Serum thyroglobulin levels in preterm infants with and without the respiratory distress syndrome. I. Cord blood study

Cord serum levels of thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in 147 term and preterm infants were related to gestation age, birth weight, respiratory distress syndrome (RDS), and several perinatal factors by means of multiple linear regression analysis. None of the perinatal factors influenced Tg and TSH cord serum levels. However, in infants who developed RDS, Tg and TSH cord serum levels differed significantly from values in infants who did not develop this syndrome. In RDS infants, significantly higher Tg values were found. Tg cord serum levels increased with birth weight in the "average" RDS infant (i.e. infants with birth weights according to the 50th percentile of the growth chart for their gestation age), while these levels decreased in the "average" non-RDS infant. In RDS infants TSH cord serum levels increased with increasing birth weight, while these levels did not vary in non-RDS infants. Although Tg and TSH cord serum levels in RDS infants increased during gestation, no correlation between Tg and TSH cord serum levels could be demonstrated. There was no correlation between Tg and TSH cord serum levels in non-RDS infants. Since we found a clear correlation between Tg cord serum levels and gestation age, but no correlation between Tg and TSH cord serum levels, we suggest that other phenomena are responsible for the high Tg levels such as organ immaturity.     

Does the risk of childhood diabetes mellitus require revision of the guideline values for nitrate in drinking water?

In recent years, several studies have addressed a possible relationship between nitrate exposure and childhood type 1 insulin-dependent diabetes mellitus. The present ecologic study describes a possible relation between the incidence of type 1 diabetes and nitrate levels in drinking water in The Netherlands, and evaluates whether the World Health Organization and the European Commission standard for nitrate in drinking water (50 mg/L) is adequate to prevent risk of this disease. During 1993-1995 in The Netherlands, 1,104 cases of type 1 diabetes were diagnosed in children 0-14 years of age. We were able to use 1,064 of these cases in a total of 2,829,020 children in this analysis. We classified mean nitrate levels in drinking water in 3,932 postal code areas in The Netherlands in 1991-1995 into two exposure categories. One category was based on equal numbers of children exposed to different nitrate levels (0.25-2.08, 2.10-6.42, and 6.44-41.19 mg/L nitrate); the other was based on cut-off values of 10 and 25 mg/L nitrate. We determined standardized incidence ratios (SIRs) for type 1 diabetes in subgroups of the 2,829,020 children with respect to both nitrate exposure categories, sex, and age and as compared in univariate analysis using the chi-square test for trend. We compared the incidence rate ratios (IRRs) by multivariate analysis in a Poisson regression model. We found an effect of increasing age of the children on incidence of type 1 diabetes, but we did not find an effect of sex or of nitrate concentration in drinking water using the two exposure categories. For nitrate levels > 25 mg/L, an increased SIR and an increased IRR of 1.46 were observed; however, this increase was not statistically significant, probably because of the small number of cases (15 of 1,064). We concluded that there is no convincing evidence that nitrate in drinking water at current exposure levels is a risk factor for childhood type 1 diabetes mellitus in The Netherlands, although a threshold value > 25 mg/L for the occurrence of this disease can not be excluded.     

Acute Puerperal Inversion of the Uterus — An Obstetric Emergency

Over a 17-year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 deliveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.     

Amino acids in parenteral nutrition of preterm infants. Comparison of oral and parenteral supply

Parenteral feeding of preterm infants has been accepted as an alternative form of nutrition in those infants unable to accept oral feeding. The amount of amino acid nitrogen and the composition of the amino acid solution to be used, however, have not yet been defined. The amino acid intake and the plasma amino acid concentration of three groups of preterm infants were compared. Twenty-three infants were fed parenterally. Of these, 16 were studied during the first week of life (group I) and 7 during the second week (group II). A control group of 9 infants fed with oral formula was also studied in the second week (group III). In general, plasma amino acid concentrations in the parenterally fed groups were higher than in the orally fed group, in spite of a lower intake. Comparison of the amino acid intake of groups I and II relative to group III, with the plasma amino acid concentrations of groups I and II relative to group III, revealed a rather constant ratio with the exception of tyrosine and aspartic acid, where higher values were found. It is concluded that further increase in the amino acid nitrogen in parenteral feeding of preterm infants requires a more adapted preparation.     

Uveitic glaucoma

Glaucoma is a common and challenging complication of uveitis. This article reviews the risk factors for uveitic glaucoma and provides a logical approach to identification of the underlying mechanisms of raised intraocular pressure. Management is discussed with special reference to the relative merits and disadvantages of the newer glaucoma drugs, antiproliferative trabeculectomy, glaucoma drainage devices, and cyclophotocoagulation.     

Odontogenic keratocyst with dentinoid formation

Although rare, hard tissue deposits, namely dystrophic calcifications and cartilage, have been reported to occur in the connective tissue wall of the odontogenic keratocyst. However, dentinoid formation has not been previously documented. A case involving the left mandibular premolar-molar region in a 37-year-old Malay male is described here along with a brief review on the reported prevalence of hard tissue deposits in the odontogenic keratocyst. Differential diagnosis of this case from other dentinoid-forming odontogenic cysts and tumors-notably calcifying odontogenic cyst, odontoma, ameloblastic fibro-odontoma, central odontogenic fibroma and adenomatoid odontogenic tumor that may present with dentin/dentinoid formation-is discussed.