Fetal serum beta2-microglobulin predicts postnatal renal function in bilateral uropathies

BACKGROUND: Predicting postnatal renal function is crucial for the prenatal evaluation of fetal bilateral uropathies. Prenatal ultrasound can identify intrauterine terminal renal failure, but is not sensitive enough to identify those infants who would survive with an impaired renal function. Because it reflects fetal glomerular filtration, fetal serum beta2-microglobulin is a potential predictor of postnatal renal function. METHODS: Fetal serum beta2-microglobulin (beta2m) was assayed in 61 cases of bilateral or low obstructive uropathy, 74 controls, and 17 cases of bilateral renal agenesis, and was correlated with renal function. RESULTS: Fetal serum beta2m was 3.2 mg/L (range 1.5 to 4.7) in controls (N = 74), 9.5 mg/L (range 6.7 to 11.3) in bilateral renal agenesis (N = 17), 7 mg/L (5.1 to 10.6) in uropathy in which terminal renal failure resulted in termination of pregnancy (N = 26), and 3.7 mg/L (range 2.3 to 11.2) in live births with uropathy (N = 35). In the latter subgroup, fetal serum beta2m was significantly and positively correlated (r2 = 0.91) with postnatal serum creatinine. All survivors with a postnatal serum creatinine < or =50 micromol/L ha a fetal serum beta2m lower than 5 mg/L. Four of 6 survivors with a postnatal serum creatinine> 50 micromol/L had a fetal serum beta2m greater than 5 mg/L. CONCLUSION: Fetal serum beta2-microglobulin is a marker for renal function and predicts postnatal serum creatinine in bilateral or low fetal obstructive uropathy.     

Management of fetal thyroid goitres: a report of 11 cases in a single perinatal unit

Fetal thyroid goitres may reveal hormonal imbalance. This can jeopardize neurological development and fetal outcome even when early postnatal treatment is provided. We report a series of 11 goitres diagnosed antenatally in women with past or present thyroid disorders or discovered fortuitously on ultrasound scan. Fetuses presented with hyperthyroidism in three cases and hypothyroidism in eight. Hypothyroidism was iatrogenic in five cases, due to maternal anti-thyroid drugs. Hyperthyroidism was induced by transplacental transfer of thyroid stimulating antibodies (TSHrab). Accurate diagnosis of fetal thyroid status was obtained by fetal blood sampling but this invasive method was deemed necessary only in four cases as maternal clinical and biological data and ultrasound signs provided sufficient information to infer the type of thyroid disorder in the remaining patients. Fetal therapy relied on reduction of maternal antithyroid medication and, in selected cases, intra-amniotic injection of levothyroxin in hypothyroidism, and on administration of antithyroid drugs in hyperthyroidism. All newborns were healthy and none displayed consequences of severe thyroid imbalance. No caesarean section was performed for dystocia. Fetal thyroid goitres can be managed successfully with selected use of invasive diagnostic and therapeutic techniques.     

Fetal anal incontinence evaluated by amniotic fluid digestive enzyme assay in myelomeningocele spina bifida

The goals of this study were to determine whether anal sphincter dysfunction in spina bifida develops during fetal life or after birth and whether it reflects the severity of spina bifida and therefore can be used as a criterion to select the cases that could benefit from in uterosurgery. Total protein and digestive enzyme activities [gamma-glutamyl transpeptidase (GGTP), aminopeptidase M (AMP), and alkaline phosphatase isoenzymes including the intestinal form (iALP)] were assayed retrospectively in amniotic fluid from 80 myelomeningocele spina bifida cases without unrelated associated malformation (gestational age 14-33 wk). A normal enzyme activity profile was observed in 46 of the 80 cases. Two abnormal profiles were observed: 1) bilious vomiting, characterized by abnormally high GGTP and AMP activities but normal iALP, and 2) digestive enzyme leakage, characterized by abnormally high activities of GGTP, AMP, and iALP, typical of anal incontinence. No relation was observed between these enzyme activity profiles and the different secondary signs of spina bifida or the level of the damage. In conclusion, anal sphincter dysfunction in spina bifida revealed by amniotic fluid digestive enzyme activities occurred before 24 wk in fetal life in 28.7% of cases. This criterion may be indicative of the severity of spina bifida and therefore perhaps could be used to select cases that are suited to in utero surgery. It could also be used to establish the potential benefit of this surgery in fecal incontinence.     

Prenatal diagnosis of horseshoe lung: contribution of MRI

Horseshoe lung is a very rare pulmonary anomaly that is characterized by an isthmus of lung parenchyma bridging the right and left lungs and extending through the mediastinum. We report on the prenatal diagnosis of such a malformation in a 33-week-gestation fetus. The diagnosis was initially suspected on antenatal ultrasonography performed at 33 weeks and confirmed by fetal MRI and subsequent pathological examination after termination of pregnancy. To our knowledge, this is the first reported case of antenatal diagnosis of horseshoe lung.     

Oxidative stress in pulmonary fibrosis: a possible role for redox modulatory therapy

Idiopathic ulmonary fibrosis (histopathology of usual interstitial pneumonia) is a progressive lung disease of unknown etiology. No treatment has been shown to improve the prognosis of the patients with this disease. Recent evidence, including the observations that the patients with idiopathic pulmonary fibrosis have higher levels of oxidant stress than control patients, and a recent multicenter European study examining the effect of the antioxidant N-acetylcysteine on the progression of idiopathic pulmonary fibrosis suggest that the cellular redox state may play a significant role in the progression of this disease. These complex mechanisms include activation of growth factors as well as regulation of matrix metalloproteinases and protease inhibitors. Potential future approaches for the therapy of interstitial pulmonary fibrosis may involve synthetic agents able to modulate cellular redox state. Investigation into therapeutic approaches to inhibit oxidant-mediated reactions in the initiation and progression of pulmonary fibrosis may provide hope for the future treatment of this disease.     

Ultrasonographic cervical length measurement is not a better predictor of preterm delivery than digital examination in a population of patients with idiopathic preterm labor

OBJECTIVE: To compare digital and ultrasonographic cervical examination for the prediction of preterm delivery in patients hospitalized for preterm labor. STUDY DESIGN: Fifty-nine patients were included. The Bishop score was evaluated upon admission, weeks gestational age. Ultrasonographic measurement of cervical length was done within 24h after entry. Delivery before 37 weeks gestational age was the primary endpoint. Attending obstetricians were blinded to the results of echography. RESULTS: Preterm delivery rate was 39% (23/59). The risk of preterm delivery was significantly increased when the Bishop score was greater than or equal to 6 (OR = 4.45 [1.41-14.01]) or when ultrasonographic cervical length was less than or equal to 27 mm (OR = 4.04 [1.32-12.3]), but digital examination was the only independent risk factor in multivariate analysis. Sensitivity, specificity, positive and negative predictive value for digital examination and ultrasonography were respectively 74, 61, 55 and 79%, 70, 64, 55 and 77%. Combination of digital examination and ultrasonography did not yield better results. CONCLUSION: In our series, prediction of preterm delivery was not improved by ultrasonography compared to digital examination. The size of the cervical shift observed in most patients hospitalized for preterm labor may render ultrasonography less relevant in identifying patients anticipated to deliver prematurely.     

Contrast Echocardiography as an Intraoperative Method to Determine the Area of Myocardium Perfused by Transmyocardial Laser Channels: An Experimental Study

OBJECTIVES: Transmyocardial laser revascularization (TMLR) of the ischemic myocardium has been recognized as a potentially useful adjunct in the treatment of coronary arterial heart disease. Although there are methods to visualize the induced channels, they have been complex or concerned with long-term patency. The present work was designed as a feasibility study to determine whether contrast echocardiography could provide a simple and rapid method to assist the surgeon in determining the extent of the TMLR-treated area. METHODS: Transmyocardial channels were created in five Targhee adult sheep myocardium using a Holmium-YAG laser over the area supplied by the second diagonal branch. A commercially developed echocontrast agent (Optison) was injected into the left atrium. RESULTS: Passage of the dye through the myocardium was observed by epicardial echocardiography in all the animals. CONCLUSION: The current study shows that contrast echocardiography using a newer generation contrast agent capable of enhanced and persistent opacification of left ventricular cavity may serve as an effective tool in delineating intraoperatively the area of myocardium treated with TMLR.     

Mathematical simulation model of cardiac contraction]

The authors describe a mathematical model simulating cardiac contraction based onMaxwell's well known analogue model. The general equations of the model are presented and discussed in relation to published findings. The functioning and compute application of the model are briefly described. The investigations were carried out in normal subjects and in some cases with simulated pathology. The first results obtained with the model and their relation to some biological phenomena (hemodynamics, ATP phasic activity, cardiac contractility) are discussed. The hypotheses on which the model is based are also discussed.