Meconium analysis for improved identification of infants exposed to cocaine in utero.

We screened anonymously all mothers and infants born during a 3 1/2-month period to determine the prevalence of intrapartum cocaine use, test the maternal characteristics that are specific predictors of intrauterine cocaine exposure (IUCE), and compare the sensitivity of infant urine versus meconium samples for identification of IUCE. Of 1237 live births during the study period, a sample was obtained from 1201 mother-infant pairs. The overall prevalence of documented intrapartum cocaine exposure was 66 (5.5%) of 1201 pairs. Previously developed drug screening guidelines had a sensitivity of 89% for detecting IUCE in infants. Direct comparisons of samples from the same mother-infant pair revealed that there were no cases in which cocaine was found in infant urine but not in meconium; however, infant urine testing missed 25% of the infants who had positive findings in meconium. We conclude that (1) meconium testing was more likely than urine testing to identify an infant with IUCE, detecting an additional 33%; (2) there was significant maternal cocaine use (5.5%) in a teaching hospital with a mixed patient population; (3) maternal characteristics known to identify infants at risk of having IUCE were useful in our population; and (4) IUCE of neonates admitted to the neonatal intensive care unit was more common than that of infants admitted to the regular newborn nursery.

Psychological response to disaster: implications for Hawaii.

Given the frequency of natural disasters in Hawaii, it is important for practitioners to be aware of the numerous resulting psychological responses and risk factors, especially those unique to Hawaii. Practical guidelines are presented for practitioners, both in providing leadership during the disaster and in screening for psychopathology thereafter.

Prenatal sonographic assessment of early, rapidly growing fetal cervical teratoma.

Although malignant transformation of fetal cervical teratoma is extremely rare, perinatal morbidity is high and usually related to the size of the tumour, which may compromise fetal swallowing and subsequently lead to upper airway obstruction. We present a case in which mid-trimester serial sonography demonstrated markedly rapid early growth of a lesion of this type between 17 and 19 weeks' gestation indicating the aggressive nature of this tumour, assisting parental decision to terminate the pregnancy. Histopathology confirmed grade 3 immaturity of the lesion.

Fetal allograft survival in immunocompetent recipients is age dependent and organ specific.

This study explores whether fetal allograft survival is age dependent and organ specific. Fetal rat tissue (renal, gonadal, hepatic) from the third trimester of gestation (days 15-21) was transplanted into 306 outbred adult rats for 10-30 days. Grafts were studied by morphometric and histologic analysis. Ten days after implantation, renal tissue (N = 75) from late gestation (days 19-21) showed no increase in size. In contrast, 17-day fetal grafts (N = 20) grew 6.8 +/- 3.4 times,* while 15-day fetal grafts (N = 28) grew 17.5 +/- 6.1* times. (The symbol "*" indicates p less than 0.05, compared to original size). Twenty days after implantation, these 15-day fetal grafts (N = 20) grew 48.8 +/- 17.7* times. Ten days after grafting, the younger fetal tissue showed excellent maturation of renal elements and no sign of rejection; older fetal grafts had poor renal architecture and a dense lymphocytic infiltrate. The 15-day fetal gonadal tissue (N = 18) showed a moderate 10.6 +/- 3.2* increase in size while the 15-day hepatic grafts (N = 16) were regularly rejected within 10 days. Selected fetal allografts from early in the third trimester can not only survive but can grow and mature in an immunocompetent recipient. This fetal graft growth appears to be both age dependent and organ specific. The use of fetal organs may broaden the potential pool for transplantation. However, further studies are needed to define the ontogeny of graft acceptance.

Can fetal and newborn allografts survive in an immunocompetent host?

This study explores methods of prolonging allograft survival by varying the ontogeny of the donor tissue (fetal, newborn, and adult), and the recipient (newborn and adult) in a series of outbred Sprague-Dawley rats. Allografts of renal or adrenal tissue (1 mm2) were implanted under the renal capsule of the recipient animal. Six experimental groups were constructed with the adult as the recipient in the first three, and four-to six-day-old newborn rat pups in the last three groups. A total of 212 animals were grafted and the animals were killed between 7 and 83 days later, and we carried out morphometric and histologic analyses of all grafts. In Group I (adult donor----adult host), all 17 grafts implanted for ten days or longer were completely rejected. In Group II, newborn tissue was implanted into 23 adults. By nine days after implantation, 17 grafts were fully rejected and the average graft had decreased in size by 68% +/- 78.7% (P less than .05 compared with their initial size). In contrast, when fetal renal or adrenal grafts were implanted into 93 adults (Group III) we saw a 17.6 +/- 9.7 fold increase in graft size when recipients were killed at least 7 days after implantation (P less than .05 compared with their initial size). When we used the newborn as a recipient, we found that all 20 adult grafts (Group IV) were rejected within 10 days. When newborn tissue was implanted into 15 newborns (Group V) all 15 animals rejected their grafts within ten days.(ABSTRACT TRUNCATED AT 250 WORDS)