Maternal vitamin D supplementation during pregnancy prevents vitamin D deficiency in the newborn: an open-label randomized controlled trial.

OBJECTIVE: To determine whether maternal vitamin D supplementation, in the vitamin D deficient mother, prevents neonatal vitamin D deficiency. DESIGN: Open-label randomized controlled trial. SETTING: Metropolitan Melbourne, Australia, tertiary hospital routine antenatal outpatient clinic. PARTICIPANTS: Seventy-eight women with singleton pregnancies with vitamin D deficiency/insufficiency (serum 25-OH Vit D < 75 nmol/l) at their first antenatal appointment at 12-16-week gestation were recruited. INTERVENTION: Participants were randomized to vitamin D supplementation (2000-4000 IU cholecalciferol) orally daily until delivery or no supplementation. MAIN OUTCOME MEASURES: The primary outcome was neonatal serum 25-OH vit D concentration at delivery. The secondary outcome was maternal serum 25-OH vit D concentration at delivery. RESULTS: Baseline mean maternal serum 25-OH vit D concentrations were similar (P = 0·9) between treatment (32 nmol/l, 95% confidence interval 26-39 nmol/l) and control groups (33 nmol/l, 95% CI 26-39 nmol/l). Umbilical cord serum 25-OH vit D concentrations at delivery were higher (P < 0·0001) in neonates of treatment group mothers (81 nmol/l, 95% CI; 70-91 nmol/l) compared with neonates of control group mothers (42 nmol/l, 95% CI; 34-50 nmol/l) with a strongly positive correlation between maternal serum 25-OH Vit D and umbilical cord serum 25-OH vit D concentrations at delivery (Spearman rank correlation coefficient 0·88; P < 0·0001). Mean maternal serum 25-OH Vit D concentrations at delivery were higher (P < 0·0001) in the treatment group (71 nmol/l, 95% CI; 62-81 nmol/l) compared with the control group (36 nmol/l, 95% CI; 29-42 nmol/l). CONCLUSION: Vitamin D supplementation of vitamin D deficient pregnant women prevents neonatal vitamin D deficiency.

Disseminated Acanthamoeba sp. infection in a dog.

Several species of free-living amoebae can cause encephalomyelitis in animals and humans. Disseminated acanthamoebiasis was diagnosed in pyogranulomatous lesions in brain, thyroid, pancreas, heart, lymph nodes, and kidney of a one-year-old dog. Acanthamoeba sp. was identified in canine tissues by conventional histology, by immunofluorescence, by cultivation of the parasite from the brain of the dog that had been stored at -70 degrees C for two months, and by PCR. The sequence obtained from the PCR product from the amoeba from the dog was compared to other sequences in the Acanthamoeba sp. ribosomal DNA database and was determined to be genotype T1, associated with other isolates of Acanthamoeba obtained from granulomatous amebic encephalitis infections in humans.

Ultrasound evaluation of piglet diaphragm function before and after fatigue.

Clinically, a noninvasive measure of diaphragm function is needed. The purpose of this study is to determine whether ultrasonography can be used to 1) quantify diaphragm function and 2) identify fatigue in a piglet model. Five piglets were anesthetized with pentobarbital sodium and halothane and studied during the following conditions: 1) baseline (spontaneous breathing); 2) baseline + CO2 [inhaled CO2 to increase arterial PCO2 to 50-60 Torr (6.6-8 kPa)]; 3) fatigue + CO2 (fatigue induced with 30 min of phrenic nerve pacing); and 4) recovery + CO2 (recovery after 1 h of mechanical ventilation). Ultrasound measurements of the posterior diaphragm were made (inspiratory mean velocity) in the transverse plane. Images were obtained from the midline, just inferior to the xiphoid process, and perpendicular to the abdomen. M-mode measures were made of the right posterior hemidiaphragm in the plane just lateral to the inferior vena cava. Abdominal and esophageal pressures were measured and transdiaphragmatic pressure (Pdi) was calculated during spontaneous (Sp) and paced (Pace) breaths. Arterial blood gases were also measured. Pdi(Sp) and Pdi(Pace) during baseline + CO2 were 8 +/- 0.7 and 49 +/- 11 cmH2O, respectively, and decreased to 6 +/- 1.0 and 27 +/- 7 cmH2O, respectively, during fatigue + CO2. Mean inspiratory velocity also decreased from 13 +/- 2 to 8 +/- 1 cm/s during these conditions. All variables returned to baseline during recovery + CO2. Ultrasonography can be used to quantify diaphragm function and identify piglet diaphragm fatigue.

Diagnosis of ruptured intracranial dermoid cyst: value MR over CT.

The CT and MR findings of seven patients with pathologically proved ruptured dermoid cysts were reviewed to analyze the MR characteristics and to see if MR evaluation had significant advantages over CT. In six cases, both CT and MR identified fatty material in the CSF spaces. Hemorrhage complicated preoperative diagnosis in one case. Patterns of extraaxial fat distribution were as follows: intraventricular fat/CSF levels (three patients), generalized subarachnoid spread (six patients), and localized subarachnoid spread with sulcal widening (one patient). There was no correlation between fat distribution and clinical symptoms. MR showed the vascular involvement better than CT did in five of seven cases, and showed extension of the cysts into the skull base in two cases. Signal intensity of the solid mass was low on T1-weighted MR images and inhomogeneously high on T2-weighted images, which correlated pathologically with the presence of crystal cholesterol, hair, sebaceous glands, and epithelial cells in all cases. On MR, brain parenchyma showed little edema or other reaction to the masses, which were typically large. The value of MR over CT in the examination of ruptured dermoid cysts is the conspicuity of the extent of subarachnoid spread, involvement of the extraaxial structures, and evidence of vascular compromise, which can obviate angiography. MR had no advantage over CT in making the initial diagnosis of ruptured dermoid, but it would be the preferred preoperative study.

Demonstration of diastematomyelia and associated abnormalities with MR imaging.

Three patients were studied with a 0.3 T superconducting magnet to assess the role of magnetic resonance (MR) imaging in the recognition and evaluation of diastematomyelia and associated abnormalities. Comparison was made with other imaging techniques, including metrizamide computed tomographic (CT) myelography. With MR imaging, the divided spinal cord was well imaged in its entire craniocaudal extent, comparable to CT myelography. The bony septum, when it contained a marrow cavity, was also seen well. In two patients, dural ectasia and low position of the spinal cord with and without associated lipoma were clearly imaged. MR imaging demonstrated associated syringohydromyelia in one patient that was not detected by other radiologic studies. This preliminary experience with MR imaging of diastematomyelia suggests that once the bony details of the abnormality are defined, MR imaging can delineate the presence and extent of the divided spinal cord as well as its associated abnormalities adequately, obviating other studies.

Radiology, surgery, and the pediatric chest.

Preoperative imaging of the tracheobronchial tree should focus on identifying the location, severity, and extent of tracheal narrowing, as well as possible causes of extrinsic compression. Plain film radiography and esophagography can be supplemented with CT or MR imaging for the evaluation of mediastinal masses or vascular abnormalities impinging on the airway. Surgical planning for the removal of intrathoracic tumors or cysts requires a detailed evaluation of the location and extent of the lesion, identification of encasement or compression of vital structures, and intraspinal extension to determine resectability and the need for neurosurgical consultation. Precise preoperative histologic diagnosis in most patients is not essential for surgical planning. Although the anatomic information provided by CT and MR imaging is comparable, MR offers the advantage of multiple imaging planes and allows the identification of intraspinal involvement of posterior mediastinal tumors or neuroenteric cysts without the use of intrathecal contrast agents. Conversely, MR imaging has little role in the assessment of pulmonary parenchymal abnormalities. These are best imaged with radiography and CT. Plain film radiography and contrast esophagography are often sufficient for the identification and delineation of postoperative complications in the chest. Complex air or fluid collections, however, may require further study with CT or ultrasonography for better characterization.

Magnetic resonance imaging in the spinal column and craniovertebral junction.

The sensitivity of magnetic resonance imaging (MRI) to tissue alterations is particularly useful in spinal cord imaging. In addition to excellent anatomic display of this compact and complex area, syrinx cavities, tumors, and degenerating disks can be identified before they cause the anatomic distortion often necessary for detection by conventional means.

Relationship between nutrient intake, body mass index, menstrual function, and ballet injury.

The effects of inadequate nutrition, menstrual dysfunction, and low body weight on the injury rate of ballerinas were studied. Forty-nine female ballet dancers, mean age 18.7 years, completed food frequency and injury questionnaires. Subjects were placed in one of two groups: those with an intake less than 70% of the Recommended Dietary Allowances (RDA) for key nutrients and those with an intake greater than 70% of the RDA for key nutrients. Sixty-nine percent of the dancers had intakes less than 70% of the RDA and were randomly assigned to either a vitamin/mineral supplement or to placebo for 6 months. The remaining dancers with diets adequate (greater than 70% RDA) in key nutrients received no treatment. All groups were questioned monthly about the incidence, severity, and nature of ballet injuries. Information regarding menses and height and weight was obtained. There were no significant differences in the severity or type of injuries among the dancers in the supplement, placebo, or no treatment groups. Dancers with abnormal menses had more bone injuries (mean = 15.00) than normally menstruating dancers (mean = 4.97) (p less than .05). Dancers with a Body Mass Index less than 19.0 spent more days with a low-grade injury (mean = 24.05) than dancers with a greater BMI (mean = 11.63) (p less than .05). There appears to be a relationship between dance injuries and both BMI and menstrual function.

The relationship in neonates between clinically measured head circumference and brain volume estimated from head CT-scans.

OBJECTIVE: To determine if the frontal-occipital head circumference correlates with brain volume on CT and to investigate correlations between the volumes of different brain subdivisions in live neonates. METHODS: Records were studied from 27 neonates with anatomically normal head CT-scans which were ordered for clinical reasons, and which were performed at Johns Hopkins Hospital. Clinical data were abstracted from medical records. Brain volumes were estimated by digitizing the structures of interest on each slice of head CT-scans. RESULTS: In this sample of 27 infants with a mean birth weight of 3000.4 +/- 668 g, mean head circumference of 33.5 +/- 1.8 cm, and mean gestational age of 37 weeks and 4 days +/- 24 days, the mean of total brain volume was 333.0 +/- 78.3 ml. The correlation between clinically measured head circumference and total brain volume was 0.55 (P < 0.003). Regression of total brain volume on head circumference and its second and third powers accounted for 43% of the variation in total brain volume. Other predictor variables, namely infant race, sex, gestational age, and maternal age, were not significant in this regression once head circumference was included. The slope of the cubic function of head circumference as a predictor of brain volume was greatest below the mean head circumference of 33.5 cm. Brain volume leveled off at head circumferences greater than the mean. CONCLUSION: Head circumference is a powerful predictor of total brain volume in the neonate: below the approximate head-circumference mean of 33.5 cm, smaller head circumference indicates smaller total brain volume.

Effect of porcine reproductive and respiratory syndrome virus infection on the ovary and progesterone levels in third trimester pregnant sows.

Porcine reproductive and respiratory syndrome virus (PRRSV) is a common cause of reproductive failure and abortion in swine. The mechanism of abortion is not fully defined, and the effect of the virus on luteal function has not been explored. In this study, we exposed late-term pregnant swine to varied doses of PRRSV strain NADC-8 and evaluated effects on ovarian function by serial determination of plasma progesterone levels and by microscopic evaluation of ovarian pathologic alterations combined with immunohistochemistry and in situ hybridization to detect PRRSV antigen. We identified no specific trend in plasma progesterone level associated with PRRSV infection status and no microscopic ovarian lesions. PRRSV antigen was not demonstrated in ovarian tissues by immunohistochemistry or in situ hybridization at necropsy 21 days postexposure. Based on these findings, it does not appear that either a direct or an indirect effect on luteal function contributes to PRRSV-induced abortion.

Retropsoas hernia as a cause of chronic abdominal pain: CT diagnosis.

Congenital retropsoas small bowel herniation is reported as the cause of long-standing recurrent abdominal pain in a teenage girl. Knowledge of this entity is important for differential diagnosis of abdominal pain, mass, or retroperitoneal gas and fluid, and for avoiding complications of percutaneous renal interventions.

A spectrum of bronchopulmonary anomalies associated with tracheoesophageal malformations.

The combination of tracheoesophageal and pulmonary malformations is unusual and reportedly carries a high mortality. We have observed six patients with esophageal atresia and tracheoesophageal fistula and one with a bronchoesophageal fistula who had associated bronchopulmonary anomalies ranging from lobar hypoplasia and agenesis to unilateral pulmonary hypoplasia or agenesis. All of the pulmonary malformations were right-sided. Vertebral or rib anomalies were present in five patients, congenital heart disease in two, imperforate anus in one and one patient had radial aplasia and Pierre Robin syndrome. The bronchopulmonary anomalies complicated the surgical care of tracheoesophageal malformations and required radiologic differentiation from aspiration pneumonia and atelectasis. Six of the seven patients survived. Mortality and morbidity were related to complications and associated cardiac anomalies as well as severity of the lung anomaly.

Effect of oral sensorimotor treatment on measures of growth, eating efficiency and aspiration in the dysphagic child with cerebral palsy.

Twenty-seven children (mean age 5.1 years) with cerebral palsy and moderate eating impairment were studied to determine frequency of aspiration and the effect of 10 and 20 weeks of oral sensorimotor therapy on eating efficiency and measures of growth (weight, skinfold thickness). The eating efficiency of the children did not change markedly in response to oral sensorimotor therapy. Children maintained their centile rank in weight-for-age and skinfold-for-age measurements. However, there was no catch-up growth. The findings suggest that eating efficiency is not a good estimator of treatment outcome, but rather a diagnostic indicator of the severity of eating impairment. Monitoring of these children's growth is essential in order to provide nutritional rehabilitation as soon as their eating skills can no longer keep up with growth demands.