Simultaneous determination of hemoglobin and coproporphyrin by second derivative differential spectrophotometry: application to the diagnosis of meconium aspiration.

We describe a simple, fast method for simultaneous measurement of hemoglobin and coproporphyrin in urine and amniotic fluid, by second-derivative differential spectrophotometry. Both pigments were determined in biological samples without prior extraction. Despite the slightly overlapping spectra, the method permitted satisfactory resolution and avoided interspectral interference. Its sensitivity, sufficiently good, allowed to detect hemoglobin and coproporphyrin in slightly pathological urine and amniotic fluid as an aid to the diagnosis of meconium aspiration.

Changes in phospholipid composition of tracheal aspirates from newborns with hyaline membrane disease or transient tachypnoea.

Phospholipid analysis of tracheal aspirates obtained from 37 newborn infants, all intubated for respiratory diseases, was performed in order to compare infants having hyaline membrane disease (HMD) (n = 11), to those presenting with transient tachypnoea (TT) (n = 16) or another respiratory disorder (n = 10) and to determine if distinguishing features could be discovered for HMD or TT. In the HMD group, a significantly lower amount (about 20%) of recoverable phospholipid material was observed. Furthermore, the groups differed in their phospholipid profile: infants with HMD presented with a deficiency in saturated phosphatidylcholine, but had a related increase in unsaturated phosphatidylcholine, and an increased proportion of phosphatidylethanolamine (about 2.5 times more) as compared with both other groups. In infants suffering HMD and TT, phosphatidylglycerol was lower and phosphatidylinositol was higher than in infants with other diseases. This change was the only one displayed in infants with TT. We speculate that the observed changes reflect changes in amount and composition of surfactant and are involved in the etiology of HMD and TT.

Lactate dehydrogenase isoenzyme activity in malignant haematological diseases.

The isoenzymes 1 and 2 (LDH1 and LDH2) of lactic dehydrogenase (LDH) were studied in the serum of 32 patients with malignant haematological diseases. In non-Hodgkin lymphoma (NHL) a diminution in LDH1 and an increase in LDH2 was a sign of evolution towards a more aggressive phase of the disease, or the absence of clinical remission, even when no significant variation of total LDH can be observed in the serum. In acute lymphoblastic leukaemia (ALL), the isoenzymatic variations are not an early indication of relapse. No significant variations in serum LDH or of these isoenzymes was observed in chronic lymphocytic leukaemia (CLL) or Hodgkin's disease (HD). Only in NHL did the variations of LDH1 and LDH2 appear to be a biochemical marker of the tumour process and of cellular differentiation.

[Determination of fructosamine on the Cobas-Bio centrifuge system. Importance of white reagent]. / Dosage de la fructosamine sur appareil centrifuge Cobas-Bio. Importance du blanc réactif.

An automated assay for fructosamine on Cobas-Bio centrifugal analyzer with subtracting the contribution of the albumin matrix present in standards is described. This rapid and simple test has suitable analytical performances. Fructosamine concentrations were measured in 100 healthy subjects and in 95 diabetic patients. For the diabetic patients, results were compared with those obtained from a commercialized test kit.

[Biochemical aspects of amniotic fluid aspiration]. / Aspects biochimiques de l'inhalation amniotique.

The authors propose a simple, quick and reliable biochemical method for diagnosis of amniotic aspiration in the newborn infant. The optical density of the infant's first urine is determined at 420, 390 and 405 nm. A urinary meconial index (IMU) is computed from these values. A meconial amniotic inhalation must be suspected if this index is greater than one. The presence of coproporphyrins identified in urine of infants having inhaled meconial amniotic fluid seems to be at the origin of the spectral characteristics of pathological urines.

[Concentrations of superoxide dismutase (copper and manganese), catalase and glutathione peroxidase in red cells, platelets and plasma in patients with rheumatoid polyarthritis]. / Concentration en superoxyde dismutase (cuivre et manganèse), catalase et glutathion peroxydase dans les hématies, les plaquettes et le plasma de sujets atteints de polyarthrite rhumatoïde.

Antioxidant enzymes assays (CuZnSOD, MnSOD, catalase glutathione peroxidase) have been performed by radioimmunoassay in erythrocytes, platelets and plasma of rheumatoid polyarthritis patients. No difference has been shown as compared with control subjects whatever the therapy or the length of time for which the patients have been affected. If a deficiency in antioxidant enzymes is related to the destruction of joint tissues by free radicals, it cannot be detected in blood tissue elements.

[Phosphatidylglycerol in amniotic fluid. Value of rapid determination using an immunologic technic]. / Le phosphatidylglycérol dans le liquide amniotique. Intérêt de son évaluation rapide à l'aide d'un test immunologique.

We have studied 55 samples of amniotic fluid taken by amniocentesis from 32 women, most of whom had arterial hypertension, with or without intra-uterine growth retardation; with or without uncertainty as to their dates. Fetal pulmonary maturity was estimated by determining the lecithin/sphingomyelin (L/S) ratio and the levels of phosphatidylglycerol (PG) in 55 samples. The semi-quantitative levels of PG were worked out using a simple and rapid immunological method. Our results show that there is a good correlation between the two tests. The level of PG is, however, more specific than the L/S ratio, for which we found some false negatives. In particular, there were 7 samples looked at 48 hours before delivery which showed an L/S ratio lower than 2 and a PG at or above 2 micrograms/ml. None of these 7 had hyaline membrane disease. Furthermore the simplicity and speed of this test make it possible to use it routinely.

[A study of fetal pulmonary maturity using amniotic fluid obtained from the vagina after premature rupture of membranes]. / Etude de la maturité pulmonaire foetale dans le liquide amniotique prélevé par voie vaginale aprés rupture prématurée des membranes.

Amniotic fluid was obtained from the vagina not more than 24 hours before delivery in 100 patients who had premature rupture of the membranes. Thirty per cent of these cases had contamination with blood or with meconium. Phosphatidylglycerol (PG) estimate the degree of lung maturity using an immunological method (AMNIOSTAT-FLM test). In the 22 cases where the gestational age was 35 weeks or less there were two cases of hyaline membrane disease. In 68% of the 22 cases, the PG was negative, intermediate in 14% and positive in 18%. One of the cases of hyaline membrane disease was accompanied by fluid that was not infected and that was negative for PG; the other case had infection with S. faecalis and the PG was intermediate. On the other hand in the 78 cases when the pregnancies had lasted longer than 35 weeks there were no children who had hyaline membrane disease. The PG reaction was positive in only 57% of these cases. Search for bacteria showed infection in 10 cases (three with alpha-haemolytic streptococci, four with group B beta-haemolytic streptococci and three with E. coli). Determination of PG on the supernatant of reference strain cultures showed positive results for S. faecalis and E. coli. In conclusion, the poor specificity of the test (48%) and the possibility that when there was bacterial contamination false positive results were obtained shows that looking for fetal maturity by testing amniotic fluid from the vagina is unreliable and is contra-indicated.

[Iron deficiency in the pregnant woman. Its repercussions on the newborn. The influence of systematic iron treatment (author's transl)]. / La carence martiale chez la femme enceinte. Etude de son retentissement chez le nouveau-né. Influence d'un traitement martial systématique.

We have studied the haematological and iron state of 203 women from the sixth month of pregnancy till two months after delivery, and of their newborn from birth to the age of two months. Iron deficiency affects more than a third of women with a higher risk for multipara and for immigrants. The only sure way of screening for this is by estimating the plasma ferritin. When iron was given routinely as a supplement we found that the tissue reserves of iron rose from the third trimester onwards and two months later were entirely normal in treated women, but an iron deficiency persisted in women who were not treated. The transfer of iron to the fetus in the third trimester of pregnancy is related to the quantity of iron given to the mother in her diet. The iron reserves in the tissues of these children were higher at two months of age when the mothers had been treated with iron during the pregnancy. The value of estimating ferritin in the blood as an indicator of tissue reserves should be considered in the neo-natal period.

[Fast determination of pulmonary surfactant in amniotic fluid using fluorescent polarization (FLM test Abbott)]. / Détermination rapide du surfactant pulmonaire dans le liquide amniotique par polarisation de fluorescence (FLM test Abbott).

A study of 60 amniotic fluids obtained by amniocentesis shows that the measurement of total surfactant phospholipids by the TDX Fetal Lung Maturity assay makes it possible to predict accurately fetal lung maturity. A sensitivity of 100% is similar to that of other tests currently used but with a higher specificity (93% instead of 65% for the L/S ratio and 55% for the phosphatidylglycerol). The phospholipid/albumin ratio is carried out automatically by means of a fluorescence polarization method with the TDX Abbott apparatus. A cut off value of 50 mg/g should be considered as a good fetal lung maturity indicator. The population studied was composed of women with an arterial hypertension (n = 6), diabetes (n = 9) preterm premature rupture of the membranes (n = 8), gemellary pregnancy (n = 5) or with a risk of premature outcome (n = 10). In all cases delivery occurred within 24 hours after the amniocentesis. The average gestational age was 36 weeks. Seven newborns (11%) presented hyaline membrane disease. In conclusion, this simple and rapid test seems to be adequate to evaluate with accuracy the fetal lung maturity in abnormal pregnancies. It must however, be associated with the determination of phosphatidylglycerol, when the fluid is contaminated by blood or meconium.

[Fructosamine, a new marker of blood glucose control in the diabetic]. / La fructosamine, nouveau marqueur du contrôle glycémique chez le diabétique.

Serum fructosamine assay is a new, simple and fast method used to evaluate serum glycosylprotein concentrations. We performed this assay in 96 healthy controls, 95 patients with diabetes (insulin-dependent in 71, non insulin-dependent in 24) and 23 non diabetic pregnant women. Serum fructosamine concentrations were increased and correlated with percents of glycosyl haemoglobin in all diabetics, irrespective of the type of diabetes. However, the low correlation coefficient and the fact that some individual values plotted were distant from the regression slope suggested that fructosamine does not have the same biological significance as glycosyl haemoglobin: the formation and degradation kinetics of these two substances are known to be very different. Fructosamine values were tightly close together in controls and in pregnant women, the latter showing lower values.

[Value of a rapid determination of phosphatidylglycerol in the endotracheal aspirate of the newborn infant in respiratory distress]. / Intérêt d'une détermination rapide du phosphatidylglycérol dans le liquide d'aspiration endo-trachéale chez le nouveau-né en détresse respiratoire.

An immunological method to measure phosphatidylglycerol (PG) levels was studied in 48 neonates with respiratory distress, by comparing the results with the lecithin sphingomyelin ratio (L/S) and with radioclinical data. In hyaline membrane disease (HMD), PG suggested immaturity in 91% of cases, as did L/S in 78%. In 6 of 20 cases with respiratory distress (30%) from other causes, PG level was low, which allows for discussion on the significance of this biological criterion as opposed to radiological and clinical criteria. This method of PG determination appears to be a more sensitive and reliable measure of lung maturity than the L/S ratio.

Phosphatidylglycerol in tracheal aspirates for diagnosis of hyaline membrane disease.

Lecithin:sphingomyelin ratio and phosphatidylglycerol were determined by a rapid, simple method in tracheal aspirates obtained from 132 newborn infants with respiratory diseases, sixty five of whom developed hyaline membrane disease. Phosphatidylglycerol determination was more sensitive (97%) than lecithin:sphingomyelin ratio, but their specificities were similar (76%).

[Iron reserves in blood donors. Should we prescribe systematic iron supplementation?]. / Etude des réserves en fer chez les donneurs de sang. Faut-il prescrire une supplémentation martiale systématique?

1. Iron status has been assessed in 171 blood donors and 58 controls. 2. In men, ferritinemia was lower in blood donors, as compared to controls, but hemoglobin and erythrocytes values are found normal. 3. In women, both M.C.V. and ferritinemia were lower in donors. Ferritinemia could reach values below the threshold of iron deficiency. Microcytosis occurred 7 times. It appeared to be related either to the association of hypermenorrhea with blood donation, or to a number of 4 blood donations a year. 4. Iron supplementation was randomized. The comparison of the two groups of donors with and without iron supplementation showed that supplementation had no effect on male blood donors, but improved both ferritinemia and M.C.V. values in females. 5. However, systematic iron supplementation does not seem to be appropriate in France, as long as one excludes hypermenorrheic women, and if the periodicity of blood donation does not exceed three times a year for females.

Apolipoprotein AI and alcoholic liver disease.

A prospective study of apolipoprotein AI has been undertaken in 581 alcoholic patients and in 100 controls in order to describe the changes of apolipoprotein AI according to the different stages of the alcoholic liver disease, to correlate the changes to serum liver tests and to estimate its diagnosis and prognostic value. Results showed that apolipoprotein AI concentration is highly related to the degree of liver injury, reaching a maximum in patients with steatosis (229 +/- 90 mg per dl), beginning to decrease in patients with fibrosis (188 +/- 88 mg per dl) and reaching a minimum in patients with severe cirrhosis (91 +/- 46 mg per dl). Apolipoprotein AI had an independent and discriminative value for the diagnosis of fibrosis (p less than 0.001) vs. steatosis and for the diagnosis of cirrhotic vs. noncirrhotic fibrosis (p less than 0.001) or vs. acute alcoholic hepatitis without cirrhosis (p less than 0.001). Cirrhotic patients with apolipoprotein AI less than 100 mg per dl had a lower survival rate at 1 year (62 +/- 7%) than patients with greater value (80 +/- 6%; p less than 0.05), but this prognostic value disappeared in multivariate analysis when other known prognostic factors were taken into account.

Importance of simultaneous determination of coproporphyrin and hemoglobin in contaminated amniotic fluid.

To detect the presence of meconium and blood, we determined coproporphyrin and hemoglobin in 78 amniotic fluid samples, classified according to their visual aspect as clear (n = 45) or meconium-stained (n = 33). Among the 33 samples visually judged as meconial, a comparison of the results of their biochemical analysis with the mean values for clear amniotic fluids showed that only five of the 33 were contaminated solely with meconium. Seven others were exclusively bloody, and 19 were meconial and bloody. In two, the contaminant was neither meconium nor blood. Evidently, when the fluid is brownish, simple visual examination does not suffice for distinguishing meconium from old blood or other pigments. We propose a simple, rapid, and reliable method for simultaneously measuring contamination with meconium or blood.