The early development of the fetal kidney-an in utero sonographic evaluation between 13 and 22 weeks' gestation

OBJECTIVES: To establish a nomogram for early fetal kidney development during early gestation. METHODS: The study is a prospective, cross-sectional evaluation of 275 male and female fetuses between 13 and 22 weeks in normal singleton pregnancies. Measurements of fetal kidney length were performed by high resolution transvaginal ultrasonography between 14 and 17 weeks' gestation, and by transabdominal ultrasonography beyond 18 weeks' gestation. RESULTS: Adequate kidney length measurements were obtained in all 275 normal fetuses as well as in six fetuses with urinary tract anomalies. Kidney length as a function of gestational age was expressed by the regression equation: (square root) kidney length (mm) = -11.66 + 1.52 x gestational age (weeks). The correlation coefficient, r = 0.983 was found to be highly statistically significant (p < 0.0001). The normal mean and the 90% prediction limits were defined. Four cases with single kidney and two cases with posterior urethral valve had kidney length above the 95% upper limit. CONCLUSION: The present data offer a normal range of fetal kidney length from early stages of gestation that may allow intrauterine assessment of its development. It may also be helpful in the early prenatal diagnosis of renal abnormalities.     

The role of sonographic assessment of cervical length in the prediction of preterm birth in primigravidae with twin gestation conceived after infertility treatment

OBJECTIVE: To identify the risk factors for preterm birth in primigravidae with twin gestation and the role of transvaginal ultrasonographic assessment of the cervix. METHODS: Between January 1996 and December 1996, 54 twin pregnancies were prospectively enrolled. All women were at their first pregnancy. All women conceived following infertility treatments and all had a normal uterine cavity proven by hysterosalpingography (HSG) or hysteroscopy. Multiple logistic regression analysis was used to evaluate the association between the length of the cervix at 18-24 weeks of gestation and outcome variables, controlling for possible confounding factors. RESULTS: The mean +/- SD maternal age was 30.9 +/- 5.3 years (range 22-46), and five of them were aged 40 or more. Nine patients (20.5%) delivered prematurely, defined as spontaneous delivery at or before 34 weeks of gestation. There was no statistically significant difference between women who delivered before or after 34 weeks of gestation in regard to maternal age, body mass index (BMI), weight gain in pregnancy, smoking and work during pregnancy. The mean cervical length of patients who delivered before 34 weeks of gestation (30.1 +/- 6.1 mm) was significantly shorter than that of women who delivered after 34 weeks of gestation (42.2 +/- 6.2 mm; P < 0.001). Cervical length longer than 35 mm predicted delivery after 34 weeks of gestation with sensitivity and specificity of 88.5% and 88.9%, respectively. The positive and negative predictive values were 96.9% and 66.7%. CONCLUSION: A transvaginal ultrasonographic measurement of the cervix > 35 mm at 18-24 weeks in twin gestation can identify patients at low risk for delivery before 34 weeks. Maternal age, BMI, weights gain, smoking and work during the pregnancy did not influence the duration of the pregnancy.     

Antimicrobial susceptibilities of urinary pathogens in a multidisciplinary long-term care facility

In order to determine bacterial distribution and antimicrobial susceptibility of urinary pathogens in a long-term-care-facility (LTCF), urine cultures were examined when clinically indicated. The LTCF consists of 286 beds, housing 931 residents during 32 months, in various wings; independent and frail residents (wing-A), nursing and demented patients (wing-B), and skilled-nursing patients (wing-C). A total of 1,401 positive urine cultures were obtained: E. coli was isolated significantly less often in wing-C than in wing-A (p = 0.02) and wing-B (p = 0.009). There was no significant difference in frequency of other organisms. Susceptibility of organisms decreased significantly from wing-C to wing-B (p < 0.05-0.001), and from wing-B to wing-A (p < 0.05-0.001). Susceptibility rates' decreased significantly over time in wing-B, less in wing-C and not at all in wing-A. In conclusion: When selecting empiric antibiotic therapy for serious urinary tract infection in a long-term-care resident, one should take into account the microbial environment of the individual patient's department.     

Characterization of a murine model of endotoxin-induced acute lung injury

Endotoxin-induced microvascular lung injury in mice is a commonly used experimental model of the acute respiratory distress syndrome (ARDS). The present paper aimed to characterize this popular model in a comprehensive and systematic fashion. Male C57bl/6 mice (n = 5) were administered an LD55 dose of E. coli endotoxin (15 mg/kg, i.p.), and lungs were harvested at several time points and evaluated for injury as well as for expression of a variety of inflammatory mediators. Endotoxin induced many features characteristic of acute microvascular lung injury. These included early (1-2 h) expression of inflammatory mediators (IL-1alpha, IL-1beta, IL-4, IL-6, IL-10, TNF-alpha, interferon-alpha, interferon gamma, and MCP-1) and leukocyte accumulation in lung tissue (lung myeloperoxidase activity 18.5 +/- 7.8 U/g tissue, P < 0.05), followed by pulmonary edema (lung water content index 17.4% +/- 2.5%, P < 0.05) and mortality. Histopathological evaluation of lung tissue was compatible with these findings. The characterization of this murine model of endotoxin-induced microvascular injury will facilitate its utilization in ARDS research.     

Ras interference as cancer therapy

Activating point mutations of the small GTPase Ras are present in about 30% of all human tumors. Constitutively active Ras induces growth factor independent cell proliferation and cell survival. Oncogenic Ras appears to be essential for tumor progression and maintenance. Several therapeutic agents have been developed to inhibit Ras, such as FTIs and antisense oligonucleotides. A new tool for blocking oncogenes in cancer cells has emerged with the discovery that RNA interference can specifically silence expression of endogenous human genes. The therapeutic potential of a RNAi-mediating vector was recently demonstrated by the stable suppression of oncogenic K-Ras in tumor cells.     

Management of a triplet pregnancy with two anencephalic fetuses and polyhydramnios

The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the first case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.     

Sex-related differences in the development of the human fetal corpus callosum: in utero ultrasonographic study

A cross-sectional study of pregnant women presenting for routine fetal ultrasonographic examination was conducted at the Obstetric Ultrasonographic Unit of the Chaim Sheba Medical Center to investigate in utero development of the fetal corpus callosum (CC) in relation to fetal gender. A total of 255 consecutive healthy fetuses of low-risk pregnancies between 16 and 36 weeks' gestation were examined. Thickness and width of the anterior mid-body of the CC were measured in the mid-coronal plane, and length was measured in the mid-sagittal plane. Fetal gender was determined by an independent observer. Female fetuses had statistically significantly thicker CC than males for each gestational age. The mean +/- standard deviation (SD) CC thickness in females was 2.13 +/- 0.8 mm [95% confidence interval (CI) 1.98-2.28] while the mean +/- SD CC thickness in males was 1.8 +/- 0.5 mm (95% CI 1.70-1.89; p < 0.01). The length and width of the CC during gestation did not differ significantly between the sexes. Corpus callosum size as a function of gestational age (GA) in both sexes was expressed by linear regression equations. The correlation coefficients r = 0.93, r = 0.61 and r = 0.62 for length, width and thickness, respectively, in males and r = 0.92, r = 0.71 and r = 0.72 in females were found to be statistically significant (p < 0.01). The present data suggest that female fetuses have a thicker CC than males. These findings support previous studies suggesting sex dimorphism of human CC and raise the possibility that prenatal sex hormones may play a role in determining callosal development.     

Ritual behavior in children and mothers' perceptions of family patterns

This study examined the relationships between family patterns and the characteristics of rituality and fears in children. The study assessed mothers' perceptions of two family characteristics: adaptability, which refers to the ability of the family system to change its power structure, role relationships and relationship rules, and cohesion, which refers to the emotional bonding of family members. Data were collected from 108 mothers of children aged 5-7, drawn from kindergartens in Northern Israel. Participants completed the Adaptability and Cohesion Scale, the Childhood Rituality Inventory (CRI), and the Fear Scale for Children. Family cohesion was positively related to "Just Right" and to Repetitive Behaviors. In addition, children's "Just Right" behaviors were highly correlated with fears of harm and death, and children's Repetitive Behaviors were highly correlated with fears of noises and night terrors, fear of strangers, and fears of harm and death.     

The subarachnoid space: normal fetal development as demonstrated by transvaginal ultrasound

Enlargement of the subarachnoid spaces can be seen in the following conditions: communicating hydrocephalus, brain atrophy and benign enlargement of the subarachnoid spaces. These disorders may begin in utero. There are no established normograms for the fetal subarachnoid spaces. This study was conducted in order to determine its normal development. Transvaginal sonography was used to examine the subarachnoid space in 80 fetuses between 16 and 40 weeks' gestation. The sinocortical width (SCW) and craniocortical width (CCW) were measured in a coronal plane at the level of the foramen of Monro. The SCW remained relatively constant during the gestational period. The CCW increased in size from the 20th to the 28th week of pregnancy, with a subsequent gradual decrease until term. Determination of fetal subarachnoid space normograms may potentially help in the diagnosis of pathological conditions affecting this space and allow prenatal counselling.