Molecular and clinical aspects of embryotoxicity induced by acetylcholinesterase inhibitors.

Acetylcholinesterase inhibitors are widely used for a variety of medical, agricultural and public health purposes. Consequently, exposure is highly possible during lifetime. However, their systematic use raises concerns for the potential impact on the fetus and newborn since these substances may affect angiogenesis, the neonatal and maternal intensive care, neuroimmune function and response, mammary growth/lactation via cholinergic/non-cholinergic central and peripheral neuroendocrine pathways. New methodologies, neuroscientific technologies and research studies are needed to harness existing knowledge along with the proper management, availability for new acetylcholinesterase inhibitors, with stable pharmacodynamics and clinical outcomes.

Multimodal cancer chemotherapy during the first and second trimester of pregnancy: a case report.

This paper reports treatment with combined chemotherapy during pregnancy. A 39-year-old woman with breast cancer was given adjuvant chemotherapy including cyclophosphamide, methotrexate and 6-fluorouracil from the 6th to the 24th week of gestation. The possibility of teratogenic effects on the fetus was explained to the patient however she refused to terminate the pregnancy. A 30-week male infant with only a minor malformation was delivered. The authors reviewed the literature regarding chemotherapeutic agents given during the first trimester of pregnancy. Most cytotoxic drugs have teratogenic effects on experimental animal subjects. However, actual data on human fetuses are sparse because of the variety of therapeutic regimens and the rarity of administering chemotherapy during pregnancy. The long-term effects of exposure to cytotoxic drugs in utero, needs further research.

Genital tuberculosis in a HIV infected woman: a case report.

The incidence of HIV-associated tuberculosis is increasing worldwide, especially in developing countries. HIV infected patients rapidly develop clinically significant disease, respond poorly to complete treatment and present with extrapulmonary tuberculosis. Although a relative increase of genital tuberculosis would be expected, this has not been reported. Probably, tuberculous systemic disease is diagnosed earlier, before genital tuberculosis occur. The present study is a report of case of a young African female patient, who was admitted with symptoms of acute pelvic inflammatory disease due to genital tuberculosis and proved to be HIV infected. The patient was managed by intravenous antibiotic administration, but since no clinical or laboratory improvement was achieved, a laparotomy and salpingooophorectomy was performed. Histopathology revealed tuberculosis and after that the patient proved to be HIV infected. Further investigation did not reveal pulmonary or other extragenital manifestation of tuberculosis. The only manifestation of HIV infection and genital tuberculosis was the symptoms of an acute pelvic inflammatory disease, which is extremely rare.

Early exploration in perinatal torsion of the spermatic cord: a case report.

Perinatal testicular torsion is a rare condition presenting with signs of an acute scrotum. Review of the literature indicates that there is controversy about optimal management, particularly as regards the risks and the benefits of immediate versus delayed surgical treatment. We report a case that was treated by immediate surgical intervention.

Infantile myofibromatosis with visceral involvement and complete spontaneous regression.

Infantile myofibromatosis is an unusual mesenchymal disorder characterized by the proliferation of tumors in the skin, muscle, bone, and viscera. Two types can be distinguished; the solitary type, defined by the presence of one nodule in the skin, muscle, bone or subcutaneous tissue; and the multicentric type which can be divided into two sub-types. In the first sub-type the lesions are multicentric but without visceral involvement, while in the second, visceral involvement is present. The prognosis of the disease depends on whether visceral involvement is present. Solitary and multicentric nodules without visceral involvement usually have excellent prognosis with spontaneous regression of lesions within 1 to 2 years of diagnosis. On the other hand, visceral lesions are associated with a significant morbidity and mortality, resulting from vital organ obstruction, failure to thrive, or infection. Death in these cases often occurs at birth, or soon after, and is usually due to cardio-pulmonary or gastrointestinal complications. The case being reported here, is that of a female newborn who had multiple skin, subcutaneous tissue, skeletal muscle, bone, and lung lesions immediately after bith. At the age of three years, the child is in good health, her psychomotor development is in accordance with her age group, and the lesions have completely regressed. This is a case of the multicentic type of infantile myofibromatosis with visceral involvement, where all lesions have spontaneously regressed. This is a rarity since the prognosis in the majority of such cases is poor.

Infantile myofibromatosis: a case study and review of literature.

Infantile myofibromatosis is an unusual condition generally presenting in the newborn period. The case being reported is that of a female newborn who had multiple lesions that involved skin, subcutaneous tissue, skeletal muscles, bone, and lungs. The disease was diagnosed because of the easily palpable skin tumors and subcutaneous nodules that were obvious immediately after birth. The diagnosis was established by histopathological examination of one nodule that showed a spindle-celled mesenchymatogenic lesion demonstrating the morphological and immuno-phenotype characteristics of myofibroblastic differentiation. The histologic picture, combined with the clinical manifestations and the imaging findings, are consistent with infantile myofibromatosis. The physical condition of the newborn was excellent and remains so six months later. The tumors of the skin and the subcutaneous nodules have gradually regressed without therapy. At the age of six months, four (4) nodules are palpable; the infant is under continuous observation.

Breast feeding--when nature fails to satisfy.

Human milk is the ideal source of nutrition for the healthy neonate. Milk from the mother whose diet is sufficient will supply the necessary nutrients. It is a considerable problem to discern if the milk supply is the adequate quantity for the infant. If the infant's water and caloric needs are not met for several days, signs and symptoms of hypernatremic dehydration >10% may develop. This report presents a case of a 15-day-old, breast-fed infant who developed significant hypernatremic dehydration.

Neonatal screening for developmental dysplasia of the hip on the maternity wards in Crete, Greece. correlation to risk factors.

OBJECTIVE: To evaluate the effects of ultrasound examination of newborns in early detection and management of developmental dysplasia of the hip (DDH), and its correlation to known risk factors. The incidence of DDH in newborns throughout the general population of Crete has also been investigated. METHODS: From 1996 to 2000, 6,140 full-term newborns were examined in the Maternity Department of the University Hospital. All received standard assessments, with their medical history recorded, and a physical examination performed on the first and the fifth postpartum days. Ultrasonography of both hips using the Graf technique was performed on the 15th day after birth on both high-risk newborns and those with any clinical suspicion of DDH. Treatment was initiated according to the Graf classification. RESULTS: Ultrasound examination was performed on 220 newborns (3.58%). Ultrasound findings were positive in 65 neonates (10.83 per 1,000). Twenty-one neonates whose clinical examination was normal, but who underwent ultrasound because of the presence of risk factors had pathological findings on the hip sonography (32.30%) CONCLUSION: The incidence of DDH in Crete is estimated to be 10.83 per 1,000; higher than in the rest of Greece. Medical and family histories and clinical examination play an important role in the diagnosis of hip instability. Selective ultrasonography for all infants with risk factors, and those with clinical abnormality of the hip, is an adjunctive tool which aids early diagnosis and offers higher control in the results of treatment.

Effects of gestation age and of birth weight in the concentration of carnitine in the umbilical plasma.

To investigate the factors which affect the concentrations of the total, the free, and the acylcarnitine in neonates, blood was taken from the umbilical cord of 49 newborn infants ranging in gestation age (g. a.) from 32-40 weeks (mean g. a.: 36.8 +/- 2.6 weeks) and in birth weight (b. w.) from 1300 gr.-4300 gr. (mean b. w.: 2299 +/- 457 gr.). The carnitine and its fractions were studied in plasma. Twenty-eight of the neonates studied were premature (g. a. < or = 37 weeks) and 21 were full-term (g. a. > 37 weeks). The concentration of the total, free, and acylcarnitine in premature neonates was 28.0 +/- 2.3 mumol/L, 15.9 +/- 1.3 mumol/L, and 12.0 +/- 1.3 mumol/L, respectively. For the full-term neonates the respective concentrations were: 25.2 +/- 2.2 mumol/L, 14.6 +/- 1.5 mumol/L, and 10.7 +/- 1.5 mumol/L. These differences in concentrations between premature and full-term infants were statistically significant. For the total number of neonates studied the concentration of total, free, and of acylcarnitine was 26.8 +/- 2.6 mumol/L, 15.3 +/- 1.9 mumol/L, 11.5 +/- 1.5 mumol/L respectively. The calculation of the correlation coefficients for the total number of neonates showed the existence of a statistically significant negative correlation between the total, free and acetyl carnitine in terms of gestation age and birth weight. The comparative analysis of the correlation coefficients showed greater coefficient values between the total and the acylcarnitine in terms of birth weight. The latter finding, combined with the low rate of acylcarnitine decline, are indirect indications that the fetus uses carnitine as a source of energy, which affects the levels of total and acylcarnitine in the plasma.

Conservative treatment of multiple pregnancies after delivery and a fetal miscarriage: two case reports.

Due to the increased availability of infertility treatment, multiple pregnancies, with various resulting complications, have become more common. Two cases of triplet pregnancies with delayed delivery--interval ranged from 6 to 56 days--are reported. The first woman in the 23rd week of a triplet pregnancy came to the hospital because of premature rupture of membranes of one amniotic sac and had a miscarriage of one of the fetuses the same day. The second woman in the 26th week of a triplet pregnancy also came to the hospital because of bleeding and contractions and had vaginal delivery of the first triplet a few hours later. After confirming that the remaining two fetuses were in good condition, both patients were kept under observation with only antibiotic therapy for the first one and antibiotic and tocolysis for the second. Fifty-six days following admission to our hospital the first woman gave birth to twins while in her 32nd week. The second woman gave birth six days following admission (in her 27th week). The successful outcome of these cases demonstrates that non-intervening conservative methods could be a feasible alternative to invasive intervention. We hope that our cases will encourage more physicians to try out and report non-intervening methods so that enough information can be gathered to help make correct management decisions in the future.

Congenital infection by human parvovirus B19 ascites-anaemia.

A case of intrauterine infection by human parvovirus B19 (HPV B19) manifested as ascites during pregnancy is presented. Ascites was diagnosed by ultrasound at 27 weeks' gestation. A caesarean section was performed at 37 weeks'. owing to affected mobility of the fetus. A pale, female infant with low haemoglobin and bradycardia was delivered. Polymerace Chain Reaction (PCR) lab tests revealed that the mother and the fetus were infected by HPV B19. The neonate was born with low haemoglobin (Hb = 10 g/dl) and with ascites; it was discharged in good general condition 50 days after delivery.

Association between duration of neonatal hospital stay and morbidity in the first month of life.

The morbidity of 506 healthy full-term newborns was studied in the first month of life in relation to the time they stayed in the hospital. The average time for the newborns who were born by vaginal delivery was 73.3+/-11.7 hours, while for those who were born by cesarean section it was 135+31.5 hours. Thirty-seven newborns presented health problems during the neonatal period (7.3%) and only 2% needed hospital readmission. The commonest problem in the newborns we studied was jaundice which appeared from the fourth to sixth day of life. During the second fortnight the commonest problems were infections of the respiratory tract. From the results of our study it is obvious that only a small percentage of readmissions could have been avoided if the original stay in hospital had been prolonged.

Predictive and prognostic value of LPS-stimulated cytokine secretion in metastatic non-small cell lung cancer.

OBJECTIVE: Cancer patients usually develop malnutrition which may alter their innate immune system integrity. The aim of this study was to investigate the clinical relevance of chemokine response after lipopolysaccharide (LPS)-stimulation in metastatic non-small cell lung cancer (NSCLC). METHODS: Blood samples from metastatic NSCLC patients were incubated with LPS before the onset of systemic therapy. Interleukin (IL)-6 and IL-8 levels at baseline and after LPS-stimulation were measured and the fold change compared to baseline levels was evaluated as the stimulation index for each cytokine per patient. Results were correlated with sex, age, smoking status, histologic subtype, performance status (PS), albumin, Mini Nutritional Assessment (MNA) status and clinical outcomes. RESULTS: Totally 103 patients were evaluated. Mean (±SD) stimulation index was 37.6 (±57.8) for IL-6 and 76.7 (±133.4) for IL-8. The disease control rate after first-line chemotherapy was 44/80 (55 %) and the mean (±SD) progression-free survival (PFS) and overall survival (OS) were 4.2 (±3.9) and 9.2 (±1.1) months, respectively. MNA, PS, albumin, IL-6 and IL-8 stimulation indices were univariately associated with PFS and OS. IL-8 stimulation index emerged as an independent predictor of both PFS and OS, along with PS, and albumin levels. CONCLUSION: The extent of IL-6 and IL-8 stimulation after ex vivo induction with LPS is an important predictor of clinical outcome in metastatic NSCLC patients.

Spontaneous gastric perforation in premature twins.

Two pairs of identical and non-identical premature neonates proceeding from twin pregnancies were operated on for spontaneous gastric perforation. The newborns in our case, one girl and one boy two different pregnancies were delivered by emergency cesarean section. Their gestational ages were 30 and 32 weeks, and their birth weight 1400 and 2100 g, respectively. Both of the neonates were being treated in the Neonatal Intensive Care Unit when the perforations were diagnosed. They presented clinically abrupt symptoms of abdominal distension and pneumoperitoneum. The sites of the ruptures were located at the anterior gastric wall near the gastroesophageal junction. The sibling twins were consequently also observed very carefully and fortunately they did not develop any similar clinical symptoms. All four twins were finally discharged from the hospital in good condition.

Erythropoietin (rHuEPO) administration to premature infants for the treatment of their anemia.

In an attempt to stimulate erythrocyte production and thereby decrease the requirement for red blood transfusions, recombinant human erythropoietin (rHuEPO) was administered to 16 premature infants with birth weights less than 1000 g and to 18 with birth weights of 1000-1300 g; two corresponding groups, who did not receive rHuEPO, were used as control groups. The rHuEPO was administered subcutaneously in a dose of 300 IU/kg three times a week for 6-8 weeks. The erythropoietin decreased the red blood requirement in both groups of infants, and the increment of hemoglobin following rHuEPO administration was not statistically significant. No correlation was observed between gestational age, number of transfusions, and reticulocyte percentage. The effect of rHuEPO was higher in the group of infants with birth weights of 1000-1300 g than in those of less than 1000 g. No significant side effects were observed during rHuEPO administration.

Spontaneous intestinal perforation in a full-term infant: association with infection.

The term spontaneous intestinal perforation suggests a perforation in the gastrointestinal tract of a newborn of no demonstrable cause. Only a few cases have been described in full-term newborns. The aetiology and pathogenesis of the disease are unknown although multiple theories have been proposed. Some authors suggest ischemia as the most likely cause. Conditions associated with fetal or neonatal hypoxia are important antecedents for this emerging distinct entity. We present a case of a spontaneous, intestinal perforation in a full-term neonate with urinary tract infection. There was no clinical evidence of necrotizing enterocolitis or bowel obstruction. Radiological images revealed a pneumoperitoneum. An emergency explorative laparotomy was performed. A localized linear perforation was identified in the transverse colon. Pathological examination of the resected specimens failed to reveal any etiology for the perforation. The neonate recovered rapidly, with no gastrointestinal complications. In our case none of the factors which have previously been associated with intestinal perforation could be implicated. We suggest that focal intestinal perforation is possibly the result of infection. Further studies, including careful recording of cases and close histopathological examination of resected specimens, are required in order to provide more information and improve our understanding of the aetiology of this rare occurance.

An unusual case of lead poisoning in an infant: nursing-associated plumbism.

Lead poisoning remains a common environmental threat for children today. The majority of cases of lead poisoning are caused by oral intake of lead dust or lead-containing paint flakes and thus occur during the second and third years of life. An unusual case of severe lead poisoning in a breast-feeding infant girl is here presented; the source proved to be a nipple shield made of a lead-containing metal. Despite the severity of the intoxication, by the end of treatment and for a year afterwards the infant has been well and her psychokinetic development has been normal.

Anemia due to massive chronic foetomaternal hemorrhage.

We report a case of massive chronic foetomaternal hemorrhage. The labor course was uncomplicated. The newborn presented with pallor. tachypnea, and moderate hepatosplenomegaly. The initial hemoglobin was 6.5 g/dl. The Kleihauer-Betke stain on a maternal blood sample was 12%, which is equivalent to 540 ml of fetal blood in the maternal circulation. A clot in the umbilical vein was demonstrated sonographically. The possible association of foetomaternal hemorrhage with umbilical vein thrombosis is discussed.