Plasma fibronectin enhances fibrinolytic system in vitro

The effects of plasma fibronectin on the fibrinolytic system were studied in vitro. Fibronectin caused a time and concentration-dependent increase (up to 99% with 330 micrograms/ml) in the amidolytic activity of tissue plasminogen activator (TPA) but not of urokinase. In the presence of fibronectin the Km of the amidolytic activity of TPA decreased without a change in Vmax. It also caused a concentration-dependent increase in lys-plasminogen activation by TPA (up to 825% with 375 micrograms/ml) and by urokinase (up to 400% with 250 micrograms/ml), as well as in the amidolytic activity of plasmin (up to 55% with 300 micrograms/ml). Fibronectin did not enhance the activation of glu-plasminogen. In the presence of fibronectin the Km of lys-plasminogen activation decreased without a change in Vmax. In purified systems fibronectin significantly shortened the clot lysis time (CLT) by up to 28% and 30% in TPA- and plasmin-activated lysis, respectively. The presence of Ca2+ did not change fibronectin's effect on CLT. Clots of non-fibronectin-depleted plasma were lysed up to about twice as fast as the clots of fibronectin-depleted plasma. In conclusion, physiologic concentrations of fibronectin enhanced the fibrinolytic system in vitro. Further studies will be required to elucidate the mechanisms involved and to document whether fibronectin has a similar effect in vivo.     

Severe hypertension in newborn after pyeloplasty of hydronephrotic kidney

A case is described, believed to be the first reported, of a newborn in whom severe hyperreninemic hypertension developed after pyeloplasty of a hydronephrotic kidney. Management of the hypertension required large doses of antihypertensive agents, including sodium nitroprusside, for six postoperative days. Propranolol had to be given for eight months after surgery. The possibility that thiocyanate level in a newborn is unreliable as indicator of sodium nitroprusside overdosage is considered.     

Metal allergy in cashiers. An in vitro and in vivo study for the presence of metal allergy

Thirty healthy cashiers continuously exposed to nickel in coins were tested in vivo and in vitro for the presence of metal contact allergy. A traditional epicutaneous test and lymphocyte transformation test were used. We tested for nickel, cobalt and chromium sensitivity. Seven of the 30 cashiers were patch test positive and 3 were in vitro positive to nickel sulphate. Two were in vivo positive to cobalt and only one in vitro positive. None was chromium allergic. There was no correlation between the exposure time and the lymphocyte response towards nickel. The presence of pierced and non-pierced ear lobes was noted with and without eczema in conjunction with the wearing of ear-rings containing nickel. The lymphocyte reactivity showed no significant difference between these groups. Only 5 out of the 12 with ear lobe dermatitis were patch test positive towards nickel. The data suggest that nickel as test substance or released from nickel-containing jewellery can evoke a cutaneous response which is not always associated with allergy.     

Development of the Fetal Vermis: New Biometry Reference Data and Comparison of 3 Diagnostic Modalities–3D Ultrasound, 2D Ultrasound,and MR Imaging

BACKGROUND AND PURPOSE:Normal biometry of the fetal posterior fossa rules out most major anomalies of the cerebellum and vermis. Our aim was to provide new reference data of the fetal vermis in 4 biometric parameters by using 3 imaging modalities, 2D ultrasound, 3D ultrasound, and MR imaging, and to assess the relation among these modalities.MATERIALS AND METHODS:A retrospective study was conducted between June 2011 and June 2013. Three different imaging modalities were used to measure vermis biometry: 2D ultrasound, 3D ultrasound, and MR imaging. The vermian parameters evaluated were the maximum superoinferior diameter, maximum anteroposterior diameter, the perimeter, and the surface area. Statistical analysis was performed to calculate centiles for gestational age and to assess the agreement among the 3 imaging modalities.RESULTS:The number of fetuses in the study group was 193, 172, and 151 for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. The mean and median gestational ages were 29.1 weeks, 29.5 weeks (range, 21–35 weeks); 28.2 weeks, 29.05 weeks (range, 21–35 weeks); and 32.1 weeks, 32.6 weeks (range, 27–35 weeks) for 2D ultrasound, 3D ultrasound, and MR imaging, respectively. In all 3 modalities, the biometric measurements of the vermis have shown a linear growth with gestational age. For all 4 biometric parameters, the lowest results were those measured by MR imaging, while the highest results were measured by 3D ultrasound. The inter- and intraobserver agreement was excellent for all measures and all imaging modalities. Limits of agreement were considered acceptable for clinical purposes for all parameters, with excellent or substantial agreement defined by the intraclass correlation coefficient.CONCLUSIONS:Imaging technique–specific reference data should be used for the assessment of the fetal vermis in pregnancy.

Imaging of the fetal posterior fossa is considered a routine part of the fetal sonographic examination. Normal sonographic biometry and normal morphology of the posterior fossa rule out most major anomalies of the fetal cerebellum and vermis.¹ However, in case of an abnormal posterior fossa, evaluation of the vermian biometry and morphology is of paramount importance, considering the wide clinical spectrum of this imaging finding.²Fetal posterior fossa anomalies range from benign asymptomatic conditions to severe abnormalities associated with neurologic impairment.^3–6 The most frequent of these anomalies, Blakes pouch cyst, vermian hypoplasia, and Dandy-Walker malformation, have a similar imaging appearance^7,8 but different vermian biometry and, therefore, different prognoses.⁹Many anomalies of the posterior fossa can be depicted with sonography alone.¹⁰ Although the standard axial imaging planes may detect most anomalies of the posterior fossa, the diagnosis of the exact type of abnormality might be challenging because a clear visualization of the midsagittal plane is essential. Subtle changes in the morphology of the vermis are hidden by this axial view, and this feature can lead to false-positive diagnoses of vermian pathologies.^11,12Our group has proposed using the transabdominal sagittal plane for visualization of the fetal vermis,¹³ while Malinger et al¹⁴ reported their experience with the transvaginal approach. Vinals et al¹⁵ used volume contrast imaging (VCI) on plane C to construct nomograms for the normal fetal vermis. Our group used this same VCI on plane C technique to compare normal and abnormal fetal vermis measurements, and we concluded that the 3D sonographic technique has many advantages in the detection of posterior fossa anomalies.¹⁶ It allows off-line evaluation and reconstruction of images, even with abnormal angles when the midsagittal plane is difficult to obtain.MR imaging is a well-known complementary tool in the prenatal diagnosis of fetal brain abnormalities. The challenges described above in achieving a good visualization of the midsagittal plane in prenatal sonography led to frequent use of this tool to assess, more accurately, the structures of the posterior fossa and improve prenatal diagnosis.Various nomograms have been developed to establish normal biometric measures of the fetal vermis by using ultrasound (US) or MR imaging.^17–19 None of these nomograms provided data regarding all 4 vermian biometric parameters. Moreover, there were no comparisons among all 3 imaging modalities.²⁰The aims of our study were the following: to provide normal reference biometric data of the fetal vermis in 4 biometric parameters for 3 imaging modalities, to evaluate the reproducibility of the vermian biometry, and to compare the measurements obtained by 2D sonography, 3D sonography, and MR imaging.