oxytocin and Teratoma

An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.

Topics: Adult; Airway Obstruction; Anesthesia, Inhalation; Anesthesia, Obstetrical; Anesthetics, Inhalation; Cesarean Section; Female; Head and Neck Neoplasms; Humans; Hysterotomy; Infant, Newborn; Intubation, Intratracheal; Methyl Ethers; Methylergonovine; Oropharyngeal Neoplasms; Oxytocin; Placental Circulation; Polyhydramnios; Pregnancy; Sevoflurane; Teratoma; Tracheostomy; Uterine Contraction

DNA sequences in the 5'-flanking region of rat and bovine oxytocin genes were examined for their capacity to confer estrogen responsiveness to their homologous promoters. In contrast to the 5'-flanking region of the rat oxytocin gene, upstream promoter sequences up to 3200 bp of the bovine gene linked to the chloramphenicol acetyltransferase (CAT) reporter gene which were transfected in estrogen receptor expressing MCF-7 cells did not respond to estrogen. Testing 5'-deletion mutants of the rat upstream region linked to the luciferase gene in P19 embryocarcinoma cells co-transfected with an estrogen receptor expression plasmid showed that two regions each associated with approximately 15-fold stimulation of promoter activity were located between nucleotides -172 and -149 and between -148 and +16 in the rat gene. The former region contains the imperfect palindrome GGTGACCTTGACC which differs in one nucleotide from the estrogen response element (ERE) consensus. It is concluded that the corresponding motive CATAACCTTGACC of the bovine gene is not a functional ERE. Thus, the estrogen responsiveness of oxytocin genes is species-dependent.

Topics: Animals; Base Sequence; Breast Neoplasms; Cattle; Cell Line; Chloramphenicol O-Acetyltransferase; Estradiol; Female; Humans; Molecular Sequence Data; Oxytocin; Plasmids; Promoter Regions, Genetic; Rats; Recombinant Fusion Proteins; Sequence Homology, Nucleic Acid; Teratoma; Transfection