Cerebrospinal fluid leak in the neonate--complication of fetal scalp electrode monitoring. Case report and review of the literature.
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Biomedical subjects
Publications and source records attributed to Z Weintraub.
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Sixty-five infertile women, 37 with anovulation, eight with ovulatory disturbances and 20 with unexplained infertility were treated by a combination of clomiphene citrate (CC) from cycle day 5 (or 3) and human menopausal gonadotrophin (HMG) begun 3 days later for induction or enhancement of ovulation. Monitoring was carried out by measuring preovulatory 17-beta-oestradiol (E2) and progesterone (P) concentrations in blood samples and by follicle measurements using ultrasound. Forty-seven pregnancies resulted with a multiple pregnancy rate of 7.7% for those completed. This incidence is very low and within the range found for CC induction and might result from the later commencement of stimulation compared with many other protocols. These results were achieved with a low incidence of ovarian hyperstimulation syndrome (2.6% per cycle). The HMG doses given were low in comparison with those found in other forms of induction. The deleterious effects of this combined mode of induction on cervical mucus and the occurrence of premature spontaneous ovulation were much less than in the sequential mode of treatment. These results suggest that combined induction treatment by CC and HMG as described offers a means of achieving low rates of multiple pregnancies a known complication in the induction of ovulation.
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The changes during the first year of life in urinary and nephrogenous cAMP levels were determined in 152 normal, full-term infants using spot urine samples. The use of spot tests simplifies considerably the logistics of the cAMP determination which can be used for the investigation of parathyroid function. Levels of urinary and nephrogenous cAMP (expressed both as a function of creatinine excretion as well as glomerular filtration rate) rose from birth to 1 year of age, whereas plasma cAMP levels did not change significantly. Levels of cAMP (both urinary and nephrogenous) were significantly correlated with age, length, weight, and urinary phosphorus concentrations of the infants. No significant correlation could be observed, however, between serum phosphorus or serum and urinary calcium on the one hand, and urinary or nephrogenous cAMP on the other.
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Bedside demonstration of the absence of the right pulmonary artery was made in a premature baby in the neonatal intensive care unit. Antegrade venous and retrograde aortic injections of contrast material excluded the possibility of the anomalous origin of the right pulmonary artery from the aorta, and suggested the above-mentioned diagnosis, with the addition of a ventricular septal defect and a right-to-left shunt.
Pulmonary interstitial emphysema (PIE) is a common complication in premature infants with respiratory distress syndrome. The development of pulmonary interstitial emphysema leads to marked respiratory embarrassment in an already compromised infant. Although usually bilateral, PIE may be unilateral. Various forms of treatment for unilateral PIE in the premature infant have been described, including selective bronchial intubation, unilateral pneumonectomy, visceral pleurotomy, pure oxygen administration, and high-frequency low-pressure ventilation. A recently reported conservative regimen consisting of downward lateral positioning of the affected lung for several days may not be successful. We describe a premature infant with progressive worsening of unilateral PIE, which was successfully treated by selective bronchial balloon catheterization after failure of conservative management. In this manner, we avoided selective bronchial intubation or other aggressive forms of treatment.
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The histological findings in the liver in four fatal cases of infantile cytomegalovirus (CMV) infection are presented, three occurred in premature infants, and all died at the ages of 2-4 months. Most previously reported cases showed various degrees of hepatitis with giant cell transformation. In three of our four cases, however, the main feature was cholestasis, portal fibrosis and bile duct proliferation, not unlike the findings seen in extrahepatic biliary obstruction. In one case, massive hepatic necrosis was found, a finding not previously reported in this disease. The diversity of liver findings in infantile CMV infection is stressed.
Adenosine 3',5'-monophosphate (cAMP) was measured in matched samples of maternal plasma (MV) and umbilical artery (UA) and vein (UV) of 14 normal infants born following an uncomplicated vaginal delivery. There was good correlation between UA and UV cAMP levels, which seems to indicate that the fetoplacental unit maintains a constant equilibrium of the nucleotide concentration in the umbilical circulation. There was a markedly increased UA cAMP concentration at term relative to that of MV, as well as an arteriovenous gradient of plasma cAMP level (UA greater than UV) in the fetoplacental circulation, which strongly suggest that the high cAMP levels in the cord blood originate mainly from the fetus.
Among 12,500 babies born in our hospital from 1977 to 1982, there was one case of neonatal sepsis due to Group B beta-hemolytic Streptococcus (GBS), an incidence which is significantly lower than that reported in Western countries (3 to 6 per 1,000 live births). Among 385 pregnant women from Jerusalem and Haifa, the vaginal colonization rate with GBS was 2.8%, in contrast with 4.6 to 36% reported in Western countries. Umbilical and ear cultures were obtained from the infants of the 85 mothers who were examined in Haifa. These cultures were repeated at 3 to 5 days of age in 60 of the 85 babies. From the above data, mother-to-infant transmission rates and neonatal nosocomial infection rates with GBS were found to be 66 and 6.6%, respectively, which correlates well with 60 to 75% and 12 to 27% reported in the literature. The low incidence of GBS neonatal sepsis in our survey may be related to the low maternal colonization rate with GBS. The low maternal colonization rate could be related to still unidentified epidemiological and environmental factors.
The effect of prolonged inhalation of crocidolite asbestos on the physical interactions between alveolar macrophages and the T-lymphocyte population was investigated. When macrophages from dusted rats (dusted macrophages) were cultured with lymphocytes, a prolonged physical interaction occurred followed by lymphocyte proliferation. It was demonstrated that dusted macrophages could bind lymphocytes nonspecifically due to the presence of aldehyde-like groups on the membrane. Dusted macrophages could also, as a consequence of antigen-like molecules appearing in the membrane, give rise to specifically sensitized lymphocytes.
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