Biomedical subjects
Publications and source records attributed to W J Watson.
Chorioamnionitis has generally been thought to be a contraindication to attempting a delayed interval delivery in a multiple gestation. We present a twin gestation in which a delay of 88 days between the birth of the two infants occurred. Chorioamnionitis observed immediately after the delivery of Twin A was successfully treated with antibiotic therapy.
We report the first two documented cases of neonatal zygomycosis caused by Absidia corymbifera. A premature infant developed disseminated disease from a cutaneous site with pulmonary, gastrointestinal, and cerebral involvement. The infant died despite amphotericin B therapy and surgical debridement. The second case occurred in a full-term infant with congenital heart disease and fungal pneumonitis. Zygomycosis was not suspected because of underlying cardiac disease and a complicated postoperative course, and this infant also died. Absidia joins a growing list of opportunistic fungal pathogens of the compromised neonate.
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Vertical transmission of the Human Immunodeficiency Virus is the major cause of pediatric AIDS cases. It is known that zidovudine therapy will substantially reduce the incidence of perinatal vertical transmission. Some authorities have made recommendations for universal HIV screening based on these findings. However, in an area of low prevalence of HIV, such as South Dakota, the benefits of such testing are questionable. We undertook a survey of one thousand consecutive deliveries in which a sample of cord blood was tested for HIV in an anonymous fashion. In all cases, the ELISA test was negative. Based on this extremely low incidence of HIV in our population, it is reasonable at the present time to undertake a selective screening protocol for testing for HIV during the antepartum period, based on the presence of risk factors, rather than applying universal screening to our population.
Haemophilus influenzae type b (Hib) organisms produce pili, which mediate attachment to human cells and are multimeric structures composed of a 24-kDa subunit called pilin or HifA. Although pili from other organisms contain additional proteins accessory to pilin, no structural components other than pilin have been identified in Hib pili. Previous analysis of a Hib pilus gene cluster, however, suggested that two genes, hifD and hifE, may encode additional pilus subunits. To determine if hifD and hifE encode pilus components, the genes were overexpressed in Escherichia coli and the resulting proteins were purified and used to raise polyclonal antisera. Antisera raised against C-terminal HifD and HifE fragments reacted with H. influenzae HifD and HifE proteins, respectively, on Western immunoblots. Western immunoblot analysis of immunoprecipitated Hib pili demonstrated that HifD and HifE copurified with pili. In enzyme-linked immunosorbent assays, antisera raised against a recombinant HifE protein that contained most of the mature protein reacted more to piliated Hib than to nonpiliated Hib or to a mutant containing a hifE gene insertion. Immunoelectron microscopy confirmed that the HifE antiserum bound to pili and demonstrated that the antiserum bound predominantly to the pilus tips. These data indicate that HifD and HifE are pilus subunits. Adherence inhibition studies demonstrated that the HifE antiserum completely blocked pilus-mediated hemagglutination, suggesting that HifE mediates pilus adherence.
OBJECTIVE: To assess maternal morbidity associated with cesarean delivery among high-risk obstetric patients in a private practice setting. STUDY DESIGN: Maternal outcome parameters were prospectively studied in 1,000 consecutively delivered patients over a one-year period. RESULTS: Three hundred forty-one patients (34%) delivered by cesarean; 194 of the procedures were performed without labor. The incidence of febrile morbidity and wound infection in patients undergoing cesarean delivery without labor, 0.5%, was no greater than that of patients who delivered vaginally (P = 1.0). There was a higher incidence of transfusion in patients delivered by cesarean without labor, but these patients were more likely to have preoperative anemia (P = .036). Patients undergoing cesarean with labor or ruptured membranes had an increased incidence of both febrile morbidity (P = .023) and wound seroma (P = .008). CONCLUSION: Maternal morbidity following cesarean delivery in high-risk obstetric patients in a private practice setting is low.
Objective. The purpose of this paper is to present our experience with Mycobacterium tuberculosis infections in immunocompetent children.Subjects and methods. Radiology, pathology, microbiology, and discharge records at two institutions identified the study population. Children who were immunocompromised and those with a positive skin test and no radiological or clinical evidence of active infection were excluded. Active mycobacterial infection was defined by a positive culture, biopsy, or a reactive purified protein-derivative skin test (PPD) with an appropriate clinical presentation and response to therapy and/or known exposure to an adult with active tuberculosis. Results. There were 22 children in whom Mycobacterium tuberculosis (MTb) was identified. Fourteen of the patients with MTb were 5 years of age or younger. The most common sites of radiological involvement were the lungs (15 cases) and the hila (eight cases). Four patients had evidence of extrathoracic MTb infection. Three cases of miliary tuberculosis were identified, all in children less than 9 months of age. Conclusion. Although pulmonary and/or hilar disease remains the most common radiological presentation of childhood tuberculosis, the radiologist must be aware of the many radiological presentations of childhood Mycobacterium tuberculosis infection, and should have a high index of suspicion with the increasing incidence in both normal and immunocompromised children.
OBJECTIVE: To evaluate maternal parity, the sonographic measurement of cervical length, and the five components of the Bishop score to determine which factors best predict the length of latent-phase labor in women undergoing labor induction. METHODS: Cervical position, cervical consistency, cervical effacement, cervical dilation, station of fetal presenting part, maternal parity, and sonographic measurement of cervical length were studied prospectively in 109 women undergoing labor induction. A multiple regression model was used to determine which factors best predict the length of latent-phase labor. RESULTS: A model using these seven factors was predictive in determining the number of hours of latent-phase labor (F = 32.1, P < .001). Backward stepwise multiple linear regression indicated that only cervical dilation independently predicted the length of latent-phase labor. There was a significant correlation between the clinical assessment of cervical effacement and the sonographic estimation of cervical length, (r = -0.523, P < .001). CONCLUSION: Only cervical dilation appears to predict the length of latent-phase labor. The sonographic evaluation of cervical length and maternal parity do not add significant independent information.
The optimal method for antenatal treatment of pleural effusions from congenital chylothorax unknown. A fetus with bilateral congenital chylothorax and hydrops had a pleural catheter placed in utero on only one side of the fetal chest for 14 days prior to delivery. The fetal hydrops partially resolved. After birth there was significantly less drainage from the pleural space that had been antenatally drained. This case demonstrates potential neonatal advantages of pleuro-amniotic shunt placement.
A 28-year-old woman with a mechanical aortic heart valve experienced an embolic stroke in early pregnancy after her anticoagulation therapy was changed from warfarin to heparin. This occurred despite use of a subcutaneous heparin infusion pump and optimal anticoagulation. Thromboembolism can occur in pregnant patients with mechanical heart valves despite optimal heparin therapy.
The endovaginal probe can be used in the umbilicus to improve fetal imaging. In 27 of 31 patients, an optimal ultrasound examination was achieved because of this added technique. The procedure is most useful in obese women and those with prior abdominal surgery.
Oligonucleotide fragments can be directionally subcloned into vectors at a single restriction site. By using T4 DNA polymerase exonuclease activity to treat vector DNA, single-stranded ends can be generated. The oligonucleotide sequences are designed to have sequence complementary to these single-stranded ends. Through the homologous annealing of oligonucleotides to the treated vector ends, the successfully subcloned molecules forms a circular recombinant DNA that is ready for transformation. There is no sequence restriction at the ends of the DNA fragment. All restriction site ends are accessible to this method. This approach for oligonucleotide fragment insertion and together with our previously described general method of exonuclease induced DNA subcloning provide convenient methods for the construction of recombinant DNA.
Complete laryngeal atresia is a rare congenital malformation that is known to cause hypertrophy of the fetal lung in utero. A fetus with laryngeal atresia was found to have markedly immature amniotic fluid lung maturity studies at term. Inappropriately low amniotic fluid lung maturity studies may be an important clue to the diagnosis of this condition.
The reported manifestations of thyrotoxicosis in the fetus include tachycardia, preterm birth, intrauterine growth retardation, and increased perinatal mortality. Presented is a twin pregnancy in a euthyroid mother with a history of Graves' disease and high levels of thyroid-stimulating immunoglobulin G antibodies, which resulted in nonimmune hydrops in one of the twins.
A sonographic standard for assessment of amniotic fluid volume in normal twin pregnancy is provided. In 210 uncomplicated twin pregnancies, amniotic fluid volume was assessed sonographically, by measuring the total amniotic fluid index (AFI), as well as the deepest single vertical pocket in each sac. The mean AFI was greater than values found in singleton gestations; the AFI increased up to 27 weeks' gestation, and decreased thereafter. It correlated well with measurement of the deepest vertical pocket in each sac (r = 0.71; p < 0.0001). In twin pregnancy at 26 to 32 weeks' gestation a fluid pocket of at least 8 cm was found in 9.8% of cases and did not indicate pathologic states. Either AFI or measurement of the deepest fluid pocket in each sac can be used to assess fluid volume in twin pregnancy. A table specific to twin pregnancy should be used when evaluating twin gestations sonographically.
Ninety-seven primigravid patients were prospectively studied to assess the predictive value of the pressor response to aerobic exercise as a screening test for preeclampsia. The blood pressure response to cycle ergometry exercise to a maternal pulse of 140 beats/min was recorded on each subject. Each subject was studied in the second trimester of pregnancy at a mean gestational age of 23 weeks (range, 18 to 27). Three of the study subjects developed hypertension with proteinuria in the third trimester. A rise in systolic blood pressure of at least 30 mm Hg occurred in 29 patients, but this did not predict third trimester preeclampsia (p = 0.21). A rise in diastolic blood pressure of 20 mm was observed in 18 patients, two of whom developed preeclampsia (p = 0.08). An increase of diastolic pressure of 20 mm Hg with moderate cycle ergometry exercise in the second trimester may predict a subset of patients at elevated risk of preeclampsia in the third trimester. However, the positive predictive value of this 20 mm Hg pressor increase (11%) limits its applicability as a screening test. Thus, we cannot recommend the use of an exercise screening test at this time.
Polyhydramnios and oligohydramnios in twin gestation is most often caused by twin-twin transfusion syndrome. Presented is a monozygotic twin pair with polyhydramnios and oligohydramnios, in which both twins had glomerulocystic kidney disease of differing severity. The more severely affected donor twin died of renal failure in the neonatal period. The surviving twin is well following unilateral nephrectomy. This case illustrates the varied spectrum of pathology in glomerulocystic kidney disease.
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