Spastic diplegia as a complication of interferon Alfa-2a treatment of hemangiomas of infancy.

We report the development of spastic diplegia in infants during the course of interferon Alfa-2a (IFN) therapy for potentially life-endangering hemangiomas. Five infants who displayed diplegia were selected from a group of 26 infants treated with IFN. Diplegia persisted in three infants, and in the remaining two significant recovery occurred after IFN was discontinued. Magnetic resonance imaging showed no significant brain or spinal abnormalities except minor to moderate delayed myelination in two patients. Myelination was normal on subsequent radiographic examination in all five patients. We conclude that IFN can adversely affect the immature central nervous system and produce spastic diplegia, which is potentially reversible. We recommend careful clinical assessment of neurodevelopmental status during IFN therapy.

Asphyxia.

The prevention of fetal asphyxia or hypoxia starts with prepregnancy counseling and continues with careful antenatal care and intrapartum fetal surveillance. Further progress in eliminating antepartum and intrapartum deaths will only be made when it is accepted that, even with intense investigation by detailed autopsy, the cause of many deaths remains unknown. Many of these deaths may be ascribed to hypoxia. In the future, with more detailed non-invasive probing with CAT scanning and magnetic resonance imaging, other causes may be determined. The mother at risk of hypoxia requires specialized attention. Such mothers will include those with severe cardiac, pulmonary or circulatory problems. Others will be those with endocrine problems, such as diabetes or thyroid dysfunction. At present, failure of fetal growth is generally ascribed to hypoxia, but undoubtedly, in solution to such problems of possible hypoxia is elective delivery at the appropriate time. What Hensleig said in 1986 (Hensleig et al, 1986) is equally true today: 'Preventative programmes will remain unsuccessful until the causation of cerebral palsy is more understood. What we are presently lacking is an understanding of the underlying conditions responsible for brain injury when asphyxia occurs despite our best efforts. While we have learned much about the causation and prevention of perinatal mortality very little has been established about the causation and prevention of cerebral palsy'. Finally, Hall (1989), in a review of birth asphyxia and cerebral palsy, concludes the following five points. 1. The incidence of cerebral palsy is not falling despite improved obstetrics. 2. The cause of more than 90% of cases of cerebral palsy remains unknown. 3. Asphyxia is hard to define and measure and is rarely the cause of cerebral palsy. 4. Hypoxic ischaemic encephalopathy is the most reliable indicator of asphyxia. 5. Neither traditional clinical signs nor electronic monitoring allow reliable recognition of asphyxia.

Determinants of serum 1,25-dihydroxyvitamin D concentration in healthy premenopausal subjects.

Concentrations of serum phosphate and parathyroid hormone (PTH) are well known regulators of the production of 1,25-dihydroxyvitamin D (1,25-(OH)2D) and acidosis is known to affect the serum concentration of 1,25-(OH)2D. However, the factors that play a role in the regulation of serum 1,25-(OH)2D concentration in healthy subjects have not been fully evaluated. The associations of ionised calcium, pH, serum concentration of phosphate, PTH, 25-hydroxyvitamin D (25-OHD) and serum 1,25-(OH)2D were examined in 296 healthy premenopausal women (age range 17-40 years). Calculation of partial correlation coefficients showed that serum 1,25-(OH)2D was significantly correlated with phosphate (r = -0.148, P < 0.01), pH (r = 0.221, P < 0.001) and PTH (r = 0.136. P < 0.01). Ionised calcium was not related to serum 1,25-(OH)2D. When the results were stratified according to quartiles based on serum 1,25-(OH)2D concentration, significant trends (by analysis of variance) were seen in phosphate, pH, age, albumin and 25-OHD. Stepwise multiple regression analysis showed that phosphate and pH were the major contributors of serum 1,25-(OH)2D levels. There was a small contribution from PTH and 25-OHD. The results suggest that in young healthy premenopausal women plasma phosphate and pH may be important determinants of serum 1,25-(OH)2D concentration.

Histopathological studies on experimental murine salivary gland tumours treated with adriamycin: evidence for an anti-myoepithelial cell action.

Mice bearing pleomorphic salivary tumours induced by polyoma virus underwent chemotherapy with Adriamycin. Animals were killed at 2 day intervals and the tumours examined histologically. Two days after a single dose of Adriamycin, gross vacuolation degeneration was seen around ductal cells at sites corresponding to myoepithelial cells. At subsequent time periods there was progressive degeneration of other tumour elements. It is proposed that myoepithelial cell death in salivary gland tumours induced by Adriamycin may be an important factor in the early response of this tumour to chemotherapy.