CD8+CD60+ T cells, cells expressing epsilon specific mRNA and Th1/Th2 cytokines in cord blood and at 7 months of age.

IgE levels in cord blood have been investigated as predictors of atopy, but no definitive findings have been made. Other factors, including cells and/or cytokines may serve as predictors of this disease. Cord blood and peripheral blood was obtained at birth and at 7 months of age, respectively, from children (n = 2) with a family history of allergy. Cells in cord blood and peripheral blood were phenotyped and levels of serum immunoglobulins (IgM, IgG, IgA and IgE) were determined. In addition, placentas from these pregnancies were obtained and stained for IgE+ cells and CD8+CD60+ T cells. We found immunoglobulin levels were within normal ranges although IgE levels were negligible in cord blood and at 7 months of age. Similar numbers of CD8+ T cells and CD19+ B cells were detected in cord blood and at 7 months of age. However, CD4+ T cells increased (twofold) and CD16+/CD56+ natural killer precursor cells decreased (twofold) at 7 months of age. CD8+ T cells in their cord blood and at 7 months of age comprised of >50% CD8+CD60+ T cells. Cord blood cells expressed epsilon-specific mRNA and mRNA for interleukin-2 (IL-2), IL-4, IL-10 and interferon-gamma (IFN-gamma) but not IL-6. At 7 months of age, peripheral blood mononuclear cells expressed epsilon-specific mRNA and mRNA for all cytokines. In the placental membrane, we detected IgE+ cells, while CD8+CD60+ T cells were detected in the chorionic villi. CD8+CD60+ T cells, cells expressing epsilon-specific and IL-6-specific mRNA may contribute to the pathobiology and provide important prognostic indicators of atopy.

Association between a shift in vaginal flora on Papanicolaou smear and acute chorioamnionitis and preterm delivery.

Bacterial vaginosis has been implicated as a cause of acute chorioamnionitis and preterm delivery. This study was designed to determine any association between the detection of bacterial vaginosis on a prenatal Papanicolaou (Pap) smear, defined as a shift in vaginal flora, and the subsequent occurrence of acute chorioamnionitis or preterm labor. A 47-mo retrospective case-control analysis comparing 186 patients with histologically-proven acute chorioamnionitis (cases) and 186 controls was performed. Initial prenatal Pap smears were evaluated for the presence of altered vaginal flora. Pap smears from women with acute chorioamnionitis were more likely to have altered vaginal flora than those without chorioamnionitis (P < 0.01). Preterm delivery was also more common among women with a shift in vaginal flora (P < 0.01). In conclusion, women at risk for chorioamnionitis and/or preterm delivery may be able to be identified by the results of their prenatal Pap smear.

A system for the delivery of remote obstetrical care by telepresence.

This paper describes the development of a system to provide obstetrical care to remote and/or medically underserved areas. The ROC project is an attempt to develop new telemedicine hardware and software which will enable the provision of high quality obstetric care to individuals who are normally denied access to this care by reasons of distance, handicap, economics, or other causes. As broadband data communications links and increasingly powerful and affordable computing resources become widely available, the barriers of distance and economics will no longer prevent the provision of this care. Increased efficiency and access may also meet society's requirements for cost containment and productivity.

Molecular topography of the secondary constriction region (qh) of human chromosome 9 with an unusual euchromatic band.

Heterochromatin confined to pericentromeric (c) and secondary constriction (qh) regions plays a major role in morphological variation of chromosome 9, because of its size and affinity for pericentric inversion. Consequently, pairing at pachytene may lead to some disturbances between homologous chromosomes having such extreme variations and may result in abnormalities involving bands adjacent to the qh region. We encountered such a case, where a G-positive band has originated de novo, suggesting a maternal origin from the chromosome 9 that has had a complete pericentric inversion. In previously reported cases, the presence of an extra G-positive band within the 9qh region has been familial, and in the majority of those cases it was not associated with any clinical consequences. Therefore, this anomaly has been referred to as a "rare" variant. The qh region consists of a mixture of various tandemly repeated DNA sequences, and routine banding techniques have failed to characterize the origin of this extra genetic material. By the chromosome in situ suppression hybridization technique using whole chromosome paint, the probe annealed with the extra G-band, suggesting a euchromatic origin from chromosome 9, presumably band p12. By the fluorescence in situ hybridization technique using alpha- and beta-satellite probes, the dicentric nature was further revealed, supporting the concept of unequal crossing-over during maternal meiosis I, which could account for a duplication of the h region. The G-positive band most likely became genetically inert when it was sandwiched between two blocks of heterochromatin, resulting in a phenotypically normal child. Therefore, an earlier hypothesis, suggesting its origin from heterochromatin through so-called euchromatinization, is refuted here.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring system for adverse events following immunization.

The Monitoring System for Adverse Events Following Immunization (MSAEFI) has collected data from the public sector nationwide on adverse events occurring during the 4-week period following administration of vaccine. From 1979 to 1984, 6483 reports were received. Although rates of reporting have increased throughout the 6-year period, increases were larger for less serious events (209%) than for more serious events (53%). The MSAEFI data have been used to evaluate risk factors for adverse events following immunization, will continue to provide information on the safety of both current and future vaccines and may identify other factors that increase the risks of adverse events following immunization.

History of convulsions and use of pertussis vaccine.

Data on 2062 reports from the Monitoring System for Adverse Events Following Immunization, Centers for Disease Control (CDC), were analyzed to compare the risk of a personal or family history of convulsions in children who had a neurologic adverse event after receipt of diphtheria-tetanus-pertussis (DTP) vaccine with those who had a nonneurologic adverse event. Children with a neurologic event after DTP vaccine had a 7.2 times higher risk for personal history of convulsions (95% confidence limits 4.5 to 11.5) and a 4.5 times higher risk for family history of convulsions (95% confidence limits 3.1 to 6.7) than did children with an adverse event that did not affect the nervous system. Children with either a febrile or nonfebrile convulsion after receipt of DTP were significantly more likely to have a personal history of convulsions than children with a nonneurologic adverse event (P less than 0.0001). Children with a febrile convulsion after receipt of DTP but not children with nonfebrile convulsions were significantly more likely to have a family history of convulsions than those with a nonneurologic adverse event. It is recommended that pertussis vaccination be deferred in children with a personal history of a convulsion until it can be determined that an evolving neurologic disorder is not present. If such disorders are found, these children should be given the combined pediatric diphtheria and tetanus toxoids (DT) vaccine to complete the series.

Adverse events following immunization with DTP vaccine.

The Monitoring System for Adverse Events Following Immunization became fully operational in late 1978 in all 50 States, New York City and Washington, D.C. This system compiles information on adverse events temporally associated (within four weeks) to the administration of a vaccine. A total of 2,062 reports of adverse events following diphtheria and tetanus toxoids and pertussis vaccine (DTP) were received between 1979 and 1982. The number of reports received in 1979 was 387, increasing to 707 reports in 1982. The increase is predominantly in local reactions and fever. The number of persons with serious illnesses temporally associated with vaccine remained relatively constant over the four year period. The overall rate of reported adverse events following DTP (70.8 per million doses administered in the public sector) was about twice that of Td (33.5) or DT (38.4); however it was not substantially different from those following measles- or rubella-containing vaccines. Those who had convulsions (whether febrile or non-febrile) following receipt of DTP vaccine were substantially more likely to have had a personal history of convulsions than those who had a non-neurologic adverse event following DTP (p less than 0.0001). This information, along with data from the literature, has led to recent recommendations by advisory groups in the United States that any infant or child with a personal history of convulsions should be thoroughly evaluated before initiating or continuing immunization with pertussis vaccine.

Reversal of intractable uremic pericarditis by triamcinolone hexacetonide.

Of 74 patients undergoing long-term hemodialysis who were observed during a 21-month period, seven developed uremic pericarditis. Five of these patients developed intractable pericarditis, unresponsive to intensive dialysis and pericardiocentesis, and were treated with prolonged pericardial drainage (16 to 60 hours) by an indwelling polyethylene catheter and instillation of triamcinolone hexacetonide. Evidence of intractability was based on either the recurrence of cardiac tamponade after pericardiocentesis (two patients) or progression in the size of the pericardial effusion despite four weeks of intensive dialysis (three patients). These five patients recovered and subsequently were observed from 1 to 15 months with no evidence of recurrent pericarditis. This procedure may be an effective alternative to the surgical management of intractable uremic pericarditis, particularly in the patient at high risk for anesthesia and major surgery.