Acute polyhydramnios.

A case of acute polyhydramnios successfully managed via therapeutic amniocentesis is reported. A discussion and review of this rare entity is presented.

Cerebral blood flow velocity in term newborn infants: changes associated with ductal flow.

The effects of ductal closure on range-gated pulsed Doppler cerebral blood flow velocity (CBFV) patterns in the internal carotid, anterior cerebral, and middle cerebral arteries were studied in 10 normal term infants (mean birth weight 3302 +/- 294 g (SD) and mean gestational age 39.6 +/- 1.3 weeks). Pulsatility was calculated from flow velocities and used as an estimate of cerebral blood flow (CBF). Ductal closure was associated with a rise in mean blood pressure from 45.0 +/- 4.2 to 51.3 +/- 6.5 mm Hg (P less than 0.05) and a significant decrease in pulsatility in all three vessels (mean = 0.77 +/- 0.07 vs 0.70 +/- 0.05 (P less than 0.02]. Changes in pulsatility were correlated with changes in mean blood pressure (P less than 0.02), providing evidence that systemic blood pressure may influence postnatal cerebral arterial pulsatility indices. We also noted significant differences in the velocity and pulsatility of individual vessels that were independent of blood pressure, suggesting that Doppler flow studies may be useful in describing regional CBF patterns. The temporal association between ductal closure and decreased pulsatility suggests that CBFV patterns reflect ductal shunting in normal term newborn infants. Diastolic runoff and reduced systemic blood pressure in the presence of ductal shunting appear to reduce diastolic flow velocity and increase CBFV pulsatility in normal term infants during the first days of life. Normal mechanisms of cerebral autoregulation compensate for decreased flow with vasodilation; therefore the increased pulsatility associated with ductal shunting may be due to diastolic runoff rather than increased cerebrovascular resistance.

Defective in vitro gamma interferon production and elevated serum immunoreactive thymosin beta 4 levels in patients with inflammatory bowel disease.

Gamma interferon (IFN-gamma) production by peripheral blood mononuclear cells (PBM) was measured in 21 patients with Crohn's disease, in 15 patients with ulcerative colitis, in 12 patients with non-IBD gastrointestinal disease (disease control), and in 28 healthy controls. T-cell subset proportions and serum levels of thymosin alpha 1 and thymosin beta 4, two hormonelike thymic peptides, were also determined. No differences were seen in T-cell subset proportions in patients with Crohn's disease or ulcerative colitis when compared to healthy controls or to the disease-control group. In vitro IFN-gamma production was markedly decreased in Crohn's disease and in untreated, but not treated, patients with ulcerative colitis. Preincubation of PBM prior to the addition of inducer mitogen resulted in enhanced IFN-gamma production in patients with Crohn's disease or ulcerative colitis which significantly exceeded that seen either in healthy controls or in the disease-control group. Serum thymosin alpha 1 levels were comparable in all study groups; however, serum thymosin beta 4 concentrations were significantly higher in all patient groups than in the healthy controls. These results confirm a defective in vitro IFN-gamma production in patients with IBD which is apparently independent of endocrine thymus regulation.

Conservative management of placenta accreta. A case report.

Placenta accreta is a rare complication of pregnancy. Traditional therapy has centered upon total abdominal hysterectomy to prevent serious hemorrhagic and infectious sequelae. Conservative management, however, may preserve reproductive function without jeopardizing maternal welfare.

Indicators of perinatal asphyxia.

Creatinine phosphokinase and its isoenzymes (myocardial-specific MB and brain-specific BB) are elevated in the presence of specific tissue injury. The value of this serum marker as an objective indicator of perinatal asphyxia was studied. Forty-nine patients with gestational ages ranging from 36 to 42 weeks were prospectively studied. Patients who by interpretation of the fetal heart rate tracing alone were diagnosed as having fetal distress demonstrated significantly lower pH (p = 0.001) and base excess (p less than 0.0001) in umbilical venous blood. Umbilical venous cord MB (p less than 0.05) and BB (p less than 0.01) were increased in this group. Abnormal fetal heart rate patterns correlate well with acid-base abnormalities and elevated creatinine phosphokinase values. These tests may demonstrate more efficient and improved indicators of tissue injury and damage from perinatal asphyxia than clinical observation alone.

Hyperbaric oxygen therapy for the treatment of acute carbon monoxide poisoning in pregnancy. A case report.

Acute carbon monoxide poisoning occurred in pregnancy. An acute treatment plan involving hyperbaric oxygen administration was employed in place of the more traditional passive approaches usually used during pregnancy. This treatment plan may help circumvent the potentially lethal effect of this gas.

Magnesium sulfate and ritodrine hydrochloride: a randomized comparison.

The efficacy of magnesium sulfate was analyzed in relation to ritodrine hydrochloride. Patients presenting in preterm labor between 20 and 35 weeks' gestation were prospectively randomized. Tocolysis was achieved for more than 72 hours in 35 of 40 cases (88%) where magnesium sulfate was administered and 31 of 39 cases (79%) in which ritodrine hydrochloride was infused. Delay of greater than or equal to 7 days was achieved in 75% and 72% of cases, respectively. The mean dosage to achieve tocolysis was 4.5 gm/hr, in the magnesium sulfate group and 210.0 micrograms/hr in ritodrine hydrochloride-treated patients. The mean magnesium level to achieve tocolysis was 6.60 mg/dl. Side effects in the two groups were similar in number but less alarming in the magnesium sulfate group. Magnesium sulfate was found to be easy to administer and clinically efficacious. Its tocolytic action was found to be dose dependent and drug concentrations are easily determined. On the basis of this work and data from other investigators, magnesium sulfate should be used as the first line of tocolytic therapy with ritodrine hydrochloride as its pharmacologic backup.

Elephantiasis nostras 1984.

Elephantiasis nostras is a rare condition that usually presents as a persistent swelling of the lower extremity secondary to recurrent lymphangitis. We present a patient, originally referred for "angioneurotic edema of the lip," who presented with a history of several months of persistent swelling of the upper lip. There was probable evidence for recent infection of the lip that is consistent with the diagnosis of elephantiasis nostras. This disease should be included in the differential diagnosis of chronic persistent angioedema of the lip.