Transplantation of the liver for metastatic endocrine tumors of the intestine and pancreas

In the Pittsburgh series of 1,000 orthotopic liver transplants (OLTx), from January 1981 to July 1987, the indication for transplantation in five patients consisted of unresectable hepatic metastases arising from endocrine tumors of gastrointestinal origin: glucagonoma, two patients; carcinoid, two, and gastrinoma, one patient. Three patients underwent resection of the primary tumor (two distal pancreatectomies and one ileal resection) at the time of the hepatic transplantation. All patients underwent extensive nodal dissection. Three of the five patients are alive with no evidence of residual disease after a median follow-up study of 12 months. Hepatic transplantation broadens the concept of radical excision of tumor and may be considered as a potential therapeutic approach for some highly selected instances of unresectable hepatic metastases arising from endocrine tumors of the intestine and pancreas.     

Pleuroamniotic shunting for decompression of fetal pleural effusions

Pleuroamniotic shunting was performed at 22-35 weeks' gestation in 11 fetuses with pleural effusions. Eight of the infants, born two to 16 weeks after shunting, had no evidence of pulmonary hypoplasia. Three died in the neonatal period; one because of pseudomonas septicemia, one because of pulmonary hypoplasia caused by an associated diaphragmatic hernia, and the third because of a major cardiac defect. Pleural effusions and their prenatal decompression offer an experimental human model for the study of the effect of intrathoracic compression on pulmonary development.     

Thyroid function in anemic fetuses

Thyroid function was studied in 75 fetal blood samples obtained by cordocentesis from red cell isoimmunized pregnancies at 18-37 weeks of gestation. Thyroid-stimulating hormone (TSH), and free and total thyroxine and triiodothyronine were significantly higher than in normal controls. Furthermore, there was a significant association between the increase in TSH and the degree of fetal anemia.     

Prenatal diagnosis of the fragile X syndrome using fetal blood and amniotic fluid

Nineteen pregnancies at risk for the Martin-Bell syndrome have been monitored during the second trimester for the presence of the fragile Xq27. Of the 19 potential carrier mothers, 14 showed the presence of the fragile X in their lymphocytes at a level of 4 per cent or above. As one was a twin pregnancy, fetal blood was obtained at fetoscopy from 20 fetuses and amniotic fluid obtained simultaneously from 19 of them. Of the 20 fetuses, 18 were males (including both of the twins) and two were females. Of these 18 males, seven were found to carry the fragile Xq27 in lymphocytes and subsequently six of the seven were terminated. The diagnosis was confirmed in five of the six terminated fetuses (the sixth case was a patient whose pregnancy was terminated abroad) and also in a full-term male baby. Five of the seven males without the marker X who came to term had their karyotypes confirmed post natally. Of the two female fetuses one was found to be a carrier of the fragile X and the other was not. Both babies had full-term deliveries and both had their karyotypes confirmed post natally. In some cases the diagnosis made in fetal lymphocytes was confirmed later in amniocytes.     

Sevoflurane analysis in serum by headspace gas chromatography with application to various biological matrices

Sevoflurane is a nonflammable general anesthetic administered by inhalation of vaporized liquid that rapidly partitions out of aqueous biological matrices into a gaseous phase because of its volatility and hydrophobicity. We describe a headspace analysis of sevoflurane that can be performed without the use of an expensive automated headspace analyzer. Sevoflurane standards (0-109 mg/L) and quality control specimens (12.2 and 72.9 mg/L) were prepared and quantitated on an intraday and interday basis. Headspace gas was manually injected (150 degrees C) with a 2.5-mL gas-tight syringe into a Perkin-Elmer model 8500 gas chromatograph equipped with a 6-ft x 2-mm i.d. glass column (100 degrees C) containing 0.2% Carbowax 1500 on Carbopak C packing with a flame-ionization detector (200 degrees C), which allowed for elution of the internal standard, 1-propanol (1.56 min), and sevoflurane (2.92 min). Linear regression of the peak-area ratios of sevoflurane to 1-propanol (6.38 g/L), versus the sevoflurane concentrations yielded an average intraday correlation coefficient of 0.989 (S.D. = 0.003, n = 5) and mean quality control specimen values of 14.19 mg/L (C.V. = 5.1%, n = 5) and 66.72 mg/L (C.V. = 3.3%, n = 5). The average interday standard curve correlation coefficient was 0.987 (S.D. = 0.01, n = 5), and the mean quality control specimen values were 12.22 mg/L (C.V. = 13.7%, n = 5) and 74.27 mg/L (C.V. = 8.7%, n = 5). The chromatographic method described produced accurate and reproducible results with a simple on-column headspace gas injection. This method allows for quantitation of sevoflurane in various biological matrices by chromatographic separation of the headspace gas in a sealed specimen container.     

Short communication: trophoblast proliferation is increased in chorionic villi from pregnancies with fetal trisomy 18

Pregnancies with fetal trisomy 18 suffer from severe intrauterine growth restriction from the first trimester. This cross-sectional study of chorionic villi obtained from ongoing singleton pregnancies at 10-14 weeks of gestation, semiquantitatively examines chorionic villus stromal and trophoblastic cell proliferation rates in ongoing chromosomally normal and trisomy 18 pregnancies. Chorionic villi were stained using a standard immunohistochemistry protocol with a monoclonal antibody to the Ki-67 antigen and the number of Ki-67 positive trophoblastic and stromal cells per villous cross-section was compared between groups. The number of Ki-67 positive trophoblastic and stromal cells was significantly higher in the group (n=10) with trisomy 18 compared to the chromosomally normal group (n=25;t=2.1, P=0.03 and t=5.3, P<0.001 respectively). Abnormalities in control of cell turnover during development may be important in the pathogenesis of the clinical features of trisomic pregnancies.     

The influence of ethnic origin on first trimester biochemical markers of chromosomal abnormalities

In a first trimester study of 5422 Caucasian women, 752 Afro-Caribbean women and 170 Asian women we have shown that the median maternal serum marker MoMs for free beta-hCG and PAPP-A were 19% and 48% higher in Afro-Caribbean women and 19% higher and 35% higher in Asian women, compared to Caucasian women. Correcting for maternal weight made very little difference to the effect in Afro-Caribbeans (21% and 57% higher after weight correction) but reduced the effect in Asians (4% and 17% higher after weight correction ). It is estimated that correcting for maternal weight and ethnicity overall would increase the detection rate by a modest 1.4%. However, the effect on an individual's risk could result in as much as a two-fold increase in the patient specific risk for trisomy 21. The impact of ethnic origin seems to be greater than that observed with second trimester biochemical markers and larger studies are required in order to develop robust algorithms for correcting for ethnic origin in the first trimester.     

Serum CA125 at 11-14 weeks of gestation in women with morphologically normal ovaries

In a number of pregnant women ovarian cysts are found incidentally during the routine first trimester scan. These cysts may pose diagnostic difficulties, and the measurement of serum CA125 levels can be used to aid management. In this study we measured maternal serum CA125 levels in 188 women with uncomplicated pregnancies between 11–14 weeks of gestation. All women had morphologically normal ovaries observed on ultrasound examination. The median serum CA125 levels were 23.4 U/mL (range 2.2–166.3 U/mL, 95% reference interval 5.28–70.15) and did not change significantly with gestation. We conclude that CA125 levels are increased at 11–14 weeks of gestation and cut off values which are used to assess the nature of ovarian cysts in nonpregnant women cannot be applied to pregnant women at this gestation.