Possible Etiological Factors in Extensive Periventricular Leukomalacia of Preterm Infants

ABSTRACT. During a twelve-month period five cases of extensive periventricular leukomalacia (PVL) in preterm infants with a gestational age of 31–32 weeks were diagnosed by routine ultrasound screening of preterm infants. The perinatal courses and later development of these infants were compared with 12 other infants with a comparable gestational age born during the same time period. PVL babies were delivered more often by the vaginal route ( p =0.0034), and their mean highest serum total bilirubin value was significantly higher ( p =0.0054) than that of the control infants. The mean value of the highest blood pH during the first 72 hours of life was also significantly higher ( p =0.0311) in PVL babies than in control babies. On the basis of these results we speculate that in addition to ischaemia in the periventricular area, bilirubin toxicity may play an additional role in the severe damage seen in extensive periventricular leukomalacia.     

FETAL RISKS DUE TO WARFARIN THERAPY DURING PREGNANCY

Abstract. Two mothers with heart valve prosthesis were treated with warfarin during pregnancy. In the first case a caesarean section was done one week after replacement of warfarin with heparin. The baby died of cerebral and pulmonary hemorrhage. The second mother had a male infant by caesarean section. The baby showed warfarin-induced embryopathy with nasal hypopiasia and stippled epiphyses (chondrodysplasia punctata). Nasal hypopiasia with or without stippled epiphyses has now been reported in 11 infants born to mothers treated with warfarin during the first trimester, and a causal association is probable. In view of the risks to both mother and fetus in women with prosthetic cardiac valves it is recommended that therapeutic abortion be advised as the first alternative.     

ANTITHYROID TREATMENT OF MATERNAL HYPERTHYROIDISM DURING LACTATION

Eleven pregnant women were treated for hyperthyroidism with carbimazole (CZ) and one with propylthiouracil (PTU). Based upon a previous study it was decided that lactation should be permitted if the dose required after delivery did not exceed 15 mg of CZ or 150 mg of PTU. In the patients studied here the daily dose of CZ varied from 5 to 15 mg and that of PTU was 125 mg. TSH was measured in cord blood and in the blood of the newborn infants usually after 2 and 3 weeks of lactation. Serum T4 was measured serially in the infants' blood from day 4 up to 21 day of age, at least. In all instances the TSH concentration in cord blood remained below 45 mU/l the level used in screening for neonatal hypothyroidism. Serum TSH and T4 were all within the appropriate reference limits during the 3 weeks of study with only one exception. In the infant whose mother was treated with PTU the serum T4 measured 5 d after birth was slightly below the lower limit but later returned to normal. Since serum TSH and T4 did not deviate from the reference range in newborn infants during lactation, we conclude that breast-feeding can be permitted if the daily dose of CZ does not exceed 15 mg (or 150 mg of PTU) and if facilities are available for measuring neonatal serum TSH and T4.     

ALPHA FETOPROTEIN LEVELS IN NEONATAL HYPERBILIRUBINAEMIA

Abstract. Ikonen, R. S., Lindgren, J., Niemi, E., Sorto, A. E., Seppälä, M. and Ruoslahti, E. (Department of Paediatrics, Central Hospital of Tampere; Department of Bacteriology and Immunology, University of Helsinki; Department of Paediatrics, Central Hospital of Satakunta, Pori; Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland and Division of Immunology, City of Hope National Medical Center, Duarte, California, USA). Alpha fetoprotein levels in neonatal hyperbilirubinaemia. Acta Paediatr Scand, 69:59, 1980.—Serum alpha fetoprotein (AFP) levels were studied in 15 neonatally hyperbilirubinaemic children and 15 controls matched for sex and gestational age. All children were born between 38 and 40 weeks of gestation. During the first seven weeks of postnatal life hyperbilirubinaemic children had serum AFP concentrations over twice as high as controls. At the age of 5–7 days the mean (± S.E.M.) serum AFP values were 52.4.i-5.8 mg/I for hyperbilirubinaemic children and 24.8 ± 4.3 mg/l for controls ( p < 0.001). At 20–25 days of age they were 7.28 ± 1.10 and 2.75 ± 0.45 mg/I, respectively ( p < 0.001), and at 40–49 days 1.39 ± 0.21 and 0.46 ± 0.07 mg/l ( p < 0.001). However, no correlation was found between serum bilirubin and AFP concentrations in hyperbilirubinaemic children     

Neonatal Septicaemia in Finland 1981–85

ABSTRACT. A survey of blood culture-confirmed neonatal septicaemia was carried out in seven delivery hospitals in 1981–85, for a second successive five-year period. The total number of cases was 377, to compare with 410 in the previous five-year period. Group B streptococcus (GBS) was throughout the major pathogen (29%), followed by Staphylococcus aureus (15%) and Escherichia coli (14%), while Staphylococcus epidermidis (10%) has emerged as a significant new causative agent. Septicaemia with very early onset was predominant: 49% of the cases had onset within the first 24 hours; in the majority the symptoms were present from birth. GBS was responsible for 49% of the cases detected in the first 24 hours of life. The overall mortality was 20% as compared to 23% in the previous five-year period, whereas in the very early onset septicaemia mortality was now 18%, down from the preceding 30%. Despite the modest progress, GBS septicaemia with very early onset remains a significant problem, and effective preventive measures are needed.     

MAGNETIC RESONANCE IMAGING OF CLINICALLY LOCALIZED PROSTATIC CANCER

Purpose

We assess the accuracy of endorectal coil magnetic resonance imaging (MRI) for detecting tumor localization, capsular penetration and seminal vesicle invasion in clinically organ confined prostate cancer. We also evaluate intra-observer and interobserver agreement in interpreting MRI studies.

Materials and Methods

MRI studies of 51 consecutive patients a mean of 61 years old with biopsy proved prostate cancer were retrospectively read twice by 2 radiologists in random order. Both radiologists marked tumor localization, capsular penetration and seminal vesicle invasion on standard tumor maps. These findings were compared with the histopathological results of radical prostatectomy specimens.

Results

The overall accuracy of detecting cancer localization was 61%. The detection rate for cancer foci less than 5 mm. was only 5% but for lesions greater than 10 mm. it was 89%. There was 91 and 80% accuracy for detecting capsular penetration and seminal vesicle invasion, respectively. Sensitivity and specificity were 60 and 63, 13 and 97, and 59 and 84% for localization, capsular penetration and seminal vesicle invasion, respectively. Intra-observer and interobserver agreement ranged from fair to good (kappa coefficient 0.240 to 0.647).

Conclusions

Endorectal MRI seems to be better than previously reported for detecting seminal vesicle invasion and tumor foci in the anterior half of the prostate. Sensitivity in detecting minor capsular penetration of the tumor was low, which can probably be improved by methodological development. MRI may be useful for locating cancer foci in patients with high prostate specific antigen values but repeatedly negative biopsy findings.