Using umbilical cord tissue to detect fetal exposure to illicit drugs: a multicentered study in Utah and New Jersey.

OBJECTIVE: We assessed umbilical cord tissue as a means of detecting fetal exposure to five classes of drugs of abuse. STUDY DESIGN: In a multicentered study in Utah and New Jersey, we collected umbilical cord tissue when high-risk criteria were met for maternal illicit drug use. The deidentified umbilical cord specimens were analyzed for five drug classes: methamphetamine, opiates, cocaine, cannabinoids and phencyclidine. For each umbilical cord specimen, an enzyme-linked immunosorbent assay (ELISA)-based screening test was compared with a 'gold standard' test, consisting of gas or liquid chromatography tandem mass spectrometry. RESULT: A total of 498 umbilical cord samples were analyzed of which 157 (32%) were positive using mass spectrometric detection. The sensitivity and specificity of the ELISA-based test for each class of drugs tested were as follows: methamphetamine 97 and 97%, opiates 90 and 98%, cocaine 90 and 100%, cannabinoids 96 and 98% and phencyclidine (only 1 of the 498 umbilical cord sample was positive for phencyclidine) 100 and 100%. CONCLUSION: We judge that the performances of the ELISA-based tests are sufficient for clinical testing of fetal exposure to methamphetamine, opiates, cocaine and cannabinoids. Studies obtained on umbilical cord tissue can result in a more rapid return to the clinician than meconium testing, because waiting for meconium to be passed sometimes requires many days. Moreover, in some cases the meconium is passed in utero making collection impossible, whereas umbilical cord tissue should always be available for drug testing.

A comparison of barium sulphate preparations used for the double contrast barium meal.

Radiologists' opinions of the properties of six barium suspensions with their recommended gas-producing agents designed for upper gastrointestinal use were assessed, using a linear analogue scale. Five radiologists independently assessed mucosal coating of stomach and duodenum, areae gastricae, gaseous distension and bubble formation in a total of 258 patient examinations. Preparation 1 (EZHD) was judged to give best overall results, coating stomach and duodenum particularly well. Preparation 2 (X-Opaque) gave good distension and also coated mucosa fairly well, as did preparations 3 and 4 (Medebar XAC and Field 2C). The latter two preparations produced good distension at the expense of bubble formation. Preparations 5 and 6 (Micropaque DC and Baritop G) were judged, by comparison, to have performed poorly as regards mucosal coating. None of the preparations delineated areae gastricae well, even in the presence of good, bubble-free gastric distension.

Vascular rings causing pulmonary collapse.

Mediastinal vascular anomalies (rings) have not previously been reported to cause pulmonary collapse. We record two cases where anomalous subclavian arteries were involved in the ring. This association can be predicted by considering the embryology of the subclavian arteries which arise from the lowest intersegmental arteries and migrate in a cephalad direction. An anomalous subclavian artery which did not complete this migration could cross the mediastinum at the carina. Investigation of a suspected vascular ring is firstly by a barium swallow which will show extrinsic compression of the oesophagus by the anomalous vessel. Arteriography demonstrates the exact anatomy of the vascular ring, but is a pre-surgical investigation undertaken in cases where the collapsed lung may re-expand following division of the vascular ring.