Can fetal echocardiogram and karyotyping be fairly offered for fetal umbilical cord abnormalities?

A prospective study to determine if fetal echocardiography and karyotyping by amniocentesis are strongly indicated in fetus with single umbilical artery [SUA]? During the period from March 2002-September 2006 all cases of fetal SUA, from Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia, in a routine obstetric population were studied. Targeted sonograms and perinatal follow up were obtained. Sixteen thousand women completed the study, 162 cases of SUA were diagnosed on the basis of prenatal sonograms, however 169 cases [53 non isolated SUA and 116 isolated SUA] confirmed postnatafly. The sensitivity, specificity, positive predictive value and negative predictive value of prenatal ultrasonographic diagnosis of SUA were 90.5%, 99.9%, 94.4% and 99.8% respectively. Aneuploidy and cardiac abnormalities were present in 8 out of the 53 [15%] and 17/53 [32%] In none isolated SUA respectively. fetuses with SUA should get further evaluation at centers that handle high-risk cases and parent should strongly counseled for fetal echocardiogram and fetal karyotyping In case of none isolated SUA

values of vaginal fetal fibronectin and transvaginal ultrasonographic measurement of cervical length for prediction of spontaneous preterm birth

A prospective observational study to examine the diagnostic performance of transvaginal ultrasonographic measurement of the cervical length and vaginal fetal fibronectin separately or in combination to determine the prediction of preterm delivery in asymptomatic high risk patients for preterm labor. This study was performed on 98 patients at high risk for preterm delivery. Patients were followed up prospectively from 24 weeks gestation. Subsequent visits were scheduled every 2 weeks apart up to 36 weeks then weekly after. Vaginal Fetal fibronectin was estimated and transvaginal ultrasonography for cervical length measurement was performed. The outcome measures were deliveries before 37 weeks' gestation. The preterm birth was 22.4% [22/98]. The predictive values of positive fetal fibronectin test and cervical length < 25mm, separately, were calculated. The negative predictive values of each were 91.5% and 86.7% respectively. While the positive predictive values were 43.5% and 43.3% respectively. Combination of both tests improves positive predictive value slightly, [52.1%]. The negative predictive value, when fetal fibronectin is negative and the cervical length is >25 mm, increases slightly as well [94.2%]. Vaginal fetal fibronectin test and cervical length measurement by transvaginal ultrasound between 24-37 weeks' gestation are approximately equivalent in prediction of preterm labor in patients at high risk for preterm labor. Combination of both tests could reduce the high rates of false-positives resulting from the poor specificity of the clinical indicators for preterm birth

value of determination of paraproteins in malignant lymphoma

Forty three patients in stage III and IV malignant lymphoma [17 H.D. and 26 N.H.L] were investigated in this study for presence of paraproteins in their sera and subsequently of clinical manifestations of paraproteinaemia. Twenty nine of them were males and 14 were females. Their ages ranged between 15 and 65 years. Twenty one [48.8%] presented with one or more of the clinical manifestations related to paraproteins in their sera: cold urticaria was detected in 12 occasions, purpura in 8, chilblains in 6. tingling and numbness in 4, Chronic leg ulcers in 4, acrocyanosis in 2, vasculitis and Raynaud's phenomenon each in one occasion. Qualitative and quantitative determination of the different types of paraproteins was performed. Cryoglobulin was found in the sera of 30 patients [69.7%]. paraglobulin was detected in 14 patients [32.5%]. Simple type of cryoglobulin [mostly of IgG] was present in 19 patients and mixed type [IgG and IgM] in 11 patients and both types were more frequent in females. Cold urticaria, purpura, chilbains and chronic leg ulcers were associated with simple cryoglobulins in most occasions, while patients complaining of tingling sensation and numbness, acrocyanosis and vasculitis had mostly mixed cryoglobulins. Pyroglobulin have no clinical significance, yet it was associated with high level of cryoglobulin. Hypoalbuminaemia was detected in 56% of cases. The main disturbance in globulin was elevation in total globulin, alpha-1 and gamma fractions. Hypergammaglobulinaemia was marked in H.D. [88.1%] than N.H.L. patients [34.6%]. Chemotherapy treatment showed decrease in cryoglobulin level in some cases, while there was an obvious increase in the albumin, normalisation of globulin and improvement in the general condition of patients