[Breastfeeding and infectious diseases: state of the art]

Despite the well-known nutritive, psychological, immunological and economical benefits of breast-feeding, some contraindications exist, such as some mother infectious diseases transmitted through the breastfeeding itself. The risk of transmitting an infectious agent through breast milk seems to be relatively low, except for some virus diseases (CMV HIV), for some invasive bacteria forms (Salmonella typhimurium and Brucella) and for the presence of abscesses and mastitis. In some mother infectious disease, a correct hygiene allows the continuation of breastfeeding without risks for the infant, whereas in other cases it is recommended to breastfeed for the role of defence carried out from specific antibodies contained in the breast milk. Therefore, the decision of interrupting the breastfeeding may be done only after comparing risks and benefits, considering current knowledge on transmission of infectious pathologies.

Development of a clinically relevant liquid chromatography tandem mass spectrometry assay for 13 drugs of abuse in urine, designed to meet the needs of the service users

Background

The clinical requirements of the users of assay results must be at the centre of assay development. We aimed to develop a single liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for drugs of abuse in urine that would meet the needs of our service users and replace the multiple screening and confirmatory techniques previously in use.

Methods

After discussion with our users, it was decided that 13 drugs and metabolites should be measured in our panel: morphine, codeine, norcodeine, dihydrocodeine, 6-monoacetylmorphine, acetyl codeine, methadone and its metabolite, buprenorphine and its metabolite, amphetamine, benzoylecgonine and cotinine. Urine samples were prepared by the addition of internal standard, enzymatic hydrolysis and solid-phase extraction. Chromatography conditions were optimized so that the analytes were separated within a run time of 6 min. Optimal parent to daughter m/z ion transitions were chosen for all drugs and daughter ion ratios were used.

Results

The LC-MS/MS assay was successfully validated with acceptable precision and lower limits of quantification for all drugs. No matrix effects were seen. The results produced by the LC-MS/MS assay compared well with the previous combination of techniques in use.

Conclusions

We have developed and validated a fit-for-purpose LC-MS/MS assay for 13 drugs of abuse in urine that obviates the need for multiple screening and confirmatory analytical techniques.

Proteomics and neonatal infection

Antimicrobial peptides plays an important role in the host innate defence network, even in humans. Recent studies demonstrated the capacity of human airways epithelial cells to synthesize antimicrobial peptides, and their multifunctional role in the primary immunity. The presence of ct-defensins in bronchoalveolar lavage fluid (BALF) was investigated in a cohort of preterm newborns with gestational age (GA) < or =30 weeks. BALF samples were analysed by High Performance Liquid Chromatography Electrospray Ionization Mass Spectrometer. Our data show that preterm newborns, also at the lower GA, are able to produce defenses, underlining that their innate defence system is already active before the at-term delivery date.

[Validation of an hourly transcutaneous bilirubin nomogram in a population of term or late preterm newborn infants: preliminary results]

OBJECTIVE

The aim of this study was to asses the validity of the TCB nomogram for the European population for predicting significant hyperbilirubinemia in healthy term and late-preterm newborns.

METHODS

This observational study was conducted from February 2009 to December 2009 in the well-baby nurseries of Gemelli hospital of Rome. The predictive ability of the skin bilirubin (TCB) nomogram was prospectively assessed in 926 neonates with gestational age ?35 weeks. TCB was measured with Bilichek and total serum bilirubin (TSB) was contemporary assayed by the standard spectrophotometric method. Every neonate was assess for a single TCB and TSB value.

RESULTS

The mean TSB values was 8.2 +/- 3.2 mg/dl, while the mean TCB values was 9.5 +/- 3.6 mg/dl A sensitivity of 100% and a negative predictive value of 100% were obtained with a single bilirubin determination applying the 75 degrees percentile of our nomogram.

CONCLUSION

The 75 degrees percentile of the skin bilirubin nomogram for the European population in the first 96 hours of life is able to predict all neonates at risk of severe hyperbilirubinemia. It could facilitate a safe discharge from the hospital and a targeted intervention and follow-up reducing the need for blood samples.

Risk factors and growth factors in ROP

Retinopathy of prematurity (ROP) is a multifactorial disease which incidence is increasing with increasing survival of very preterm infants. Pathogenic pathway is characterised by abnormal retinal vascular development modulated by vascular growth factors: low IGF-1 in the first phase and high VEGF in the second phase. Many causal factors are able to influence retinal vascularization: gestational age, birth weight, oxygen administration, perinatal bacterial or fungal infections, and blood transfusions. All risk factors, both oxygen and not-oxygen-regulated, have been studied considering the whole period from hospital birth to the hospital discharge, but it is possible that postnatal risk factors may be determinant in a time-dependent way. Analysis of factors involved in the pathogenesis of ROP suggests that their action begins long before anatomical clinical features become appreciable and this is strengthened by the essential role of risk factors from the first two to four weeks of life, thus preventive strategies in very preterm infants should be carried out since birth.

[Fetal and neonatal outcomes in infants of mothers with TSH receptor antibody positivity in pregnancy]

OBJECTIVES

To know the mother's frequency with TRAb (TSH receptor antibodies) positivity during pregnancy in the population afferent to Agostino Gemelli Hospital in the five years 2002-2007 and the itself antibodies's role determining fetal and neonatal symptoms.

MATERIALS AND METHODS

We performed a prospective analysis with maternal and neonatal variables detection in 16 couples mother-newborn with TRAb positivity during the pregnancy. The method to dose neonatal TRAb is ELISA (enzyme linked immunosorbant assay).

RESULTS

The prevalence of newborns of mothers with TRAb positivity during pregancy results 0.1 per thousand (16/16783). The prevalence of neonatal hyperthyroidism, clinical and biochemical, in the studied population results especially elevated equal to about 30% (5/16). The 5 newborns are born to mothers with Basedow disease with TRAb serum levels greater than TRAb levels of newborn without hyperthyroidism: 2 are showed the symptoms of clinical hyperthyroidism and 3 a transient biochemical hyperthirodism. 3 newborns with hyperthyroidism among 5 are born to mother undergo thyroidectomy with L-tiroxina teraphy during the pregnancy. Then the newborns of thyroidectomized mothers also many years before the pregnancy must be considered high risk of developing neonatal hyperthyroidism because of long-lasting persistence of mother's TRAb. The neonatal hyperthyroidism, clinical and biochemical, appears later in newborns of mothers using antithyroid drugs. The pharmacological treatment of neonatal hyperthyroidism was difficult to standardize and highly individualized.

CONCLUSIONS

Although the neonatal hyperthyroidism is a very rare disease it is essential to apply specific protocol assistance, both during pregnancy and the neonatal period, in the presence of maternal TRAb positive for the risk of serious cardiovascular complications.

Urinary aldosterone excretion and renal function in extremely-low-birth-weight infants following acute furosemide therapy

BACKGROUND

Increased activity of the renin-angiotensin-aldosterone system (RAAS) has been reported in the neonatal period. Until now, it has been demonstrated that the RAAS of healthy neonates responds to acute furosemide challenge while no data concerning the responsiveness of RAAS in extremely low birth weight (ELBW) infants are available.

OBJECTIVE

To assess urinary aldosterone excretion (UAE) and renal function in ELBW infants who received diuretics for the purpose of reducing the incidence of chronic lung disease (CLD).

METHODS

Infants with birth weights < or =1,000 g, at high risk to develop CLD, were studied in a prospective observational study. UAE and renal function were investigated before and after administration of furosemide given in a single dose of 2 mg/kg.

RESULTS

UAE and renal function were evaluated in 20 ELBW infants. Diuretic administration resulted in a significant rise in UAE and urinary sodium, potassium and chloride excretion. No change occurred in creatinine clearance, while urine volume increased significantly.

CONCLUSIONS

ELBW infants respond to acute furosemide challenge by increasing urine volume, urinary electrolytes and UAE.

Epithelial lining fluid neutrophil-gelatinase-associated lipocalin levels in premature newborns with bronchopulmonary dysplasia and patency of ductus arteriosus

Patency of the ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD) development represent severe affections for premature newborns, therefore the research of early markers for these two conditions is really important. The aim of this study is to analyze epithelial lining fluid (ELF) Neutrophil-gelatinase-associated lipocalin (NGAL) levels for prediction of lung injury or possible involvement of this molecule in PDA. Only scarce and contrasting results have previously been published in this field. In contrast, this molecule, included in a large macromolecular complex together with matrix metalloproteinase-9 (MMP-9), is considered an acceptable marker of infectious/inflammatory processes, cancer monitoring and induction of apoptotic pathway. NGAL was detected in 28 pre-term newborns by means of a commercially available kit in bronchoalveolar lavage fluid (BALF). The results have been corrected to ELF levels, by the urea method, to eliminate bias due to BALF collection. ELF NGAL levels were found significantly increased both in infants developing BPD or in those affected by PDA. By means of multivariate logistic regression analysis the significances were confirmed after adjusting for possible interfering variables such as gestational age and concomitant presence of both PDA and BPD. Our results stress the involvement of NGAL in the mechanisms leading to BPD and also suggest a possible association with PDA, which is often linked to prematurity and BPD development, probably due to the involvement of inflammatory and angiogenetic processes in both pathologies.

Attempt to improve transcutaneous bilirubinometry: a double-blind study of Medick BiliMed versus Respironics BiliCheck

OBJECTIVES

To compare the accuracy of a new transcutaneous bilirubinometer, BiliMed (Medick SA, Paris, France) with BiliCheck (Respironics, Marietta, GA, USA), a widely available instrument, and with total serum bilirubin measurement.

DESIGN

A prospective double-blind study comparing the two devices was carried out. 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. Serum and transcutaneous bilirubin measurements were taken with both devices within 15 minutes. The order of use of the instruments was randomised.

SETTING

Well-baby nursery ward in a university hospital, tertiary referral centre.

RESULTS

The linear regression analysis showed a better correlation between BiliCheck and serum bilirubin (r = 0.75) than between BiliMed and serum bilirubin (r = 0.45). BiliCheck variability (+/-2 SD of the mean bias from serum bilirubin) was within -87.2 to 63.3 micromol/l, while BiliMed variability was within -97.5 to 121.4 micromol/l. The receiver operating characteristic analysis (for serum bilirubin levels >205.2 micromol/l or >239.4 micromol/l) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p<0.001).

CONCLUSIONS

Despite the potential practical advantages of BiliMed, its reduced diagnostic accuracy in comparison with BiliCheck does not justify its use in clinical practice.

[Use of Meropenem in preterm newborns. Survey of the literature and case series]

AIM

The aim of this paper was to evaluate usefulness and safety of Meropenem in severe infections in neonatal intensive care unit (NICU) patients. New broad spectrum carbapenem class of -lactam antibiotics has been investigated for the treatment of a wide range of infections, including nosocomial infections with cephalosporin-resistant pathogens, an emergent problem in NICU, and meningitis. Meropenem represents the first cabapenem-class that has received Food and Drug Administration (FDA) approval for use in children 3 months of age and older. The pharmacokinetics of Meropenem has been well studied in preterm neonates.

METHODS

We report the use of Meropenem in 26 neonates with median gestational age (GA) of 27 weeks (25-32) and median birth weight of 940 g (510-1900), with severe infections due to Gram-negative or Gram-positive organisms, from 2001 to 2004. The median postnatal age was 21 days (4-75). Meropenem was administrated intravenously in 30 min at dosage of 20 mg/kg every 12 h (every 8 h in Pseudomonas Aeruginosa infections).

RESULTS

In all cases Meropenem has been used as second choice. No adverse effects (eosinophilia, trombocytosis or thrombocytopenia, increase in liver enzyme, increase in creatinine, diarrhea, vomiting and seizures) were observed. Clinical and bacterial response was ontaine in all cases but one.

CONCLUSIONS

This report suggests that Meropenem may be a useful and safe antimicrobial agent in neonatal infections caused by resistant organisms and in meningitis. Further studies are needed to confirm these results.

[Evaluation of C reactive protein and others immunologic markers in the diagnosis of neonatal sepsis]

Neonatal sepsis occurs from 1 to 21 newborns out of 1 000 live births with mortality rates as high as 30% up to 69%. The most important risk factors are prematurity, low birth weight, invasive medical procedure and prolonged hospitalization in neonatal intensive care units. An aimed and restrictive antibiotic therapy has an outstanding importance to reduce both morbidity-mortality rates and multiple drug-resistance. Generally, preterm newborns present nonspecific clinical signs of infection. The use of high sensitivity infection markers and a negative predictive value (near 100%) are important to distinguish infected and noninfected patients before the culture results and to verify adequacy and duration of antibiotic therapy. This article reviews the immunologic function and practical use of C reactive protein (CRP) and other markers in the diagnosis of neonatal sepsis. While CRP is a specific late infection marker, cytokines, cell surface markers and procalcitonin (PCT) are early infection markers. The use of multiple markers as CRP, PCT, IL-6, IL-8, CD64, CD11b is useful both to early (24-48 h) diagnose of neonatal sepsis, and to monitorate the antibiotic treatment while waiting for the results of cultural examinations.

Antenatal post-hemorrhagic ventriculomegaly: a prospective follow-up study

OBJECTIVE

The aim of this study was to evaluate the presence and the severity of neurological and cognitive impairment at 2 years of age in 16 infants (9 term born, 7 preterm of mean gestation 33.6 weeks) with cerebral ventriculomegaly of antenatal onset associated with intraventricular haemorrhage.

METHODS

Ventricular dilatation, with or without associated lesions, was, with one exception, not identified on the antenatal routine scan at approximately 22 weeks but was obvious on the scans performed between weeks 27 and 33. In 8 of the 16 cases there were signs of parenchymal involvement or of abnormalities of the corpus callosum or cerebellum. In all patients the diagnosis of antenatal IVH was confirmed by early neonatal imaging. Outcome was measured using the Hammersmith infant neurological examination and the Griffiths developmental scales at 2 years.

RESULTS AND CONCLUSIONS

At 2 years, 8 infants had normal motor outcome and 8 had cerebral palsy. The presence and severity of cerebral palsy or neurodevelopmental delay was not always related to the magnitude or symmetry of the ventricular dilatation per se. The presence of associated lesions was a negative prognostic marker. The early development of epilepsy was also associated with an abnormal outcome.

[Predictive ability of a predischarge hour-specific serum bilirubin for hyperbilirubinemia in full term infants]

AIM

The aim of this paper was to assess the ability of total serum bilirubin (TSB) levels in the first 3 days of life to predict subsequent nonphysiologic hyperbilirubinemia.

METHODS

The predictive ability of an hour-specific nomogram for TSB values in the first week of life was prospectively assessed in 1496 full term neonates admitted to a first level neonatal unit, using a single TSB value or two consecutive ones, when available.

RESULTS

The incidence of TSB values > 12 mg/dL was 9.6%, while the incidence of TSB > 15 mg/dL was 2.6%. A sensitivity of 97.9% and a negative predictive value (NPV) of 99.6% were obtained with a single bilirubin determination applying Trend 12, while 82.5% of sensitivity and 99.4% of NPV were obtained with Trend 15. Two consecutive TSB determinations identified all infants reaching TSB values > 12 mg/dL and all neonates but 5 reaching TSB values > 15 mg/dL (92.1% of sensitivity and 99% of NPV) CONCLUSION: The hour-specific TSB determination in the first 3 days of life is able to predict all neonates at risk of nonphysiologic hyperbilirubinemia and could facilitate a safe discharge from the hospital and a targeted intervention and follow-up.

[Pulmonary infections in preterm newborns]

AIM

The aim of this study was to evaluate retrospectively the incidence and etiology of connatal pneumonia and ventilator-associated pneumonia (VAP) in preterm newborns who had birth weight = or < 1250 g and required intubation for at least 12 h.

METHODS

We have reported data about preterm newborns who had birth weight = or < 1250 g and required intubation for at least 12 h with diagnosis of connatal pneumonia and VAP, admitted to the neonatal intensive care unit from 1994 to 2004. We divided these 11 years into 4 periods. For each period we determined etiology associated with connatal pneumonia or VAP.

RESULTS

A total of 417 patients were studied; 311 (74.6%) required mechanical ventilation (MV) for more than 48 h (the least for the diagnosis of VAP). Connatal pneumonia occurred in 35/417 patients (8.4%). VAP incidence did not change over time showing a slight increase in the last 2 years (from 27% to 33%). Mycoplasma and Chlamydia as causative organisms of connatal pneumonia dissapear during years. Gram-negative micro-organisms were isolated more frequently in last years in VAP episodes.

CONCLUSIONS

The incidence of VAP does not decrease over time although length of MV was reduced. Additional studies are needed to improve criteria for the diagnosis and prevention of VAP in NICU patients.

Neonatal hyperthyroidism: neonatal clinical course of two brothers born to a mother with Graves-Basedow disease, before and after total thyroidectomy

BACKGROUND

About 1-2% of infants born to mothers with Graves' disease or Hashimoto's thyroiditis develop neonatal hyperthyroidism because of transplacental passage of IgG stimulating TSH receptors (TRAb).

OBJECTIVE

To evaluate the effect of maternal total thyroidectomy on neonatal clinical course.

METHODS

We describe two brothers born to a mother with Graves' disease, before and after total thyroidectomy.

RESULTS

The first child showed persistent tachycardia, the presence of TRAb and a laboratory pattern of hyperthyroidism. Lugol's solution was started and then propylthiouracil was added. Digitalis, furosemide and diazepam were necessary for treatment of heart failure, hypertension and irritability. On the 70th day of life, hormone serum levels normalized and treatment was interrupted. TRAb normalized by the third month of life. The second infant was born 2 years after the mother underwent total thyroidectomy. In spite of a laboratory pattern of hyperthyroidism and positivity to TRAb, he showed only considerable weight loss, and no therapy was required.

CONCLUSIONS

TRAb may persist after total thyroidectomy: clinical and instrumental follow-up of the newborn is recommended.

[Prebiotics and probiotics in infant nutrition]

Many studies have recently analyzed the modulation of the intestinal microflora showing a benefic effects reducing the number of enteritis, improving the oligoelements absorption and stimulating the immunitary system. To do so three way are available: the use of prebiotics, the use of probiotics and the symbiotic way. Prebiotics are non-digestible oligosaccharides that can stimulate selectively the growth bifidogenus bacteria. Probiotics are dietary supplements made of live micro-organisms which improve the microbial environment of the gut. In this review literature is examined the possible efficacy of prebiotics and probiotics in the pediatric age; however, the studies available do not permit to obtain definitive conclusions.

Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia?

AIM

To assess the correlation of echocardiographic signs of myocardial damage to serum cardiac troponin T (cTnT) concentrations in newborn infants with perinatal asphyxia.

METHODS

Electocardiograms (ECG) and echocardiograms (Echo) were obtained during the first 24 h of life from 29 asphyxiated and 30 control infants and correlated with cTnT concentrations. The echocardiographic parameters included systolic ventricular performance, preload, afterload, diastolic function, stroke volume (SV), left ventricular output (LVO), hyperechogenity of the papillary muscles and insufficiency of the atrioventricular valves.

RESULTS

LVO and SV were lower but CTnT were significantly higher in asphyxiated than in control infants: 0.15 (010-0.23) vs. 0.05 (0.02-0.13), p < 0.001). Asphyxiated infants with signs of myocardial damage were associated with significantly higher cTnT than those without, 0.20 (0.11-0.28) and 0.11 (0.05-0.14 ug/L), p = 0.04.

CONCLUSION

Cardiac troponin may prove to be valuable in evaluating myocardial damage in birth asphyxia. However, the degree of prematurity may complicate the assessment.

Urban-rural differences in gynaecological cancer occurrence in a central region of Italy: 1978-1982 and 1998-2002

Differences in gynaecological cancer incidence and mortality in the urban and rural areas of the Umbria region (central Italy) were investigated. All women with primary invasive breast cancers, uterine cervix and uterine corpus, and ovarian cancers diagnosed during the periods 1978-1982 and 1998-2002 were identified and analysed according to place of residence (either urban or rural). Mortality data were supplied by the National Institute of Statistics (ISTAT) for the period 1978 to 1982, whereas for the 1994-2002 period they were supplied by the Regional Nominative Causes of Death Registry (ReNCaM). Incident cases considered were taken from an ad hoc survey for the first period and from the Umbrian Population Cancer Registry database for the second one. For each site the age-adjusted incidence (AAIR) and mortality (AADR) rates were calculated. The expected number of rural cases was obtained from indirect standardisation with urban incidence and mortality rates of several sites. The significance of the observed expected ratios (SIRs for incidence and SMRs for mortality) and the corresponding 95% confidence intervals were based on the Poisson distribution. Urbanisation levels were established following the classification of the Italian Institute of Statistics. For all sites, excluding the ovary during the most recent period, the SIR relative to rural areas was below 1, but the rates were statistically significant only for breast cancer in both periods (SIR 0.81, 95% CI 0.74-0.88 and SIR 0.82, 95% CI 0.77-0.88, respectively) and for cervix uteri in the first period (SIR 0.77, 95% CI 0.59-0.94). The lower breast cancer incidence in the rural area could also be due to lesser compliance with screening procedures which, up until 2002, were not provided in the form of mass-screenings throughout the region by the Regional Health Department. These results underscore the need for continued efforts to provide preventive health services to medically underserved women throughout Umbria, including rural communities. Underutilisation of preventive healthcare services may result in failure to identify healthcare problems that might be successfully managed with medication or lifestyle changes, as well as missed opportunities to prevent potentially life-threatening diseases.

Outcome of newborns with asymptomatic monomorphic ventricular arrhythmia

BACKGROUND

Frequent premature ventricular contractions (PVCs), couplets (CPLTs) and episodes of ventricular tachycardia are extremely rare in the neonatal population. Limited information is available with regard to clinical relevance and outcome.

OBJECTIVES

To evaluate the clinical characteristics and outcomes of a group of newborns with ventricular arrhythmias without heart disease.

PATIENTS AND DESIGN

Between January 2000 and January 2003, 16 newborns with ventricular arrhythmias in the absence of heart disease were studied. The newborns were divided into three groups: PVC group (n = 8), CPLT group (n = 4) and ventricular tachycardia group (n = 4). All patients underwent physical examination, electrocardiography, Holter monitoring and echocardiography at diagnosis and at follow-up (1, 3, 6 and 12 months, and yearly thereafter).

RESULTS

Mean (standard deviation, SD) age of the patients was 3 (1.19) days in the PVC group, 3.25 (0.95) days in the CPLT group and 6.5 (9.1) days in the ventricular tachycardia group. Median follow-up was 36 months (range 24-48 months). PVCs disappeared during follow-up in all the neonates, in the PVC group, at a mean (SD) age of 2.1 (1.24) months; in the CPLT group, couplets disappeared at a mean (SD) age of 6.5 (1) months. All patients with ventricular tachycardia were treated; ventricular tachycardia disappeared at a mean (SD) age of 1.7 (0.9) months. Neither death nor complications occurred.

CONCLUSIONS

Ventricular arrhythmias in newborns without heart disease have a good long-term prognosis. Frequent PVCs and CPLTs do not require treatment. Sustained ventricular tachycardia or high-rate ventricular tachycardia must be treated, but the prognosis is generally favourable.

Neurological examination at 6 to 9 months in infants with cystic periventricular leukomalacia

The Hammersmith Infant Neurological Examination was performed in 24 infants with cystic periventricular leukomalacia whose gestational age ranged between 26-38 weeks. The infants were examined between 6 and 9.5 months corrected age. The aim of the study was to establish the different patterns of neurological abnormality as well as the optimality scores that predict the severity of motor sequelae at 2 years. Increased neck and trunk extensor tone, and a posture of flexed arms and extended legs between 6 and 9 months were always associated with the inability to sit unsupported at 2 years, whilst truncal hypotonia and extended arms and legs were associated with unsupported sitting but not walking. Optimality scores between 41 and 60 were generally associated with sitting but not walking at 2 years whilst scores below 40 were always associated with the inability to sit independently at 2 years. All infants who did not develop cerebral palsy at 2 years had scores > 60. Our results suggest that the pattern of findings on neurological examination performed between 6 and 9 months as well as the calculated optimality score helps to predict motor impairment in infants with PVL.

CT imaging of wet specimens from a pathology museum: How to build a “virtual museum” for radiopathological correlation teaching

X-rays and CT have been used to examine specimens such as human remains, mummies and formalin-fixed specimens. However, CT has not been used to study formalin-fixed wet specimens within their containers. The purpose of our study is firstly to demonstrate the role of CT as a non-destructive imaging method for the study of wet pathological specimens and secondly to use the CT data as a method for teaching pathological and radiological correlation. CT scanning of 31 musculoskeletal specimens from a pathology museum was carried out. Images were reconstructed using both soft-tissue and bone algorithms. Further processing of the data produced coronal and sagittal reformats of each specimen. The container and storage solution were manually removed using Volume Viewer Voxtool software to produce a 3D reconstruction of each specimen. Photographs of each specimen (container and close-up) were displayed alongside selected coronal, sagittal, 3D reconstructions and cine sequences in a specially designed computer program. CT is a non-destructive imaging modality for building didactic materials from wet specimens in a Pathology Museum, for teaching radiological and pathological correlation.

Crossed cerebellar atrophy of prenatal onset

BACKGROUND

Crossed cerebellar atrophy after hemorrhagic-ischemic injury in the contralateral cerebral hemisphere was reported in adults with stroke and in children with acquired lesions. It was also reported in preterm infants after perinatal or postnatal contralateral supratentorial lesions.

CASE REPORT

We report crossed-cerebellar atrophy in a preterm neonate with prenatal posthemorrhagic ventriculomegaly and periventricular ischemic lesion in whom contralateral cerebellar involvement was detected on antenatal scans.

DISCUSSION

The result of our study suggests that in the developing brain, cross cerebellar atrophy may occur antenatally and that fetal MRI may help to identify such cases.

Emerging antifungal azoles and effects on Magnaporthe grisea

Derivatives of pyrazolo[1,5-a][1, 3, 5]triazine-2,4-dione,pyrazolo[1,5-c][1, 3, 5]thiadiazine-2-one, pyrazolo[3,4-d][1, 3]thiazine-4-one, and pyrazolo[3,4-d][1, 3]thiazine-4-thione were screened for antifungal activity against the causal agent of rice blast disease, Magnaporthe grisea. The compounds were tested at doses ranging from 10 to 200mugml(-1), using the commercial fungicide tricyclazole as reference compound. All triazine derivatives inhibited the growth and pigmentation of the mycelia less effectively than tricyclazole. The thiadiazine derivatives proved to be more effective than their triazine counterparts, but only 4-(butylimino)-7-methylpyrazolo[1,5-c][1,3,5]thiadiazine-2-one (2h) and 4-(cyclohexylimino)-7-methylpyrazolo[1,5-c][1,3,5]thiadiazine-2-one (2j) were more effective than tricyclazole. Pyrazolo[3,4-d][1,3]thiazine-4-one derivatives were active only at the highest doses, whereas members of the pyrazolo[3,4-d][1,3]thiazine-4-thione series inhibited fungal growth at the lowest concentrations used, at which tricyclazole had no effect. A dose-dependent mechanism might be responsible for this effect, with lipophilicity as the governing factor. Within a given set, the presence of a cyclohexyl or an n-butyl group generally increased antifungal activity, with respect to both growth inhibition and cell de-pigmentation of the mycelium, suggesting that a higher lipophilicity might improve transport inside the cells. SEM and TEM of M. grisea hyphae showed that treatment with the most active substance (2h) caused significant ultrastructural effects, particularly on the endomembrane system, suggesting a mechanism of action similar to that of most azole fungicides. Dissimilarities were also observed, with no alterations of the cell wall evident. In conclusion, several compounds showed greater inhibition than tricyclazole, and therefore provide useful new chemistry for control of M. grisea infections.