How to assess fetal metabolic acidosis from cord samples.

The degree of metabolic acidosis at birth has been calculated in cord artery and vein samples from 21 term fetuses with cord artery pH less than 7.20. The aim of the study was to compare base deficit values calculated from either Siggaard-Andersen alignment nomogram (BD blood) or the Acid-Base chart (BD extra cellular fluid, BDecf). BDblood was found to be consistently higher in the cord artery as compared with BDecf, 13.2 +/- 3.5 and 9.9 +/- 2.9 mmol/l (Mean +/- SD), respectively. A significant correlation was found between cord artery PCO2 and BDblood whereas BDecf appeared unaffected by PCO2. In cases with cord entanglement BDecf a-v differences were increased to 3.4 +/- 2.3 mmol/l as compared with the small a-v difference noted in acidotic cases without cord entanglement, 1.1 +/- 1.25 mmol/l. It is speculated that with acutely emerging, intermittent asphyxia due to cord compression, a cord artery and vein difference in metabolic acidosis may exist and where the vein captures the basal level and the artery the acute changes. It is concluded that BDecf in both cord artery and vein add valuable information on the mechanisms behind metabolic acidosis.     

Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT.

Disease processes in the peritoneum, omentum, and mesentery occasionally are not recognized at radiologic examination. The authors have used computed tomography (CT) to categorize the radiologic appearances of the more common abnormalities into three basic patterns: (a) solid but relatively well-defined masses, (b) cystic-appearing masses, and (c) ill-defined or infiltrative processes. The most common solid masses to affect these anatomic regions are secondary neoplasms, which are associated with enhancement of the peritoneum on contrast material-enhanced CT scans and, typically, ascites. The various cystic-appearing masses (including cystic lymphangioma, cystic mesothelioma, teratoma, and loculated ascites) and infiltrating masses (such as peritoneal mesothelioma, retractile mesenteritis, desmoid, and carcinoid) must be differentiated on the basis of clinical findings and additional imaging findings (eg, CT depiction of fat and calcium in teratomas and the radiating appearance of carcinoids). Although the CT appearances of some of the abnormalities overlap, classifying them by pattern is helpful in narrowing the range of the differential diagnosis.     

A cholesterol embolism following coronary angioplasty. A case report

Cholesterol embolism is a rare but serious complication of heart catheterization. We report a patient in whom cholesterol embolization syndrome developed after coronary angioplasty complicated by an acute myocardial infarction which was treated with streptokinase and heparin. The clinical outcome was satisfactory. Cholesterol embolism occurrence might have been precipitated in this patient by thrombolytic and anticoagulant therapy.     

Diameters of the common carotid artery and aorta change in different directions during acute asphyxia in the fetal lamb

The aim of this experimental ultrasound study on six fetal lambs was to evaluate how blood flow variables and vessel diameters of the descending aorta and the common carotid artery change during fetal asphyxia in the acute preparation. When acute asphyxia was induced by obstructing the maternal aortic blood flow all fetuses reacted with significant decrease in the aortic diameter and blood flow. In the common carotid artery vessel diameter and the blood flow increased significantly. The results support the theory of a brain sparing effect during fetal distress with significant changes of blood vessel diameters occurring in opposite directions in the aorta and the common carotid artery, thereby contributing to the centralisation of circulation.     

Hepatic angiomyolipoma: Is fat in the liver friend or foe?

This article is a commentary on the preceding articles by E. Carmody et al., V. H. S. Low et al., P. Bergeron et al., J. C. Chang et al., and L. D. Hooper et al.     

Sensitivity to UV light during treatment with chloroquine in rheumatoid arthritis.

Chloroquine and hydroxychloroquine have long been suspected of causing light sensitivity in patients with rheumatoid arthritis (RA). To gain insight into the effect of chloroquines and ultraviolet (UV) light in RA we have phototested 25 RA patients with and without chloroquine. The thresholds for UVA and UVB did not change upon treatment with chloroquine or hydroxychloroquine. Provocation with high dose UVA and UVB was similar with and without treatment with chloroquine or hydroxychloroquine. Our results have shown that photosensitivity during medication with chloroquine and hydroxychloroquine is uncommon and that there is no need to stop this treatment due to sun exposure.     

Are parents accurate in their assessment of fluid volumes?

Ingestions constitute a common problem in pediatric emergency medicine. Management decisions are frequently based on parental assessments of the amount of the ingested material. The purpose of this study was to examine the accuracy of parental estimates of fluid volumes. One hundred parents of children seen in an outpatient clinic and emergency department were asked to estimate fluid volumes in four containers. There were no significant differences (P greater than 0.05) in the accuracy of fluid volume assessment between younger and older parents, between participants with and without high school education, or between parents with one or more children. While most parents are accurate in their fluid volume estimates, 14.5% of the assessments were overestimates of over 300% of the actual volume. In view of our findings, caution should be used when management decisions are being based on parental fluid volume estimates.     

A 44,000 glycoprotein is involved in the attachment of echovirus-11 onto susceptible cells.

Cellular receptors play an important role in viral pathogenesis. Until now little was known on echovirus (EV) receptor. Using detergent-treated KB cell extracts as immunogen, a mouse monoclonal antibody (Mab 143) was produced that selectively blocks the attachment of EV-11 to KB and other susceptible cells. By immunoblotting, Mab 143 detected a 44,000 protein on susceptible cell lines but not on cell lines from nonprimate origin. The receptor protein complex, purified from KB cell membranes by immunoaffinity using Mab 143 as ligand, was shown to contain a single glycoprotein with apparent molecular weight of 44,000 (gp44). The role of gp44 in the attachment of EV-11 onto KB cells was demonstrated by the ability (i) of affinity-purified gp44 to reduce the infectivity of EV-11 and (ii) of rabbit polyclonal antisera raised against gp44 to protect cells from the replication of various EV, as did Mab 143.