Spontaneous lun lobe torsion in a mixed-breed dog followed by an apendicular bone nooplasm

Se describe el caso de un canino mestizo hembra de ocho años de edad que presentó historia de diez días de letargia, anorexia, pérdida de peso, vómito ocasional, tos esporádica y dificultad respiratoria; los hallazgos clínicos, radiográficos y ultrasonográficos sugirieron como diagnóstico diferencial más probable torsión lobar pulmonar del lóbulo medio derecho, lo cual se confirmó mediante toracotomía exploratoria. El manejo terapéutico incluyó resección del lóbulo afectado; no se identificó ninguna etiología subyacente. La paciente tuvo una recuperación completa de la torsión lobar; sin embargo, dos semanas después de la cirugía presentó claudicación severa del miembro anterior derecho y se encontraron hallazgos radiográficos compatibles con neoplasia ósea en la epífisis proximal del húmero. Por decisión de los propietarios sólo se realizó manejo analgésico y un mes después se practicó eutanasia debido a una posible metástasis pulmonar. Es posible que la neoplasia y posible metástasis se tratasen de eventos concomitantes sin relación causa-efecto; sin embargo, pudo haber existido una asociación entre un proceso estresante y traumático (la torsión pulmonar) con el desarrollo y manifestación de una patología oncológica subyacente.

In this report, the case of a mixed-breed, female intact, eight-year- old dog, that was presented with a ten-day history of lethargy, anorexia, weight loss, occasional vomiting, coughing and sporadic dispnea is described; the clinical, radiographic and ultrasonographic findings suggested as the most likely diagnosis a lung lobe (right middle) torsion, which was confirmed by means of an exploratory thoracotomy; the therapy included resection of the affected lobe; no underlying etiology was identified. The patient recovered fully from the lobar torsion; however, two weeks after surgery the dog showed severe right forelimb lameness and the radiographic findings suggested a bone tumor in the proximal epiphysis of the humerus; the owners allowed only analgesic therapy and one month later the patient was euthanized due to a possible lung metastases; it is possible that the neoplasm and the metastases were concomitant events without a cause-effect relationship; however, there might also have been an association between a traumatic and stressing process (the lung torsion) with the development of an underlying oncologic process.

Lesiones ulceraiivas cutáneas en tortugas dulceacuícolas / Cutaneos ulcerattive lesions in freshwater urrtles

Las úlceras cutáneas en tortugas dulceacuícolas se han atribuido a la enfermedad ulcerativa cutánea septicémica (SCUD) descrita por Kaplan en 1957, asociada con bacterias como Citrobacter freundii, Serratia spp. y Beneckea chitinovora. Esta enfermedad tiene un curso agudo con úlceras cutáneas, anorexia, letargia, septicemia y muerte. Ha sido reportada en Norte América y Europa. Algunos estudios sugieren la existencia de otra enfermedad ulcerativa del caparazón, no septicémica, que está diseminada por el mundo, se asocia con varias bacterias, principalmente gramnegativas, y afecta principalmente a las tortugas dulceacuícolas. La enfermedad ha sido reportada ocasionalmente en tortugas marinas y terrestres y se caracteriza por un curso crónico con erosión y descamación del caparazón. Sin embargo, no existe consenso acerca de si SCUD y la enfermedad ulcerativa del caparazón no septicémica son la misma enfermedad o se trata de dos patologías diferentes. En esta revisión de literatura se intenta encontrar diferencias entre las patologías relacionadas con infecciones microbianas del tegumento en quelonios.

Cutaneous ulcerations in freshwater turtles have been related to the Septicaemic Cutaneous Ulcerative Disease (SCUD), it has been described by Kaplan in 1957, associated with bacteria like Citrobacter freundii, Serratia spp.and Beneckea chitinovora. This disease has an acute course with cutaneous ulcerations, anorexia, lethargy, septicaemia and death. It has been reported in North America and Europe. Reports suggest that the ulcerative shell disease is disseminated over the world and it is associated with bacteria, mainly g-negative, and it affects mainly the freshwater turtles. The disease has been reported occasionally in land and marine turtles, and it is characterized by a chronic course with erosion and flaking of the shell. However, there is not a consensus about if the SCUD and the ulcerative shell disease are the same disease or they are two different pathologies. In this review, we are trying to differentiate the pathologies related with microbial infections of the tegument in chelonians.

Hipoadrenocortiiismo primario canino: reporte de caso / Canine priary hyypoadrenocorticism: case report

Un canino macho Cocker Spaniel de 6 meses de edad fue presentado a la Clínica para Pequeños Animales de la Universidad Nacional de Colombia, con historia de vómito y diarrea de una semana de duración. El paciente presentaba hiperkalemia, y los electrocardiogramas realizados fueron compatibles con este hallazgo. El diagnóstico de hipoadrenocorticismo primario fue confirmado mediante la realización de una prueba de estimulación con ACTH. Posteriormente a la muerte súbita del paciente, el examen microscópico de las glándulas adrenales reveló cambios histológicos compatibles con la enfermedad de Addison. El hipoadrenocorticismo primario es un desorden endocrino poco común que afecta principalmente pacientes caninos; está caracterizado por la destrucción inmunomediada de las cortezas adrenales, lo cual conduce a deficiencia de glucocorticoides, mineralocorticoides y hormonas sexuales adrenales. La historia de los pacientes afectados es variable y los signos clínicos son usualmente inespecíficos; las pruebas de laboratorio, por lo general, revelan hiperkalemia e hiponatremia, resultantes de la pérdida de la secreción de aldosterona. La historia, el examen clínico, la ecografía abdominal y los hallazgos de laboratorio pueden indicar enfermedad de Addison, sin embargo, la prueba de estimulación con hormona adrenocorticotrópica (ACTH) es considerada como la prueba de oro para el diagnóstico definitivo de la entidad. La enfermedad de Addison no tiene cura, pero puede ser manejada con terapia médica para reemplazar las deficiencias de mineralocorticoides y glucocorticoides.

Six month old, male Cocker Spaniel was presented to the Small Animal Clinic at the Universidad Nacional de Colombia with a one week history of vomiting and diarrhea. The patient was hyperkalemic and the electrocardiogram results were consistent with this finding. The diagnosis of primary hypoadrenocorticism was confirmed by performing an ACTH stimulation test. Following the patient’s sudden death, micros copic examination of the adrenal glands revealed histologic changes consistent with Addison`s disease. Primary hypoadrenocorticism is an uncommon endocrine disorder that primarily affects canine patients. The disorder is caracterized by the immune-mediated destruction of the adrenal cortices, resulting in mineralocorticoid, glucocorticoid and adrenal sex hormone deficiencies. Patient history is variable and clinical signs are often nonspecific; laboratory testing commonly reveals hyperkalemia and hyponatremia resulting from lack of aldosterone secretion. Clinical history, physical exam, abdominal ultrasound and laboratory findings may indicate Addison disease, however, the adrenocorticotrophic hormone (ACTH) stimulation test is considered to be the gold standard for definitive diagnosis of primary hypoadrenocortisism. Addison disease is not curable but can be managed with pharmaceutical therapy that replaces the mineralocorticoids and glucocorticoids deficiency.

Cervical dimensions and risk of preterm birth: a prospective cohort study.

OBJECTIVE: To examine the relation between cervical dilatation and length and the risk of spontaneous preterm birth, including its subtypes preterm labor and preterm premature rupture of membranes (PROM). METHODS: Cervical dimensions assessed by clinical examination were recorded prospectively at 24-29 weeks' gestation in 871 subjects with singleton pregnancies who were followed to delivery. Relative risks (RRs) of preterm birth, preterm labor, and preterm PROM were calculated for clinically distinguishable categories of cervical dilatation and length and for cervical score (length minus dilatation). Regression analysis was used to adjust for confounding. Time to delivery from baseline examination was summarized using survival analysis. RESULTS: There were 73 spontaneous preterm births (8.3%), 46 preterm labors and 27 cases of preterm PROM. All cervical measurements were associated with increased risks of preterm birth, with increasing abnormality more strongly predictive of risk. The adjusted RR for preterm birth with dilatation of at least 0.5 cm was 2.9 (95% confidence interval [CI] 1.2, 7.3); for length of 1.5 cm or less, the RR was 2.1 (95% CI 1.0, 4.5), and for cervical score less than 2.0, the RR was 2.8 (95% CI 1.4, 5.6). The association with cervical measurements was stronger for preterm PROM than for preterm labor, although precision was limited. These measurements had high specificity (93-99%) and low sensitivity (8-20%) for predicting preterm birth. CONCLUSION: In asymptomatic women at 24-29 weeks' gestation, greater cervical dilatation and shorter length were associated with increased risk of spontaneous preterm delivery, particularly preterm PROM.

Bacterial vaginosis associated with HIV infection in pregnant women from North Carolina.

BACKGROUND: We investigated whether bacterial vaginosis is associated with HIV infection in pregnant women in North Carolina, U.S.A. METHODS: At 24 to 29 weeks' gestation, we recruited 724 women receiving prenatal care to provide interview information and vaginal swabs for Gram's stain scoring of vaginal flora. FINDINGS: As vaginal flora score increased, prevalence of HIV increased (trend p = .03). HIV prevalence was 0.8% (4 of 489 patients), 1.2% (1 of 84 patients), and 3.3% (5 of 151 patients) among women with normal, intermediate, and abnormal vaginal flora, respectively. All HIV-infected women were free from AIDS and were taking antiretroviral medication. Compared with women with normal vaginal flora, the relative risk for prevalence of HIV infection with intermediate flora was 1.5 (95% confidence interval [CI], 0.2, 12.9) and with abnormal flora was 4.0 (95% CI, 1.1, 14.9). The association between abnormal vaginal flora and HIV infection could not be explained by age, ethnicity, number of sexual partners in the past 6 months, sexually transmitted diseases (STDs), or douching during pregnancy. INTERPRETATION: In a population with a relatively low HIV prevalence, vaginal flora abnormalities were associated with prevalent HIV infection. We cannot determine whether vaginal flora abnormalities increase women's susceptibility to HIV infection or become more common after infection. The increased prevalence of bacterial vaginosis among HIV-infected pregnant women increases risk for preterm delivery. Incidence studies are required to discern whether control of bacterial vaginosis might reduce HIV infectivity.

Repeated ethanol withdrawal experience selectively alters sensitivity to different chemoconvulsant drugs in mice.

Repeated ethanol withdrawal experience has been shown to result in exacerbated seizures associated with future withdrawal episodes. This sensitization of the withdrawal response has been postulated to represent a "kindling" phenomenon. The present study employed an established model of repeated ethanol withdrawals to examine the potential role of GABA(A), and NMDA and non-NMDA glutamate receptor systems in mediating enhanced seizure activity, as assessed by sensitivity to seizures induced by pentylenetetrazol (PTZ), NMDA, and kainic acid (KA) i.v. infusions, respectively. Adult C3H mice were chronically exposed to ethanol vapor in inhalation chambers. A multiple withdrawal (MW) group received four cycles of 16-h ethanol vapor exposure interrupted by 8-h periods of abstinence; a single withdrawal (SW) group was tested after a single 16-h bout of ethanol intoxication; and the third group was ethanol-naive, serving as controls (C). Results indicated that the MW group evidenced significantly lower PTZ and NMDA seizure thresholds compared to SW and C groups at 8 and 24 h post-withdrawal. In contrast, MW and SW groups exhibited reduced sensitivity (higher seizure threshold) to KA in comparison to controls, and this effect only emerged at 24 h post-withdrawal. Further, MW mice required significantly less additional PTZ or NMDA to induce more severe convulsions once initial signs of seizures were elicited. Conversely, latency and amount of KA required to transition from initial seizure signs to more severe end-stage convulsions was significantly greater for MW and SW groups compared to controls. Taken together, these results suggest that repeated ethanol withdrawal experience does not result in a global non-specific lowering of threshold to convulsive stimuli, but rather, selective changes in CNS mechanisms associated with neural excitability may underlie potentiated withdrawal responses. Thus, reduced GABA(A) receptor function and increased NMDA receptor activity may become exaggerated as a consequence of repeated withdrawal experience, while reduced sensitivity to KA induced seizures may represent a compensatory response to withdrawal-related CNS hyperexcitability.

Effects of prenatal and early postnatal ethanol exposure on [3H]MK-801 binding in rat cortex and hippocampus.

The effects of prenatal and/or early postnatal exposure to ethanol at high concentrations on N-methyl-D-aspartate (NMDA) receptor number and functioning in the weanling rat were examined. The binge-like exposure protocol was used in an animal model of acute ethanol effects at two critical periods of development. [3H]MK-801 binding parameters for the internal channel phencyclidine site were assessed in the presence of 10 microM glutamate and 10 microM glycine activation. Four treatment groups were included: (1) animals exposed to ethanol both prenatal and postnatal; (2) animals exposed only prenatal; (3) animals exposed early postnatal only; and (4) control animals with no exposure to ethanol. The results of the [3H]MK-801 binding experiments showed that both prenatal and postnatal exposure to ethanol resulted in a significant decrease in the density of NMDA receptors. In addition, data indicated an apparent increase in the percentage of high-affinity state (open channel state) relative to low-affinity state (close channel state) receptors in the ethanol-treated groups. These results show that both prenatal and postnatal ethanol exposure decrease NMDA receptor density in the cortex and hippocampus. The findings are consistent with previous observations by our laboratory and others that NMDA-mediated calcium influx is reduced in these regions, as well as in whole brain by prenatal ethanol exposure. It is suggested that after ethanol exposure, the remaining functional NMDA receptors might have altered sensitivity to coagonist activation with an increased probability of channel opening.

Repeated ethanol withdrawal experience increases the severity and duration of subsequent withdrawal seizures in mice.

Repeated ethanol withdrawal experience has been shown to result in an exacerbation of future withdrawal episodes. This sensitization of the withdrawal response has been hypothesized to represent a "kindling" phenomenon. The present study was designed to examine whether a systematic increase in the number of previous ethanol withdrawal experiences increases both the severity and duration of a subsequent withdrawal response. An established model of repeated ethanol intoxication/withdrawal was employed in which adult C3H mice were chronically exposed to ethanol vapor in inhalation chambers. In the first experiment, multiple withdrawal (MW) groups of mice received nine (MW x 9), six (MW x 6), or three (MW x 3) cycles of 16-h ethanol vapor separated by 8-h periods of abstinence prior to testing: a single withdrawal (SW) group was tested following a single bout of 16-h ethanol exposure; and a control (C) group did not receive any ethanol treatment throughout the experiment. In a second experiment, a group of mice (MW1-9) were repeatedly tested over nine cycles of withdrawal. A third experiment was designed to assess the effects of repeated pyrazole administration on the potentiated withdrawal seizure response. Results indicated a positive relationship between the number of previously experienced ethanol withdrawals and the severity and duration of a subsequent withdrawal episode. Blood ethanol levels were similar for all ethanol-exposed groups prior to withdrawal assessment. Further, the intensity of withdrawal seizures (handling-induced convulsions) progressively increased over nine cycles of intoxication/withdrawal and repeated testing did not significantly influence the development of this potentiated response. In addition, repeated administration of pyrazole did not appear to influence this withdrawal sensitization phenomenon. Collectively, these results provide further support for the "kindling" hypothesis of ethanol withdrawal.

Exacerbation of ethanol withdrawal seizures in mice with a history of multiple withdrawal experience.

Repeated ethanol withdrawal experience has been shown to result in an exacerbation of future withdrawal episodes. This sensitization of the withdrawal response has been hypothesized to represent a "kindling" phenomenon. We previously demonstrated that mice exposed to ethanol vapor for a total of 48 h exhibited more severe withdrawal seizures if the exposure was divided into three 16 h intoxication/8 h abstinence cycles than if the 48 h of exposure occurred in a single bout. The present study was designed to further characterize this model of ethanol withdrawal "kindling" and determine whether such a "kindled" response may be evident when withdrawal testing is conducted after an additional bout of intoxication that is the same for all groups. Adult C3H mice were chronically exposed to ethanol vapor in inhalation chambers for 40 h prior to withdrawal testing. Prior to this 40 h intoxication period, one group (Multiple Withdrawal; MW) received three cycles of 16 h ethanol vapor separated by 8 h abstinence; a second group (Single Withdrawal; SW) did not receive any ethanol exposure prior to the 40 h test cycle; a third group (Continuous Exposure; CE) received the same total ethanol exposure as the MW group (48 hr), but without interruption: and a control group (C) did not receive any ethanol treatment throughout the experiment. Blood ethanol levels following the 40 h bout of ethanol intoxication were 100-140 mg/dl for all ethanol-exposed groups. The severity of handling-induced convulsions during withdrawal was significantly greater in the MW group compared to CE and SW groups. These results suggest that differences in the severity of ethanol withdrawal seizures due to differences in prior withdrawal experience can be demonstrated even when later ethanol exposure patterns are equated. As such, the results provide further support for the "kindling" hypothesis of ethanol withdrawal.

Teratogenic actions of ethanol in the mouse: a minireview.

The deleterious effects of prenatal ethanol exposure have been extensively documented in clinical and experimental studies. This paper provides an overview of work conducted with mice to examine the myriad of adverse consequences that result from embryonic/fetal exposure to ethanol. All of the hallmark features of the clinical fetal alcohol syndrome have been demonstrated in mice, including prenatal and postnatal growth retardation, structural malformations and behavioral abnormalities associated with central nervous system dysfunction. As expected, the severity and profile of effects is related to both dosage level and timing of exposure. In addition, these effects have been demonstrated following acute and chronic exposure, with a variety of routes of administration employed. Furthermore, a number of strains have been used in these studies and the variant response (susceptibility) to the teratogenic actions of ethanol exhibited among different mouse strains support the notion that genetic factors govern, at least in part, vulnerability to these effects of ethanol. More recent studies using mouse models have focused on examining potential mechanisms underlying the full spectrum of ethanol's teratogenic actions.

Selective activity enhancement and persistence in weanling rats after hippocampal X-irradiation in infancy: possible relevance for ADHD.

We examined the effects of focal X-irradiation of the hippocampus in infancy on the partial reinforcement extinction effect (PREE) in weanling rats in a runway and on running wheel activity at 40 days of age. Our results show a dose-dependent X-irradiation-related reduction in granule cell neurogenesis. Weanling rats showed a corresponding increase in running speed in both acquisition and extinction and a dose-dependent reduction in the PREE--an increase in persistence after CRF and a decrease in persistence after PRF training. The same degree of hippocampal granule cell agenesis had no effect on running wheel activity. These results suggest that the enhanced speeds in the runway are incentive-related and do not reflect simple hyperactivity but rather hyperreactivity. The discussion of these results is in part a speculation regarding their possible relation to some explanations of attention deficit-hyperactivity disorder in children.

Postnatal high-peak blood ethanol concentration and external cue-based discrimination learning and reversal in the preweanling rat: comparison with memory-based discrimination learning.

Postnatal exposure to ethanol that produces high-peak blood ethanol concentrations (HP-BEC) in artificially reared infant rats affects hippocampal neuroanatomy and discrimination learning based on memorial cues from a patterned (single) alternation (PA) schedule in preweanling rats (P. L. Greene, J. L. Diaz-Granados, & A. Amsel, 1992). In the present experiments, discrimination by preweanling rats exposed to ethanol in the same way was tested with nonmemorial, external cues. In this external cue-based discrimination and in its reversal, ethanol-exposed rats were not different from normal or artificially reared controls whether the cues were presented in a PA or random manner, although there was some evidence that the memorial cues from the PA schedule contributed to learning a discrimination based on external cues, suggesting that the deficit reported earlier in ethanol-exposed rats is a memorial deficit and not a general discrimination deficit.

Mitigating effects of combined prenatal and postnatal exposure to ethanol on learned persistence in the weanling rat: a replication under high-peak conditions.

Replicating an earlier report under low-peak blood ethanol concentration (BEC) conditions, weanling rats, exposed in utero or postnatally to levels of ethanol that resulted in high-peak BECs, showed an attenuated partial reinforcement extinction effect, whereas pups exposed both pre- and postnatally did not differ from controls. Also supporting earlier work, postnatal exposure resulted in significantly reduced brain weight and had effects on hippocampal measures. These results from the combined-exposure group, along with earlier work, point to a possible mitigating influence in the rat of prenatal exposure to ethanol on the behavioral effects of postnatal exposure. They suggest that a protective factor may be operating, akin to the proactive immunoreactive effects of heat shock proteins shown in recent work at the cellular and hippocampal levels.

Memory-based learning in preweanling and adult rats after infantile x-irradiation-induced hippocampal granule cell hypoplasia.

Infantile exposure to x-irradiation induced severe hippocampal granule cell hypoplasia in preweanling and young adult rats. Hippocampally damaged pups, tested at 16 days of age, showed deficits in a memory-based discrimination based on single alternations of reward and nonreward when training was conducted at a 60-s intertrial interval (ITI) but not when conducted at a 30-s ITI. This deficit was still present at the 60-s ITI in animals x-irradiated in infancy and tested at 60-65 days of age. These data provide further support for the role of the hippocampus in intermediate-term memory and demonstrate, in a developmental context, the importance of an intact hippocampus in learning that depends on nonspatial memory.

Outcome of pregnancy during imprisonment.

The scant available information on pregnancies in women in prison suggests that the outcome is poor. We studied a cohort of 69 incarcerated pregnant women cared for over a one-year period. They were compared with 69 controls who were matched for age, parity, race and date on which they entered prenatal care. Thirty-six percent of the prisoners acknowledged using illicit drugs, primarily cocaine, during their pregnancies as compared to 3% of the controls. Sixty-eight percent of the incarcerated women smoked cigarettes as compared with 20% of the controls. In spite of those facts, there was a tendency toward better pregnancy outcomes among the prisoners. They were less likely to deliver prematurely (10% vs. 22%) and significantly less likely to experience premature rupture of the membranes (2.8% vs. 2.6%, P less than .001).

Blood ethanol concentration from early postnatal exposure: effects on memory-based learning and hippocampal neuroanatomy in infant and adult rats.

Early postnatal exposure to ethanol (EtOH) that results in daily high-peak blood ethanol concentration (BEC) retarded the acquisition of single-patterned alteration (PA), a kind of memory-based discrimination learning, and was related to reduced brain weight, hippocampal cell number, and CA1 area in infant rats. These behavioral and neuroanatomical effects survived into young adulthood. On the PA discrimination, in both pups and young adults, postnatal exposure to high-peak EtOH condition, in relation to low-peak and control conditions, impaired the acquisition of PA at 60-s but not at 30-s intertrial intervals. These results provide further evidence of hippocampal involvement in intermediate-term memory and indicate that early postnatal EtOH is a behavioral and neuroanatomical teratogen, particularly when the BEC is relatively high.

Effects of prenatal ethanol exposure on learned persistence and hippocampal neuroanatomy in infant, weanling and adult rats.

The present experiment examined whether deficits in learned persistence, previously seen in 15-day-old infant rats prenatally exposed to ethanol, would be present in weanling and adult animals. Three prenatal treatments, EtOH, PAIR-FED, and LAB CHOW, were combined factorially with partial (PRF) or continuous (CRF) reinforcement training followed by extinction, at 21 days or 6 months of age. The results at 21 days were virtually the same as our earlier findings for 15-day-olds: we did not find the higher level of persistence in PRF-trained EtOH pups relative to CRF-trained EtOH pups, which characterizes the partial reinforcement extinction effect (PREE). The EtOH-PRF and EtOH-CRF animals extinguished at about the same rate, both faster than PRF controls. However, when tested as adults, the EtOH-exposed animals showed a normal PREE, with no deficits relative to controls. An analysis of CA1 pyramidal cells in midtemporal hippocampus demonstrated no significant differences in cell density or in CA1 area among the 3 prenatal diet conditions; however, there was a significant reduction in cell density with age for all groups. These results suggest that a developmental delay, unrelated to these neuroanatomical measures, is responsible for the lack of persistence in young rats exposed prenatally to ethanol.

Preparation for cesarean delivery: a multicomponent analysis of treatment outcome.

We evaluated the effects of sensory information about cesarean delivery on prenatal maternal anxiety and on recovery subsequent to delivery by cesarean section. The 42 participants were recruited from a population of obstetric patients. Patients were assigned to either treatment or control groups and identified as sensitizers or repressors. Treatment groups viewed a slide/tape program presenting procedures involved in cesarean delivery. Control groups viewed a program presenting neutral information. Prepared patients classified as sensitizers showed less physiologic arousal during surgery and enhanced postsurgical recovery. Physiologic and self-report measures of anxiety indicated that the intervention itself was not a stressful event. The relations among arousal, subjective anxiety, coping styles, and treatment outcome are discussed and recommendations are made for further investigation.

Increased amniotic acetylcholinesterase activity with a fetus papyraceus and aplasia cutis congenita.

A case of an infant with aplasia cutis congenita, a fetus papyraceus, abnormal maternal serum alpha-fetoprotein (MSAFP), elevated amniotic alpha-fetoprotein, and positive amniotic acetylcholinesterase activity represents an uncommon abnormality. Such a case came to our attention as a result of MSAFP screening. The delivery of a neurologically intact infant in the presence of amniotic acetylcholinesterase activity is described.

Survey of the management of postterm pregnancy.

A survey of the management of postterm pregnancy was conducted among the 80 institutions with approved maternal-fetal medicine programs. Seventy-two (90%) completed questionnaires were received. After 42 weeks' gestation, when the cervix is unfavorable for induction, the nonstress test is the most commonly used test to assess fetal well-being (84.7%). In 50% of the institutions, pregnancy is terminated at some point beyond the 42nd week, in spite of an unripe cervix and lack of evidence of fetal compromise. In the other half, intervention does not take place under such conditions. The need for more consistent guidelines for the management of postterm pregnancy is emphasized.