaneously to undetectable levels was 0.2% (2/876, 95% confidence interval 0-0.8%). No women developed persistent gestational trophoblastic neoplasia after their hCG level fell to undetectable levels using an assay with a sensitivity of 5 mIU/mL (n = 82, 95% confidence interval 0-4.5%). CONCLUSION: Based on our experience with women with complete hydatidiform molar pregnancies whose hCG values spontaneously fell to undetectable levels after molar evacuation, we conclude that the risk of recurrent neoplasm after hCG levels fall to less than 5 mIU/mL approaches zero.

Adult↗
PubMed2004

No evidence for apoptosis of decidual leucocytes in normal and molar pregnancy: implications for immune privilege.

Complete hydatidiform moles are totally paternally derived and represent complete allografts that might be expected to provoke maternal immune rejection. Our previous and other studies have shown expression of Fas by increased numbers of activated decidual CD4(+) T cells in both complete and partial molar pregnancy as well as increased FasL(+) expression by molar trophoblasts compared with trophoblasts in normal pregnancies. As the Fas/FasL system represents a major apoptotic pathway that can play a role in immune privilege, the aim of this study was to investigate whether apoptosis of decidual immune cells, particularly T cells, could be responsible for maternal immune tolerance in molar pregnancy. Using terminal deoxynucleotidyl transferase (TdT)-mediated nick end-labelling (TUNEL), a significant increase in TUNEL(+) cells was demonstrated in decidua associated with partial (P = 0.0052) and complete (P = 0.0096) hydatidiform mole compared with normal early pregnancy. Co-labelling immunoperoxidase studies showed that the TUNEL(+) cells in both normal and molar pregnancies were not activated CD45RO(+) immune cells, CD3(+) T cells, CD56(+) uterine natural killer (NK) cells or CD14(+) CD68(+) macrophages. Double immunohistochemical labelling with antiactive caspase-3 and leucocyte markers confirmed the lack of leucocyte apoptosis. Double immunostaining with anticytokeratin to detect trophoblast and M30 CytoDeath, which detects a neoepitope of cytokeratin 18 revealed after caspase-mediated cleavage, revealed apoptotic extravillous trophoblast cells within decidual tissue. We conclude that there is no evidence that apoptosis of decidual leucocytes plays a role in maintaining maternal tolerance in either normal or molar pregnancy.

Antigens, CD↗
PubMed1995

Fluoride distribution of rat molar cementum in relation to age and fluoride levels in the drinking water.

The present study was undertaken to determine the fluoride distribution profile in rat molar cementum with age in relation to fluoride in drinking water. Fifty-four female Wistar rats were used for the experiment. Before the experiment 6 rats were killed under chloroform anesthesia at 4 weeks of age as controls. The remaining 48 rats were divided into two groups: a control group given distilled water and the other group given water containing 100 ppm fluoride ad libitum. Six rats from each group were killed at the ages of 6, 12, 24, and 48 weeks. The fluoride distribution in the molar cementum was analyzed from the surface to the cementodentinal junction by abrasive microsampling. The fluoride concentrations in molar cementum from control rats on distilled water remained relatively constant until 24 weeks. A small increase then occurred between 24 and 48 weeks. The fluoride concentration in cementum from rats drinking water containing 100 ppm fluoride increased markedly with age, both in outer and inner regions of the molar cementum for all rats. On the other hand, the fluoride concentration in the cementum of older rats drinking water with 100 ppm fluoride was significantly higher in the outer than in the inner region of the cementum. It was concluded that the fluoride distribution in rat molar cementum may increase throughout life in relation to the fluoride level in the drinking water.

Age Factors↗
PubMed2005

Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial.

We hypothesized that the six-monthly application of silver diamine fluoride (SDF) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars. A prospective controlled clinical trial was conducted on the efficacy of a 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos. The second group served as controls. The 36-month follow-up was completed by 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren.

Cariostatic Agents↗
PubMed1976

Growth hormone, prolactin and chorionic somatomammotropin in normal and molar pregnancy.

Twenty patients with molar pregnancy, ten normal pregnant women and ten healthy non-pregnant women were given 30 g of arginine intravenously. The serum concentration of growth hormone, prolactin and chorionic somatomammotropin (CS) was determined by radioimmunoassay. In addition, serum 17beta-estradiol, estriol and progesterone were also measured. Arginine infusion induced a sharp rise of GH in patients with molar pregnancy and in nonpregnant subjects, but the response in normal pregnancy was blunted. The response of PRL was high in patients with molar pregnancy, blunted in normal pregnancy and very small in nonpregnant subjects. CS did not respond at all to arginine infusion both in normal pregnancy and molar pregnancy. The high response to argine of PRL, normal response of GH and low baseline secretion and no response of CS may be characteristic of molar pregnancy.

Arginine↗
PubMed1977

Thyroid function in molar pregnancy.

Various aspects of thyroid hormone economy were examined in 15 patients with molar pregnancy and in 5 patients with choriocarcinoma. None of the patients with molar pregnancy was clinically thyrotoxic, though serum thyroxine (T4) was increased in 13 and free T4 concentrations were above normal in four of ten in whom measurements were made. In 2 patients with elevated serum T4 levels and in one patient with normal serum T4 levels, the daily rate of T4 disposal was increase, and most of 131I derived from 131I-T4 was excreted into urine in two patients in whom estimation of urinary excretion was made. Serum total triiodothyronine (T3) concentrations closely paralleled those of serum T4, but T3/T4 ratios were lower than those previously found in patients with toxic diffuse goiter of Graves' disease. Unresponsiveness to exogenous thyrotropin-releasing hormone (TRH) was observed in 5 patients with molar pregnancy whose serum total T4 and T3 levels were increased. Human chorionic gonadotropin (hCG) concentrations in serum ranged from 0.5 to 2830 IU/ml and were less than 200 IU/ml in 36% of the patients, possibly because molar pregnancy was diagnosed by ultrasonography, rather than high titers of urinary or serum hCG. Serum thyroid stimulating activity measured by the McKenzie bioassay closely paralleled values for hCG (r:+0.94). All thyroid abnormalities disappeared quickly after removal of the mole. In choriocarcinoma, no abnormality of thyroid function was found. These results suggest that: 1) some patients with molar pregnancy display a marked elevation of serum T4, T3, and free T4 concentrations, probably as a result of the action of a thyroid stimulator which is closely related to serum hCG or may be hCG itself; 2) T4 production rates are increased in these patients, and the pituitary responds to TRH in a manner similar to that found in thyrotoxicosis. Despite this, frank clinical thyrotoxicosis is usually absent, possibly because of relatively low serum T3/T4 ratios, possibly because of the limited duration of thyroid hyperfunction, and possibly because of other factors that for the present remain unknown.

Adult↗
PubMed1991

Choice as a function of local versus molar reinforcement contingencies.

Rats were trained on a discrete-trial probability learning task. In Experiment 1, the molar reinforcement probabilities for the two response alternatives were equal, and the local contingencies of reinforcement differentially reinforced a win-stay, lose-shift response pattern. The win-stay portion was learned substantially more easily and appeared from the outset of training, suggesting that its occurrence did not depend upon discrimination of the local contingencies but rather only upon simple strengthening effects of individual reinforcements. Control by both types of local contingencies decreased with increases in the intertrial interval, although some control remained with intertrial intervals as long as 30 s. In Experiment 2, the local contingencies always favored win-shift and lose-shift response patterns but were asymmetrical for the two responses, causing the molar reinforcement rates for the two responses to differ. Some learning of the alternation pattern occurred with short intertrial intervals, although win-stay behavior occurred for some subjects. The local reinforcement contingencies were discriminated poorly with longer intertrial intervals. In the absence of control by the local contingencies, choice proportion was determined by the molar contingencies, as indicated by high exponent values for the generalized matching law with long intertrial intervals, and lower values with short intertrial intervals. The results show that when molar contingencies of reinforcement and local contingencies are in opposition, both may have independent roles. Control by molar contingencies cannot generally be explained by local contingencies.

Animals↗
PubMed1999

Molar pregnancy presenting with hyperemesis gravidarum.

Nausea and vomiting are common complaints in pregnancy, occurring in more than 50% of pregnant women. Occasionally, the vomiting becomes severe and persistent enough to develop into the syndrome called hyperemesis gravidarum and sometimes requires hospitalization. A 20-year-old woman presented with hyperemesis gravidarum, which was later found to be associated with a molar pregnancy. Hyperemesis gravidarum is reported to occur in as many as 26% of molar pregnancies. Increases in the level of serum beta-human chorionic gonadotropin may be the mechanism of hyperemesis gravidarum in molar pregnancy. Hyperthyroid states linked to molar pregnancy may further exacerbate hyperemesis gravidarum. Physicians should be aware of this possibility of molar pregnancy in all patients with hyperemesis gravidarum and be familiar with the appropriate management to monitor and prevent an often-fatal trophoblastic neoplasm.

Adult↗
PubMed1999

Sonographic appearance of early complete molar pregnancies.

Since our anecdotal experience indicates that the classically described "snowstorm" appearance on ultrasonography of early molar pregnancies is often not present and that theca-lutein cysts are also rare, we examined the ultrasonographic appearance of early complete molar pregnancies. We reviewed the ultrasonographic reports and clinical data of 21 cases of histologically diagnosed complete molar pregnancies with a mean gestational age at sonography of 10.5 weeks (range, 4 to 18 weeks). The diagnosis of molar pregnancy was made on ultrasonography in 12 (57%) cases, was second in the differential diagnosis of one (4.8%) case, and was not considered in eight (38%) cases. No theca-lutein cysts were identified. Five of five (100%) molar pregnancies of 13 weeks or over were diagnosed prospectively, while only eight of 16 (50%) earlier pregnancies were correctly diagnosed prospectively. In a retrospective review of the available images of 16 patients, only nine of 16 (56%) images demonstrated the classic appearance, and no theca-lutein cysts were seen. We conclude that the classic appearance of complete moles on ultrasonography is seen in less than two thirds of cases and even less commonly in the first trimester. The prevalence of theca-lutein cysts is very low.

Adult↗
PubMed1999

[Manual intrauterine aspiration om the treatment of molar pregnancy].

Thirty six cases of molar pregnancy treated by Manual Vacuum Aspiration (MVA) were reviewed in the Instituto Nacional de Perinatología from January 1st to october 31, 1997. Molar pregnancy rate was 2.3 per 1000 pregnancies. Sixty percent of the cases occurred in women aged 20-30 years old. Previous molar pregnancy was the most frequent risk factor found, it was present in 44.5% of the cases. The mean gestational age was 12.6 weeks. Peridural blocking was used for anesthesia de 86.1% of the cases, in the remainder general anesthesia was used. MVA was performed by different surgeons, following the technique that has been previously reported. Twelve women received sharp curettage immediately after MVA. There were tree women with bleeding complications (1000 cc or more), one case needed blood transfusion. In two cases the evacuation was incomplete. Seven cases became persistent trophoblastic disease. The histopathologic report was consistent with complete molar pregnancy la more than 90% of the cases. Oral contraceptives were selected by 66.7% of the women after the evacuation. It was concluded that MVA is a safe and effective method for the evacuation of molar pregnancy.

Adolescent↗
PubMed2001

[Regression of hCG in various types of molar pregnancies--clinical course and prognosis].

OBJECTIVE: To evaluate spontaneous regression curves of hCG serum positivity in patients with surgically treated molar pregnancies. Comparison of complete, partial and invasive mole. The study should result in optimalisation of follow up criteria of molar pregnancies in respect to their potential malignant change. DESIGN: Retrospective comparative clinical study. SETTING: Obst. Gyn. Dpt., Oncogynecology div., 2nd Medical Faculty, FNM, Charles University Prague, Pathology Dpt., 2nd Medical Faculty, Institute of Biology and Medical Genetics. METHODS: Evaluation of spontaneous regression curves of serum hCG levels in 104 molar pregnancies. 46 patients with partial hydatiform mole, 48 patients with complete hydatiform mole, 10 patients with invasive mole. Serum hCG levels were detected by radioimunoassay (RIA) in the first period and imunochemoluminisent assay (LIA) in the second period. Regression curves of hCG positivity in particular moles were statistically evaluated by Fischer test and t-test. RESULTS: There is statistically significant difference in spontaneous regression of hCG positivity in different types of molar pregnancies. Recommended criteria for gestational trofoblastic disease (GTD) diagnosis and follow up are fully applicable in clinical practice. There is exception in partial hydatiform moles, where plateau in hCG regression does not necessarily implicate chemotherapy in patient with good compliance. CONCLUSION: Early diagnosis of GTD predominantly due to the widespread use of ultrasonography changes classical clinical features of molar pregnancies. Spontaneous regression in hCG positivity in serum is more rapid in patients with partial hydatiform mole, slower in complete hydatiform mole and invasive mole. There is no significant change in malignant potential regarding early detection and treatment.

Chorionic Gonadotropin↗
PubMed1999

Early detection of persistent trophoblastic tumour by serum human chorionic gonadotrophin monitoring after molar pregnancy.

OBJECTIVE: To study the outcome of a multi-centred post-molar pregnancy serum human chorionic gonadotrophin (hCG) surveillance programme. METHODS: Patients recruited into the multi-centred post-molar serum hCG surveillance programme between 1988 and 1996 were studied. The clinical data were obtained from medical records and computer database. RESULTS: There were 616 patients in the study. Twenty-five (11%) of 224 patients with molar pregnancy and 28 (7%) of 392 patients with partial molar pregnancy were diagnosed to have persistent trophoblastic tumour (PTT) requiring chemotherapy. Of the 53 patients treated for PTT, 58.5% received intravenous methotrexate (MTX), 22.6% received both MTX and actinomycin D, and 19% received CHAMOC, a multiple chemotherapeutic regimen. Four patients receiving single drug had to change the regimen because of poor response, and all recovered and remained well. There were 3 cases of recurrence, one in each group of patients receiving single, dual or multiple agents. One patient died because of treatment complication. The rest were well with a mean follow-up of 42 months. CONCLUSIONS: Post-molar serum hCG surveillance is important to detecting persistent trophoblastic activity. Early treatment of PTT by the appropriate chemotherapy has a near hundred percent cure and prevents the progression of PTT into more advanced trophoblastic malignancy such as choriocarcinoma.

Adolescent↗