The role of prenatal diagnosis in the perinatal management of urinary tract abnormalities

The use of ultrasonography is one of the most appropriate and less invasive techniques for the identification of prenatal assessment of urinary tract anomalies. This technique is able to distinguish malformations which are not compatible with life from those which could benefit from appropriate prenatal management treatment in view of a successful outcome after birth. During the past three years, 13 cases of urinary tract anomalies were found and treated. On the basis of our experience, we believe that ultrasonography is especially indicated: to make an early diagnosis of the type of malformation; in the presence of a complex malformation, gives the physician the possibility of showing and explaining to the parents all the aspects involved in reconstructive surgery thus giving them the possibility to decide for abortion or not; to reveal latent malformations: in these cases postnatal treatment may be efficiently programmed. to prepare the mother for early cesarean section, thus avoiding the trauma of vaginal delivery in cases of high risk such as fetuses with hydronephrotic kidneys. Thus, together with more experience in the field of intrauterine microsurgery, the outlook on the future of fetuses with malformations is certainly becoming brighter.     

An analysis of fetal hemoglobin variation in sickle cell disease: the relative contributions of the X-linked factor, beta-globin haplotypes, alpha-globin gene number, gender, and age

Five factors have been shown to influence the 20-fold variation of fetal hemoglobin (Hb F) levels in sickle cell anemia (SS): age, sex, the alpha-globin gene number, beta-globin haplotypes, and an X-linked locus that regulates the production of Hb F-containing erythrocytes (F cells), ie, the F-cell production (FCP) locus. To determine the relative importance of these factors, we studied 257 Jamaican SS subjects from a Cohort group identified by newborn screening and from a Sib Pair study. Linear regression analyses showed that each variable, when analyzed alone, had a significant association with Hb F levels (P < .05). Multiple regression analysis, including all variables, showed that the FCP locus is the strongest predictor, accounting for 40% of Hb F variation. beta-Globin haplotypes, alpha-globin genes, and age accounted for less than 10% of the variation. The association between the beta-globin haplotypes and Hb F levels becomes apparent if the influence of the FCP locus is removed by analyzing only individuals with the same FCP phenotype. Thus, the FCP locus is the most important factor identified to date in determining Hb F levels. The variation within each FCP phenotype is modulated by factors associated with the three common beta-globin haplotypes and other as yet unidentified factor(s).     

Production of and response to interleukin-2 in peripheral blood lymphocytes of cancer patients

Interleukin-2 (IL2) is essential for the expansion of antigen-triggered lymphocytes and cytotoxic T-cells, processes necessary for tumor control that are frequently depressed in malignancy. The authors measured certain aspects of IL2 function in cancer patients and controls and correlated the findings with the general immune response as indicated by the proliferative response to phytohemagglutinin (PHA) in peripheral blood lymphocytes (PBL). The major questions focused on the capacity of PBL to produce IL2, the correlation of this with the proliferative response to PHA, and whether exogenous IL2 could restore T-cell responses and natural killer cell activity in immunodepressed cancer patients. IL2 production was measured by the 3H-thymidine-labeled CT6 assay on the supernatants of the PBL of cancer patients and normal controls after 24 hours of stimulation with PHA. There were 115 cancer patients (70 head and neck, 13 melanoma, 12 breast, 10 colorectal, and 6 other) and 52 controls. IL2 production was essentially normal in the head and neck cancer patients as a group, although their PHA response was depressed. The mean IL2 generated per 3 X 10(6) PBL over 24 hours were 129 mu/ml in the head and neck patients and 132 mu/ml in the breast patients, similar to the 129 mu/ml generated in the controls. There was modest but not significant depression in the melanoma (78 mu/ml) and colorectal cancer patients (81 mu/ml). Although subsets of patients showed depressed IL2 production, there was no significant correlation of IL2 production with the PHA response. Depressed IL2 production showed only limited correlation with depressed lymphocyte responses (r = -0.25), which suggested a dissociation of these functions. Of interest was the finding that indomethacin did augment IL2 production in both cancer patients and controls, suggesting that prostaglandin-mediated regulation is involved. Addition of exogenous IL2 of recombinant origin (Biogen) produced significant augmentation in more than three fourths of the cancer patients and controls. Adding indomethacin further increased this response. Addition of IL2 also significantly increased natural killer activity in both groups. It was concluded that PBL in cancer patients generally have a normal capacity to generate IL2, and this capacity is not related to the proliferative response, which is frequently depressed in these patients. Exogenous IL2 can significantly augment lymphoproliferative and natural killer responses in cancer patients, suggesting that there is merit in exploring the potential therapeutic role of IL2 in these patients.     

Obesity, weight loss, and health

Obesity is a multifactorial, complicated condition or group of conditions that afflicts a growing number of people in the United States. Precise etiologies are not well understood, and both commercial and medical treatment programs are characterized by high rates of recidivism. A cultural preoccupation with slimness has created a huge industry serving millions of people who are attempting continually to reduce weight. Contradictory messages from professionals have led to confusion concerning the health implications of obesity and the potential risks of repeated dieting. This review summarizes the major areas of consensus and controversy concerning the health implications of obesity and weight loss and suggests directions for treatment that take into account the complex causes and consequences of obesity.