Pregnancy outcome after ultrasound diagnosis of fetal intra-abdominal umbilical vein varix.

OBJECTIVES: Fetal intra-abdominal umbilical vein (FIUV) varix is a focal dilatation of the intra-abdominal portion of the umbilical vein, which has been reported to be associated with intrauterine death and other anomalies. Our aim was to examine our experience with this diagnosis at a single tertiary-care center and to correlate it with clinical outcome. METHODS: This was a retrospective case series study. Our ultrasound database was searched for all cases with a diagnosis of FIUV varix identified at our facility between 1997 and 2007. We reviewed all ultrasound examinations, maternal antenatal records, delivery records and newborns' medical records. RESULTS: We identified 52 cases of FIUV among a population of approximately 68,000. Three cases of trisomy 21 were identified, all of which were accompanied by other anomalies. There was intrauterine death of one fetus with trisomy 21 at 35 weeks of gestation. We did not find an association between FIUV varix and other obstetric complications. CONCLUSIONS: The outcome of pregnancies with FIUV varix is generally favorable. The finding of a FIUV varix should prompt the search for other anomalies, especially markers of aneuploidy.

Double-peak emission of hot electrons generated by femtosecond laser interaction with solid targets.

Double-peak emission of hot electrons has been observed in the interaction of a 60-fs, 125-mJ, 800-nm, p-polarized laser pulse with Al targets. One peak in the specular direction is due to the reflected laser light, which excites a plasma wave to accelerate electrons. The other peak, which is more consistent with theories of Phys. Plasmas 6, 2855 (1999)] and Phys. Rev. Lett 82, 743 (1999)], is produced by the resonance absorption at approximately 15 degrees from the target normal.

The effect of 17beta-estradiol on isolated omental arteries from preeclamptic women.

OBJECTIVE: To study the effect of 17beta-estradiol on isolated omental arteries from preeclamptic women. STUDY DESIGN: Rings of omental artery with intact endothelium were mounted in organ chambers for isometric tension recording. We studied the effect of pharmacological concentrations of 17beta-estradiol on potassium chloride-induced tension and the concentration-contraction relationships for norepinephrine and calcium. RESULTS: Cumulative application of 17beta-estradiol, in a concentration-dependent manner, relaxed potassium chloride contracted rings. Sixty minutes of incubation with 17beta-estradiol (10(-5)mol/l) attenuated the tension developed in response to potassium chloride, norepinephrine and calcium. Tamoxifen (10(-6)mol/l) did not antagonize the inhibitory actions of 17beta-estradiol. CONCLUSIONS: Pharmacological concentrations of 17beta-estradiol retain the capability for relaxing omental artery rings from preeclamptic women. The loss of refractoriness to norepinephrine, increased responsiveness to calcium ions and decreased ability of 17beta-estradiol to inhibit calcium-induced tension may be responsible for increased vascular reactivity in preeclampsia.

Candida chorioamnionitis: a report of two cases.

Intra-amniotic infection (IAI) across intact membranes by Candida albicans is a rare occurrence. We report two cases of preterm labor and Candida chorioamnionitis that were diagnosed by intrapartum amniocentesis. The diverse maternal and neonatal outcomes observed indicate that Candida IAI is associated with significant, unpredictable maternal and neonatal morbidity.

Prolonged prior infection with Chlamydia prevents adverse pregnancy outcome in a murine model.

OBJECTIVE: Our purpose was to compare the rate of adverse pregnancy outcome in pregnant mice with lower genital tract chlamydial infection who had a prior short chlamydial infection versus a prior long-term infection. STUDY DESIGN: A total of 127 female mice were divided into short-term and long-term infection groups. We infected the lower genital tracts with Chlamydia trachomatis. After 7 days in the short-term infection group and 30 days in the long-term infection group, we treated the mice with tetracycline-impregnated chow. After documentation of cure, the mice were mated and transvaginally reinfected with Chlamydia trachomatis. Forty-one of the 127 (32%) mice became pregnant. We noted the number of mice with fetal death and the number of pups present. We cultured the lower uterine segment and the pups for Chlamydia. RESULTS: Seven of 21 (33%) mice in the short-term infection group had fetal deaths compared with 1 of 20 (5%) in the long-term infection group (p < 0.05). In the short-term infection group 21 of 21 (100%) mice had positive transvaginal chlamydial cultures after reinoculation compared with only 7 of 20 (35%) in the long-term infection group (p < 0.000004). Seventeen of 21 (81 %) mice in the short-term infection group had positive chlamydial cultures from the lower uterine segment versus 1 of 20 (5%) in the long-term infection group (p < 0.000001). Sixty-five percent of pups in the short-term infection group and none (0%) of the pups in the long-term infection group were positive for Chlamydia (p < 0.00001). CONCLUSIONS: We conclude that in this murine model a prior 30-day genital tract infection with Chlamydia protects pregnant mice from subsequent reinfection and adverse pregnancy outcomes.

The direct action of 17 beta-estradiol in isolated omental artery from nonpregnant and pregnant women is related to calcium antagonism.

OBJECTIVE: Our purpose was to study the mechanism by which 17 beta-estradiol modulates contractile activity in isolated rings of omental artery from nonpregnant and pregnant patients. STUDY DESIGN: Rings of omental artery with intact endothelium from nonpregnant and pregnant women were mounted in organ chambers for isometric tension recording. The concentration-relaxation relationship to 17 beta-estradiol (10(-7) mol/L to 3 x 10(-5) mol/L) was studied in rings contracted with 60 mmol/L potassium chloride (in both the absence and the presence of tamoxifen, 10(-6) mol/L). The effect of 17 beta-estradiol (10(-5) mol/L) on the contraction induced by 60 mmol/L potassium chloride and on the concentration-contraction relationships to both norepinephrine (10(-9) mol/L to 10(-5) mol/L) and calcium ion (0.05 mmol/L to 2.5 mmol/L in calcium-free depolarizing solution) were studied in the presence and absence of tamoxifen (10(-6) mol/L). The maximal contraction, negative logarithm of the concentration producing 50% relaxation or 50% contraction to the reference 60 mmol/L potassium chloride contraction, and the area under the curve were calculated. Data analysis was by one-way analysis of variance, Newman-Keuls test, and two-sample tests as appropriate. Probability values less than 0.05 in a two-tailed test were considered statistically significant. RESULTS: 17 beta-Estradiol relaxed omental arteries contracted with 60 mmol/L potassium chloride, and this effect was potentiated by tamoxifen in both groups. Incubation of the omental arteries with 17 beta-estradiol inhibited contractions induced by 60 mmol/L potassium chloride in rings from both groups of patients, and tamoxifen did not antagonize this effect in either group. Rings of omental artery from the nonpregnant patients (expressed as percentage of the reference potassium chloride contraction) showed greater contraction than rings from the pregnant women when exposed to norepinephrine, a statistically significant difference. 17 beta-Estradiol decreased the norepinephrine-induced contraction in omental arteries from nonpregnant but not pregnant women in a statistically significant way. Tamoxifen did not influence the effect of norepinephrine for either group. 17 beta-Estradiol inhibited calcium ion-induced contraction similarly in rings of omental artery from both nonpregnant and pregnant patients. Tamoxifen potentiated estradiol-induced inhibition in arteries from pregnant patients. CONCLUSIONS: 17 beta-Estradiol inhibits norepinephrine-induced contractions in omental arteries from nonpregnant but no pregnant patients. The inhibition of the ter sion developed after exposure to potassium chloride, norepinephrine, and calcium ion is caused by a calcium channel blocking action.

Crossed cerebellar atrophy in children: a neurologic sequela of extreme prematurity.

Unilateral atrophy of a cerebellar hemisphere occurring as a sequela of ischemic or destructive injury of the contralateral cerebral hemisphere is uncommon in children. We reviewed our experience with this phenomenon and found an unexpected association with extreme prematurity and a complicated perinatal course with a poor subsequent neurologic outcome. We retrospectively identified eight children, aged 8 months to 13 years, in whom cerebellar atrophy associated with cerebral injury was diagnosed on MR or CT, and reviewed their past medical history, neurologic findings, and neuroimaging studies. Seven patients were born extremely premature, EGA 25-28 weeks, and had severe perinatal intracranial hemorrhage. Neurologic problems include severe developmental delay in seven, spastic paresis in six, and seizures in five. Neuroimaging showed severe unilateral holohemispheric atrophy in four, bilateral asymmetric holohemispheric atrophy in two, and left temporoparietal atrophy in one. Cerebellar atrophy was unilateral in five and bilateral but asymmetric in two. Gliosis of the atrophic cerebellum occurred in one patient. Sequential neuroimaging in one patient showed evolution of crossed cerebellar atrophy at 8 months of age. The final patient, a term infant, had an idiopathic perinatal left cerebral infarct. In our experience, crossed cerebellar atrophy was an uncommon manifestation of extreme prematurity complicated by severe intracranial hemorrhage and/or ischemic necrosis of white matter. The cerebellar atrophy is most often a secondary degenerative phenomenon rather than a result of direct cerebellar injury.

Protein accumulation in cerebrospinal fluid during -90 degrees head-down tilt in rabbit.

Plasma proteins are only somewhat larger than the intercellular spaces of the cerebral microvessels that constitute the blood-brain barrier or of the choroid plexus villi that elaborate cerebrospinal fluid (CSF). We hypothesized that the integrity of these barriers in anesthetized rabbits might be compromised during head-down tilt (HDT). Plasma protein and osmolality, hematocrit, and CSF protein concentration were compared in rabbits exposed to 1 h of HDT (n = 20) and prone rabbits (n = 10). In addition, the concentration of trypan blue dye, injected intravenously at the end of HDT or the prone position, was measured in brain homogenate. Finally, arterial blood pressure was measured via a catheterized carotid artery. HDT disrupted the barrier between blood and CSF, as indicated by a significantly (P < 0.01) greater brain trypan blue concentration in the HDT rabbits [172.2 +/- 14.4 (SD) micrograms/g dry wt] than in the prone rabbits (29.8 +/- 4.4 micrograms/g dry wt). Moreover CSF protein 5 min after HDT onset was significantly increased compared with control in HDT rabbits (54.6 +/- 1.9 vs. 81.4 +/- 5.2 mg/dl; n = 8) but not in prone rabbits (55.6 +/- 2.7 vs. 57.2 +/- 5.0 mg/dl; n = 6). Changes in the plasma protein-to-hematocrit ratio in the HDT animals, but not in the prone animals, were also compatible with a loss of fluid from the vascular compartment.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of clinical intra-amniotic infection and meconium.

The objective of this study was to determine the rate of intra-amniotic infection in patients with meconium-stained amniotic fluid compared to controls. With a retrospective case-controlled study design, we compared 100 pregnant women with meconium to 100 pregnant women without meconium for the development of intra-amniotic infection. Patients delivered between September 1 and December 31, 1990. Exclusion criteria were active infection prior to labor or antibiotic use within the 7 days prior to delivery. We diagnosed clinical intra-amniotic infection in patients with ruptured membranes by a maternal temperature 100.4 degrees F or higher and any two of the following: maternal or fetal tachycardia, uterine tenderness, white blood cell count 10,500 mm3 or more, or foul-smelling amniotic fluid. Demographic variables, labor characteristics, maternal infectious morbidity, and neonatal outcome were analyzed using the Wilcoxin rank test, chi-square test, or Fisher's exact test as appropriate. The rate of clinical intra-amniotic infection was significantly higher in women with meconium-stained amniotic fluid (8%) compared with women with no meconium (2%) (p = 0.05).