Twin pregnancy with complete hydatidiform mole (46,XX) and fetus (46,XY): genetic origin proved by analysis of chromosome polymorphisms.

Abstract

concentration was 12-5 mg/I. Treatment was changed to metronidazole 400 mg three times daily and cultures rapidly ceased to grow C difficile. The organism was not isolated over the succeeding 18 months and radiological changes suggested a resolving infection. The patient had no gastrointestinal symptoms at any time during the illness. DiscussionOsteomyelitis caused by anaerobic bacteria is rare, and we are not aware of any previous reports of C difficile causing this disease. C difficile was first isolated by Hall and O'Toole,3 who found it to be part of the normal gastrointestinal flora of infants. Smith and King4 reported the isolation of C difficile from several extraintestinal sites, and more recently it has been implicated as the causative agent of pseudomembranous colitis.5The interesting features of this case are the unusual site of infection for this organism, the length of time over which the organism was isolated despite apparently appropriate treatment, and the development of penicillin resistance during treatment.The source of the organism was probably the patient's own gastrointestinal tract, but the possibility of environmental infection cannot be excluded. Possibly the infection did not occur until after the initial drainage. The first abscess may have been sterile, as suggested by the first culture results, and merely a response to the foreign body present. It is unclear why the organism persisted for so long. On some occasions only very few organisms were present and thus enrichment media were required for isolation. The production of spores in vivo could explain the organism's persistence. The development of resistance to antibiotics during treatment is certainly not uncommon, and its occurrence in the present case added interest to an already interesting case. It is worth noting that transferable drug resistance in C difficile has recently been reported.

Triploidy, partial mole and dispermy. An investigation of 12 cases

“…Several explanations can be advanced: (1) the two types of cells represent a twin pregnancy of a complete mole (46,XX) and a triploid foetus. Fisher et al (1982) have recently reported a twin pregnancy involving a complete mole (46,XX) and a 46,XY foetus. However, it seems most unlikely that this rare set of events would happen three times in our small series.…”

The Prospective Management of a Coexistent Hydatidiform Mole and Fetus

“…In these cases it is hypothesized that there are twin fertilizations in which one ovum develops normally whilst the other develops into a classical mole. Only 3 reports have verified this twin fertilization on chromosomal analysis (9,11,12).…”

Triploidy: Pregnancy complications and clinical findings in seven cases

“…Recent reviews on the origin of triploidy have suggested that approximately three quarters of all triploid conceptuses are paternally derived, probably through double fertilization (Beatty, 1978;Couillon et al, 1978;Jacobs et al, 1978;Uchida and Freeman, 1985). An androgenic origin has also been documented for true diploid hydatidiform moles (Kajii and Ohama, 1977;Lawler et al, 1982;Ohama et al, 198 1;Fisher et al, 1982;Jacobs et al, 1980). Of triploid cases attributed to digyny, twothirds are the result of retention of the second polar body (Meulenbruek and Geraedts, 1982).…”