International Collaborative Effort (ICE) on birthweight; plurality; and perinatal and infant mortality. I: Methods of data collection and analysis

This paper describes the collection and analysis of data by a group of international collaborators (International Collaborative Effort on Perinatal and Infant Mortality) interested in comparative studies on birthweight distributions and reproductive outcome. This is the first of a series of reports on the results of these studies. It gives an account of the countries or states involved, and the collection and characteristics of the data. The countries and states included sixteen of the United States, plus England and Wales, Denmark, Bavaria and North Rhine-Westphalia from the Federal Republic of Germany, Israel, Japan, Norway, Scotland, and Sweden. The data comprised birthweight distributions in 500-gram groups for all births and for singletons separately, for livebirths, stillbirths, first week deaths and, where available, late neonatal and infant deaths, from 1970 up to 1985.     

First trimester diagnosis and early in utero treatment of obstructive uropathy

The earliest diagnosis and treatment of obstructed fetal bladder is reported. Placement of vesico-amniotic shunt at 14.5 weeks of gestation enabled preservation of bilateral renal function and maintenance of normal amniotic fluid volume with normal pulmonary development. The shunt functioned adequately for more than 12 weeks. At birth, a mild 'prune' belly was the only deformity noted.     

Porencephaly and optic hypoplasia in neonatal isoimmune thrombocytopenia.

Five children with prenatal intracerebral damage associated with neonatal isoimmune thrombocytopenic purpura are described, and characteristic neurological features listed. These include optic hypoplasia which has not been previously documented in this condition.     

Plasma amino acids in appropriate- and small-for-gestational-age fetuses

The fetal plasma amino acid profiles of 28 small-for-gestational-age fetuses were established in umbilical venous blood samples obtained by cordocentesis and the values were compared with those of 62 appropriate-for-gestational age fetuses. In the appropriate-for-gestational-age group fetal levels were significantly correlated with but were higher than the maternal levels, which indicates that amino acids are actively transported by the placenta. In the small-for-gestational-age group, the fetal plasma concentration and the fetomaternal ratio of essential amino acids was decreased and this decrease was significantly correlated with the degree of fetal hypoxemia. There was a variable response (e.g., alanine was increased, whereas serine and tyrosine were decreased) involved with nonessential amino acids. In umbilical venous hypoxemia the plasma ratio of nonessential/essential amino acids was increased, and the maternal plasma concentrations of both essential and nonessential amino acids were increased. These findings suggest that in uteroplacental insufficiency there is intrauterine starvation.     

Maternal serum alpha-fetoprotein in twin pregnancy.

Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum alpha-fetoprotein value in the remaining 136 twin pregnancies paralleled a curve 2.5 times the median curve for singleton pregnancies over the gestational range studied. Higher serum alpha-fetoprotein values correlated significantly with increasing incidence of fetal and neonatal death, premature delivery (less than 35 weeks' gestation), and twin-to-twin birth discordance (greater than 20%), most pronounced at greater than 4 multiples of the singleton median level. A significant negative correlation between alpha-fetoprotein and birth weight was observed (p less than 0.001), but was related more to prematurity than to poor fetal growth. Theoretically, serum alpha-fetoprotein screening detected 56.5% of the twins in this study when a cutoff level of 2.5 multiples of the median was used, enhancing twin detection in the study population by 40%. These data indicate that maternal serum alpha-fetoprotein screening has a valuable role in the management of twin pregnancy, both in the detection of twins and in the prediction of perinatal outcome in twin pregnancy.     

Promoting interactions with basic scientists and clinicians: the NIA Alzheimer's Disease Data Coordinating Center

To benefit Alzheimer's disease research, a central data co-ordinating centre (CDCC) is planned that will systematically collect data from 27 Alzheimer's disease centres (ADCs) located nationwide. This CDCC will combine, analyse and disseminate epidemiologic, demographic, clinical and neuropathological data to researchers from the ADCs and the broader scientific community. New and larger scale collaborative studies on Alzheimer's disease will be possible through this centre. Since 1 July 1997, an interim data co-ordinating centre (IDCC) has been serving as the agent of the ADCs to begin the data sharing process until a permanent CDCC is established. The data collected by the IDCC are limited to administrative information and to indexing of specimens and clinical material, with future plans for the transfer of the data collected to the CDCC once it is established.     

In utero surgical treatment of fetal obstructive uropathy: A new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy

OBJECTIVES: We present a new approach to prenatal evaluation and prediction of renal function and long-term outcomes for fetuses considered candidates for in utero surgery. STUDY DESIGN: A review of 34 cases of obstructuve uropathies was made, with analysis of our approach to prenatal evaluation, the predictive value of urinary electrolytes and protein analysis in identifying renal dysplasia, and the outcomes of cases with and without in utero surgical intervention. RESULTS: Ten of 11 pregnancies that were terminated had dysplasia; one female had cloacal dysgenesis. In three of eight unshunted cases megacystis resolved after vesicocentesis. Eight of 15 shunted fetuses survived. Of those predicted to have good postnatal outcome, six of six demonstrated good postnatal renal function. Of those predicted to have poor outcomes, two of two had poor postnatal renal function and dysplasia. Seven of 15 shunted fetuses died, four of four predicted to have dysplasia were confirmed, and three died of nonrenal causes. CONCLUSIONS: Our prenatal approach successfully differentiated fetuses with underlying renal dysplasia from those without irreversible damage who subsequently benefited from in utero vesicoamniotic shunt placement. (AM J Obstet Gynecol 1994;170:1770-9.)     

Semi-synthesis of C20 3H-resiniferatoxin

There has recently been considerable interest concerning the biochemical and pharmacological mechanisms of action of resiniferatoxin (Rx). Rx is a daphnane diterpene ester, which is part of the phorbol ester family of diterpenes. We have synthesized ³H-Rx in a three-step process from the parent alcohol, resiniferonol (Ro). The tritium label is incorporated into the resiniferonol nucleus at the C₂₀ position, before esterification of ³H-Ro to ³H-Rx. This compound will be of use in the elucidation of the binding characteristics of Rx to its biochemical receptor site(s).     

Protracted venous infusion 5-fluorouracil and interferon-{alpha} in advanced and refractory colorectal cancer

BACKGROUND: The management of patients with advanced colorectal cancer remainsdependent on the optimal use of 5-Fluorouracil (5-FU). Enhanced5-FU activity can be achieved by either adding a modulator orby altering the administration schedule, in particular usinga protracted venous infusion. Based on encouraging phase IIdata using bolus 5-FU and interferon-