Prenatal therapy in transient abnormal myelopoiesis: a systematic review.

OBJECTIVE: To systematically review current evidence regarding prenatal diagnosis and management of transient abnormal myelopoiesis (TAM) in fetuses with trisomy 21. A novel case of GATA1-positive TAM, in which following serial in utero blood transfusion clinical improvement and postnatal remission were observed, is included. SEARCH STRATEGY AND DATA COLLECTION: A systematic search of electronic databases (inception to October 2014) and reference lists, hand-searching of journals and expert contact. All confirmed cases of prenatal TAM were included for analysis. Data on study characteristics, design and quality were obtained. RESULTS: Of 73 potentially relevant citations identified, 22 studies were included, describing 39 fetuses. All studies included comprised single case or small cohort studies; overall quality was 'very low'. Fetal/neonatal outcome was poor; 12 stillbirths (30.8%), 4 neonatal deaths (10.2%) and 7 infant deaths (17.9%). In two cases, the pregnancy was terminated (5.1%). TAM was primarily detected in the third trimester (79.4%), and in 14 a retrospective diagnosis was made postpartum. Ultrasound features indicative of TAM included hepatomegaly±splenomegaly (79.5%), hydrops fetalis (30.8%), pericardial effusion (23.1%) and aberrant liquor volume (15.4%). When performed, liver function tests were abnormal in 91.6% of cases. CONCLUSIONS: Prenatal TAM presents a challenging diagnosis, and prognosis is poor, with consistently high mortality. A low threshold to measure haematological and biochemical markers is advised when clinical features typical of TAM are detected in the context of trisomy 21. Larger prospective studies are warranted to accurately ascertain the role of GATA1 analysis and potential value of prenatal therapy.

Smoking history and nicotine effects on cognitive performance.

This study examined the effects of abstinence from smoking, of smoking history, and of nicotine administration on visual attention (2-Letter Search Task), verbal information processing (Logical Reasoning Task), and working memory (N-Back Tasks). Fourteen smokers, 15 ex-smokers, and 9 never-smokers took part. All subjects participated in a training session (when smokers had been smoking ad libitum) and in two subsequent test sessions after administration of 4 mg nicotine gum or placebo, respectively. Smokers were 12-h abstinent when they received gum. An effect of acute nicotine administration (independent of smoking history) was seen only with respect to reaction time on the 2-Letter Search Task. Working memory performance was related to smoking history (smokers performed most poorly and never-smokers best). The Logical Reasoning Task showed no effects of either acute or chronic nicotine exposure. The findings indicate that nicotine may influence focusing of attention in smokers as well as nonsmokers, and that trait-like differences in some cognitive domains, such as working memory, may be either long-term effects or etiological factors related to smoking.

Vagal tone regulation during sustained attention in boys exposed to opiates in utero.

Attention and learning problems among children exposed to opiates in utero have been previously reported but are difficult to interpret due to imprecise measurement and inadequate control of postnatal factors. In this study, we used a behavior-based measure of attention (continuous-performance tasks) and a physiological index of sustained attention (cardiac vagal tone) to measure more precisely the process of sustained attention. Boys, aged 7 to 12, exposed to opiates in utero, were compared to boys whose mothers began using illicit substances after the child's birth (environmental controls), and boys whose mothers were non-drug users. This three-group design was intended to isolate in utero effects from postnatal environmental influences. Vagal tone, a measure of heart-rate variability sensitive to vagal influences on the heart, was measured pre- and postbaseline and during the three tasks of the Gordon Diagnostic System (Delay, Vigilance, and Distractibility). Vagal tone has been found to be sensitive to changes in environmental demand for sustained attention in infants, school-age children, and adults. Results indicated that when distractors were added to the vigilance task (Distractibility task), opiate-exposed boys failed to suppress vagal tone compared to both control groups. However, both the opiate-exposed boys and the environmental controls made fewer correct responses than non-drug-exposed controls on this task. These results indicate that normal physiological responses to increased attentional demand may be impaired in boys exposed in utero to opiates in this age range. However, the poor Distractibility scores of both the opiate-exposed and environmental controls suggests an important role of environmental influences on attentional performance.

Mediastinal abscess secondary to vertebral osteomyelitis.

A 29-year-old man with complaints of pain in the low back, both flanks, and midepigastrium was found to have vertebral osteomyelitis. Mediastinal abscess was also diagnosed on the basis of findings on chest x-ray film, thoracic ultrasonography, thoracentesis, and cultures of pleural fluid. Antibiotic therapy was begun, and open drainage with rib resection was performed. After six weeks of treatment, the patient was free of symptoms. We believe this is the first report of mediastinal abscess secondary to vertebral osteomyelitis in an adult since the advent of antibiotics.

Bacteremia due to Haemophilus infections: a retrospective study with emphasis on the elderly.

We performed a retrospective study of all patients in a large health maintenance organization in Southern California who were identified as having positive blood cultures for Haemophilus organisms during a 20-month period (September 1990 to May 1992) to assess the incidence, presentation, and predisposing conditions of bacteremia due to these organisms and to examine some of the features of these infections in the elderly. Thirty-eight patients with bacteremia due to haemophilus infections were identified. Ten (26.3%) patients were 65 years of age or older. The incidence of bacteremic haemophilus infections in the elderly group was estimated at 2.7 per 100,000 individuals per year, which was almost three times greater than that for the younger age groups studied. When analyzed statistically, the presenting feature of the infection did not differ among age groups. Six patients died, four of whom were elderly. All six deaths were due to nontypable Haemophilus influenzae strains. Cancer was the only chronic underlying condition frequently found among the elderly patients. Three of 10 elderly patients lived in nursing homes; all three were infected with nontypable H. influenzae strains, and all three died.

Unique temperature-sensitive nutritional requirements of bacteremic Escherichia coli isolates.

Of 50 strains of Escherichia coli isolated from blood cultures of bacteremic patients, 14 (28%) were unable to grow on minimal medium at 42 degrees C, compared to only 2 of 50 nonbacteremic strains. In 7 of the 14 bacteremic strains, growth at 42 degrees C was restored by adding nicotinic acid. These unique temperature-sensitive auxotrophic patterns warrant evaluation as a marker correlating with clinical pathogenicity in E. coli.