RESUMO
Pylephlebitis, or suppurative thrombophlebitis of the portal vein, typically occurs in the context of an intraabdominal infection or abdominal sepsis. Antibiotics are the mainstay of treatment. The role of anticoagulation in the management of pylephlebitis is controversial, and data regarding its impact on outcomes is limited. The records of 67 consecutive patients with pylephlebitis treated at our institution over a 19 year period were retrospectively reviewed. Data was gathered regarding their baseline characteristics, presentations, management, and outcomes. Patients who did and did not receive anticoagulation were compared. Outcomes of interest included survival, portal vein thrombosis (PVT) resolution, development of chronic symptomatic portal hypertension, and major bleeding. Forty-seven patients received anticoagulation and 20 did not. The anticoagulated and non-anticoagulated groups did not differ significantly with respect to potential covariates or confounders. Anticoagulated patients had significantly higher rates of PVT resolution than non-anticoagulated patients (58% vs. 21%, p = 0.0201). This translated to lower rates of future chronic portal hypertensive symptoms among anticoagulated patients (11% vs. 47%, p = 0.0034). Anticoagulated patients had a trend toward improved survival however this improvement was not significant on multivariable analysis. There was no significant difference in rates of major bleeding between groups. Thrombophilia testing was common in this cohort however the occurrence of meaningful positive results was exceedingly low. Anticoagulation significantly improves the rate of PVT resolution, and significantly reduces the rate of chronic symptomatic portal hypertension, among patients with pylephlebitis. Treatment of pylephlebitis should incorporate the use of systemic anticoagulation whenever possible.
Assuntos
Anticoagulantes/administração & dosagem , Flebite/diagnóstico por imagem , Flebite/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Trombofilia/sangue , Trombofilia/diagnóstico por imagem , Trombofilia/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
AIM: We aimed to investigate the association between serum levels of resistin and the biochemical and histological features of patients with nonalcoholic fatty liver disease (NAFLD) to determine the usefulness of this relationship in the clinical practice. METHODS: A total of 97 patients with NAFLD and 66 age- and sex-matched healthy controls were recruited. Detailed epidemiological, anthropometric and laboratory data were recorded. Serum levels of resistin were measured with ELISA. RESULTS: Serum levels of resistin were significantly higher in patients with NAFLD (32.10±10.0 ng/mL and 26.57±13.60 ng/mL, respectively) compared with healthy controls (P=0.003). Serum resistin levels were associated with AST, ALT, HOMA-IR, histological steatosis, portal inflammation and nonalcoholic steatohepatitis (NASH) scores. The serum levels of resistin were significantly higher in patients with definite NASH compared to patients with simple steatosis (29±13 and 20±10 ng/mL, respectively, P=0.03). There was no association between the serum resistin levels and the liver fibrosis stages. CONCLUSION: Our data suggest that resistin levels are elevated in patients with NAFLD and could discriminate simple steatosis from definite NASH.
Assuntos
Fígado Gorduroso/sangue , Resistência à Insulina , Resistina/sangue , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Estudos de Casos e Controles , Fígado Gorduroso/complicações , Fígado Gorduroso/patologia , Fígado Gorduroso/fisiopatologia , Feminino , Humanos , Fígado/patologia , Masculino , Hepatopatia Gordurosa não Alcoólica , Flebite/sangue , Sistema Porta , VasculiteRESUMO
OBJECTIVE: To describe the etiology, symptoms and management of portal vein thrombosis associated with biliary tract infection and to compare our findings with classical causes of pylephlebitis. MATERIAL AND METHODS: We performed a retrospective descriptive study of 10 patients in a tertiary hospital. RESULTS: Portal vein thrombosis was associated with biliary tract infection in seven patients and with classical causes of pylephlebitis in three. In both groups, symptoms consisted of fever and abdominal pain accompanied by leukocytosis and increased liver enzymes. Blood cultures were positive in most patients and the main complication was liver abscess. The therapeutic management and outcomes were similar in both groups. CONCLUSIONS: Portal vein thrombosis can be associated with biliary tract infection. Clinical presentation and outcomes are highly similar to those in classical causes of pylephlebitis.
Assuntos
Colangite/complicações , Flebite/complicações , Veia Porta/patologia , Trombose Venosa/etiologia , Dor Abdominal/etiologia , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Aspartato Aminotransferases/sangue , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Carcinoma Hepatocelular/complicações , Colangite/sangue , Colangite/diagnóstico , Colangite/tratamento farmacológico , Colangite/cirurgia , Terapia Combinada , Diagnóstico por Imagem/métodos , Drenagem , Feminino , Hepatectomia/métodos , Humanos , Leucocitose/etiologia , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Flebite/tratamento farmacológico , Estudos Retrospectivos , Trombose Venosa/sangue , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , gama-Glutamiltransferase/sangueRESUMO
PURPOSE: Oxidative damage to cellular membranes plays an important role in the pathobiology of tissue injury. Free radical-induced peroxidation of membrane lipid and protein is associated with alterations in cellular, morphological, biochemical, and physical dynamics, which are related to the mobility of lipid molecules. Retinal photoreceptors and platelets have been shown to be an easy target of oxidants because of their high proportion of polyunsaturated fatty acids. This study was undertaken, for the first time, to investigate membrane fluidity in the platelets of patients with Eales' disease. METHODS: Assays of malonaldialdehyde levels and the enzymes superoxide dismutase and catalase and fluorescence polarization, for estimating membrane fluidity, were carried out on platelets from 20 patients with Eales' disease (stage 1 characterized by periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages) and 15 healthy controls. RESULTS: A significant increase was observed in the malonaldialdehyde levels. A significant decrease in the activity of superoxide dismutase and catalase was also observed. Platelet fluorescence polarization was significantly higher in the patients, indicating decreased membrane fluidity compared to controls (p<0.01). CONCLUSION: A decrease in platelet membrane fluidity occurs as a result of oxidative stress in retinal periphlebitis in Eales' disease. The decreased membrane fluidity suggests alterations in the physiological events, which may result in alterations in the functioning of retinal photoreceptors.
Assuntos
Plaquetas/metabolismo , Fluidez de Membrana/fisiologia , Estresse Oxidativo/fisiologia , Flebite/sangue , Vasculite Retiniana/sangue , Veia Retiniana , Adulto , Biomarcadores/sangue , Humanos , Malondialdeído/sangue , Índice de Gravidade de Doença , Superóxido Dismutase/sangueRESUMO
OBJECTIVE: Elevated serum IgG4 levels are an important hallmark for diagnosing IgG4-related disease (IgG4-RD), but can also be observed in other diseases. This study aimed to compare two different testing methods for IgG4: ELISA and nephelometric assay. Both assays were used to measure serum IgG4 concentrations, and to assess the prevalence of high serum IgG4 levels in both IgG4-RD and non-IgG4-RD diseases. METHODS: A total of 80 serum samples were tested using the nephelometric assay and ELISA method that we established. Serum IgG4 concentrations were determined by ELISA for 957 patients with distinct diseases, including 12 cases of IgG4-RD and 945 cases of non-IgG4-RD. RESULTS: IgG4 levels from 80 selected serum samples examined by ELISA were in agreement with those detected using the nephelometry assay. Meanwhile, the serum IgG4 concentrations measured by ELISA were also consistent with the clinical diagnoses of patients with IgG4-RD during the course of disease. The Elevated levels of serum IgG4 (>1.35 g/L) were detected in all IgG4-RD (12/12) patients, and the prevalence of high IgG4 serum levels was 3.39% in non-IgG4-RD cases. Among them, the positive rates of serum IgG4 were 2.06% in patients with carcinoma and 6.3% in patients with other non-IgG4 autoimmune diseases. CONCLUSION: Our established ELISA method is a reliable and convenient technique, which could be extensively used in the clinic to measure serum IgG4 levels. High levels of IgG4 were observed in IgG4-RD. However, this phenomenon could also be observed in other diseases, such as carcinomas and other autoimmune diseases. Thus, a diagnosis of IgG4 disease cannot only be dependent on the detection of elevated serum IgG4 levels.
Assuntos
Ensaio de Imunoadsorção Enzimática/métodos , Hipergamaglobulinemia/sangue , Imunoglobulina G/sangue , Doenças Autoimunes/sangue , Carcinoma/sangue , Doenças Cardiovasculares/sangue , Doenças do Sistema Digestório/sangue , Feminino , Fibrose , Doenças dos Genitais Femininos/sangue , Doenças Hematológicas/sangue , Humanos , Hipergamaglobulinemia/diagnóstico , Hipergamaglobulinemia/etiologia , Hipergamaglobulinemia/patologia , Infecções/sangue , Nefropatias/sangue , Masculino , Neoplasias/sangue , Nefelometria e Turbidimetria , Doenças do Sistema Nervoso/sangue , Flebite/sangue , Flebite/etiologia , Flebite/imunologia , Plasmócitos/imunologia , Plasmócitos/patologia , Transtornos Respiratórios/sangueRESUMO
OBJECTIVE: To characterize a group of phakic patients with idiopathic intermediate uveitis as defined by vitritis, cystoid macular edema, and retinal periphlebitis. DESIGN: Cross-sectional study. PARTICIPANTS: Nineteen phakic patients (35 eyes) with vitreous inflammation, cystoid macular edema, and/or retinal periphlebitis of unknown cause. INTERVENTION: None. MAIN OUTCOME MEASURES: Best-corrected final visual acuities, standardized clinical examinations, photographic and fluorescein angiographic evaluations, and class I and II HLA analysis on all 19 patients. RESULTS: Fifteen of the 19 patients were women. The mean age was 38 years, the mean follow-up was 104 months, and the mean duration of symptoms was 154 months. All 35 affected eyes had significant vitritis; 21 eyes (60%) had cystoid macular edema, 21 eyes (60%) had retinal periphlebitis. The median initial visual acuity was 20/30. The median final visual acuity was 20/20 with 32 (91%) of 35 eyes having 20/40 or better visual acuity at the final visit. No patient developed "snow-banks" or evidence of systemic disease, including multiple sclerosis or sarcoidosis, during the follow-up period. There were no statistically significant HLA associations in these patients compared with controls from another study from Iowa, but the Iowa phakic patients with cystoid macular edema did differ from the Iowa patients with pars-planitis at loci HLA-B8, HLA-B51, and HLA-DR2. CONCLUSIONS: We describe a disease entity of idiopathic intermediate uveitis that affects primarily young to middle-aged women and usually causes bilateral vitritis, cystoid macular edema, and retinal periphlebitis. Most patients retained good vision over a prolonged follow-up period. Multiple sequential examinations and HLA associations suggest that these conditions are distinct from other syndromes of intermediate uveitis, particularly parsplanitis.
Assuntos
Edema Macular/etiologia , Flebite/etiologia , Veia Retiniana/patologia , Uveíte Intermediária/complicações , Corpo Vítreo/patologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Oftalmopatias/sangue , Oftalmopatias/etiologia , Oftalmopatias/patologia , Feminino , Angiofluoresceinografia , Antígenos de Histocompatibilidade Classe I/análise , Antígenos de Histocompatibilidade Classe II/análise , Humanos , Edema Macular/sangue , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Flebite/patologia , Doenças Retinianas/sangue , Doenças Retinianas/etiologia , Doenças Retinianas/patologia , Uveíte Intermediária/sangue , Uveíte Intermediária/patologia , Acuidade VisualRESUMO
Infections with Bacteroides species have been noted to occur in association with cases of thrombophlebitis. This association has led to the speculation that the microorganisms themselves may contribute to the pathogenesis of thrombus formation through elaborated enzymes, including heparinases, or by interactions between the clotting cascade and the unique structure of the Bacteroides lipopolysaccharide. Anti-phospholipid antibodies have been linked with hypercoagulable states and thrombus formation. Although a number of infections have been associated with the transient production of anti-cardiolipin antibodies, the effect the antibodies may have in contributing to thrombus formation is not well understood. The occurrence of Bacteroides species infection with transient anti-cardiolipin antibody has not been previously reported.
Assuntos
Anticorpos Anticardiolipina/sangue , Infecções por Bacteroides/diagnóstico , Flebite/sangue , Veia Porta , Infecções por Bacteroides/sangue , Infecções por Bacteroides/complicações , Infecções por Bacteroides/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/complicações , Flebite/diagnóstico , Flebite/patologiaRESUMO
A case of recurrent, superficial phlebitis in the lower extremities, with raised blood uric acid levels, responsive to colchicine and to urate pool depletion, but unassociated with articular complaint is reported. The possibility that such a phlebitis may represent an isolated, critical manifestation of acute gout is stressed.
Assuntos
Gota/sangue , Flebite/etiologia , Ácido Úrico/sangue , Doença Aguda , Colchicina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Flebite/tratamento farmacológicoRESUMO
Authors analyses most recent concepts on pathogenesis of trophic changes in post-phlebitic syndrome: particularly they consider the role of extravascular fibrin deposition, in patients with depressed plasmatic fibrinolytic activity. In this patients, according to recent reports, it seems useful a fibrinolytic therapy to improve trophic conditions of the post-phlebitic limb, particularly in respect to dermatoliposclerosis. Authors refer their experience on a double blind study with stanozolol an anabolizing steroid with fibrinolytic activity: in all treated patients good clinical results were obtained; however no enhancement of plasmatic fibrinolytic activity was demonstrated.
Assuntos
Extremidades/irrigação sanguínea , Flebite/complicações , Estanozolol/uso terapêutico , Adulto , Idoso , Testes de Coagulação Sanguínea , Ensaios Clínicos como Assunto , Fibrinólise , Humanos , Pessoa de Meia-Idade , Flebite/sangue , Distribuição Aleatória , SíndromeRESUMO
Criteria for positive assay of the D-dimer were defined in order to establish its diagnostic value for phlebitis in the post-operative period. A retrospective study was carried out on the files of 94 patients who had received a total hip prosthesis in 1990. A semi-quantitative assay technique was used to measure the D-dimer because it is the only method giving immediate results. Three criteria were used to classify the results: criterium A: D-dimer greater than or equal to 2 micrograms/ml; criterium B: D-dimer greater than or equal to 4 times the preceding test; absence of both of these criteria. The results were compared to echo-doppler results and confirmed by phlebography when necessary. The incidence of proximal phlebitis was low (2 percent); criterium B showed a 100 percent negative predictability and a 29 percent positive predictability. None of the cases of phlebitis diagnosed with this test had been suspected clinically. This test provides a means of patient screening and spares the need for other explorations.
Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Prótese de Quadril/efeitos adversos , Flebite/prevenção & controle , Ecocardiografia Doppler , Humanos , Monitorização Fisiológica , Flebite/sangue , Flebite/diagnóstico por imagem , Flebite/etiologia , Flebografia , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Just at a time, when practical education and post-graduate training is really a permanent problem, it is necessary to pay attention again and again to the rare problems, which also appear in the doctor's office. They are by far not only "rare and useless": The recognition by the physician may be vital for the patient. Four examples from daily practice illustrate the significance of rarities in the physician's office as a permanent challenge.
Assuntos
Dor nas Costas/etiologia , Doença Celíaca/diagnóstico , Vértebras Lombares/irrigação sanguínea , Síndromes de Malabsorção/diagnóstico , Flebite/diagnóstico , Transtornos de Fotossensibilidade/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aglutininas/análise , Vasos Sanguíneos/anormalidades , Temperatura Baixa , Crioglobulinas , Medicina de Família e Comunidade , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Transtornos de Fotossensibilidade/etiologia , Plantas Tóxicas , RecidivaAssuntos
Diatrizoato/efeitos adversos , Ácido Iotalâmico/efeitos adversos , Flebite/patologia , Animais , Membrana Basal , Plaquetas , Adesão Celular , Cães , Veia Femoral/efeitos dos fármacos , Fibrina , Junções Intercelulares , Veias Jugulares/efeitos dos fármacos , Leucócitos , Microscopia Eletrônica , Microscopia Eletrônica de Varredura , Flebite/sangue , PseudópodesAssuntos
Injúria Renal Aguda/complicações , Transfusão de Sangue Autóloga , Sangue/efeitos da radiação , Falência Renal Crônica/complicações , Flebite/radioterapia , Sepse/radioterapia , Terapia Ultravioleta , Infecção dos Ferimentos/radioterapia , Injúria Renal Aguda/sangue , Humanos , Falência Renal Crônica/sangue , Flebite/sangue , Flebite/etiologia , Dosagem Radioterapêutica , Sepse/sangue , Sepse/etiologia , Infecção dos Ferimentos/sangue , Infecção dos Ferimentos/etiologiaRESUMO
El reemplazo según indicación clínica no aumenta las infecciones asociadas al catéter venoso periférico comparado con el reemplazo de rutina, en pacientes con tratamiento endovenoso. Se recomienda su uso considerando las preferencias del usuario, ya que reduce significativamente los costos asociados a la instalación. En algunos servicios de pediatría los catéteres venosos periféricos se reemplazan según indicación clínica y no cada 72 horas como en el resto de los servicios. La justificación es que los accesos venosos son escasos y difíciles de canalizar, por lo que se evita la multipunción; sin embargo, esta medida podría aumentar la incidencia de infecciones asociadas al catéter.
The replacement according to clinical indication does not increase the infections associated to the peripheral venous catheter, compared with the replacement of routine in patients with intravenous therapy. Its use is recommended considering the user's preferences, since it significantly reduces the associated costs to the installation. In some pediatric services the peripheral venous catheters are replaced according to clinical indication and not every 72 hours as in the rest of the services. The justification is that the venous accesses are few and difficult to canalize, reason why the multi-puncture is avoidedB nevertheless, this measurement could increase the incidence of infections associated to the catheter.
Assuntos
Humanos , Criança , Adulto , Cateterismo Periférico/efeitos adversos , Bacteriemia/prevenção & controle , Catéteres , Flebite/sangue , Cateterismo/métodosRESUMO
We evaluated a recently developed commercial assay for quantifying thrombin-antithrombin III (TAT) complexes in human plasma. The assay is precise (within-assay CV less than 10%, between-assay CV less than 13%), and sensitive (detection limit 0.7 micrograms of TAT per liter of plasma). Measurements for healthy volunteers yielded a normal reference (95 percentile) interval of 0.8 to 5.0 micrograms/L (n = 50, mean 2.1 micrograms/L, range 1.1 to 7.5 micrograms/L). TAT concentrations were increased in 25 of the 41 patients who fulfilled the clinical criteria of disseminated intravascular coagulation (DIC, overall mean 15.8 micrograms/L) and in 30 of the 35 patients with deep-vein thrombosis of the leg (overall mean 9.4 micrograms/L). We assessed the accuracy of the TAT assay by comparison with established criteria for the laboratory diagnosis of DIC involving various cutoff values for antithrombin III, factor V, fibrinogen, platelet count, fibrin/fibrinogen degradation products, and activated partial thromboplastin time. The low specificity of the TAT assay with regard to some of these criteria indicates that the latter are probably insensitive.
Assuntos
Antitrombina III/sangue , Trombina/sangue , Coagulação Intravascular Disseminada/sangue , Humanos , Métodos , Flebite/sangueRESUMO
Antithrombin III (AT-III) deficiency may be due to quantitative or qualitative AT-III reduction. The diagnosis of qualitative disorder is suspected when a discrepancy is found between immunological and functional levels of AT-III. Heterogeneity has been hypothesized in both quantitative and qualitative deficiency of AT-III. A technique based on crossed immunoelectrofocusing (CIEF) was applied to investigate molecular variants of AT-III. 3 families with low functional and immunological levels of AT-III and 1 family with only a low functional AT-III level were investigated. An abnormal AT-III pattern was found with CIEF in the family with suspected qualitative disorder and in 1 of the families with quantitative disorder. The 2 abnormal patterns were different. Thus the use of CIEF AT-III patterns could help to define congenital AT-III deficiencies and could serve as a basis for classification of different forms of AT-III deficiency.
Assuntos
Deficiência de Antitrombina III , Flebite/genética , Adulto , Criança , Feminino , Humanos , Concentração de Íons de Hidrogênio , Imunoeletroforese Bidimensional , Masculino , Pessoa de Meia-Idade , Flebite/sangueRESUMO
The authors report the case of a young woman aged 29, mother of 2 children, presenting a post-phlebitic syndrome with hyperalgic capillaritic ulcer, a 10 year history of serious thrombophlebitic episodes with repeated pulmonary embolism despite heparin therapy, and reports of similar episodes in the family, some of which proved fatal. Haematological study showed a clear diminution in progressive antithrombin activity. A discussion follows on the clinical and haematological aspects of this constitutional and familial deficiency, which has been known since 1965 (Egelberg). The relative rarity of this condition should not prevent the routine search (by combined functional, immunological and chromogenic estimation) in the presence of repeated thrombosis, and when the thrombosis is biologically resistant to heparin : in such cases, the indication for long term treatment with vitamin K antagonists is undeniable.
Assuntos
Deficiência de Antitrombina III , Flebite/sangue , Trombose/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Flebite/genética , Recidiva , Trombose/etiologia , Vitamina K/antagonistas & inibidoresRESUMO
Concentrations of plasma fibrinopeptide A (FPA) were measured by radioimmunoassay in 50 patients with venous thromboembolism or disseminated intravascular coagulation or both. A consistent discrepancy was observed in values obtained with two anti-FPA antisera. Analysis of extracts from plasma of these patients by high-performance liquid chromatography (HPLC) revealed the presence of a phosphorylated and an unphosphorylated form of the A peptide. Differences in concentrations of FPA measured with the two antisera could be accounted for by their different reactivity with phosphorylated FPA (FPA-P). The differences were abolished by treatment with alkaline phosphatase. A good correlation was observed between the FPA-P content of free A-peptide material and of fibrinogen in plasma as determined by HPLC (r = .88, P less than .001, n = 11). In patients with elevated FPA levels, the mean FPA-P content of fibrinogen was significantly higher (P less than .002, n = 13) than in patients with normal FPA levels (n = 8) and in healthy controls (n = 14). Phosphorus in fibrinogen did not correlate with fibrinogen degradation products or fibrinogen levels and became normal on adequate anticoagulation. Therefore, blood-clotting activation may lead to a high phosphate content of fibrinogen and of free FPA in plasma.
Assuntos
Coagulação Intravascular Disseminada/sangue , Fibrinogênio/análise , Fibrinopeptídeo A/análise , Flebite/sangue , Fosfatos/análise , Adulto , Idoso , Cromatografia Líquida de Alta Pressão , Coagulação Intravascular Disseminada/tratamento farmacológico , Feminino , Fibrina/análise , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Flebite/tratamento farmacológicoRESUMO
Acute inflammation of the umbilical cord, acute funisitis, is a sign of fetal inflammatory response, and the clinicopathological need for its identification is increasing. This study was conducted in order to describe the topographic distribution of acute funisitis, and thereby to provide more information on the intrinsic nature of acute funisitis and find a better way of pathologically examining the umbilical cord. A total of 10 umbilical cords affected by acute funisitis were histopathologically examined throughout their entire lengths at 1 mm intervals. Pathological examination was done to characterize the extent of the funisitis, the involvement of the vein (phlebitis) or of one or both arteries (arteritis), and the presence of inflammation in Wharton's jelly. Umbilical cord plasma interleukin (IL)-6 was measured by specific immunoassay to assess whether or not the severity of acute funisitis correlates with fetal cytokine response. It would appear that the inflammatory reaction begins as a discrete, multifocal process which eventually becomes contiguous as the inflammatory reaction proceeds. Umbilical cord plasma IL-6 concentrations tended to correlate with the extent of umbilical cord inflammation. The initial phase of acute funisitis involves discrete and multiple foci along the length of the umbilical cord. Moreover, the extent of acute funisitis reflects the severity of systemic fetal cytokine response. Therefore, adequate sampling using multiple sections would facilitate the identification of acute funisitis. We propose a standard sampling procedure taking one section from each third of the umbilical cord.