Observation of a narrow charm-strange meson D(+)(sJ)(2632)-->D(+)(s)eta and D(0)K(+).

We report the first observation of a charm-strange meson D(+)(sJ)(2632) at a mass of 2632.5+/-1.7 MeV/c(2) in data from SELEX, the charm hadro-production experiment E781 at Fermilab. This state is seen in two decay modes, D(+)(s)eta and D0K+. In the D(+)(s)eta decay mode we observe a peak with 101 events over a combinatoric background of 54.9 events at a mass of 2635.4+/-3.3 MeV/c(2). There is a corresponding peak of 21 events over a background of 6.9 at 2631.5+/-2.0 MeV/c(2) in the decay mode D0K+. The decay width of this state is <17 MeV/c(2) at 90% confidence level. The relative branching ratio Gamma(D0K+)/Gamma(D(+)(s)eta) is 0.14+/-0.06. The mechanism that keeps this state narrow is unclear. Its decay pattern is also unusual, being dominated by the D(+)(s)eta decay mode.

First observation of the doubly charmed baryon Xi(+)(cc).

We observe a signal for the doubly charmed baryon Xi(+)(cc) in the charged decay mode Xi(+)(cc)-->Lambda(+)(c)K-pi(+) in data from SELEX, the charm hadroproduction experiment at Fermilab. We observe an excess of 15.9 events over an expected background of 6.1+/-0.5 events, a statistical significance of 6.3sigma. The observed mass of this state is 3519+/-1 MeV/c(2). The Gaussian mass width of this state is 3 MeV/c(2), consistent with resolution; its lifetime is less than 33 fs at 90% confidence.

Precision measurements of the lambda(+)(c) and D0 lifetimes.

We report new precision measurements of the lifetimes of the Lambda(+)(c) and D0 from SELEX, the charm hadroproduction experiment at Fermilab. Based upon 1630 Lambda(+)(c) and 10 210 D0 decays we observe lifetimes of tau[Lambda(+)(c)] = 198.1+/-7.0+/-5.6 fs and tau[D0] = 407.9+/-6.0+/-4.3 fs.

Effect of exposure to lead on postural control in workers.

OBJECTIVES: To examine the effect of lead on postural control of workers who have been exposed to lead. METHODS: 63 Male, lead battery workers mean (SD) age 41.0 (7.4) were compared with 48 age matched male controls after excluding those with acute or chronic diseases. Exposed workers had mean (SD) past blood lead concentrations of 37.5 (9.2) micrograms/dl and 11.2 (5.7) years of employment. Postural control was measured with a computerised postural sway measurement system which measured both sway and total movements. RESULTS: Workers standing straight with eyes open on the bare plates had sway and total movements which were not notably different from controls. On the other hand increased movements were needed in the exposed workers to maintain stability (the general stability quotient 18.2 (5.4) v 15.4 (4.4) in controls, p < 0.01) when standing directly on the foot-plates with closed eyes,, and with the head tilted (15.0 (3.8) v 11.5 (3.0) in controls, p < 0.001). Exposed workers also had a trend for less ability to synchronize anterior posterior and lateral sway in the stress positions (0.0625) than had non-exposed workers. Significant but low correlations were found between the estimate of the chronic internal dose of lead and three of 10 of the postural control measurements, and present lead blood concentrations and only one of the 10 measurements and (r values ranged from 0.21 to 0.31, p < or = 0.03). CONCLUSIONS: These findings suggest that lead affects postural control in asymptomatic workers. Further studies are warranted to find whether workers with decreased postural control are at increased risk of accidents and the relation, if any, of these measurements with subsequent morbidity.

Seronegativity to varicella-zoster virus in a tertiary care obstetric population.

OBJECTIVE: To determine the seronegativity rate of varicella-zoster virus in a tertiary care obstetric population. METHODS: At their initial prenatal visit, all obstetric patients at Westchester County Medical Center have a varicella-zoster virus IgG antibody titer (Varicella Stat; Biowhittaker, Inc., Walkersville, MD) performed. A value of 0.99 or greater units is positive. Patients were divided into three groups: seronegative, seropositive, and those with no test results. Mean maternal age was compared among groups using the unpaired two-tailed Student t test, with P < .05 considered significant. RESULTS: From February 1, 1994, to May 30, 1996, 927 women had an initial prenatal visit. Ninety-nine patients were varicella-zoster virus antibody negative (seronegativity 11.6%, which is significantly higher than that reported in other studies); 755 were varicella-zoster virus antibody positive, and 73 had no results. The mean age of the seronegative patients was 27 years and of the seropositive patients 28 years, which was not significantly different. CONCLUSION: Varicella-zoster virus seronegativity is higher in our obstetric population than generally is reported in adults. This may reflect the number of immigrants from tropical countries attending metropolitan hospitals. Mathematic models evaluating the impact of varicella-zoster virus vaccination and decisions regarding screening and postpartum vaccination must be based on accurate epidemiologic data, particularly in view of the effect of varicella-zoster virus on pregnant women, their fetuses, and their neonates.

Correlation of neonatal nucleated red blood cell counts in preterm infants with histologic chorioamnionitis.

OBJECTIVE: The aim of this study was to compare the neonatal nucleated red blood cell counts in preterm infants in the presence and absence of clinical and histologic chorioamnionitis while controlling for gestational age and birth weight percentile. STUDY DESIGN: Nucleated red blood cell counts were obtained from preterm infants delivered after preterm labor or preterm premature rupture of membranes. Patients were divided on the basis of clinical and histologic chorioamnionitis. Nucleated red blood cell counts between groups were compared, and regression analysis controlling for gestational age and birth weight percentile was performed. RESULTS: Of 359 patients, both measures of infection status were significantly associated with increased nucleated red blood cell counts. In the regression analysis histologic chorioamnionitis retained significance, whereas clinical chorioamnionitis did not. CONCLUSIONS: Histologic chorioamnionitis produces an erythropoietic response in the fetus. Whether fetal erythropoiesis is a direct response to mediators of inflammation or whether it is the result of a rise in erythropoietin is unknown.

Intrauterine transmission of hepatitis A virus.

BACKGROUND: Hepatitis A is a common, self-limited disease transmitted by fecal-oral contamination. CASE: A 23-year-old woman, para 2-0-0-2, developed hepatitis A at 20 weeks' gestation. At 27 weeks, ultrasound revealed polyhydramnios and fetal ascites. Hepatitis A immunoglobulin M antibody in fetal blood obtained by funipuncture confirmed acute hepatitis A infection in the fetus. Polyhydramnios and ascites persisted until 35 weeks, when the fetus developed ultrasound signs of meconium peritonitis, and delivery was accomplished uneventfully. Meconium peritonitis was diagnosed in the neonatal period and treated surgically. CONCLUSION: To our knowledge, this is the first report of intrauterine transmission of hepatitis A. The disease presented with fetal ascites and was confirmed by positive fetal blood serology.

Acute myocardial infarction in pregnancy with subsequent medical and surgical management.

BACKGROUND: Myocardial infarction is a rare event in pregnancy that requires medical stabilization with possible surgical interventions. CASE: A 37-year-old woman developed an anterior wall myocardial infarction secondary to severe coronary artery disease during the early third trimester of pregnancy. The patient was managed with multiple modalities to stabilize her condition and prolong the gestation. The salient point in the management included: defibrillation and pharmacologic agents, intra-aortic balloon pump, coronary artery bypass graft surgery using a cardiopulmonary bypass pump while maintaining continuous fetal heart rate monitoring, and delivery of the neonate at term. CONCLUSION: Aggressive management of this patient allowed continuation of pregnancy with good outcome for mother and neonate.

Relationship between neonatal nucleated red blood cell counts and hypoxic-ischemic injury.

OBJECTIVE: To determine if nucleated red blood cell counts(RBC) are different in infants who develop intraventricular hemorrhage and periventricular leukomalacia in the first week of life and in those who do not. METHODS: Nucleated RBCs were obtained from 441 infants weighing more than 499 g and less than 1751 g. Neonatal cranial fontanel sonography was performed on days 3 and 7 of life, and neonates were divided into those with normal and abnormal sonographic findings. The nucleated RBCs were compared between these groups and between normal and abnormal groups matched for birth weight and gestational age. RESULTS: Mean gestational age, birth weight, birth weight percentile, Apgar score, respiratory distress syndrome and mortality were different between the infants with normal and abnormal ultrasound findings. The nucleated RBCs (per 100 white blood cells) were not different (40.5 +/- 126.8 versus 41.8 +/- 71.7, t = 0.09, P = .9). When we controlled for gestational age and birth weight, there was no significant difference between nucleated RBCs in those with normal and abnormal sonography (54.3 +/- 206.5 versus 41.4 +/- 72.0,t = 0.56, P = .6). In growth-restricted neonates, there was a significant increase in nucleated RBCs regardless of whether growth restriction was defined as tenth percentile or less, 25th percentile or less, or 50th percentile or less, even when we controlled for gestational age. CONCLUSION: Nucleated RBCs are not different in preterm infants with or without intraventricular hemorrhage and periventricular leukomalacia, even when one controls for gestational age and birth weight. There are significant elevations in nucleated RBCs in growth-restricted fetuses. Birth weight percentile must be considered when using nucleated RBCs as a marker of intrauterine hypoxia.

Recurrent chorioamnionitis and second-trimester abortion because of an enterouterine fistula.

BACKGROUND: Chorioamnionitis, a common cause of second-trimester abortion, is usually secondary to an ascending infection. Recurrent chorioamnionitis with second-trimester abortion secondary to an occult enterouterine fistula has not been reported previously. CASE: A 26-year-old Indian woman, para 0-0-2-0, presented with two spontaneous second-trimester losses. Her third pregnancy carried to 24 weeks, but she delivered after the development of pneumonia, bacteremia, preterm labor, and chorioamnionitis. The patient passed melena containing blood clots after the delivery. After the last pregnancy, laparoscopy and laparotomy revealed an ileal-uterine fistula and a foreign body (necrotic cartilage). The blind loop of bowel was resected and the fistulous tract excised. CONCLUSION: Our patient's recurrent pregnancy wastage was caused by chorioamnionitis secondary to an enterouterine fistula resulting from foreign body ingestion. A complete reversal of this problem is anticipated.

Epidemiologic predictors of hepatitis C virus infection in pregnant women.

OBJECTIVE: To identify sensitive epidemiologic predictors of a positive hepatitis C virus antibody test in asymptomatic persons, and to compare the cost of testing only persons with an epidemiologic predictor to that of universal screening. METHODS: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for antibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative. Cohort and control patients were interviewed and their medical records were reviewed to identify those with chosen predictors of a positive hepatitis C virus antibody test. RESULTS: Seventy-four of 75 cohort patients and 108 of 257 controls had one or more predictors of a positive antibody test. Cohort patients were significantly more likely (P < .001) to have the following: human immunodeficiency virus infection, a sex partner with a risk factor for hepatitis, age greater than 30 years, and a history of drug use, blood transfusion, sexually transmitted disease, hepatitis, or incarceration. The sensitivity and specificity of a single predictor in identifying a person with a positive test were 99 and 58%, respectively. The cost of finding a single individual with a positive antibody test by universal screening was $674, compared to $303 by selectively screening persons with one or more predictors of a positive antibody test. CONCLUSIONS: Most individuals with positive hepatitis C virus antibody tests can be identified on the basis of epidemiologic predictors, reducing the cost of testing by 55%. These patients may receive appropriate medical therapy, and their children may be evaluated for possible infection by vertical transmission of hepatitis C virus.

Failure to detect vertical transmission of hepatitis C virus.

OBJECTIVE: To search for transmission of hepatitis C virus (HCV) from infected mothers to their infants. DESIGN: Prospective clinical, serologic, and molecular biologic follow-up (at least 3 months) of the infants of mothers with anti-HCV antibody. SETTING: A county hospital providing primary and referral care in high-risk obstetrics (perinatology). PATIENTS: Twenty-three mothers with anti-HCV antibody and their 24 infants. METHODS: An enzyme-linked immunosorbent assay (EIA) and a four-antigen recombinant immunoblot assay (RIBA) were used to test for anti-HCV antibody; serum HCV RNA was measured in two independent laboratories by reverse transcription and polymerase chain reaction (PCR) using nested primers in the 5'-noncoding region. Infant samples were tested for HCV RNA by PCR at delivery and after 3 to 6 months of follow-up. Each sample was tested at least four times in two independent laboratories. RESULTS: Twenty-nine of 648 mothers (4.5%; 95% Cl, 3.0% to 6.4%) had anti-HCV antibody; these women had 30 babies. Twenty-three mothers and their 24 babies were followed at least 3 months (mean follow-up, 52 weeks). Of the 23 mothers, 21 (91%; Cl, 72% to 99%) had a reactive RIBA; one woman had an indeterminate RIBA and was positive for HCV RNA by PCR. In 16 of 23 mothers (70%; Cl, 47% to 87%), PCR yielded a positive result in both laboratories. The mean maternal alanine aminotransferase (ALT) level was 1.6 times the normal value. All the babies had anti-HCV antibody in cord-blood samples, but antibody disappeared or diminished in strength in interval samples, and no infant had evidence of active production of anti-HCV antibody. Only 1 of 24 (4%; Cl, 0.1% to 21%) cord-blood samples was HCV RNA positive, and none of 24 (0%; Cl, 0% to 14%) follow-up samples was positive for HCV RNA by PCR in either laboratory. Four mothers and one baby had antibody to HIV. CONCLUSIONS: Infant anti-HCV antibody is most likely acquired passively in utero, and vertical transmission of HCV is uncommon.

Comparison of nifedipine and ritodrine for the treatment of preterm labor.

Treatment of preterm labor with beta-sympathomimetics has been questioned because of the many maternal and fetal complications associated with its use. Nifedipine, a calcium antagonist, has been shown to suppress uterine activity in vitro and in vivo. A randomized prospective study was performed to compare the efficacy of nifedipine to ritodrine in the suppression of preterm labor. Data obtained from 42 women, of which 19 were randomized to the ritodrine group and 23 to the nifedipine group, were analyzed. Ritodrine and nifedipine proved to be equally effective in the suppression of preterm labor. However, the nifedipine group had fewer maternal and fetal complications.

Prophylactic insulin in gestational diabetes.

Patients with gestational diabetes were divided into two groups according to the results of three-hour oral glucose tolerance tests. Those with fasting euglycemia (serum glucose 95 mg/dL or lower) on oral glucose tolerance test (class A) were treated with diet alone, whereas those with fasting hyperglycemia on oral glucose tolerance test (class A/B) were treated with both diet and insulin (15 U neutral protamine Hagedorn insulin before breakfast). The frequency of macrosomia (birth weight more than 4000 g) among class A/B gestational diabetics was 16.2%, which was significantly greater than the 5.6% incidence in class A diabetics and the 6.4% incidence in controls. After controlling for potential confounding risk factors, it was determined that class A diabetics had a frequency of macrosomia no different from that of nondiabetics. Nonobese gestational diabetics with fasting hyperglycemia (class A/Bs), who were treated with diet and prophylactic insulin, also had a frequency of macrosomia no different from that of nondiabetics or class A diabetics. However, the diet and insulin regimen did not prevent excess macrosomia in class A/B diabetics who were obese.

Abnormal glucose screening tests in pregnancy: a risk factor for fetal macrosomia.

Of 2276 patients who underwent screening for gestational diabetes mellitus, 1854 (81.5%) had normal glucose screening tests after a 50-g carbohydrate load (serum glucose below 135 mg/dL). Three hundred fifty-seven patients (15.7%) had abnormal glucose screening tests and went on to complete three-hour glucose tolerance tests, of whom 176 (48.7%) were shown to be nondiabetic when further tested using a carbohydrate-loaded, 100-g glucose, three-hour glucose tolerance test. The 176 women with abnormal glucose screens but normal glucose tolerance tests were compared with the 1854 who had normal screening values. The frequency of infants weighing more than 4000 g (greater than 95th percentile at our institution) was 11.9% in the study group and 6.4% in the control group (P = .0086). When the data were corrected for other macrosomia risk factors (advanced age, high parity, obesity, white race, and prolonged gestation), there was still a significantly higher frequency of macrosomia in the study group; this fact suggests that patients with minor abnormalities of carbohydrate metabolism during pregnancy are at risk for delivering a macrosomic infant.

Hydrocephalic fetus in an abdominal pregnancy.

We present an unusual case of an abortion at 20 weeks elected after a diagnosis of fetal hydrocephalus and spina bifida. Unsuccessful attempts at abortion with prostaglandin suppositories ultimately led to a diagnosis of abdominal pregnancy. This is the first reported case of an abdominal pregnancy discovered during an abortion that was elected because of an anomaly identified by ultrasound.