Volumt· 1~3 Number I

Correspondence

2. Sternberl!. W. H.: Discussion. AM. T. 91: 257, l965.

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0BSTET. GYNECOL.

3. Krause, D. E., and Stembridge, V. A.: Luteomas of pregnancy,

.A.M.

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0BSTET. GYNECOL.

Dimes, New York, New York, and the National Institute of General Medical Sciences (U. S. A.). Digamber S. Borgaonkar David R. Bolling

95: 192, 1966.

!nternetkme! Reg!etry of Abnorme! Karyotypes

To the Editors:

We have established an International Registry of Abnormal Karyotypes. For inclusion in the Registry, the data should include information on the person(s) reporting on the case, the chromosomal variation or abnormality in as much detaiP as possible regarding the region and band of the chromosome(s), and the case number of the laboratory. (The latter is to avoid duplication of the data in multipie pubiications, to facilitate further communications about the case, and to protect the confidential nature of the data. The Registry has been computerized. From the data in the Registry, it is possible to obtain readily information on any abnormality and to sort data by chromosome, type of abnormality, and the locale of the reporting laboratory. It is planned to have computer printouts of the Registry about two or three times a year, and they will be available at cost. The organization of the Registry is by sections, each headed by an entry number as in the catalog of published chromosomal variants and aberrations also maintained in this Department. 2 • 3 The entry number has as its first two characters the chromosome number; the third character represents the chromosome arm, and the fourth, fifth, and sixth characters refer to the region, band and subband. Within each section, all reports are arranged alphabetically by the last name of the first author. The Registry has been established with a view to facilitating access to data which now lie buried in laboratory files. Through the Registry, these data will be available to those planning collective studies on specific chromosomal abnormalities, clinically delineating isolated cases with rare chromosomal anomalies, using cell lines with chromosomal rearrangements in regional gene assignments, etc. A registry of abnormal karyotypes is a desirable compilation from many points of view. For example, we would be able to have at a glance the total range and extent of abnormalities for a chromosome or a band thereof. From a public health point of view, such a registry ought to be of some help in proper planning of facilities such as amniocentesis clinics, genetic counseling centers, and management institutions. It is hoped that the system adopted in arranging the data may be used to catalog the mammalian Xchromosome and break points in different species such as the house mouse, Mus musculus, for which the chromosome regions have now been well defined. Preliminary financial support for this effort has been received from The National Foundation-March of

105

Division of Medical Genetics Department of Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland 21205

REFERENCES Conference 1971, Standardization in Human Cytogenetics, Birth Defects: Original Article Serit·s 8, New York, 1972, The National Foundation, p. 7. 2. Borgaonkar, D. S., Bolling, D. R., Partridge, C., Ruddle, F. H., and McKusick, V. A.: Chromosomal variation in man, A catalog of chromosomal variants and anomalies, in Rotterdam Conference 1974, Birth Defects: Orii!Pnal Artil. Paris

cle Series, !'-.Jew York, 1975, The ~~ational Foundation. In

press. 3. Borgaonkar, D. S.: Chromosomal Variation in Man, A cataiog of chromosomai variants and anomai~es, Baitimore, 1975. The Johns Hopkins University Pres,.

A comfortable operating room table To the Editors:

Operating room-table mattresses are the most uncomfortable, rock hard, unorthopedic coverings designed for a patient to be placed upon. X-ray tables are worse, but at least the patient is not anesthetized. A recent review of our patients revealed that the vast majority had varying degrees of back pain on returning from the operating room. In some cases, the back pain was worse than the pain from the incision. Anyone who tries to watch a football game while reclining in a "beanbag" chair finds it most difficult to stay awake for the last quarter. With the use of this principle of mobile styrofoam peas, an operating room mattress was made for the gynecologic service. This mattress has been well received by patients, and the problem of backache has been eliminated, e'oen after exenterations. The mattress was made with the same design used for standard operating table covers, with the exception that it was three inches thick and slightly wider than the table. It was found important not to overstuff the bag with "beans." A zipper at one end allowed for refilling if necessary. Head and feet cushions were made in a like fashion. It was necessary to bolster the arm board because of the extra height of the mattress. We found that positioning the patient on the mattress before administering the anesthetic is important. The patient should be instructed to wiggle, thus shifting the beans into the small of the back. A perfect mold of the back is formed for each individual, providing maximum support and comfort. Acceptance by the anesthetists and nurses has been enthusiastic. Patients do not mind waiting on the table and often remark that thev wish thev had one at home.

106 Correspondence

Scptemht'J 1. Am.

We have also used this mattress in the exammmg rooms with equal success. For obstetric tables, a wide design is necessary. John D. Trelford, M.D. Department of Obstetrics and Gynecology University of California at Davis School of Medicine Davis, California 95616

False negative oxytocin challenge tests To the Editors: In his article, Dr. Freeman (AM. J. OBSTET. GvNECOL. 121: 481, 1975) placed great reliance on the value of a negative oxytocin challenge test. (OCT). He stated that his group had only one fetal death within a week of a negative OCT in over 1,500 tests carried out in 600 patients. From our experience of 280 negative OCT's in ~05 patients, we would agree that a negative test is usually predictive of fetal well-being in utero for a further week. However, we would like to record three exceptions in this group of patients. A Class B diabetic patient with no other complications and low normal urinary estriol levels had a negative OCT at 36 weeks' gestation. This was followed by intrauterine death seven days later. At delivery, the baby was normal, and there was no cord entanglement. A chronically hypertensive patient with a negative OCT at 30 weeks' gestation had an intrauterine death seven days later. During the interval between the negative OCT and fetal death, the blood pressure was lowered from II 0 to 80 diastolic by hypotensive agents. The baby was severely growth retarded, but there was no cord entanglement at delivery. In this case administration of hypotensives could be incriminated as the cause of fetal death. A Class B diabetic patient with normal estriol levels had acute abruptio placentae at 36 weeks' gestation, two days following a negative OCT. A prompt cesarean section salvaged the fetus. Approximately one third of the placenta had separated.

In the first two cases mentioned above, the fetus died approximately 12 hours before the weekly repeat OCT was scheduled. From our experience we also agree with the finding that a negative OCT does not preclude the development of fetal distress in labor. T. F. Baskett, M. B., F.R.C.S., M.R.C.O.G. E. Sandy, R.N.. S.C.M. Women's Centre Health Sciences Centre Winnipeg, Manitoba, Canada

Serum lactic dehydrogenase and ovarian carcinoma To the Editors: In recent years, the early identification of patients with ovarian cancer has begun to focus on biochemical



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Ohqr-t (;'"'""'/

Table lA. Summary of serum LDH determinations . . . m ovanan carcmoma Serum LD.l-1. Pretreatment

Stage

Normal

High

Norrnal

2 2 8

2 4 5

2

_I 13

I 12

I (5*)

II (7)

III (23) IV (7) Total

Posttreatment

0 4

JL 8

High

2 5

10 4 21

*No. of patients.

and immunologic parameters. Reports in this JOURNAL have emphasized the use of lactate dehydrogenase (LDH) in identifying patients with ovarian carcinoma. McGowan and associates 4 have found markedly elevated levels of LDH in peritoneal fluid in patients with ovarian carcinoma compared to those of patients with benign tumors of the ovary. Awais 2 has presented data (based on 20 cases) demonstrating that patients with ovarian carcinoma display high serum LDH values prior to treatment which decline to normal after treatment. These observations initiated our interest in the use of serum LDH values for the identification and prognosis of patients with ovarian carcinoma. Our data are based on 52 cases of ovarian carcinoma evaluated and treated at Cleveland Metropolitan General Hospital between January. 1969. and january, 1975. Of these patients, ten had no serum LDH determinations, 13 patients had only pretreatment determinations. 17 patients had only posttreatment determinations. and 12 patients had both pre- and post-treatment determinations. Serum LDH ieveis were determined in the routine laboratory manner (as were those of Awais 2 ), in which !-lactate and nicotinamide adenine dinucleotide are converted to pyruvate and nicotinamide adenine dinucleotide reduced, which is measured at 340 nm. * Normal values in this hospital are 100 to 225 I. U. per milliliter. Five patients had Stage I disease; seven, Stage II; 23, Stage III; 7, Stage IV (classified according to the International Federation of Gynecologists and Obstetricians) (Table IA). The summary of the serum LDH values from these 42 patients appears m Tabie IA. Prior lo treatment, about half of the patients had serum LDH values in the normal range, \vhile half \vere elevated. Follov:ing treatment, about a third of the patients (8/29) had normal serum LDH values, while the remainder had elevated values (Table IA). No obvious pattern exists in relation to the stage of the disease. Table IB summarizes the findings in the 12 patients who had both pre- and post-treatment serum LDH determinations. There are two cases in which the pre*SMA I2/60. Technicon Corp .. Tarrytown, New York l 0591.

Letter: A comfortable operating room table.

Volumt· 1~3 Number I Correspondence 2. Sternberl!. W. H.: Discussion. AM. T. 91: 257, l965. - 0BSTET. GYNECOL. 3. Krause, D. E., and Stembridge,...
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