Pentoxifylline does not delay bacterially induced preterm delivery in rabbits.

OBJECTIVE: Our purpose was to determine whether pentoxifylline, a potent cytokine inhibitor, would delay bacterially induced preterm delivery in rabbits. STUDY DESIGN: The study was a randomized, blinded, prospective trial. Twenty-seven rabbits underwent laparotomy. Of these, five (shams) received an intrauterine injection of endotoxin-free water, and the remaining 22 received an injection of 10(5) Escherichia coli into the lower uterine segment. Postoperatively the animals that received the Escherichia coli were divided into two groups. The placebo group (n = 11) received subcutaneous injections of saline solution three times a day and the treatment group (n = 11) received pentoxifylline 20 mg/kg/day in three divided doses. The following parameters were evaluated: (1) time until delivery, (2) time until death, and (3) intrauterine pathologic features. RESULTS: All five of the sham rabbits were delivered at term without any evidence of infection. There were no differences in the preterm delivery rates between the placebo group (eight of 11) and the pentoxifylline-treated group (seven to 11). However, there was a trend toward prolonging time until death in the treatment group. There were no differences in intrauterine pathologic feature between the placebo and treatment groups. CONCLUSION: Pentoxifylline does not delay Escherichia coli induced preterm delivery in rabbits.

Aneurysm of the right ventricular outflow tract: a complication of aorta-main pulmonary (central) shunt.

The ascending aorta-main pulmonary artery (central) polytetrafluoroethylene (PTFE) Gore-Tex shunt was introduced in 1975 by Gazzaniga and coworker. It is a widely used palliative procedure. We present a case study with an unusual late complication. An aneurysm was discovered at autopsy in a patient who was diagnosed at birth with hypoplastic right ventricle, pulmonary valve atresia, small main and branched pulmonary arteries. At 4 days of age, the patient underwent an aorta to main pulmonary artery (PTFE) Gore-Tex shunt. Subsequent echocardiogram showed dilatation of the right ventricular outflow tract. To our knowledge, this is the first reported case of right ventricular outflow tract (RVOT) aneurysm following central aortopulmonary shunt.

Cluster of iniencephaly in Miami.

This report details a cluster of 5 cases of iniencephaly with anencephaly and rachischisis occurring over a 4-month period at Jackson Memorial Hospital/University of Miami Medical Center in Miami, Florida. All 5 cases of this rare, lethal, congenital malformation seen in the cluster included diaphragmatic defects with accompanying hernia, omphalocele, small adrenals, renal dysmaturity, gastrointestinal malformations, cleft lip and palate, and hypoplastic lungs. No single causative agent for this cluster was identified. A brief review of the literature regarding categorization of these malformations and as a discussion of the embryological basis for these lesions and possible etiologic factors are included.

Congenital syphilis: the University of Miami/Jackson Memorial Medical Center experience, 1986-1988.

Between January 1, 1986 and July 1, 1988, 56 cases of congenital syphilis were identified at the University of Miami/Jackson Memorial Medical Center. The overall rate was 18.4 cases per 10,000 births, with a threefold increase found from 1986 to 1988. A case-control study using matched pairs was done to identify differences in maternal demographics and pregnancy outcome. Congenital syphilis case mothers were predominantly black American women who lacked prenatal care (67%) and who were substance abusers (71%) significantly more often than their matched controls (P less than .005). Three cases of seroconversion in pregnancy were identified. Failure to screen or inappropriate treatment occurred in four patients. Seven women were treated during pregnancy: Five received benzathine penicillin G for 3 consecutive weeks and two received erythromycin. All treated patients presented for initial care in the late second or third trimester. Thirty-seven infants (66%) were live-born and 19 (34%) were stillborn. Preterm labor and premature rupture of the membranes were significantly more common in infected pregnancies than in controls (P less than .005). Live-born case infants had significantly lower birth weights than controls (P less than .005), with 21% of case infants growth-retarded. Seven neonatal deaths and one infant death occurred. The resultant perinatal mortality rate from congenital syphilis in this series was 464 pe 1000.

Histopathologic features of the liver in pediatric acquired immune deficiency syndrome.

Autopsy and liver biopsy specimens from 30 pediatric patients with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) were retrospectively reviewed. Of 28 cases with histologic abnormalities, the following findings were noted singly or in combination: giant-cell transformation, cytomegalovirus inclusions, Kaposi's sarcoma, diffuse lymphoplasmocytic infiltrate, granulomatous hepatitis, mild portal inflammation, necrosis around central veins, steatosis, and cholestasis. For the most part, abnormalities in the liver were not predictive of those in other organs, but the two children with the diffuse parenchymal lymphoplasmocytic infiltrate also had lymphoid interstitial pneumonitis (LIP). Liver histopathology in pediatric patients with AIDS shares some features with that in adults, but appreciable differences are noted. In particular, these differences include the higher frequency of giant-cell transformation and the lower frequency of granulomas in children and the observation of diffuse lymphoplasmocytic infiltrate associated with LIP.

Congenital syphilis and necrotizing funisitis.

During the past 5 years we encountered 16 cases of necrotizing funisitis, a deeply seated inflammatory process within the matrix of the umbilical cord, and established that all of them were associated with maternal and congenital syphilis. During that time necrotizing funisitis was not found to be associated with any other infection. The relationship was unexpected on the basis of current knowledge of the condition, but we found the older medical literature documents syphilis as the virtually specific cause of deep funisitis with angiophlebitis. Necrotizing funisitis has a characteristic macroscopic appearance, the "barberpole" cord, that permits the presumptive diagnosis of congenital syphilis at the time of birth.

Morphologic alterations in rat brain following systemic and intraventricular methotrexate injection: light and electron microscopic studies.

To determine the morphological substrate of acute methotrexate (MTX) encephalopathy, light and electron microscopic studies were performed on rat brains after short-term intraperitoneal (IP) and intraventricular (IV) injections of MTX. In both models, Alzheimer type II astrocytosis was the initial and major pathologic alteration seen by light microscopy. The neurons, oligodendrocytes, myelin and endothelial cells were relatively spared. Ultrastructural studies showed pleomorphism and condensation of mitochondria, membrane-bound vacuoles, prominent stacks of sparsely granular, rough endoplasmic reticulum and progressive hydropic swelling of astrocytic perikarya and their processes. The astroglial alterations were reversible after cessation of the drug but persisted for a longer time with repeated IP administration. Gastrointestinal complications and overall mortality were also greater with higher doses and increasing frequency of IP MTX injection. White matter necrosis was noted only after IV injection of high-dose MTX. The neuropathologic changes of MTX leukoencephalopathy can be replicated in an animal model by IV injection of the drug. The reversibility of the changes that were seen following IP administration correlates with the transient neurologic deficits observed in some patients after high-dose systemic MTX therapy. The initially selective astroglial effect suggests that astrocytes might be a target for MTX toxicity, although other central nervous system components may also be adversely affected by the drug.

Neonatal hemochromatosis: failure of deferoxamine therapy.

We describe a premature neonate with severe hepatic dysfunction from birth which progressed to fatal hepatic failure at 3 months of age. The diagnosis of a familial disorder, neonatal hemochromatosis, was made, and therapy was attempted with deferoxamine. Features of iron metabolism are presented, and this infant's illness is contrasted with other liver diseases of infancy associated with hepatic iron overload.

Extended survival of MHC-compatible islet grafts from diabetes-resistant donors in spontaneously diabetic BB/W rat.

Transplantation of a large inoculum of incubated islets of MHC-compatible donors led to an extended survival of the grafts to an average of greater than 86 days in 71% of male diabetic BB/W recipients. Identical results were obtained whether the immunologically privileged abdominal testis or the nonimmunologically favored renal subcapsular space was used as the organ site for the injection of the islets. Survival of the islet grafts was also independent of the duration of diabetes in the BB/W rats at the time of transplantation. These results showed that under our experimental conditions the grafted islets were able to become established and survive for extended periods in nonimmunosuppressed spontaneously diabetic BB/W hosts.

Listeriosis as a cause of maternal death: an obstetric complication of the acquired immunodeficiency syndrome (AIDS).

A case of maternal death due to Listeria monocytogenes bacteremia, with survival of the prematurely delivered infant, is presented. Lymphopenia and a Haitian origin suggest that the fatal outcome was related to the acquired immunodeficiency syndrome (AIDS). To our knowledge, this is the first recorded instance of a maternal death due to listeriosis.

Pulsed Doppler echocardiographic findings in total anomalous pulmonary venous drainage to the coronary sinus.

The pulsed doppler echocardiographic (PDE) findings in a premature cyanotic infant with total anomalous pulmonary venous return to the coronary sinus are reported. Features that suggested the diagnosis of total anomalous pulmonary venous return were 1) an area of systolic-diastolic turbulent flow posterior to the apparent left atrial border, which was interpreted as representing the convergence of pulmonary venous return to a common pulmonary vein, and 2) systolic and diastolic turbulent flow within the right atrium suggesting pulmonary venous return through the coronary sinus. We suggest that PDE should be included as part of the evaluation of cyanotic infants in whom the diagnosis of total anomalous pulmonary venous return is considered.

Microangiopathic hemolytic anemia and thrombocytopenia in a neonate associated with a large placental chorioangioma.

The case of an infant born in association with a large chorioangioma of the placenta is presented. The maternal complications of polyhydramnios, preeclampsia, and premature labor are those described in the "syndrome" of a chorioangioma. The immediate neonatal course was unusually complicated by severe microangiopathic anemia with persistent thrombocytopenia and hemolysis which required three exchange blood transfusions. The relationship between the neonatal complications and the placental tumor is discussed in terms of possible pathophysiologic mechanisms.

Cebocephalus associated with trisomy 13-15 mosaicism.

A case of cebocephalus occurred in association with a 10% mosaicism of trisomy 13-15. Both parents of the affected child had normal karyotypes. Cebocephalus has been associated with abnormal chromosomes such as a deletion of the short arm of chromosome 18 as well as the trisomy 13-15.

The association of Wilms' tumor with second primary malignancies.

Medulloblastoma occurs uncommonly in the neonatal period. Metastatic Wilm's tumor in a newborn is extremely rare. The coincidence of these two neoplasms in one infant, and an equally uncommon combination of Wilms' tumor and a cerebellar medulloephithelioma in another child prompted this report. The authors speculate on the mechanism of oncogenesis in these and other infants with neonatal malignancies.

Metastatic neonatal Wilms' tumor: a case report with review of the literature.

An unusual case of congenital Wilms' tumor is discussed. Although the very existence of neonatal Wilms' has been challenged, this case represents a well documented example, rendered all the more unusual by concurrent metastatic disease and a second primary malignancy in the posterior fossa.