Can the Autogenous Nanofat Injection Improve the Symptoms of Patients With Temporomandibular Joint Internal Derangement? A Prospective Observational Clinical Study

Since nanofat is considered one of the richest sources of adipose-derived stem cells with an increased need for new biological approaches for managing temporomandibular joint internal derangement (TMJ-ID) symptoms that impair a patient's lifestyle, this study evaluated the effectiveness of autogenous nanofat intra-articular injection in managing ID symptoms regarding pain, mouth opening, and joint sound. Furthermore, to assess the consequences and complications of this procedure, 20 patients with 38 TMJs with varying stages of Wilkes classification were included in the study. All involved patients were previously diagnosed with ID depending on a clinical and radiographical basis and had no previous response to conservative management for at least 4 to 6 months. Evaluation of the ID in the preoperative phase, as well as 2 weeks, 1 month, 3 months, and 6 months postoperatively. An evaluation was done depending on pain assessment using a visual analog scale (VAS), measuring maximum mouth opening (MMO) and joint noise if it was present or absent preoperatively and postoperatively. The results show improvement in the symptoms in all follow-up appointments since the VAS of pain decreased significantly with increased MMO and the absence of clicking in most cases during follow-up appointments. We conclude from this study that nanofat intra-articular injection was influential in managing ID symptoms and was safe without significant side effects.

Wastewater-based epidemiology for tracking bacterial diversity and antibiotic resistance in COVID-19 isolation hospitals in Qatar

BACKGROUND

Hospitals are hotspots for antimicrobial resistance genes (ARGs), and play a significant role in their emergence and spread. Large numbers of ARGs will be ejected from hospitals via wastewater systems. Wastewater-based epidemiology has been consolidated as a tool to provide real-time information, and represents a promising approach to understanding the prevalence of bacteria and ARGs at community level.

AIMS

To determine bacterial diversity and identify ARG profiles in hospital wastewater pathogens obtained from coronavirus disease 2019 (COVID-19) isolation hospitals compared with non-COVID-19 facilities during the pandemic.

METHODS

Wastewater samples were obtained from four hospitals: three assigned to patients with COVID-19 patients and one assigned to non-COVID-19 patients. A microbial DNA quantitative polymerase chain reaction was used to determine bacterial diversity and ARGs.

FINDINGS

The assay recorded 27 different bacterial species in the samples, belonging to the following phyla: Firmicutes (44.4%), Proteobacteria (33.3%), Actinobacteria (11%), Bacteroidetes (7.4%) and Verrucomicrobiota (3.7%). In addition, 61 ARGs were detected in total. The highest number of ARGs was observed for the Hazem Mebaireek General Hospital (HMGH) COVID-19 patient site (88.5%), and the lowest number of ARGs was found for the HMGH non-patient site (24.1%).

CONCLUSION

The emergence of contaminants in sewage water, such as ARGs and high pathogen levels, poses a potential risk to public health and the aquatic ecosystem.

Identification and characterization of App: an immunogenic autotransporter protein of Neisseria meningitidis

In a search for immunogenic virulence factors in Neisseria meningitidis, we have identified a gene encoding a predicted 160 kDa protein with homology to the autotransporter family of proteins. Members of this family are secreted or surface exposed and are often associated with virulence in Gram-negative bacterial pathogens. We named the gene adhesion and penetration protein (app), because of its extensive homology to the hap gene of Haemophilus influenzae. We reconstructed the gene with reference to genomic sequence data and cloned and expressed the protein in Escherichia coli. Rabbit antiserum raised against recombinant App reacted with proteins in all meningococcal isolates examined, which represented clonal groups responsible for the majority of meningococcal invasive disease. Antibodies to the protein were detected in the sera of patients convalescing from meningococcal infection. Purified App had strong stimulating activity for T cells isolated from a number of healthy donors and from one convalescent patient. We confirmed that App is surface localized, cleaved and secreted by N. meningitidis. Importantly, the rabbit anti-App serum killed the organism in the presence of complement. Thus, App is conserved among meningococci, immunogenic in humans and potentially involved in virulence. It therefore merits further investigation as a component of a future multivalent vaccine.

Structure-activity relationship of polyisoprenyl benzophenones from Garcinia pyrifera on the tubulin/microtubule system

Microtubule disassembly inhibitory properties have been established for the known polyisoprenylated benzophenones xanthochymol (1a) and guttiferone E (1b). The compounds were isolated from the fruits of Garcinia pyrifera collected in Malaysia. A structure-activity relationship study, including natural and semisynthetic derivatives, delineated some structural features necessary for the interaction with tubulin within this compound class.

Cytotoxic polyisoprenes and glycosides of long-chain fatty alcohols from Dimocarpus fumatus

The ethanolic extract from the stem bark of Dimocarpus fumatus, showed in vitro cytotoxic activity against KB cells. Fractionation of the extract gave compounds belonging to different classes. The two major components have been identified as a benzoquinone, sargaquinone, and a chromene, sargaol. One sphingolipid, soyacerebroside I, two glycosides of sitosterol, and fatty acids were also identified. Besides these known compounds, two new glycosides of long-chain fatty alcohols have been identified as 1-O-[alpha-L-rhamnopyranosyl-(1-->2)-beta-D- glucopyranosyl-(1-->3)-alpha-L-rhamnopyranosyl-(1-->6)-beta-D- glucopyranosyl]hexadecanol and 1-O-[[alpha-L-arabinopyranosyl-(1-->3)]-alpha-L-rhamnopyranosyl-(1 -->2)- beta-D-glucopyranosyl-(1-->3)-alpha-L-rhamnopyranosyl-(1-->6)-beta-D- glucopyranosyl] hexadecanol, and a mixture of three new diacylglycerylglucosides has been isolated. These structures were elucidated by analysis of 2D-NMR and mass spectra.

Characterization of Campylobacter spp. using restriction fragment length polymorphism and SDS-polyacrylamide gel electrophoresis

Twenty four Campylobacter jejuni and coli isolates obtained from Egyptian children were characterized using restriction fragment length polymorphism (RFLP) of flagellin genes and polyacrylamide gel electrophoresis of whole cell and glycine-extracted proteins. The isolates were found to fall into nine polymorphism groups, eight of which were reported previously in Egypt but one group displayed by 3 isolates represented a new group that was not reported before. Furthermore, the relative prevalence of polymorphic groups in the population studied is different from that reported previously. Analysis of whole-cell and acid glycine-extracted proteins showed that the profiles of these isolates are typical profiles of Campylobacters isolated from other humans.

In utero treatment of fetal goitrous hypothyroidism caused by maternal Graves' disease

We present two cases of maternal Graves' disease complicated by fetal goitrous hypothyroidism. Both patients had elevated maternal thyroid-stimulating immunoglobulin and thyrotropic-binding inhibitory immunoglobulin antibody titers. Diagnosis of fetal hypothyroidism was made by cordocentesis, and serial injections of thyroxine into the amniotic fluid resulted in return to normal of fetal thyroid size and function at birth. Significance of in utero management of fetal hypothyroidism is discussed.

Clinical significance of neurofibromatosis in pregnancy

Neurofibromatosis (NF) is a common genetic disease that affects multiple organ systems. We studied eight women with NF and the outcome of their 14 pregnancies. One patient and her fetus died of a massive intracranial hemorrhage as a result of ruptured glioblastoma of the basal ganglia. The incidence of live birth and preterm labor were 50% and 28.6%, respectively. One of 14 pregnancies (7.1%) resulted in spontaneous abortion. There was also one growth-retarded fetus in this series (7.1%). Perinatal implications of this disease and management guidelines are discussed.

Prenatal diagnosis and management of fetal goiter caused by maternal Grave's disease

We present a case of maternal Grave's disease associated with fetal goitrous hyperthyroidism. Fetal goiter was diagnosed by ultrasound and diagnosis of fetal hyperthyroidism was established by umbilical blood sampling. Fetus was successfully treated by increasing maternal propylthiouracil dosage. Fetal thyroid status was normal at birth. Role of sonography and umbilical blood sampling in management of fetal goiter complicated with maternal Grave's disease is discussed.

Clinical significance of human parvovirus B19 infection in pregnancy

We present a case of human parvovirus B19 infection in a term pregnancy that resulted in rapid development of hydrops fetalis and death. Clinical aspects of this virus in pregnancy and therapeutic options are discussed.

Prenatal diagnosis of cerebellar hemorrhage: medicolegal implications

Perinatal brain damage and compromised long-term neurologic outcome have been a topic of major concern and continuing debate. Until recently the occurrence of fetal brain injury was attributed to intrapartum events. However, evidence continues to accumulate that neurologic damage can occur during fetal life unrelated to intrapartum events. We report a case of massive cerebellar hemorrhage of unknown cause diagnosed by ultrasonography at 36 weeks of gestation after decreased fetal movements. Fetal heart rate pattern and Doppler flow study of cerebral arteries are correlated with neuropathologic findings, and the medicolegal aspects of this condition are discussed.

Premature rupture of the membranes between 20 and 25 weeks' gestation: role of amniotic fluid volume in perinatal outcome

OBJECTIVE

Our purpose was to prospectively study the relationship between amniotic fluid volume and perinatal outcome in pregnancies complicated by premature rupture of the membranes before fetal viability.

STUDY DESIGN

The study population consisted of 178 singleton pregnancies with premature rupture of membranes between 20 and 25 weeks' gestation who were managed expectantly. Serial amniotic fluid volume measurements were made and their relationship to the neonatal survival rate, incidence of chorioamnionitis, and other perinatal outcomes was determined.

RESULTS

Seventy-four patients were delivered before 25 weeks of gestation and only five infants (6.7%) survived. In contrast, 104 patients were delivered between 26 and 34 weeks, and 93 infants (89.4%) survived (p < 0.001). There were 107 pregnancies with adequate amniotic fluid volume after premature rupture of membranes on admission. Of these 16 patients were delivered before 25 weeks of gestation, and the remaining 91 patients were able to carry their pregnancies beyond 25 weeks of gestation. This was significantly different from 71 patients who demonstrated inadequate amniotic fluid volume on admission to the hospital, of whom 58 were delivered before 25 weeks and only 13 continued the pregnancy beyond 25 weeks (p < 0.05). At gestations between 26 and 34 weeks chorioamnionitis occurred in 22 of 91 (24.1%) patients with adequate amniotic fluid volume versus nine of 13 patients (69.2%) with inadequate amniotic fluid volume (p < 0.001). The incidence of perinatal death for pregnancies between 26 and 34 weeks with adequate versus inadequate amniotic fluid volume was 2.1% and 69.2%, respectively (p > 0.001). Overall survival rate and incidence of chorioamnionitis were 55% and 26.4%, respectively.

CONCLUSIONS

Delivery of pregnancies between 20 and 25 weeks of gestation with premature rupture of membranes carries very high risk of neonatal mortality. The results of this study suggest that women with adequate amniotic fluid volume have a better chance to continue their pregnancy beyond 25 weeks of gestation and have a higher neonatal survival rate than those with inadequate amniotic fluid volume. The incidence of perinatal death and chorioamnionitis in patients who carry a pregnancy beyond 25 weeks is correlated with inadequate amniotic fluid volume.

Maternal transposition of the great arteries in pregnancy. A case report

We present a rare case of successful pregnancy completion in a patient with D transposition of the great arteries corrected by the Mustard procedure. Cardiac performance during pregnancy was followed by echocardiography.

Electroconvulsive therapy in a twin pregnancy: a case report

We present a case of twin gestation complicated by severe depression and psychotic behavior; the mother was treated with electroconvulsive therapy (ECT). She had received multiple medications for treatment of her depression earlier during the first part of the pregnancy. However, frequent use of ECT later in the course of pregnancy did not result in adverse fetal outcome as is evident from normal fetal surveillance tests. We conclude that, when indicated, ECT during pregnancy improves maternal condition and does not adversely affect fetal well-being.

Measurement of pulmonary capillary pressure during ritodrine tocolysis in twin pregnancies: a new noninvasive technique

Five twin pregnant women were studied during treatment of preterm labor with ritodrine. Maternal pulmonary capillary pressure (PCP) and cardiac function were measured by noninvasive simultaneous recordings of the indirect carotid pulse, electrocardiography, phonocardiography, and M-mode echocardiography. Pulmonary capillary pressure significantly increased from the control value of 9 +/- 3.0 to 18 +/- 2.2 mmHg during the infusion period of therapy. Cardiac index and preejection period to left ventricular ejection time ratio were also increased during treatment with ritodrine. Our findings suggest that noninvasive measurement of PCP and cardiac function may be useful in monitoring twin pregnancies that develop cardiovascular side effects during tocolytic therapy.

Placental chorioangioma: prenatal diagnosis and clinical significance

We report the prenatal diagnosis of placental chorioangioma in a 32-week intrauterine pregnancy associated with polyhydramnios and enlarged fetal cardiac size that resulted in intrauterine fetal death. Ultrasound appearance, pathophysiology, and clinical significance of this entity are discussed.

Effect of chronic intrauterine stress on the disappearance of tunica vasculosa lentis of the fetal eye: a neonatal observation

We performed ophthalmologic examinations on 180 neonates (27 to 34 weeks gestational age) shortly after birth, and disappearance of the anterior capsule of the lens vessels was used to estimate gestational age. Three groups of patients were studied: I: chronic hypertension (n = 80); II: preeclampsia (n = 60); III: normal pregnancies (n = 40). The gestational age was also determined by a reliable menstrual history or early ultrasound examination, or both, and Ballard's scoring and compared with that assessed by grading of the anterior vascular capsule of the lens. We found a significant acceleration of gestational age in vascular capsule of the lens when maternal chronic hypertension existed. This study shows that chronic intrauterine stress results in the disappearance of the tunica vasculosa lentis of the fetal eye and therefore suggesting accelerated maturation of this vascular compartment.

Cardiac isoenzymes and electrocardiographic changes during ritodrine tocolysis

To investigate the potential myocardial ischemic effects of ritodrine, we studied 36 singleton and four twin preterm pregnancies during ritodrine therapy. We serially determined serum creatinine phosphokinase (CPK-MB fraction) and lactic dehydrogenase isoenzymes and performed electrocardiography before and during ritodrine infusion and again within the first 24 hours of oral drug therapy. We observed that serum CPK-MB and lactic dehydrogenase isoenzymes remained within the normal range during therapy periods. The incidence of sinus tachycardia and non-specific T wave changes were 100% and 25%, respectively. In three of four twin pregnancies, ST-T segment depression in leads I, V4, V5, and V6 of the electrocardiogram was noted. Our study suggests that (1) the recommended ritodrine regimen does not produce direct myocardial damage, and (2) ritodrine may cause cardiac ischemia as determined by electrocardiography, which theoretically would progress to myocardial damage if not treated properly.

Pleural effusions and pulmonary hypoplasia

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Cardiovascular effects of ritodrine tocolysis: a new noninvasive method to measure pulmonary capillary pressure during pregnancy

The cardiovascular effects of ritodrine tocolytic therapy were assessed by noninvasive simultaneous recordings of indirect carotid pulse, electrocardiogram (ECG), phonocardiogram, and M-mode echocardiogram in 12 patients in preterm labor. The study was performed before and during infusion, and afterward when the patient was on oral drug therapy. Ritodrine therapy increased heart rate, left ventricular fractional shortening, pre-ejection period/left ventricular ejection time ratio, and cardiac index. A progressive rise in pulmonary capillary pressure was observed in all patients, exceeding 18 mmHg (the threshold for the development of pulmonary congestion) in six patients. Systolic arterial pressure, left ventricular end-diastolic dimension, and plasma protein oncotic pressure remained unchanged during therapy. Ritodrine therapy resulted in a significant drop in diastolic blood pressure and peripheral vascular resistance. This noninvasive means of measuring cardiovascular parameters, including pulmonary capillary pressure, may be useful in monitoring patients who develop significant cardiovascular side effects during tocolytic therapy.

Outcome of fetal meningomyelocele after vaginal delivery

Eight neonates with meningomyelocele were delivered vaginally. Diagnosis of meningomyelocele was made by ultrasonography during the latter half of pregnancy in three patients. The remaining five did not have ultrasound examination during the antenatal period. None of the meningomyelocele sacs (less than or equal to 4 cm in diameter) was ruptured at the time of delivery. Cesarean section may not be necessary for all fetuses with meningomyelocele.

Peripheral neuronal changes in growth-retarded neonates: an ultrastructural study

To study the effect of intrauterine growth retardation (IUGR) on fetal peripheral neuronal elements, we examined preputial skin tissues of ten growth-retarded neonates (mean gestational age 36 +/- 2.3 weeks) and six normal control neonates (mean gestational age 35 +/- 3.0 weeks) by transmission electron microscopy. The myelinated and unmyelinated nerve fibers of growth-retarded neonates contained significant ultrastructural alterations, consisting of 1) local aggregation of mitochondria, 2) loss of mitochondrial cristae, 3) the presence of large vacuoles within the axoplasm, and 4) myelinated fiber degeneration. The Schwann cells of these neonates exhibited accumulation of glycogen, disruption of cytoplasm, dilatation of rough endoplasmic reticulum, and extensive development of polyribosomes. None of the above changes were observed in the control infants, those appropriate for gestational age. We conclude that IUGR may cause significant ultrastructural changes in developing peripheral neuronal tissue.

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.

Comparison of uterine activity induced by nipple stimulation and oxytocin

Intermittent nipple stimulation has been proposed as a substitute for exogenous oxytocin infusion in the performance of contraction stress tests. To compare the uterine activity produced by these two methods, we studied a group of 45 term pregnant women undergoing indicated inductions of labor. Twenty-five patients had nipple stimulation and 20 patients received oxytocin infusions according to a study protocol. The two groups were similar in all obstetric parameters. Pre- and posttest uterine activity was measured by internal tocodynamometry and quantified in Montevideo units. A significant increase in uterine activity occurred in both groups (P less than .01). Regular uterine activity (three contractions in ten minutes) was achieved more rapidly (P less than .005), but at a lower level (P less than .001) in the nipple stimulation group. Pre- and posttest tonus did not change significantly in either group. In the nipple stimulation group, five patients (20%) did not achieve adequate contraction patterns after 15 stimulation-rest cycles (a total of 110 minutes) and three subjects (12%) experienced uterine hyperstimulation. These observations suggest that exogenous oxytocin and intermittent nipple stimulation may not have equivalent effects on uterine contractility. Therefore, it may not be justified to substitute one technique for the other or to use the same criteria for interpretation of contraction stress tests produced by both techniques.

Nonimmune hydrops fetalis: clinical experience and factors related to a poor outcome

Twenty-one cases of nonimmune hydrops fetalis diagnosed at the Medical College of Georgia during a 2-year period are presented. All fetuses satisfied strict diagnostic criteria and were evaluated according to a standard protocol. The corrected mortality rate was 95% with pulmonary hypoplasia being the most common cause of perinatal death. The mean gestational age at diagnosis was 24.8 weeks; in 57% of the cases the cause of nonimmune hydrops fetalis was identified. Fifteen fetuses had serial ultrasound assessment and in 19 cases postnatal evaluation was performed. Two factors that consistently conveyed a poor perinatal outcome were ultrasonographic evidence of malformation and/or the presence of persistent pleural effusions. A method for the quantification of fetal pleural effusions is presented and its clinical relevance is discussed.

Metastatic pheochromocytoma in pregnancy and fetal biophysical assessment after maternal administration of alpha-adrenergic, beta-adrenergic, and dopamine antagonists

Metastatic pheochromocytoma, a rare complication of pregnancy, was managed from 30 weeks' gestation until delivery three weeks later with a combination of alpha-adrenergic blockade (Minipres) beta-adrenergic blockade (Timolol), and dopamine synthesis inhibition (Demser). The biophysical parameters of fetal heart rate (FHR) baseline, variability, and reactivity, as well as fetal breathing movements, body movements, tone, and amniotic fluid volume were followed sequentially during this period. A 1450-g growth-retarded infant, who subsequently did well, was delivered by cesarean section; the mother received combined surgical and medical therapy for her metastatic disease in the postpartum period. The initial fetal biophysical alteration observed was a reduction in mean FHR baseline rate; further biophysical test abnormalities appeared only after overt fetal compromise was evident. Sequential multiple parameter biophysical testing in such circumstances appears to be a valid and valuable approach to antepartum management.

Pregnancy outcome in renal transplant recipients: experience at the Medical College of Georgia and review of the literature

Between 1970 and 1982, 13 renal transplant recipients had 17 pregnancies with follow-up at the Medical College of Georgia (MCG). Nine patients received related donor grafts and four received cadaver kidneys; 11 mothers survived their pregnancies. Preeclampsia, urinary tract infections, and preterm labor were frequent complications. complications. Perinatal complications were rare, and 12 of 13 continuing pregnancies produced surviving infants. Only one infant had congenital abnormalities (premature closure of the fontanelles and umbilical hernia). We present maternal and neonatal details, with prognostic considerations for pregnancy in such patients.

Pregnancy in renal transplant recipients: a review

Although pregnancy in renal transplant patients was looked upon with skepticism in the past, it is no longer an insurmountable barrier to successful pregnancy. Gestation in these patients, once quite rare, is increasing markedly and obstetricians expect to encounter problems such as immunologic, genetic, teratogenic, and infectious disease during the course of pregnancy in these patients. The purpose of this paper is to review various maternal and fetal aspects of pregnancy in renal transplant recipients.

Ultrasonographic prenatal diagnosis of hydranencephaly. A case report

Hydranencephaly was diagnosed with a prenatal ultrasound examination, and the results were correlated with the autopsy findings.

Indications for and timing of delivery in diabetic pregnancies

The management of 430 diabetic pregnancies is presented. Our protocol emphasized "tight" metabolic control and assessment of fetal well-being by antepartum fetal heart rate testings and estriol levels. Spontaneous labor was allowed in uncomplicated Class A diabetic patients. Labor in complicated cases and insulin-dependent diabetic pregnancies was induced after establishing fetal lung maturity, except when a maternal or fetal complication dictated otherwise. A significant drop in estriol was observed in 4% of Class A diabetic patients and 10.2% of insulin-dependent diabetic patients. None developed a positive contraction stress test. Abnormal fetal well-being tests contributed minimally to the indications for induction of labor. The incidence of induced preterm delivery was 2.8% in Class A diabetic patients and 18.4% in insulin-dependent diabetic ones. The perinatal mortality was 5.6:1000 and 13:1000, respectively. The incidence of respiratory distress syndrome was very low, and none of the cases were associated with a "mature" amniotic fluid lecithin phosphorus measurement.

The unreliability of amniotic fluid bilirubin measurements in isoimmunized pregnancies in sickle cell disease patients

Amniotic fluid spectrophotometric analysis for bilirubin (delta optical density [delta OD450], at 450 nm) is used to assess the severity of fetal involvement in isoimmunized pregnancies. Two patients presented with sickle cell anemia and hyperbilirubinemia who also were isoimmunized. The first patient had anti-kell and anti-e antibodies, whereas the second patient had anti-Lewisa and anti-Coltonb antibodies. Delta OD450 was elevated in both patients. The difficulty in interpretation of high delta OD450 in the presence of maternal hyperbilirubinemia is stressed. Sickle cell diseased patients are particularly prone to present with this problem. These patients always have hyperbilirubinemia and a relatively high incidence of irregular antibodies because of the numerous blood transfusions they receive. The management of these two patients is presented with suggestions for the use of alternative modalities of monitoring isoimmunized pregnancies in patients with hyperbilirubinemia.

Diabetes insipidus during pregnancy complicated by preeclampsia. A case report

Up to 1984, 69 cases of diabetes insipidus associated with pregnancy had been reported on. In only four such cases did preeclampsia develop. We treated a patient for the fifth such case.

Sickle-cell-induced hematuria in pregnancy. The current diagnostic and therapeutic approach

Hematuria is a rather frequent complication in patients with sickling disorders. However, the occurrence, incidence and management of this complication during pregnancy have not been discussed in the medical literature. We treated three patients with sickle-cell-induced hematuria in pregnancy and developed an approach we find useful for such patients.

Fetal cerebral maturation in hypertensive disorders of pregnancy

A retrospective search of the perinatal autopsy files at Magee-Womens Hospital of Pittsburgh from 1977 to 1979 disclosed 38 autopsies of preterm infants (gestational age 27 to 34 weeks) born to women with hypertensive disorders. Of these fetuses, 23 were chosen for the study of factors that lead to accelerated cerebral maturation in the preterm fetus. The sequential developmental changes of the individual fissures, sulci, and gyri of the cerebral hemispheres were used to assess gestational development of the brain. Seventeen infants showed accelerated cerebral maturation two weeks or more in advance of gestational age. Six infants showed gyral maturation appropriate for gestational age. Chronic maternal hypertension and fetal intrauterine growth retardation were found to be significant risk factors in accelerated intrauterine cerebral maturation. The chronicity of hypertension may be more important than its severity in accelerated fetal cerebral maturation.

Pregnancy in a patient with type II polyendocrinopathy. A case report

The rare association of Addison's disease and autoimmune hypothyroidism (Schmidt's syndrome) occurred during two pregnancies in the same woman. The association of Addison's disease and pregnancy is serious, and affected patients should be followed closely for electrolyte homeostasis.

Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach

Four cases of benign intracranial hypertension (BIH) in pregnancy are presented. Literature regarding this rare entity is reviewed. Various diagnostic and therapeutic approaches in the management of BIH are described, with special emphasis on the newer neurodiagnostic and neurosurgical approaches. Guidelines have been suggested in diagnosing and managing this syndrome in pregnancy.