Potential placenta previa: definition, frequency, and significance

Sixty-three (5%) of 1239 women studied by sonography during the second trimester of their pregnancies had a diagnosis of placenta previa. Follow-up was available for 51 of the 63 patients; in three of these, the original diagnosis was complete placenta previa, and in the other 48, the first diagnosis was partial or marginal placenta previa. At term, placenta previa was seen in only four patients for an overall frequency of 0.3% (4/1227). In all three of the patients with complete placenta previa, the condition persisted from the second trimester to term; previa persisted in only one of 48 patients with marginal/partial previa. Because of the infrequent persistence of marginal or partial placenta previa to term, we recommend using the term "potential placenta previa" in the second trimester, with follow-up sonography indicated only for vaginal bleeding.     

Osteomyelitis secondary to cutaneous mucormycosis. Report of a case and a review of the literature

An unusual case of osteomyelitis secondary to cutaneous mucormycosis developed in a diabetic with chronic renal insufficiency. Recovery followed curettage of the osseous lesion and "suboptimal" treatment with amphotericin B. A review of the literature on mucormycosis of bone and skin follows the report of the case.     

High dietary folate supplementation affects gestational development and dietary protein utilization in rats.

There is new evidence that good folate status may play a critical role in the prevention of neural tube defects and in the maintenance of adequate homocysteine levels, an amino acid recently identified as a risk factor for cardiovascular disease. This has led to different folate recommendations, all of them much higher than the present dietary recommendations. Folic acid is a water-soluble vitamin with a low potential toxicity. However, the possible consequences of long-term, high folate intakes are unknown. Therefore, the present study was undertaken to determine the effects of long-term, high dietary folate supplementation on gestational and nutritional markers in pregnant and virgin rats. Four groups of Wistar rats were classified on the basis of physiological status (virgin or pregnant) and the experimental diets administered (folic acid supplemented, 40 mg/kg diet; or control diet, 2 mg folic acid/kg diet). Rats were fed their respective diets for 3 wk. Two critical periods were used for metabolic balance studies (experimental d 1-5 and 17-21), which involved the determination of fat and protein digestibilities as well as metabolic protein utilization (MPU) and net protein utilization (NPU). Gestational development (number of live fetuses) was adequate in both diet groups regardless of folate supplementation. However, body weight and vertex-coccyx length in fetuses from supplemented dams were less than (P < 0.0001) in fetuses of control dams. Fat and nitrogen digestibilities were not affected by supplementation, but MPU and NPU coefficients were significantly lower (P < 0.05) in the folic acid-supplemented groups, irrespective of physiological status, compared to control rats. These new findings of macro-micronutrient interactions caused by high folate supplementation are discussed on the basis that the vitamin may act as a xenobiotic more than as a nutrient.     

Broad band spectral EEG parameters correlated with different IQ measurements

The relationship of IQ (measured by WAIS and all its subscales) and EEG broad band spectral parameters were studied in 40 right-handed, male volunteers ranging in age from 20 to 25 years old. EEGs were recorded in 20 derivations during rest with eyes opened. The results obtained reveal positive and negative correlations with abundant frontal participation in all bands. Mean frequency data show a frequency shift in a very narrow range suggesting that more relations in narrow band could be achieved. These results highlight the need of psychological tests that measure more homogeneous abilities and finer measurement technique to reveal clearly explainable correlations and demonstrate that EEG recordings do reflect intellectual abilities.     

Short-term chemotherapy of leprosy using the combination rifampicin + cotrimoxazole + isoniazid

With the fixed combination RMP + SXT + INH an objective and subjective improvement was obtained within two months, even in severe LL-cases. Treatment resulted in final and relapse-free cure. In the majority of patients the typical erythematous infiltrative oedematous skin processes disappeared within the two months of treatment, in some of them (three of 21) within the six-month follow-up period. Lepromas (15 cases) disappeared in two patients within the two months of treatment. In the sixth month of the follow-up period nine patients were free from lepromas. In another six cases they subsided in the course of the following months. Reactions occurred in 13 patients, in part during treatment, in part during the follow-up period. Three of them were reversal reactions. Chemotherapy was not interrupted. When required, corticosteroids or thalidomide were given in addition. Erythema nodosum leprosum (17 cases) quickly subsided under treatment. Tolerance and compliance were excellent. The subjective minor "side effects" were not specific and cannot clearly be attributed to the medication. The major advantage of the combination RMP + INH + SXT described in this paper lies in the considerably reduced treatment duration (two to four months instead of two years), the rapid disappearance of the symptoms typical of leprosy, the high tolerance, the ease of application as fixed combination and the absence of relapses. So far the patients have been followed up for two years. Through the short treatment duration the cost of treatment is considerably reduced. The new combination allows outpatient treatment and is universally applicable. The patient can maintain his social and professional habits.     

Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease

BACKGROUND: Bacteremia occurs frequently after intestinal transplantation (ITx) in children. During our initial experience with this procedure, we noted that bacteremic episodes tended to occur simultaneously with the presence of rejection and/or gastrointestinal (GI) posttransplant lymphoproliferative disease (PTLD). AIM: To document the association of bacteremia with rejection and GI PTLD in pediatric ITx recipients. METHODS: Retrospective analysis of all medical records from 62 children who underwent ITx between July 1990 and January 1998 at Children's Hospital of Pittsburgh. A bacteremic episode was defined as two positive blood cultures from different sites at the same time or from the same site at different times. Rejection and PTLD were defined using previously published criteria. RESULTS: A total of 39/62 ITx recipients had 133 blood stream infections (2.1 episodes/patient) including 121 episodes of bacteremia and 12 of fungemia. Enteric organisms were the most frequently recovered pathogens (Gram negative rods, n=76; enterococci, n=36). Enteric organisms were recovered as a single organism (n=57), with another enteric bacteria (n=23), or with coagulase negative staphylococci (CONS) (n=24). CONS were recovered as a single organism on 21 occasions. An obvious source of bacteremia was not found for 115/121 episodes. Endoscopy was performed for 107 of the 115 bacteremia episodes; an abnormal histology was identified in 74 revealing rejection (n=36), GI PTLD (n=21), or both (n=17). When endoscopy showed GI pathology, enteric organisms alone or in combination with CONS were recovered on 63/107 occasions, although CONS were recovered alone only 11 times. CONCLUSIONS: Bacteremia accompanies GI rejection and intestinal PTLD in ITx recipients. Endoscopy should be performed to inspect the allograft when bacteremia occurs without an obvious source in these patients. This is especially true for patients with bacteremia due to enteric organisms.