Background and purpose: There is major evidence for the strong bi-directional interrelation of parenchymal cell apoptosis and leukocyte accumulation and inflammation in acute liver injury. Therefore, the aim of this in vivo study was to investigate the anti-apoptotic and anti-inflammatory potential of antileukoproteinase (ALP) in a murine model of acute liver failure. Experimental approach: C57BL/6J mice were given galactosamine (D-GalN) and E. coli lipopolysaccharide (LPS) followed by administration of saline or ALP. Besides survival rate, hepatic tissue damage and inflammatory response were analyzed by intravital fluorescence microscopy 6 hours after treatment. In addition, immunohistochemical analysis of NFkB-p65 and hepatocellular apoptosis, plasma levels of AST/ALT, TNF-a and IL-10 were determined. Key results: Administration of D-GalN/LPS provoked hepatic damage, including marked leukocyte recruitment and microvascular perfusion failure, as well as hepatocellular apoptosis and enzyme release. NFkB-p65 became increasingly detectable in hepatocellular nuclei, accompanied by a rise of TNF-a and IL-10 plasma levels. ALP markedly reduced intrahepatic leukocyte accumulation, nuclear translocation of NFkB and plasma levels of TNF-a and IL-10. Moreover, liver enzyme levels indicated the absence of necrotic parenchymal cell death. In contrast, ALP failed to block both apoptosis and caspase-3 levels and the mortality rate of ALP-treated animals was comparable to that of saline-treated mice. Conclusions and implications: ALP could effectively prevent D-GalN/LPS-associated intrahepatic inflammatory responses by inhibition of NFkB activity, but not apoptosis-driven mortality. Thus, a protease-inactivating approach such as application of ALP seems to be inadequate in damaged liver where apoptosis represents the predominant mode of cell death.

Background The impact of intraoperative frozen section (iFS) analysis on the frequency of completion thyroidectomy for the management of thyroid carcinoma is controversial. Although specialized endocrine centres have published their respective results, there are insufficient data from primary and secondary healthcare levels. The aim of this study was to analyse the utility of iFS analysis. Methods In the Prospective Evaluation Study Thyroid Surgery (PETS) 2 study, 22 011 operations for benign and malignant thyroid disease were registered prospectively in 68 European hospitals from 1 July 2010 to 31 December 2012. Group 1 consisted of 569 patients from University Medical Centre (UMC) Mainz, and group 2 comprised 21 442 patients from other PETS 2 participating hospitals. UMC Mainz exercised targeted but liberal use of iFS analysis for suspected malignant nodules. iFS analysis was compared with standard histological examination regarding the correct distinction between benign and malignant disease. The percentage of completion thyroidectomies was assessed for the participating hospitals. Results iFS analysis was performed in 35.70 per cent of patients in group 1 versus 21.80 per cent of those in group 2 (risk ratio (RR) 1.6, 95 per cent c.i. 1.5 to 1.8; P < 0.001). Sensitivity of iFS analysis was 75.0 per cent in group 1 versus 63.50 per cent in group 2 (RR 1.2, 1.2 to 1.3; P = 0.040). Completion surgery was necessary in 8.10 per cent of patients in group 1 versus 20.8 per cent of those in group 2 (RR 0.4, 0.2 to 0.7; P = 0.001). Conclusion iFS analysis is a useful tool in determining the appropriate surgical management of thyroid disease. Targeted use of iFS was associated with a significantly higher sensitivity for the detection of malignancy, and with a significantly reduced necessity for completion surgery.

An antenatal risk scoring form was devised. The form contains 23 risk factors in three categories: reproductive history, associated medical conditions, and the present pregnancy. Numerical scores were arbitrarily assigned to each factor. The form was applied retrospectively to 1175 deliveries, and a total score was obtained for each case. The total score was related to perinatal death, preterm birth, Apgar score, and low birth weight. It was found that increasing score was significantly associated with poor outcome. The scores were grouped into low risk, high risk, and extreme risk. This system identified 25% of the study population as high and/or extreme risk, which in turn accounted for 94% of perinatal deaths. Although such a form in general has potential limitations and should not replace clinical judgment, its simplicity and demonstrated ability to assist in high-risk selection refines risk assessment for the experienced physician and quantifies it for the neophyte. It is recommended that the form be included in the prenatal records of all patients. Obstetricians have long recognized the need for varying levels of care. Pregnant patients with certain complications have an increased chance of having a complicated pregnancy course and an infant who has a complicated course; therefore,these patients require more intensive observation and care than usual. However, in our communities, well-trained personnel and resources are limited. The accurate identification of patients requiring different levels of care is a major concern, for both the individual physician and the patient and in planning regional perinatal resources. A number of high-risk pregnancy scoring systems have been proposed, 1-6 but in general, information derived from them has not proved discernibly superior to expert clinical judgment. Many of the scoring forms are too extensive andcomplicated to be filled out by a busy clinician, without whose enthusiastic cooperation no screening system can ever be expected to function effectively. In addition, not all of the known risk factors in pregnancy are universally applicable. It has been shown that some of the accepted risk factors may not have the

Four patients had echinococcosis that required obstetric and gynecologic management. Patients under treatment for echinococcosis require timely contraceptive or prepregnancy advice, although reproductive function is rarely affected by the hydatid.EA Kidess, AS Akiel, HS Ba'aqeel, SS Malaika, Echinococcosis: An Obstetric and Gynecologic View. 1988; 8(3): 202-205 MeSH KEYWORDS: Echinococcosis; Pregnancy complications Human echinococcosis is relatively common in Saudi Arabia, and the sex incidence of patients with echinococcosis is 62.8% and 37.2% for females and males, respectively, with maximal incidence between the ages of 25 and 40 years, 1 the fertile age of females. Although mortality is low, complications may occur to make its morbidity of great interest in obstetrics and gynecology, especially in a country where pregnancy and motherhood are high priority. Here we describe four cases that stimulated us to evaluate and review the management of echinococcosis from obstetric and gynecologic viewpoints. Case Reports Case 1A 39-year-old woman, gravida 5, para 3 + 1, was referred with secondary amenorrhea of six weeks' duration and a positive pregnancy test. She had a four-year history of pain in the upper right quadrant of the abdomen. Four months prior to consultation, she underwent surgery for removal of a 5.7 × 5.2 cm hydatid cyst containing multiple daughter cysts from the right and left lobes of the liver with involvement of the diaphragm. Post-operatively a sixmonth course of mebendazole was prescribed. Four weeks prior to consultation, she was admitted with upper right quadrant pain, and fluid was aspirated from the right subdiaphragmatic area. For maternal medical indications, termination of pregnancy was approved. The patient underwent suction curettage, and an intrauterine contraceptive device was inserted. Both husband and wife refused tubal ligation. The histopathology report confirmed the presence of products of conception. This patient continued to receive mebendazole therapy. Case 2A 30-year-old woman, para 6 + 1, with regular menstrual cycles and no gynecological complaints gave a fouryear history of heaviness in the right hypochondrium. This became a colicky pain of a few weeks' duration and prompted her admission to the surgical service. Clinical, sonographic, and radiologic investigations suggested a hydatid cyst, and hydatid serology was positive. Liver function tests were normal. She underwent surgery, and a hydatid cyst measuring 12 × 15 cm and smaller multiple cysts were removed from the right lobe of the liver. Echinococcosis: An Obstetric and Gynecologic ViewAnnals of Saudi Medicine, Vol 8 No. 3; 1988 Postoperatively she received a six-month course of mebendazole. At postoperative consultation, contraception was advised, and an intrauterine contraceptive device was inserted. Case 3A 36-year-old woman, gravida 3, para 2 + 0, had regular menstrual cycles and an unremarkable gynecologic history. She presented for antenatal care at nine weeks' gestation. Her first pregnancy fiv...

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