RESUMEN
Patients with gynecologic vasculitis should be evaluated for systemic disease as prognosis and treatment can vary depending on systemic involvement versus isolated disease. Leukocytoclastic vasculitis is a rare, immune-mediated small-vessel vasculitis. Leukocytoclastic vasculitis of the uterine cervix with systemic involvement has not previously been reported. A 25-year-old female with abnormal cervical cancer screening presented for colposcopy. Biopsies were notable for dysplasia and concurrent leukocytoclastic vasculitis. The patient later recalled a recurrent rash of her lower extremities, suspicious for systemic disease. Patients with gynecologic vasculitis should be evaluated for systemic involvement because prognosis and treatment differ from that of isolated disease. Additionally, leukocytoclastic vasculitis of the uterine cervix may be associated with both hormonal contraception and infections such as human papillomavirus, and any resulting cervical dysplasia should be monitored for progression and treated accordingly.
Asunto(s)
Neoplasias del Cuello Uterino , Vasculitis Leucocitoclástica Cutánea , Vasculitis , Adulto , Femenino , Humanos , Detección Precoz del Cáncer , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/diagnóstico , Vasculitis/complicaciones , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Vasculitis Leucocitoclástica Cutánea/complicaciones , Vasculitis Leucocitoclástica Cutánea/patologíaRESUMEN
Cannabis use during pregnancy may cause fetal toxicity driven by in utero exposure to (-)-∆9 -tetrahydrocannabinol (THC) and its psychoactive metabolite, (±)-11-hydroxy-∆9 -THC (11-OH-THC). THC concentrations in the human term fetal plasma appear to be lower than the corresponding maternal concentrations. Therefore, we investigated whether THC and its metabolites are effluxed by placental transporters using the dual cotyledon, dual perfusion, term human placenta. The perfusates contained THC alone (5 µM) or in combination (100-250 nM) with its metabolites (100 nM or 250 nM 11-OH-THC, 100 nM COOH-THC), plus a marker of P-glycoprotein (P-gp) efflux (1 or 10 µM saquinavir), and a passive diffusion marker (106 µM antipyrine). All perfusions were conducted with (n = 7) or without (n = 16) a P-gp/BCRP (breast-cancer resistance protein) inhibitor, 4 µM valspodar. The maternal-fetal and fetal-maternal unbound cotyledon clearance indexes (m-f-CLu,c,i and f-m-CLu,c,i ) were normalized for transplacental antipyrine clearance. At 5 µM THC, the m-f-CLu,c,i , 5.1 ± 2.1, was significantly lower than the f-m-CLu,c,i , 13 ± 6.1 (P = 0.004). This difference remained in the presence of valspodar or when the lower THC concentrations were perfused. In contrast, neither metabolite, 11-OH-THC/COOH-THC, had significantly different m-f-CLu,c,i vs. f-m-CLu,c,i . Therefore, THC appears to be effluxed by placental transporter(s) not inhibitable by the P-gp/BCRP antagonist, valspodar, while 11-OH-THC and COOH-THC appear to passively diffuse across the placenta. These findings plus our previously quantified human fetal liver clearance, extrapolated to in vivo, yielded a THC fetal/maternal steady-state plasma concentration ratio of 0.28 ± 0.09, comparable to that observed in vivo, 0.26 ± 0.10.
Asunto(s)
Intercambio Materno-Fetal , Placenta , Embarazo , Humanos , Femenino , Placenta/metabolismo , Dronabinol , Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/metabolismo , Proteínas de Neoplasias/metabolismo , Antipirina/metabolismo , Subfamilia B de Transportador de Casetes de Unión a ATP/metabolismo , Miembro 1 de la Subfamilia B de Casetes de Unión a ATP/metabolismoRESUMEN
OBJECTIVE: To evaluate which factor, AMH or FSH, was superior in predicting live birth after assisted reproductive technologies (ART) when the tests are discordant, using data from the Society for Assisted Reproductive Technology Clinical Outcomes Reporting System database. DESIGN: Retrospective cohort. SETTING: Clinic-based data. PATIENT(S): The study population included 44,696 fresh embryo transfer cycles using autologous oocytes. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Live birth (≥22 wk gestation and ≥300 g birth weight). RESULT(S): Live birth rate per started cycle was lower in patients with low AMH and normal FSH than in patients with normal AMH and elevated FSH (26% vs. 39%). A multivariate analysis was performed on patients with normal FSH and low AMH, and the following factors were independently associated with live birth: AMH, age >40 years, body mass index >30 kg/m2, race African-American or Asian, IVF clinic region West, uterine factor infertility diagnosis, agonist suppression, and FSH dosage. IVF cycle cancellation rate was higher in patients with low AMH and normal FSH (30%). CONCLUSION(S): AMH is a superior predictor of live birth in patients undergoing IVF when FSH and AMH values are discordant. Lower AMH is independently associated with lower live birth and higher IVF cycle cancellation rates than elevated FSH in patients with discordant values.