Biomedical subjects
Publications and source records attributed to E Weiner.
The incidence of cystic hygroma, which represents dilated obstructed jugular lymph sacs, is 1 in 6000 pregnancies. Cystic hygromas can be located in the nuchal area or in any other location. The prenatal ultrasonic diagnosis of a cystic hygroma in the mediastinum is presented.
PURPOSE: Patients with primary pulmonary hypertension (PPH) frequently have Raynaud's phenomenon, serum antinuclear antibodies (ANAs), and/or pulmonary vascular lesions similar to those seen in certain connective tissue diseases, especially scleroderma. A number of relatively disease-specific autoantibodies have been described in connective tissue diseases but have not been studied in patients with PPH. Therefore, sera from PPH patients were studied for a variety of autoantibodies, seeking a possible link between this pulmonary disorder and connective tissue diseases. PATIENTS AND METHODS: Sera from 31 patients with PPH and 24 with secondary pulmonary hypertension (SPH) were studied for the following autoantibodies: anti-centromere (indirect immunofluorescence of Hep-2 cells), anti-CENP-B by immunoblotting and enzyme immunoassay (EIA) using cloned CENP-B fusion protein, anti-topoisomerase I (Scl-70), anti-Ku using immunoblotting of affinity purified antigens, anti-cardiolipin using EIA, and anti-Ro (SS-A), La (SS-B), Sm, nRNP, Jo-1, PM-Scl, and Mi-2 by counter-current immunoelectrophoresis. RESULTS: Anti-Ku antibodies were found in 23% of patients with PPH, 4% with SPH, and none of 24 normal controls (PPH versus SPH, p = 0.06: PPH versus controls, p = 0.01). Antibodies to CENP-B were found in one patient each with PPH and SPH, anti-topoisomerase I in one with SPH, and anti-Ro (SS-A) and La (SS-B) in one with PPH. Overall, 12 patients (39%) with PPH had Raynaud's phenomenon or positive ANA results, with 9 (29%) having more specific autoantibodies associated with connective tissue diseases. CONCLUSIONS: These results further suggest a link between at least a subgroup of patients with PPH and autoimmune connective tissue diseases, with anti-Ku antibodies being a possible new serologic marker.
Methotrexate peak level after intratubal injection was found to be significantly lower than the accepted toxic level. After IM injection, MTX peak level and the AUC were found to be similar to the levels observed after intratubal injection. The advantage of tubal injection over IM injection is challenged.
To generate formulas to estimate fetal weight on the basis of sonographic measurements, 226 pregnant women were scanned within 3 days of delivery. Measurements included: biparietal diameter, head circumference and area, abdominal circumference and area, and femoral length. The contribution of each parameter to the estimation of fetal weight was tested by stepwise regression analysis. The best dependent variable was found to be the log of weight. The formula based on cranial and abdominal parameters proved to be inaccurate, especially when fetal weight was less than 2500 g. The addition of femoral length improved weight estimation, with a multiple r of 0.95174. The addition of gestational age led to even more accurate formulas. The most accurate found was based on biparietal diameter, abdominal circumference, femoral length and gestational age, with a multiple r of 0.95651 and an absolute mean error of 7.976 +/- 5.657%. It also produced better weight estimates at the 2 extremes of fetal weight.
The advanced modalities of vaginal ultrasonography and sensitive human chorionic gonadotropin assays have greatly facilitated the diagnosis of early ectopic pregnancy. The treatment spectrum for ectopic pregnancy ranges from a variety of conservative operative measures, including salpingectomy and operative laparoscopy, to various medical regimens or simply watchful observation alone. We report 12 cases in which the ectopic gestation was treated by transvaginal instillation of potassium chloride or methotrexate under sonographic guidance. Three of these, one of two patients receiving potassium chloride and two of six patients receiving methotrexate, later required a laparotomy. The level of beta-subunit of human chorionic gonadotropin was found to be unreliable in predicting the outcome in these patients. Ultrasound follow-up is mandatory. A protocol for treatment is presented.
Umbilical artery velocimetry using pulsed Doppler technique was carried out in 49 pregnancies complicated by pregnancy-induced hypertension (PIH). Outcome of the pregnancies was evaluated after delivery. We found the systolic to diastolic ratio of the umbilical artery to be highly sensitive and specific in predicting abnormal outcome in pregnancies complicated by PIH. In our opinion, the pulsed Doppler technique can be a useful adjunct to other methods for evaluation of fetal well-being in patients with PIH.
In nine pregnancies, remote from term, with an abnormal Non-Stress Test (NST) and Bio-Physical Profile (BPP) of 3 or above, cordocentesis for fetal blood gas analysis was performed. In seven cases an immediate post-partum blood sample was taken from the fetal cord for a similar analysis. The two tests gave very similar results. The results showed fetal acidemia (pH 7.09-7.19 and B.E. -10-15) in 4 cases, followed by immediate delivery. In the remaining 5 cases, normal blood gases were evident (pH 7.28-7.35); despite the abnormal NST, pregnancy was allowed to continue for 2 to 7 weeks, under close supervision. At birth, 2 out of 9 newborns were deemed by the neonatologist suffering from asphyxia. Both belonged to the acidemic group of women who were managed by immediate cesarean section. The other 5 fetuses, which were managed expectantly, had normal post-partum blood gases or Apgar score; none had asphyxia. Fetal blood gas analysis, on samples obtained by cordocentesis, provides useful information that can assist in the management of premature fetuses suspected of being distressed, according to their heart traces. Normal fetal blood gases can identify those fetuses falsely identified by the NST as in distress and thereby spare them unnecessary premature birth with its known complications.
Amniocentesis was performed twice on a twin gestation, and twice there was cell growth failure in one of the twins. Therefore, funipuncture was attempted at 24 weeks. The anatomical relationship and position of the fetuses, placental cord insertion, and membranous septum dictated needle entry into the cord of the lower left fetus through the sac of the upper right fetus and the septum. The procedure was uneventful and the pregnancy was carried to 39 weeks. However, the septum between the twins had been disrupted, creating a pseudomonoamniotic pregnancy. This was noticed only after delivery of the first fetus, when it was found that the two umbilical cords were entangled. We believe that, whenever possible, puncture of the membrane between twins should be avoided. Should puncture be necessary, the possibility of pseudomonoamniotic twins must be considered.
The ratio between sonographically measured fetal femur length to abdominal circumference (F/A) was studied in 471 consecutive normal singleton pregnancies from 18 to 40 weeks' gestation. The 90th (0.2715) percentile of this ratio was evaluated as a predictor for intrauterine growth retardation (IUGR) in an additional 1,502 pregnant women; 146 fetuses were found to be above the 90th percentile, of which 20 were born growth retarded. A total of 69 fetuses was found post partum to be small for date; 44 were asymmetrically growth retarded and 25 were symmetrically growth retarded. Of the 20 growth-retarded fetuses, which were correctly diagnosed in utero, 19 were asymmetrically growth retarded. The additional 49 growth-retarded newborns were not detected using the F/A ratio as a diagnostic parameter. Low sensitivity (29.98%) together with low positive predictive value (13.69%) rendered the parameter unsuitable for screening IUGR. Nevertheless, the high specificity (91.20%), together with the high negative predictive value (96.38%), makes it a useful age-independent parameter in high risk pregnancies, where asymmetric IUGR is suspected.
Neonatal ovarian cysts are not rare. Most are small follicular cysts less than 2 cm in diameter; larger cysts are less common. Such cysts are usually discovered when complications occur or when they are occasionally detected on systematic clinical examination. 2 cases are presented in infants in whom the diagnosis was made antenatally by ultrasonic scan. In both the cysts regressed spontaneously during the neonatal period. The perinatal management of ovarian cysts should be conservative as complications are very rare and hasty surgery is unwarranted.
Cordocentesis for prenatal diagnosis was being performed in the seventies during the process of fetoscopy. Since then the technique has been used as a diagnostic tool for intrauterine infection, hematological and metabolic disorders and metabolic status of the fetus; and for rapid cytogenic analysis. We report our first 207 cordocenteses performed since December 1985. First puncture was successful in half the cases. The procedure resulted in termination of pregnancy in only 0.96% of cases. Though a new technique, cordocentesis is playing a major role in modern perinatology. The possibility of a direct route to fetal blood vessels early in pregnancy would lead to earlier diagnosis and treatment.
We studied the expression of IgG, IgM, and IgA autoantibodies in the anti-topoisomerase I and anticentromere immune responses by enzyme-linked immunosorbent assay, immunoblotting, and immunofluorescence. While IgG autoantibodies were most common, IgA autoantibodies were also frequently found, but IgM autoantibodies were rare. This is the first report of IgA autoantibodies in scleroderma.
We describe an infant born at 29 weeks' gestation with oligohydramnios sequence due to amniotic fluid leakage following chorionic villus sampling at 12 weeks. To our knowledge, this is the first such report.
Pretreatment serum levels of the antigens CA-125, tissue polypeptide Antigen (TPA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) were determined in samples from 295 women with adnexal masses. At laparotomy 48% of patients had epithelial ovarian carcinoma, 9% had tumors of low malignant potential, and 8% suffered from malignancies of other kinds. The sensitivity of CA-125 with 35 U/ml as the cutoff was 88% in women with ovarian carcinoma, but 74% among those with limited disease and 58% in borderline malignancy. Only 6 of 17 mucinous ovarian carcinomas were detected. Specificity was 83%. CEA was elevated above 5.0 micrograms/liter in 15 of 17 patients with mucinous ovarian cancer. TPA detected advanced stages of malignancy, but the sensitivity was low, 53%, in cases with limited disease. PLAP was elevated in 46% of ovarian carcinoma patients. For detecting malignancy overall, the use of a parallel combination of the CA-125 and CEA assays was more sensitive than use of CA-125 as a single marker. This test combination may be of value in the diagnosis of adnexal masses. The predictive value of a positive result was 90%, and that of a negative result, 76%.
The present study was designed to test the existence of behavioral states in the fetus at term using simplified techniques. For this purpose simultaneous recording of the fetal heart activity by means of phonocardiotocography and of fetal body movements by means of real-time ultrasound was performed by using a multichannel recorded. The fetal heart activity was analyzed for two parameters: (1) long-term variability and (2) baseline accelerations. The fetal body movements were classified into three types. 880 min of recording time from 50 fetuses at 37-41 weeks of gestation were analyzed. Each segment of 1 and 3 min was classified into four distinct states, according to the combination of the above parameters. The segments that failed to fit into one of these states were labeled as 'no state'. The frequency of each parameter was also independently calculated. The results were statistically analyzed by using a computer. The significance of the difference between the observed frequencies of the various states and their expected frequencies (obtained by the frequencies of the individual parameters) was calculated by the chi 2 test. Behavioral states of a duration of 3 min were observed in 45.6% of the total periods recorded which is significantly higher (p less than 0.001) than the 4.1% expected.
The correlation between arousal state and fetal habituation was tested. Four behavioral states were determined according to fetal heart activity and movement pattern in 52 fetuses. Repeated wide low-frequency sound was used as external stimulus. Ceasing of response to 5 consecutive stimuli indicated habituation. The time from response to habituation was defined as habituation time. Although fetuses in a lower arousal state habituate more rapidly, the difference is not statistically significant.
The effect of breast stimulation on the prostaglandin secretion was tested in 13 patients at 38-40 weeks of gestation. Uterine contractions following breast stimulation were documented in all cases. There was an increase in prostaglandin metabolite levels 10 min after breast stimulation.
In 32 fetuses from 37 to 41 weeks' gestation, motorical and heart rate response time, as well as the influence of arousal state on that time were tested. Motorical response time was defined as the time from external stimulus to fetal movement. Heart rate response time was defined as the time from stimulus to the increase in baseline of 15 beats/min. Wide low frequent sound was used as external stimulus. No correlation could be found between motoric and heart rate response time (R = 0.26652). Among the various arousal states the lower arousal state had a significantly longer motorical and heart rate response time.