Objectives.:A high proportion of women with persistent low levels of hCG,in the absence of pregnancy or any evidence of tumor,have received chemotherapy and hysterectomy for assumed malignancy. Such chemotherapy and s...Objectives.:A high proportion of women with persistent low levels of hCG,in the absence of pregnancy or any evidence of tumor,have received chemotherapy and hysterectomy for assumed malignancy. Such chemotherapy and surgery were ineffective and unwarranted. This study identifies the causes of persistent low level of hCG and provides guidelines for the management of these patients,preventing unnecessary treatment in the future. Methods.:The USA hCG Reference Service has consulted on 170 women with low levels of hCG persisting for 3 months or longer. Serum total hCG was measured in the Diagnostic Products Corporation (DPC) Immulite assay and hyperglycosylated hCG in the Nichols Advantage test. Results.:Among these 170 patients,the average persistent hCG result was 102 ±152 mIU/ml,with a range of 6.1-900 mIU/ml. Thirteen (7.6%) of the 170 patients had true malignancy,5 had placental site trophoblastic tumor,3 had other gestational trophoblastic neoplasms (GTN),and 5 had non-trophoblastic malignancies. The remaining 157 patients had false-positive hCG,quiescent gestational trophoblastic disease (quiescent GTD),or pituitary hCG(hCG of pituitary origin). Of 71 patients with false- positive hCG,47 patients received chemotherapy and 9 had surgery that had no effect on the level of hCG. Five of these patients with false-positive hCG were being monitored for hydatidiform mole or GTN. The majority of these cases were first investigated following an incidental pregnancy test. Of 69 patients who had quiescent GTD,41 received chemotherapy and 9 underwent hysterectomy. All these therapies were unnecessary and ineffective. While 21 patients with quiescent GTD followed incidental pregnancy tests,the majority were discovered while monitoring patients after treatment for hydatidiform mole or GTN/choriocarcinoma (n = 48). Seventeen cases of pituitary hCG were found among those women who were perior post-menopause. Two patients also received chemotherapy for assumed malignancy which was not present. Conclusion.:Clinicians frequently assume that an elevated hCG implies that a patient is pregnant or has GTD or recurrent GTN,even when apart from the pregnancy test,no clinical evidence was found to support such a diagnosis. In most of these cases of persistent low hCG etiologies,all therapies were found unnecessary and ineffective. Guidelines are proposed for managing these patients. It is essential to demonstrate a malignancy clinically and with readily available biochemical tests before initiating therapy. This applies whether the patient is identified by an incidental pregnancy test or is actively being monitored for gestational trophoblastic disease.展开更多
3月5日,在口罩日产能达到100万只之际,为战疫情快速扩大口罩产能的圣泉集团又传好消息:经权威机构检测,圣泉集团自主研发生产的一次性生物质石墨烯口罩通过美国FDA认证,获得出口美国准入资质。(美国食品药物管理局,U.S.Food and Drug Ad...3月5日,在口罩日产能达到100万只之际,为战疫情快速扩大口罩产能的圣泉集团又传好消息:经权威机构检测,圣泉集团自主研发生产的一次性生物质石墨烯口罩通过美国FDA认证,获得出口美国准入资质。(美国食品药物管理局,U.S.Food and Drug Administration)隶属于美国卫生教育福利部,负责全国药品、食品、生物制品、化妆品、兽药、医疗器械以及诊断用品等的管理。展开更多
文摘Objectives.:A high proportion of women with persistent low levels of hCG,in the absence of pregnancy or any evidence of tumor,have received chemotherapy and hysterectomy for assumed malignancy. Such chemotherapy and surgery were ineffective and unwarranted. This study identifies the causes of persistent low level of hCG and provides guidelines for the management of these patients,preventing unnecessary treatment in the future. Methods.:The USA hCG Reference Service has consulted on 170 women with low levels of hCG persisting for 3 months or longer. Serum total hCG was measured in the Diagnostic Products Corporation (DPC) Immulite assay and hyperglycosylated hCG in the Nichols Advantage test. Results.:Among these 170 patients,the average persistent hCG result was 102 ±152 mIU/ml,with a range of 6.1-900 mIU/ml. Thirteen (7.6%) of the 170 patients had true malignancy,5 had placental site trophoblastic tumor,3 had other gestational trophoblastic neoplasms (GTN),and 5 had non-trophoblastic malignancies. The remaining 157 patients had false-positive hCG,quiescent gestational trophoblastic disease (quiescent GTD),or pituitary hCG(hCG of pituitary origin). Of 71 patients with false- positive hCG,47 patients received chemotherapy and 9 had surgery that had no effect on the level of hCG. Five of these patients with false-positive hCG were being monitored for hydatidiform mole or GTN. The majority of these cases were first investigated following an incidental pregnancy test. Of 69 patients who had quiescent GTD,41 received chemotherapy and 9 underwent hysterectomy. All these therapies were unnecessary and ineffective. While 21 patients with quiescent GTD followed incidental pregnancy tests,the majority were discovered while monitoring patients after treatment for hydatidiform mole or GTN/choriocarcinoma (n = 48). Seventeen cases of pituitary hCG were found among those women who were perior post-menopause. Two patients also received chemotherapy for assumed malignancy which was not present. Conclusion.:Clinicians frequently assume that an elevated hCG implies that a patient is pregnant or has GTD or recurrent GTN,even when apart from the pregnancy test,no clinical evidence was found to support such a diagnosis. In most of these cases of persistent low hCG etiologies,all therapies were found unnecessary and ineffective. Guidelines are proposed for managing these patients. It is essential to demonstrate a malignancy clinically and with readily available biochemical tests before initiating therapy. This applies whether the patient is identified by an incidental pregnancy test or is actively being monitored for gestational trophoblastic disease.
文摘3月5日,在口罩日产能达到100万只之际,为战疫情快速扩大口罩产能的圣泉集团又传好消息:经权威机构检测,圣泉集团自主研发生产的一次性生物质石墨烯口罩通过美国FDA认证,获得出口美国准入资质。(美国食品药物管理局,U.S.Food and Drug Administration)隶属于美国卫生教育福利部,负责全国药品、食品、生物制品、化妆品、兽药、医疗器械以及诊断用品等的管理。
