Correlation between iodine-131 MIBG imaging and biological markers in advanced neuroblastoma

I-131 metaiodobenzylguanidine (MIBG) imaging was performed in 38 patients with advanced neuroblastoma. Abnormal images were found in patients with elevations of urinary vanillylmandelic acid and dopamine and high serum neuron-specific enolase levels. Normal or minimal elevation of markers was seen in patients with negative images. In follow-up studies after chemotherapy, the disappearance of abnormal uptake was noted in those patients with normal marker values. A persistently abnormal uptake occurred in patients with high marker values. Conversion from a normal image to an abnormal image also occurred in patients whose markers became elevated. I-131 MIBG imaging is sensitive in detecting active foci of a neuroblastoma and is useful in monitoring chemotherapy in these patients.     

Catheter-related complications of continuous ambulatory peritoneal dialysis.

OBJECTIVE--To assess the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) with particular reference to morbidity. DESIGN--Open study. SETTING--Two city general hospitals. SUBJECTS--104 Adults and 11 children with end stage renal failure. MAIN OUTCOME MEASURE--Morbidity. RESULTS--There were 29 complications (25%), the most common being obstruction of the tube (n = 8, 7%), and migration of the tube (n = 7, 6%). Others were peritonitis (n = 5), haemorrhage (n = 4), infection at the exit site (n = 3), and leakage of fluid (n = 2). All were readily treatable. CONCLUSIONS--Fixing the catheter in two places may prevent its migration. The complication rate of CAPD is acceptable, and in children with end stage renal failure it is a suitable alternative to haemodialysis while they are waiting for renal transplantation.     

Renal response of fetal lamb to complete occlusion of umbilical cord.

The renal response of the fetal lamb to repeated complete occlusion of the umbilical cord was studied in nine chronically instrumented animals. Five episodes of occlusion of the umbilical cord, each lasting for two minutes, produced a twofold rise in fetal urine osmolality and sodium, chloride, and potassium concentrations. Output of urine and glomerular filtration rate remained essentially unchanged while free water clearance decreased from a control of +0.10 to -0.02 ml. per kilogram per minute at the end of the fifth episode. Electrolyte concentrations in urine remained elevated for at least two hours following the occlusions. In addition to changes in urine composition, there was a 50- to 200-fold increase in the fetal plasma concentration of vasopressin. These studies indicate that complete interruption of the umbilical circulation, even though of short duration, produces disturbances in fetal renal function that can lead to loss of electrolytes in the urine. They provide an explanation for the low sodium levels reported in asphyxiated newborn infants in renal failure.     

The suspicious contraction stress test

From a clinical service using the contraction stress test as an evaluator of fetal well-being, a 37-month review of the significance of the suspicious contraction stress test was performed. There were no antepartum losses in a group of 107 patients whose initial test was suspicious. Following each testing a number of patients delivered spontaneously or were delivered for other reasons. Results in 5 of 67 patients at the second testing changed from a suspicious to a positive test, 36 became negative, and 26 remained suspicious. There were no further conversions to a positive test after the second testing. There is a strong correlation between the loss of fetal heart reactivity and the repeated suspicious contraction stress test. The chief value of the suspicious test is as a marker in the high-risk pregnancy appraisal for consideration of additional fetal and maternal evaluation and possible clinical management alteration.