Anti-Vel alloimmunization and severe hemolytic disease of the fetus and newborn

Only rare cases of anti-Vel-associated mild-to-moderate hemolytic disease of the fetus and newborn have been previously reported. No case of fetal anemia requiring prenatal therapy has been noted to date. We report such a case recently encountered at our Fetal Center. Strategies are discussed for managing pregnancy complicated with alloimmunization to an antibody to a high-prevalence antigen, including sources of red blood cells for intrauterine transfusions. Only rare cases of anti-Vel–associated mild-to-moderate hemolytic disease of the fetus and newborn have been previously reported. No case of fetal anemia requiring prenatal therapy has been noted to date. We report such a case recently encountered at our Fetal Center. Strategies are discussed for managing pregnancy complicated with alloimmunization to an antibody to a high-prevalence antigen, including sources of red blood cells for intrauterine transfusions.

Factors associated with chloroquine-induced retinopathy in rheumatic diseases

Antimalarials are very useful drugs in the treatment of various rheumatic diseases. One of their main side effects is ocular toxicity, specifically retinopathy. Our objective was to identify risk factors associated with chloroquine retinopathy. A single, trained evaluator reviewed patient records with rheumatic diseases. They were taking chloroquine and identified by the ophthalmologydepartment as having retinopathy during their routine eye evaluation. These cases were classified according to clinical evaluation, visual fields and fluorangiographic study. Up to four controls were selected for each case, matched by age, gender, diagnosisand similar time on chloroquine.In all, 34 variableswere studied, among these: weight, age, disease duration, keratopathy, total cumulative dose (TCD), mean daily dose (MDD), lean body weight adjusted daily dose (LBWDD) and laboratory tests. Descriptive and inferential statistics comparing cases and controls in all patients and subgroup analysis were carried out. Significance was set at the 0.05 level. Odds ratio and 95% confidence intervals were calculated. Sixteen cases of chloroquine retinopathy were identified, eight patients with rheumatoid arthritis (RA), seven with systemic lupus erythematosus (SLE) and one with dermatomyositis. All were female. Mean age was 47.3 + 12.2 years; weight 59.5 + 10.7 kg; disease duration 12.8 + 6.0 years; time on chloroquine 54.1 + 27.8 (min-max: 30-197) months. There was a significant difference in the following variables in all patients: MDD 212.3 + 52.6 versus 170 + 51.3, p 0.009; and LBWDD 5 + 1 versus 4.2 + 1.5, p 0.03, for cases and controls, respectively. In subgroup analysis the MDD remained significantly different (235.5 + 45.8 versus 169.7 + 46.l, p 0.004) only in RA, whereas LBWDD was different both in SLE and RA. Keratopathy increased the risk for retinopathy: OR, 95% CI: 5, 1.4-l7.6, p 0.01. In conclusion, in accordance with previous studies, the MDD, LBWDD and keratopathy were risk factors associated with chloroquine retinopathy. Periodic ophthalmologic evaluations are mandatory.

Myelin oligodendrocyte glycoprotein antibodies in pathologically proven multiple sclerosis: frequency, stability and clinicopathologic correlations

Controversy exists regarding the pathogenic or predictive role of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with multiple sclerosis (MS). Four immunopathological patterns (IP) have been recognized in early active MS lesions, suggesting heterogeneous pathogenic mechanisms. Whether MOG antibodies contribute to this pathological heterogeneity and potentially serve as biomarkers to identify specific pathological patterns is unknown. Here we report the frequencies of antibodies to human recombinant MOG (identified by Western blot and enzyme-linked immunoabsorbent assay (ELISA)) in patients with pathologically proven demyelinating disease, and investigate whether antibody status is associated with clinical course, HLA-DR2-genotype, IP or treatment response to plasmapheresis. The biopsy cohort consisted of 72 patients: 12 pattern I, 43 pattern II and 17 pattern III. No association was found between MOG antibody status and conversion to clinically definite MS, DR-2 status, IP or response to plasmapheresis. There was poor agreement between Western blot and ELISA (kappa = 0.07 for MOG IgM). Fluctuations in antibody seropositivity were seen for 3/4 patients tested serially by Western blot. This study does not support a pathologic pattern-specific role for MOG-antibodies. Variable MOG-antibody status on serial measurements, coupled with the lack of Western blot and ELISA correlations, raises concern regarding the use of MOG-antibody as an MS biomarker and underscores the need for methodological consensus.

Breastfeeding infants who were extremely low birth weight

OBJECTIVE

To compare the clinical effect of breastfeedings and bottle feedings in extremely low birth weight (ELBW) infants (birth weight </=800 g).

METHODS

A total of 12 ELBW infants (mean birth weight, 672 +/- 95 g; mean gestation, 26 +/- 2 weeks) served as their own controls in this prospective study comparing physiologic parameters during bottle and breastfeeding. The infants were put to breast the same week they began on bottle feedings of human milk or premature infant formula (mean gestation, 35 weeks). One breastfeeding and one bottle feeding were observed each day for 10 days. Pre- and postfeeding weights were measured, and oxygen saturation, respiratory rate, heart rate, and axillary temperature were monitored continuously and recorded every minute during feedings.

RESULTS

The infants demonstrated a higher oxygen saturation and a higher temperature during breastfeeding than during bottle feeding, and were less likely to desaturate to <90% oxygen during breastfeeding. Mean weight gain was greater during bottle feeding than during breastfeeding (31 vs 9 g).

CONCLUSIONS

Breastfeeding the ELBW infant is desirable from a standpoint of improved physiologic responses, but such practice requires breastfeeding support and possible supplementation to optimize weight gain.

Medical and social factors associated with cognitive outcome in individuals with myelomeningocele

The interrelationship between biological and social risk factors and cognitive outcome in individuals with myelomeningocele was examined. The Kaufman Brief Intelligence Test (K-BIT) was administered to 65 children and young adults, age range 4 to 29 during a recent clinic visit. Unshunted individuals had scores in the average range and individuals with uncomplicated hydrocephalus in the low-average range. Although the level of lesion was found to be most strongly associated with total K-BIT score, examination of subscores indicated that socioeconomic status was the factor most strongly associated with Vocabulary score. The importance of both social and biological factors in predicting cognitive outcome in this population is useful in planning intervention strategies.

Comparison of skin-to-skin contact with standard contact in low-birth-weight infants who are breast-fed

OBJECTIVE

To evaluate the effects of maternal-infant skin-to-skin contact (SSC) vs standard contact (SC) on low-birth-weight infants' physiological profile, maternal milk production, and duration of breast-feeding.

DESIGN

Prospective, randomized, interventional study with cohort followed up for 6 months after discharge from the hospital.

SETTING

Special care nursery with follow-up telephone calls after discharge from the hospital.

PATIENTS

Fifty infants, with birth weights less than 1500 g and whose mothers planned to breast-feed, randomized to 2 groups: SSC (experimental) and SC (control).

INTERVENTION

In the SSC group, infants were clothed in diaper and held upright between mothers' breasts; both mother and infant were covered with a blanket. In the SC group, infants were clothed, wrapped in blankets, and held cradled in mother's arms.

MAIN OUTCOME MEASURES

Infant physiological data, ie, oxygen saturation, heart rate, respiratory rate, and axillary temperature; maternal milk production; and duration of breast-feeding.

RESULTS

Oxygen saturation was higher during SSC than during SC (P < .001); 11% of the oxygen saturation recordings during SSC vs 24% during SC indicated the values less than 90% (P < .001). A more stable milk production was noted in the SSC group. No differences were noted in infant temperature, heart rate, or respiratory rate. Ninety percent of mothers in the SSC group vs 61% in the SC group continued breast-feeding for the duration of the infants' hospitalization (P < .05), and 50% in the SSC group vs 11% in the SC continued breast-feeding through 1 month after discharge (P < .01).

CONCLUSIONS

During SSC with their mothers, low-birth-weight infants maintain a higher oxygen saturation and are less likely to have desaturation to less than 90% oxygen than are infants exposed to SC. Mothers in the SSC group are more likely to continue breast-feeding until 1 month after discharge.

Parents' and pediatricians' views of individuals with meningomyelocele

The parents of 63 individuals with meningomyelocele completed a scale examining the effects of their child's disability on their family. Eighty-six pediatricians also completed the scale as they predicted parents would respond. Medical and psychosocial data were also obtained. The results showed the following: (1) A higher level lesion was associated with parental reports of a more negative impact on the family (p < .05), and (2) pediatricians predicted a more negative impact than was reported by the parents (p < .001). We conclude that pediatricians overestimate the negative effects while also underestimating the positive effects of the disability on the family.

[Anal neoplasms. Treatment with radiotherapy and exclusive chemotherapy]

We report preliminary results on treatment of anal carcinoma by radiotherapy and chemotherapy. Nine patients (mean age 64, 6 females) were treated with 5-fluorouracil and mitomycin C intravenously, associated to radiotherapy (3000 rads in 10 days). The lesion was located in the anal canal in 4 patients and at the anal margin in 5. Good response was observed in every patient with no evidence of recurrence during a 2 to 30 month follow up period (median 16). A greater number of patients and a longer follow up period is required to establish this as a valid alternative to abdomino-perineal surgery for the treatment of anal carcinoma.

[Volume, flow and respiratory muscle strength in mitral stenosis]

Pulmonary function and respiratory muscle strength was assessed in 20 patients with mitral stenosis uncomplicated by other illness. Pulmonary function was evaluated by spirometry, flow-volume curves, functional residual capacity (FRC) and total lung capacity (TLC). Respiratory muscle strength was evaluated by measurement of maximal static inspiratory and expiratory mouth pressure (PIM, PEM cmH2O) at FRC and TLC respectively. Spirometric, FRC and TLC average values were normal. The maximal expiratory flow rate at 50 and 25% of vital capacity were decreased to 49.5 and 38.3% from predicted values. The values of PIM and PEM in patients (-93 +/- 17; 128 +/- 32 cmH2O, respectively) were similar to those of 12 normal subjects studied at comparable lung volume. Our results were similar to previous reports. There was no evidence of decreased respiratory muscle force, probably because the patients nutritional status and cardiac output were normal.