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Re: immunoglobin theraphy for recurrent abortionsFrom: Robert J. Carpenter, Jr. MD (zygote@icsi.net)Sun Apr 10 22:25:33 2005
<?xml version="1.0" ?><html> <head> <title></title> </head> <body> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>Alan Beer is the major person to try WBC infusions from the paternal half. No good dataa supports its use but it still makes the rounds for doing something. Probalby more imortant is doing telomeric FISH or Microchromosomal array to look at telomere anomalies. </b></span></font></div> <div align="left"><br/> </div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>There is so much we don't know as to the causes of losses. One set of studies from the U of Hawaii in 1980-1984 demonstrated that two distinct groups exist with repetitive losses - both the ones with and without chromosomal anomalies have an 80% probability of the same type of mechanism in the next loss. However, 20% of each group with cross over to the oppositie mechanism - normal or abn chromosomes. To my knowledge that study has not been repeated to the profound cost involved. </b></span></font></div> <div align="left"><br/> </div> <div align="left"><font face="Arial"><span style="font-size:10pt">On 10 Apr 2005 at 21:39, dean@thehuffpeople.net wrote:</span></font></div> <div align="left"><br/> </div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> .</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> When I was a fellow, one of our faculty had a few patients where he</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> injected (transfused) WBC from the putative father (of course, checked</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> for blood type compatabilty) into the pregnant woman. There was a</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> write up about it in a popular (i.e., aimed at the general public)</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> science magazine, "Discovery" or "Discovery Science" or something like</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> that, back in 1986 or 1987. His name was Amankwah.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> Dean Huffman</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> - - - - </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> Quoting "art fougner, md" <evsono@pipeline.com>:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >From Cochrane ...</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Author</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Scott, JR</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Title</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Immunotherapy for recurrent miscarriage.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Source</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Cochrane Database of Systematic Reviews. 1, 2005.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Abstract</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Background:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Immunologic aberrations might be the cause of recurrent early</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > pregnancy loss in some women.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Objectives:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > The objective of this review was to assess the effects of leukocyte</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > immunisation or other immunologic treatments such as intravenous</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > immune globulin (IVIG) on the live birth rate in women with previous</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > unexplained recurrent miscarriages.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Search strategy:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > The Cochrane Pregnancy and Childbirth Group trials register was</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > searched (September 2002). Individual patient data were obtained</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > from the American Society for Reproductive Immunology.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Selection criteria:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Randomised trials of immunotherapy in women with three or more prior</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > miscarriages and no more than one live birth; all recognised</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > non-immunologic causes ruled out and no simultaneous treatment</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > intervention.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Data collection and analysis:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Eligibility and trial quality were assessed by one reviewer.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Main results:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Nineteen trials of high quality were included. The various forms of</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > immunotherapy did not show significant differences between treatment</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > and control groups in terms of subsequent live births: paternal cell</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > immunisation (11 trials, 596 women), odds ratio (OR) 1.05, 95%</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > confidence intervals (CI) 0.75 to 1.47; third party donor cell</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > immunization (3 trials, 156 women), OR 1.39, 95% CI 0.68 to 2.82;</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > trophoblast membrane infusion (1 trial, 37 women), OR 0.40, 95% CI</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > 0.11 to 1.45; intravenous immune globulin (IVIG), OR 0.98, 95% CI</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > 0.61 to 1.58.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Conclusions:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Paternal cell immunization, third party donor leukocytes,</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > trophoblast membranes, and intravenous immune globulin provide no</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > significant beneficial effect over placebo in preventing further</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > miscarriages.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > art</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > At Sat, 9 Apr 2005, Myer S. Bornstein wrote:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > ></span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >Does any one have any information or ideas about immunoglobulin</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >therapy in recurrent abortions? Is any one using it or is it still</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >experimental. I have just seen a patient that was recommend this</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >for multiple spontaneous abortions. Thanks Myer</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > ></span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >--</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > >Myer S. Bornstein, MD, MMM, FACOG, FACPE</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > ></span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > --</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > art fougner, md</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > "If you don't know where you are going, you will wind up somewhere</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > else."</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Lawrence Peter Berra</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><br/> </div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>Robert J. Carpenter, Jr. MD</b></span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>6624 Fannin, #2720</b></span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>St. Luke's Medical Tower</b></span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>Houston,TX 77030-2339</b></span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt"><b>713-795-4600</b></span></font></div> <div align="left"></div> </body> |