Serum soluble FMS-like tyrosine kinase 1 and placental growth factor concentration as predictors of preeclampsia in high risk pregnant women.

Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) contribute in the development of preeclampsia and are suggested as prediction markers in healthy pregnant women but limited data is available in women with major preeclampsia risk factors. This study aimed to determine the role of sFlt-1 and PlGF in predicting preeclampsia among high risk pregnant women. This was a prospective study and samples were collected for a period of ten months. Blood samples were obtained from 84 pregnant women who had at least one risk factor for preeclampsia at 25 to 28 weeks and at 29 to 36 weeks of gestation. SFlt-1 and PlGF concentrations were determined by immunoassay method. There were significantly higher median sFlt-1 and sFlt-1:PlGF ratio at gestational interval 25 to 28 weeks and sFlt-1:PlGF ratio at 29 to 36 weeks in high risk women who developed preeclampsia. Significant lower median serum PlGF levels at 25 to 28 weeks and 29 to 36 weeks were observed in this group of women. In conclusion, the concentrations of these markers were altered in high risk preeclamptic women, a similar pattern seen in low risk preeclamptic women. However the predictive value of these markers could not be established clearly.

Correlation of serum insulin like growth factor-I with retinopathy in Malaysian pregnant diabetics.

AIM: To study the association of serum insulin-like growth factor-I (IGF-I) with diabetic retinopathy. METHODS: Serum IGF-1 levels were measured in 25 pregnant diabetic patients and 25 pregnant non-diabetic patients who were matched for age, ethnicity, parity and period of gestation. Fundus examination was performed in both groups at 28, 32 and 36 weeks of gestation. RESULTS: The serum IGF-I level was significantly elevated in pregnant diabetics compared to pregnant non-diabetics (366±199µg/L vs 184±89µg/L, (P=0.0001) at 24 weeks, 535±251µg/L vs 356±89µg/L, (P=0.007) at 32 weeks and 404±166µg/L vs 264±113µg/L, (P=0.003) at 36 weeks of gestation). The pregnant diabetics with established diabetes had significantly higher IGF-1 level than gestational diabetes at 28, 32 and 36 weeks of gestation. The serum IGF-I level in pregnant diabetics with retinopathy was significantly higher than that in those without retinopathy at all periods of gestation. CONCLUSION: Increased serum IGF-1 in pregnancy may increase the risks for retinopathy.

Lymphangioma: Is intralesional bleomycin sclerotherapy effective?

PURPOSE: This study aims to evaluate the effectiveness of intralesional bleomycin sclerotherapy in the treatment of lymphangioma in children and to determine the incidence of complications in the treatment. METHODS: This is a retrospective study of 24 children diagnosed with lymphangioma and treated with intralesional injection of bleomycin aqueous solution from January 1999 to December 2004. RESULTS: Complete resolution was seen in 63% (15/24) of lesions, 21% (5/24) had good response and 16% (4/24) had poor response. The tumour recurred in 2 patients. Two other patients had abscess formation at the site of injection. No other serious complications or side effects were observed. CONCLUSION: Intralesional bleomycin therapy was very effective in the treatment of lymphangioma. Our results were comparable to other published studies. Bleomycin administered as intralesional injection was found to be safe as there was no serious complication or side effect observed in this study.

Invasive aspergillosis in paediatric oncology patients.

Invasive aspergillosis predominantly occurs in immunocompromised patients and is often resistant to different therapeutically strategies. However, mortality significantly increases if the central nervous system is affected. In this report we describe two cases of invasive aspergilosis, one with kidney involvement with a successful treatment while the other with pulmonary and cerebral involvement with a grave outcome.

Perioperative mortality review in relation to pregnancy-related deaths.

Pregnancy-related deaths in four published perioperative mortality review reports were analysed. The aim is to look at the quality of surgical and anaesthetic services along with the perioperative care provided. The audit identified shortfalls in the logistic and support services and recommended remedial strategies. The review was conducted by a committee consisting of practising anaesthetists, surgeons and obstetricians who analysed the questionnaires collectively. A consensus was reached to categorise the death. There were 280 pregnancy-related deaths. Post-partum haemorrhage accounted for 31.8%, followed by hypertensive disorders of pregnancy (20.0% obstetric embolism (16.1%), sepsis (10.7%) and associated medical conditions (21.4%). In brief, there were comings in preoperative, intra-operative and post-operative care in some of the cases. Increased consultant input, clinical audit, improvements in monitoring and expansion of critical care facilities were the integral issues recommended.

The treatment of neck lymphangioma with intralesional injection of bleomycin.

We report our experience with intralesional injection of bleomycin in the treatment of neck lymphangioma. From May 1995 to April 1998, 11 patients aged between 6 to 22 months were treated with intralesional bleomycin injection. Ultrasonography and computed tomography were used to assess and select the cases suitable for sclerotherapy. Patients with lesions encasing the internal jugular vein and the carotid artery were chosen. With the patient under sedation and using ultrasound guidance, the cysts were aspirated and bleomycin was injected at a dose of 0.5 mg/kg body weight. The number of procedures varied from 1 to 4 over a period of 8 months to 1 year. Patients were initially followed-up 3 monthly, then 6 monthly and subsequently yearly. In 4 patients, the neck mass was no longer visible (excellent response). In 5 patients, the neck mass had reduced to a size (more than 50% reduction) that was cosmetically acceptable (good response). There were 2 failures (poor response). There were no complications. Our results suggest that intralesional injection of bleomycin can be effectively used to treat selected cases of neck lymphangiomas.

Tumoral cystitis in children.

Three children aged 3-11 years had ultrasonography of the urinary tract for the investigation of dysuria and haematuria. A bladder mass was seen in these 3 children. One child had computed tomography scan, cystoscopy and bladder biopsy because rhabdomyosarcoma was considered. The biopsy revealed an inflammatory process. The urine culture of the other 2 children revealed E. coli. On ultrasonography, the inflammatory mass may appear homogeneously hypoechoic or may contain moderate level echoes. The mucosal surface of the mass may be smooth or lobulated. It is important to consider an infective cause for a bladder mass in children because computed tomography, cystoscopy and biopsy may be avoided.