Angiogenic imbalances: the obstetric perspective.

Clinical and experimental evidence indicates that angiogenic imbalances may participate in the mechanisms of disease of several pregnancy complications, some of which may be life threatening. This article reviews current evidence in support of this view and the possibility that the fetus may play a central role in these imbalances; it also reviews recent experimental observations that modulation of angiogenic imbalances during pregnancy may have prophylactic and/or therapeutic value.

Insights into angiogenic imbalances during pregnancy.

Background: An excess of either angiogenic or antiangiogenic factors may participate in the pathophysiology of life-threatening pregnancy complications.

Cases: We describe two patients with severe early onset preeclampsia associated with partial mole or sacrococcygeal teratoma who had an excess of circulating concentrations of the antiangiogenic factors soluble vascular endothelial growth factor receptor-1 and soluble endoglin. In contrast, a patient with severe ovarian hyperstimulation syndrome at 5 weeks of gestation had an excess of circulating free vascular endothelial growth factor, a key angiogenic factor.

Implementing a surgical skills training program.

Significant change is underway in surgical training programs. Many educators believe that an outcomes-based approach to surgical education best addresses the need for greater public accountability and patient safety in surgical education. To achieve this end, surgical educators need to understand the basic principles of curriculum design and demonstrate a willingness to apply these educational methods within their training programs.