Sub-lethal effects of calcium dinonylnaphthalenesulfonate on Western clawed frog embryos

Naphthalene sulfonic acids (NSAs) are used as additives in lubricants, dyes, and greases and commonly act as surfactants in many industrial processes. The calcium salt of dinonyl NSA (calcium dinonylnaphthalenesulfonate; CaDNS) is listed among thousands of chemicals identified as priorities for assessment by the Government of Canada's Chemical Management Plan due to the limited toxicity data. The purpose of this study was two-fold: 1) to establish the toxicity of CaDNS to Western clawed frog (Silurana tropicalis) embryos and 2) to assess the sub-lethal effects and mechanisms of toxicity of CaDNS in amphibians through targeted gene expression and metabolite analyses. Frog embryos were exposed to water overlying sand spiked with a range of concentrations of CaDNS (17-1393 μg/g) over a 72-h period. Results indicated significantly higher mortality and presence of malformations in frog larvae exposed to over 672 μg/g CaDNS in the sand (14 ng/mL CaDNS in the water) compared to control treatments. An overall decrease in the glutathione redox cycle was observed, including decreases in relative mRNA levels of enzymes (glutathione S-transferase (gst), glutathione reductase (gsr), glutathione peroxidase (gpx)) and decreases in the glutathione (GSH) and glutathione disulfide (GSSG) metabolite concentrations. In addition, transcript levels of genes involved in antioxidant capacity and essential amino acid metabolites decreased significantly in embryos exposed to low levels of CaDNS. This is the first study to assess the toxicity of NSAs in amphibians, contributing important data to aid in the assessment of NSAs.

Periphyton bioconcentrates pesticides downstream of catchment dominated by agricultural land use

Periphyton provides important ecosystem services in aquatic environments, including supporting diverse consumers. We studied pesticide bioconcentration in periphyton in a coastal marsh on Lake Erie. The marsh is within a protected area (Rondeau Provincial Park) but receives discharge from tributaries draining intensively farmed land. Periphyton bioconcentrated 20 pesticide chemicals above levels observed in adjacent water or sediment. Average bioconcentration factors ranged from 12 times for the herbicide dicamba to 6864 times for the fungicide boscalid on a dry-weight basis. Bioconcentration factors were not linearly related to pesticides' log K_ow, log K_oc, or water solubility (simple linear regressions, p > 0.43). The removal of pesticides from ambient water represents another valuable ecosystem service provided by periphyton. However, we caution that bioconcentration of pesticides in periphyton provides a mechanism through which contemporary and legacy pesticides may enter wetland food webs.

Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study

BACKGROUND

Maintenance anti-tumour necrosis factor-α (anti-TNFα) treatment for Crohn's disease is the standard of care for patients with an inadequate response to corticosteroids and immunomodulators.

AIM

To compare the efficacy and safety of infliximab and adalimumab in clinical practice and assess the value of concomitant immunomodulator therapy.

METHODS

We performed an observational cohort study in consecutive patients with Crohn's disease qualifying for anti-TNFα treatment in Australia and New Zealand between 2007 and 2011. Demographic and clinical data were prospectively recorded to identify independent factors associated with induction and maintenance of response to infliximab or adalimumab, or to either anti-TNFα therapy.

RESULTS

Three hundred and twenty-seven patients (183 infliximab, 144 adalimumab) successfully applied for treatment. Eighty-nine percent responded in all groups and median maintenance of response was similar for the two agents. Concomitant immunomodulator with infliximab, but not adalimumab, demonstrated a significantly longer response overall (P = 0.002), and significantly fewer disease and treatment-related complications (P = 0.017). Corticosteroids at baseline, and/or in the preceding 12 months, were associated with a 9-13 times greater risk of disease flare during maintenance treatment as compared to no corticosteroids (P < 0.0001). Maintenance of response was similar in the anti-TNF naïve and anti-TNF experienced subgroups.

CONCLUSIONS

In this large, real-life study, we demonstrate infliximab and adalimumab to have similar response characteristics. However, infliximab requires concomitant immunomodulator to achieve optimal maintenance of response comparable to adalimumab monotherapy. The results of this study will assist clinicians in further optimising patient care in their day-to-day clinical practice.

Pregnancy and IBD treatment: this challenging interplay from a patients' perspective

INTRODUCTION

Current data suggest that exacerbations of Inflammatory Bowel Disease (IBD) during pregnancy worsen perinatal outcomes. However, patients' perceptions regarding the interaction between pregnancy and IBD management are unexplored.

AIMS

To (1) obtain pregnancy outcome data from local female IBD patients, and (2) to gain insight into patients' understanding of the interaction between IBD and pregnancy, and how this affects medication-taking behaviour.

METHODS

Female IBD subjects aged 18-50 years were surveyed by questionnaire. This large retrospective study sought patient who reported pregnancy outcomes and examined the relationship between major adverse outcomes, IBD activity and treatment. Subjective data regarding patients' perceptions about IBD management and pregnancy were sought.

RESULTS

219 females were surveyed, 143 completing a questionnaire (68.1%). 342 pregnancies occurred, 298 of which outcome data were available. Overall IBD women reported adverse pregnancy outcome rates comparable to the local population. Major adverse outcomes were more frequent in the subgroup with severe disease during pregnancy (5/14 (35.7%)) than those with inactive disease (14/284 (4.9%)), (OR 6.8 (95% CI 1.7-26.3), p=0.006). Adjusting for disease severity, neither corticosteroid, azathioprine nor 5ASA affected pregnancy outcome. Most female patients (84%) reported (unwarranted) concerns about the effect of IBD medications on pregnancy, free text responses indicating that this was of greater concern than any effect of IBD exacerbation.

CONCLUSIONS

Unwarranted fear of adverse medication effect on pregnancy is highly prevalent in women with IBD, yet awareness of the harmful effect of IBD exacerbation during pregnancy is poor. This information gap between patients and their gastroenterologists warrants attention.

The comorbidity burden of the treated asthma patient population in British Columbia

To date there has been little investigation of the prevalence of comorbid conditions in asthma patients. Using 1996/97 cross-sectional health services administrative data for British Columbia, we compared the prevalence of comorbid conditions in treated adult asthma patients with the general adult population using a standardized comorbidity identification methodology, the Adjusted Clinical Group (ACG) Case-Mix System. We also profiled the comorbidity burden of pediatric asthma patients. Adults with asthma were significantly more likely to have a range of comorbidities, including respiratory infections, allergic rhinitis and 8 high impact/high prevalence chronic conditions (HIHPCCs). One in 4 adults with asthma had depression, the most prevalent HIHPCC. Children with asthma had a lower comorbidity burden than adults, but 12.6% had a stable or unstable chronic medical condition, with the most prevalent HIHPCC also depression. Adults with asthma had a high and complex comorbidity burden, particularly in terms of multiple chronic conditions. We discuss the implications for services planning and delivery.

Free neurovascular transfer of latisstmus dorsi muscle for the treatment of bladder acontractility: II. Clinical results

PURPOSE

Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of latissimus dorsi muscle to the bladder.

MATERIALS AND METHODS

In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed latissimus dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus muscle. The procedure involves transfer of a free neurovascular latissimus dorsi muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessels. Patients were instructed to attempt voluntary voiding 3 months postoperatively. Followup included urodynamic evaluation, biannual Doppler ultrasonography and annual dynamic computerized tomography.

RESULTS

Annual dynamic computerized tomography and/or biannual Doppler ultrasonography demonstrated vascularization and contractility of all transplanted muscle flaps. Mean followup is 44 months (range 18 to 74). Of the 20 patients 14 were able to void spontaneously within 4 months postoperatively with post-void residual volumes of less than 100 cc, voluntary voiding was restored by bladder neck incision in 4 and 2 (10%) still require self-catheterization. Postoperative detrusor pressures ranged from 5 to 218 cm. H2O (mean 72, median 55). None of the patients had morphological and functional changes of the upper tract, or de novo incontinence postoperatively.

CONCLUSIONS

Functioning free muscle transplantation was able to restore voluntary voiding in patients who had previously been dependent on long-term catheterization. Voluntary voiding has been maintained several years postoperatively without deterioration of upper tract function.

The effect of a nursing intervention on the incidence of older patient falls

This paper describes the evaluation of a fall prevention protocol that combined the assessment of the mobility and confusion status of 2,023 patients aged 70 years and over and a toileting regimen for at risk patients who were both confused and having mobility problems. The six months' study was conducted in a 450 bed metropolitan teaching hospital and involved approximately 500 nursing staff in the hospital's medical and surgical wards. Almost five percent (4.7%) of patients in the study group fell; 13 patients fell more than once and the total number of falls was 112. Twenty-four percent of patients (n = 482) were assessed as being at risk of falling and 54% of falls (n = 61) occurred in the at risk group. Sixteen percent of these falls occurred in the sub-group who had been toileted according to the study protocol and 84% in the sub-group who had not been toileted according to the protocol. There were 53% fewer patient falls during shifts which complied with both the assessment and toileting protocol than during non-compliant shifts. Given the simplicity and effectiveness of the study protocol, the finding that it was not followed on 43% of shifts is of concern.

The addition of norethindrone acetate to leuprolide acetate for ovarian suppression has no adverse effect on ovarian stimulation

PURPOSE

Our goal was to determine if the addition of norethindrone acetate (NETA) to leuprolide acetate (LA) has an adverse effect on controlled ovarian stimulation (COH) during in vitro fertilization (IVF).

METHODS

Forty-one consecutive patients undergoing COH and IVF were divided into two groups and evaluated. Group 1 consisted of 18 patients who did not become pregnant following two cycles (one of each protocol). Group 2 consisted of 23 patients who became clinically pregnant following one cycle from either protocol. The standard protocol consisted of LA (1 mg) injected subcutaneously from the first day of menses until day 8 or when ovarian suppression was evident, at which time the dose was halved and COH was initiated. The study protocol was identical except 10 mg of NETA was given orally with LA for the first 8 days. Ovarian stimulation was similar in each protocol.

RESULTS

No adverse effect on ovarian stimulation was evident on the addition of NETA to LA. No differences were noted in days of stimulation, peak estradiol (E2) level attained, peak E2-to-oocyte ratio, dosage of exogenous gonadotropins, number of aspirated oocytes, fertilization rate, or oocyte and preembryo quality.

CONCLUSIONS

The addition of NETA does not attenuate COH in women undergoing IVF.

Complications following surgical treatment for Dupuytren's contracture

Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively. Postoperative complications have been reported at 17%. These include excessive inflammation, hematoma, ischemic skin necrosis, infection, granuloma formation, transient paresthesia, scar contracture, persistent proximal interphalangeal (PIP) flexion contracture, distal interphalangeal (DIP) hyperextension deformity, joint stiffness, poor flexion and grip strength, pain, and reflex sympathetic dystrophy (RSD). The hand therapist plays a vital role in the early detection and treatment of many of these complications.

Splinting in the management of proximal interphalangeal joint flexion contracture

Proximal interphalangeal (PIP) flexion contracture is a common complication following hand injuries and conditions. This study investigated the treatment outcome of 20 subjects with PIP flexion contracture who followed a dynamic splinting program using either a Capener or low-profile outrigger. The splint applied a 250-g force to the distal end of the middle phalanx. Each patient was instructed to wear the splint for 8 to 12 hours per 24 hours for 8 weeks followed by a 2- to 3-week weaning period. Passive extension was evaluated objectively using torque range-of-motion measurement. The average pretreatment flexion contracture was 39 degrees. Final extension deficit averaged 21 degrees, an improvement of 18 degrees. There was no statistically significant effect on final results based on joint stiffness (as expressed by the slopes of the torque angle curves). Total end-range time (TERT) averaged 10 hours per 24 hours, for an average period of 4.3 months. Statistical analysis showed that splinting time was the only statistically significant factor affecting outcome. The correlation coefficients showed that the longer the contracture was present, the stiffer the joint and the less the contracture resolved. Dynamic splinting was an effective form of treatment for PIP flexion contracture.

Total wrist fusion. A functional assessment

Twenty cases of total wrist fusion, performed for post-traumatic conditions, were reviewed objectively, subjectively and radiologically. All patients were satisfied with the position of the fused wrist and had good pain relief. All patients would have had the procedure sooner, having had an average of three operations on the wrist before the fusion. There was a high complication rate (45%), although only four patients required further procedures for those complications. Hand function, as assessed by the Jebsen and Purdue tests, was found to be poor; this may be due to a reduced range of finger movements. There was no correlation between position of fusion, carpal height or number of joints radiologically fused, and the pain score, grip strength or Buck-Gramcko score.

Rearranged mitochondrial genomes are present in human oocytes

Using quantitative PCR, we have determined that a human oocyte contains approximately 100,000 mitochondrial genomes (mtDNAs). We have also found that some oocytes harbor measurable levels (up to 0.1%) of the so-called common deletion, an mtDNA molecule containing a 4,977-bp rearrangement that is present in high amounts in many patients with "sporadic" Kearns-Sayre syndrome (KSS) and progressive external ophthalmoplegia (PEO). This is the first demonstration that rearranged mtDNAs are present in human oocytes, and it provides experimental support for the supposition that pathogenic deletions associated with the ontogeny of sporadic KSS and PEO can be transmitted in the female germ line, from mother to child. The relevance of these finding to the accumulation of extremely low levels of deleted mtDNAs in both somatic and germ-line tissues during normal human aging is also discussed.

Predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction

We report a prospective study with 2 years of follow-up including 105 consecutive symptomatic patients (58.1% claudication and 41.9% severe ischemia) undergoing aortobifemoral bypass surgery (ABF/BP). Proportional-hazards, stepwise regression, and life-table analyses were used to determine predictors of the following outcome criteria: graft patency, amputation, mortality, symptomatic recurrence, and palliation. The operative mortality was 5.7% and the 2-year cumulative mortality was 15.5%. Most deaths (61.5%) were cardiac-related. There were 3 predictors of mortality: the presence of more than 1 surgical risk factor (relative risk [RR] 6.2; p less than 0.001), advanced age (RR 2.9; p = 0.03) and the presence of ischemic heart disease (RR 1.5; p = 0.045). No patient required amputation. Early graft patency rate was 94.3% and the 2-year cumulative patency was 92.8%. The only predictor of graft failure was preoperative ankle/brachial index (ABI) of less than 0.4 (RR 6.1; p = 0.003). Early symptomatic relief was 98.1% and at 2 years it was 77.3%. There were 2 predictors of symptomatic recurrence: postoperative smoking (RR 2.4; p less than 0.001) and impaired runoff (RR 2.5; p = 0.017). Cumulative palliation was 87.6% at 1 month and 66.5% at 2 years postoperatively. There were 2 predictors of palliation: the presence of more than 1 surgical risk-factor (RR 1.8; p = 0.001) and postoperative transcutaneous oximetry (PtcO2) of less than 35 mmHg (RR 3.1; p = 0.04). We conclude that the best predictors of outcome in patients undergoing ABF/BP surgery were the number of preoperative risk factors, age, ischemic heart disease, ABI, PtcO2, postoperative smoking, and angiographic runoff.(ABSTRACT TRUNCATED AT 250 WORDS)

Fractional measurements of sweat osmolality in patients with cystic fibrosis

After pilocarpine iontophoresis the change of sweat concentration during collection was studied by vapour pressure osmometry in 24 patients with cystic fibrosis and 24 healthy controls. There was a continuous but proportionate fall in sweat concentrations during the collection period. Mean (SD) initial sweat concentration in the control group was 154.4 (32.6) mmol/kg falling, after 50 microliters of sweat produced, to 92.9 (15.8) mmol/kg. In the cystic fibrosis group it was 315.9 (35.8) mmol/kg falling to 247.4 (24.9) mmol/kg. Despite different rates of fall in concentrations, separation of the two groups was maintained throughout. We conclude that there are implications for the potential improvement of the predictive value of the sweat test.

Comparison between transcutaneous oximetry and ankle-brachial pressure ratio in predicting runoff and outcome in patients who undergo aortobifemoral bypass

In a prospective study, transcutaneous oxygen tension and ankle-brachial pressure index (ABI) were measured pre- and postoperatively in 105 symptomatic patients who underwent aortobifemoral bypass to compare the ability of these two measurements to reflect the runoff status, determined by angiography, and to predict the outcome of surgery. Postoperatively, ABI better reflected the runoff status. The difference in mean ABI for good versus poor runoff was 0.17 (p less than 0.05). The difference in mean transcutaneous oxygen tension below the knee for the two runoff categories was relatively small (6.3 mm Hg, p less than 0.05). Post-minus preoperative increases in ABI reflected the runoff status better than increases in transcutaneous oxygen tension. For good runoff, the mean ABI increase was 0.25 and for poor runoff it was only 0.14 (p less than 0.05). Runoff and transcutaneous oxygen tension were found to be the best predictors of symptomatic recurrence. Poor runoff was associated with a relative risk of 2.5 (p = 0.017) and transcutaneous oxygen pressure of less than 40 mm Hg implied a relative risk of 2.3 (p = 0.029) for symptomatic recurrence. The most important predictor of graft failure was preoperative ABI. Transcutaneous oxygen tension and the ankle-brachial pressure index appear to be valuable noninvasive techniques for vascular assessment, offering different insights and different predictions for management and prognosis of peripheral vascular disease.

Mortality among United States Coast Guard marine inspectors

Work history records and fitness reports were obtained for 1,767 marine inspectors of the U.S. Coast Guard between 1942 and 1970 and for a comparison group of 1,914 officers who had never been marine inspectors. Potential exposure to chemicals was assessed by one of the authors (RP), who is knowledgeable about marine inspection duties. Marine inspectors and noninspectors had a deficit in overall mortality compared to that expected from the general U.S. population (standardized mortality ratios [SMRs = 79 and 63, respectively]). Deficits occurred for most major causes of death, including infectious and parasitic diseases, digestive and urinary systems, and accidents. Marine inspectors had excesses of cirrhosis of the liver (SMR = 136) and motor vehicle accidents (SMR = 107), and cancers of the lymphatic and hematopoietic system (SMR = 157), whereas noninspectors had deficits for these causes of death. Comparison of mortality rates directly adjusted to the age distribution of the inspectors and noninspectors combined also demonstrated that mortality for these causes of death was greater among inspectors than noninspectors (directly adjusted ratio ratios of 190, 145, and 198) for cirrhosis of the liver, motor vehicle accidents, and lymphatic and hematopoietic system cancer, respectively. The SMRs rose with increasing probability of exposure to chemicals for motor vehicle accidents, cirrhosis of the liver, liver cancer, and leukemia, which suggests that contact with chemicals during inspection of merchant vessels may be involved in the development of these diseases among marine inspectors.

The effect of postoperative smoking on femoropopliteal bypass grafts

Effect of smoking habits on limb loss rates and cumulative patency rates of 136 arterial reconstructions performed for lower limb ischemia were analyzed in a five year follow-up retrospective study. Of 121 patients, 103 (85%) smoked before the operation and 43 of the smokers (42%) discontinued smoking postoperatively. Patients who continued to smoke more than 15 cigarettes per day (34 patients) increased the probability of losing their limb approximately five times at two years and three times at five years postoperatively, compared with nonsmokers and smokers of up to 15 cigarettes per day (87 patients) (p = 0.013). Cumulative patency rates of nonsmokers and smokers of up to five cigarettes per day (Group A, 66 patients) were not significantly influenced (p = 0.518) by preoperative symptoms (claudication versus limb salvage). However, for smokers of more than five cigarettes per day (Group B, 55 patients), at five years claudicants had a cumulative patency rate of 62.9% compared to 38.3% for limb salvage patients (p = 0.015). In group A at five years, autologous saphenous vein grafts had a cumulative patency rate of 74.2%, compared to 24% for prosthetic grafts (P = 0.013). In group B the CPR differences between autologous saphenous vein and prosthetic grafts were not significantly different (p = 0.394). Multiple interactions between smoking and variables like age, preoperative symptoms, and graft material demonstrate the complexity of the effects of smoking on cumulative patency rate and the need for sub-grouping and removal of confounding factors. In view of the adverse affects of continued smoking on postrevascularization prognosis, patients should be strongly advised to discontinue smoking.

A statistical assessment of the dependability of transcutaneous tissue oxygen tension measurements

Transcutaneous oxygen tension measurements (PtcO2) were obtained for subjects in two groups: peripheral vascular patients (N = 15) and disease-free controls (N = 9). Readings were taken in each of three locations, arm, knee and foot, in supine and erect positions, at fixed and random times, on each of 3 consecutive days. The dependability (the proportion of true variance in total variance) of PtcO2 measurements was evaluated using a generalizability model. The preliminary generalizability study analysis indicated that day-to-day variation of PtcO2 level was larger than within-day variation. Therefore, in order to decrease the measurement error variance one would preferably increase the number of days for measurements (nd) rather than increase the number of measurements within each day (nt). A decision study analysis was also performed which resulted in estimates of error variance and two interdependent dependability measures: dependability coefficients (DCs) and signal to noise ratios (S/Ns). PtcO2 dependability values were generally different for the two groups. Cases had high DCs and S/Ns (DC greater than or equal to 0.9, S/N greater than or equal to 9) in all location-position combinations except for arm measurements. On the other hand, controls had low and unacceptable DCs and S/Ns (DC less than 0.8, S/N less than 4) in all location-position combinations. Cases and controls had generally lower dependability values when PtcO2 ratios were analyzed. The only two ratio-position categories for which dependability values were in the acceptable range (DC greater than or equal to 0.8, S/N greater than or equal to 4) were foot/arm erect and foot/arm supine for the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of an artificial diet on growth of patients with cystic fibrosis

The effects of an artificial diet on growth were examined in a controlled trial on 43 patients with cystic fibrosis. 28 patients received the diet for 12 months. Comparison was made between their growth before, during, and after dietary treatment. Growth changes were also assessed in 15 other patients who received a conventional diet. Artificial dietary treatment led to some improvement in height, weight, subscapular skinfold thickness, and a disproportionate advance of bone age for the group as a whole. Only 10 (36%) patients had a 'clinically' significant improvement in height, weight, or both--i.e. more than 0.5 standard deviation score. Greatest improvements were in young and mildly affected patients. It is proposed that the future use of such an unpleasant and expensive diet should be restricted to a few selected cases, rather than given as routine treatment.

Further studies of inhibitors of in vitro mammalian oocyte maturation

Studies of luteinizing hormone (LH)-mediated serum inhibition and of follicular fluid and granulosa cell inhibition of in vitro porcine, ewe, and cow oocyte meiotic maturation have been carried out. A porcine serum inhibitor or inhibitors with a molecular weight above 15,000, similar to the ewe and cow serum inhibitor(s), have been demonstrated. An LH-inactivated inhibitor or inhibitors in fluid from medium-sized ewe and cow follicles have been shown and a minimally effective porcine follicular fluid inhibitor has been confirmed. The estimated molecular weight of these inhibitors is below 1,000. Granulosa cells from the three species were not found to be dramatically inhibitory. It is postulated that the follicular fluid inhibitor(s) may be derived from the larger serum molecule(s) by an action of LH within an intermediate cell type.

Screening for cystic fibrosis by analysis of serum protein in faeces

Faecal specimens from 51 infants free of cystic fibrosis (CF) and from 9 infants with the disease were analysed for albumin and alpha1-antitrypsin content. Faeces from infants with no CF had a mean albumin content of less than 0-1 mg/g dry weight and a mean albumin: alpha1-antitrypsin ratio value of less than 0-1. Faeces from infants with CF had, with one exception, an albumin content of more than 2-0 mg/g dry weight and a ratio value greater than 3-0. It was subsequently found that the duodenal aspirate from the child with CF but whose faeces had a low albumin content and ratio value, had tryptic activity though at a much reduced level compared to the activity in aspirates from healthy infants.

Hirschsprung's disease associated with congenital heart malformation, broad big toes, and ulnar polydactyly in sibs: a case for fetoscopy

Successful fetoscopy using a 9 mm laparoscope was carried out on an 18-week pregnancy of a healthy woman who had had two previous male infants with bilateral double big toes, bilateral ulnar supernumerary digits associated with short segment Hirschsprung's disease, and ventricular septal defect of the heart, a syndrome apparently not previously described. The fetus was found to be normal, but an amniotic membrane defect was detected, which accounted for amniotic fluid leakage from 24 weeks up to delivery by caesaren section of a normal male infant at 35 weeks. The possible genetic basis and recurrence risk, put at probably one in four for this syndrome, is discussed. The indications for fetoscopy are set out and a fundal approach at laparotomy after placental localization is recommended for the procedure.

Chorea, polycythaemis, and cyanotic heart disease

Two cases of polycythaemic chorea are described, both of which were complicated by severe heart disease. The first was a child with patent ductus arteriosus and coarctation of the aorta causing severe cyanosis and secondary polycythaemia. Chorea began intermittently at an early age, becoming continuous by his fifth birthday. The second was a middle-aged male with tight mitral stenosis and a story of paralytic chorea in his teens. Polycythaemia rubra vera was eventually diagnosed two years after mitral valvotomy, some seven years after the onset of chorea.

Screening for cystic fibrosis by examination of meconium

The value of detecting albumin in meconium as a screening procedure for cystic fibrosis (CF) has been assessed on 34,228 samples in South Wales and North Staffordshire over a 4-year period; simultaneously, four methods of detecting albumin were evaluated. 12 cases of CF were detected, detection rate being 60%. The incidence of the disease in the population screened was 1 in 1850, confirmed by clinical and other test procedures. Cases of CF without impairment of pancreatic function are likely to be missed by screening methods which depend on the presence of albumin in meconium.

Gestational age assessment in Nigerian newborn infants

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Congenital facial diplegia

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Heart failure with brain damage in the newborn

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