[Delayed cerebellar histogenesis in "embryofetal alcohol syndrome". Light microscopic study of the rat cerebellum (author's transl)]

The cerebellar postnatal development of young rats (Wistar) was investigated, whose mothers were given a 12% (W/V) ethyl alcohol solution for 7 days before and during pregnancy. Besides weighing less at birth, the experimental animals had a slower postnatal linear growth and gained weight less rapidly. Histological examination of the cerebellum showed an inpeded histogenesis, which could be observed in the Purkinje cells up to the 10th postnatal day. Moreover, a thick layer of embryonal granular cells with numerous mitoses could still be seen in the experimental animals at 3 weeks of age. After 30 days there was no histological difference between the controls and experimental animals. Because the Purkinje cells in the developing cerebellum represent the units were ribosomes are most abundant, it seems appropriate to ask, whether the observed inhibition of histogenesis could derived from an impaired cerebral protein synthesis. Disturbance of organogenesis was observed in three experimental animals afflicted with an extreme internal hydrocephalus.

Severe mental retardation in a Swedish county. II. Etiologic and pathogenetic aspects of children born 1959--1970

In an unselected series of 122 children born in 1959--1970 with severe mental retardation (SMR), the magnitude and distribution of the different etiologic and pathogenetic factors were analysed. Prenatal causes were considered relevant in 73 per cent, perinatal in 10 and postnatal in 3. In 12 per cent no traceable cause whatsoever was found. Infantile primary psychoses constituted 2 per cent. Within the prenatal group, no less than 43 per cent presented firm evidence favouring a genetic etiology, chromosomal syndromes together constituting 36 per cent and mutant gene disorders 7 per cent. Etiologically unclassifiable cases with prenatal stigmata and congenital defects amounted to 18 per cent. A condition of fetal deprivation of supply was considered to have been of major importance in 8 per cent. Almost half of the cases had one or more associated CNS handicaps. Cerebral palsy syndromes were evident in 18 per cent and epilepsies in 30 per cent. The relative risk of having cerebral palsy in addition to SMR was strongly correlated to cases classified as prenatally or perinatally acquired CNS syndromes. It is concluded that prenatal prevention is of special importance for reducing the occurrence of SMR. As chromosomal aberrations are the cause in more than 1/3 of cases with SMR, the desirability of developing effective cytogenetic screening methods and programs applicable to all pregnant women is particularly emphasized.

[Symmetrical cortical calcification of the cerebrum following pre-natal encephalitis (author's transl)]

Purely cortical cerebral calcification without involvement of the cerebellum was observed radiologically in a 3-month old girl; the calcification was extensive and symmetrical. During a three year period of observation, she showed severe psychomotor retardation, spasticity, microcephaly, a secondary scoliosis, subluxation of the hips and fits. These changes have only been observed so far following pre-natal herpes encephalitis. Following this condition there may also be periventricular calcification. Therefore it is assumed that the extensive cortical calcification is due to a virus, but not necessarily a specific one and that it depends on the age of the foetus at the time of the infection.

[Immunologic development disorders and disease incidence]

Interference with any organ system during development leads to permanent damage. Severe disease or starvation during the first four months of extrauterine life lead to a persistent deficiency of cell mediated immunity, which changes the life expectancy and later disease patterns in population groups. Severe intercurrent disease, starvation or trauma later in life lower cell mediated immunity only temporarily.

Prune-belly syndrome associated with Potter (renal nonfunction) syndrome

Three fatal cases of prune-belly syndrome were associated with nonrenal features of Potter syndrome. The abdominal muscle hypoplasia is thought to be a result of large kidneys compression the developing abdominal musculature during a critical phase of fetal development. Thus, Potter syndrome and prune-belly syndrome may coexist when nonfunctioning large kidneys result in oligohydramnios. A teratogenic role of cytomegalovirus inclusion disease and other viruses is possible in the pathogenesis of these syndromes.

Cardiac malformations presenting as congenital atrial flutter

A case of congenital atrial flutter with tetralogy of Fallot is presented. Fetal tachycardia was detected three weeks prior to birth and digitalization converted the arrhythmia to a normal sinus rhythm at two days of age. The seven previously reported cases of congenital atrial flutter associated with congenitally malformed hearts are reviewed.

Aetiological survey of visually handicapped children in Northern Ireland

A survey of visually h,ndicapped children in Northern Ireland identified 486 subjects aged 0 to 20 years on January 1, 1976, with a corrected visual acuity of 6/18 or less in the better eye. The prevalence of visual handicap was 81/100,000 of the population with an estimated ascertainment rate of 80%. Genetically determined diseases accounted for 51% of the cases. Birth hypoxia secondary to prenatal and perinatal complications was the second most important aetiological factor contributing towards visual handicap.

Whence the arthrogrypotics?

During the course of a nation-wide survey of patients with bone and joint deformities, twenty-six individuals with arthrogryposis multiplex congenita, in the narrow and precise sense of the term, were investigated. No patient was more than twenty-four years of age. However, on a basis of the figures of population, it can be estimated that 21-0 +/- 6-5 older affected individuals should have been encountered. Furthermore, there was a relative excess of younger children. The series was reasonably unbiased, and as arthrogryposis is non-lethal the deficiency of affected adults is an anomalous finding. It is tentatively suggested that arthrogryposis might result from the intra-uterine influence of an unknown environmental agent which has been present in South Africa for only a limited period of time. Detection of this factor could be an important step in the prevention of the disease.

[Considerations regarding the influence of intrauterine and early postnatal diseases and nutritional deficiencies on immunity and disease epidemiology (author's transl)]

Malnutrition, infectious and toxic stress, hormonal and enzymatic deficiencies as well as graft versus host reactions during the last trimester of pregnancy and during the first six months of life lead to persistent depressions of cell mediated immunity. The subsequent imbalance between the cell mediated and humoral system of immunity leads to differences in disease prevalence in poor and rich populations. Particularly leprosy, tuberculosis, viral disease as for instance frequently fatal measles and diseases due to complexes between humoral antibody and bacterial components as for example acute rheumatic fever occur with increased frequency in B (+) T (-) populations. Desturbances of immune surveillance due to suppression of specific cell mediated immune function leads to an increased frequency of neoplasia, particularly B-cell lymphoma and gastrointestinal tumors. Populations in which the T-cell system can mature without interference show a trend towards diseases in which excessive T-cell response plays a major role, as for instance rheumatoid arthritis, Sjögren syndrome, terminal ileitis, autoimmune angiopathies, multiple sclerosis and possibly also disseminated lupus erythematodes.

[Etiopathogenesis of salaam seizures]

The author reports an analysis of 83 cases of salaam seizures in children from the standpoint of their aetiopathogenesis. In accordance with Jeavons she separates a group with congenital nervous system damage and a group of children who developed initially normally but in whom an acquired factor, most often of allergic character, caused nervous system changes manifesting themselves with salaam seizures. The comparison of both groups demonstrated a number of significant differences. The author believes that it would be wrong to consider all children with salaam seizures as a homogenous group because the only common factor in them is the occurrence of seizures. The author regards that it is insufficient to explain the type of EEG changes and the type of seizures as determined by the degree of nervous system development. Additional factors must exist, and fetal injury is this factor in the group of congenital seizures while in the group of acquired seizures the allergic factor is probably responsible. The isolation of both groups is important mainly from the standpoint of prognosis and treatment since in the group with acquired disease an acute cerebral process is the cause, in contrast to the group congenital damage, and the process is amenable to successful treatment if this treatment is applied sufficiently early. In the congenital group the prognosis is usually unfavourable in view of the underlying cause which is congenital encephalopathy acquired in the first place in pregnancy.

[Brain development: genetic and exogenous factors]

Growth disorders and differentiation of cerebral structures may be caused by mutations of exogenous noxae. The period of most active brain development is between the tenth week of pregnancy and the tenth year of life. In this period the brain is particularly sensitive to exogenous noxae. Basic research has revealed mechanisms that are responsible for normal development, and at the same time has led to the discovery of factors which may be associated with disturbance of these regulatory processess. Disorders of cerebral development may underlie minimal organic brain damage, though there is no proof of this as yet. Closer cooperation between basic and clinical research will be necessary to provide greater insight into the mechanisms of cerebral development. The knowledge thus obtained is one of the preconditions for the prevention, diagnosis and treatment of infantile minimal organic brain damage.

Recognizing the fetus at risk

Impairment of either fetal growth potential or placental growth support may cause fetal growth retardation. Impaired growth potential is associated with a number of congenital abnormalities. Awareness of the increased possibility of fetal anomaly comes from the obstetric patient's reproductive history or family history more than from anything else. In general, if the likelihood of fetal anomaly seems increased, investigation in the form of amniocentesis, ultrasonic monitoring of fetal growth, radiologic study, or all three may be required. More common than poor growth potential is poor placental growth support. Here, historical evidence of maternal hypertension or toxemic disorders, among other abnormal clinical findings, is an indication for fetal monitoring.

'Isolated' pulmonary valve stenosis as part of more widespread cardiovascular disease

In 25 patients aged 6 days to 9 years presenting as 'isolated' pulmonary valve stenosis, histology of the myocardium of right and left ventricles, coronary arteries, and ascending aorta has shown abnormality in one or all these areas. Myocardial necrosis, old and recent, unrelated to coronary occlusion was frequent. Myocardial 'dysplasia' involving both ventricles, and resembling hypertrophic cardiomyopathy (HOCM, ASH) was found in 10 and a relation of this to myocardial injury in the fetus is postulated. Varying degrees of coronary occlusion were frequently seen in both right and left coronary arteries. The histology of the ascending aorta was abnormal showing 'higgledy-piggledy' disorder of smooth muscle components in 12 (48%). In a different series of 53 patients who had pulmonary valvotomy for apparent 'isolated' pulmonary valve stenosis there were 14 with clinical evidence of left ventricular abnormality consistent with the pathological changes described, 2 with the same aortic histological changes, and 2 with macroscopical left ventricular hypertrophy. Two of them developed classical hypertrophic cardiomyopathy years later. It is suggested that when pulmonary valve stenosis presents with a thick tricuspid poorly mobile valve, particularly in infants or in patients with evidence of other congenital stigmata, it may be part of a more widespread cardiovascular abnormality. This should be recognized and considered in the evaluation of surgical patients and late survivors who may show unexpected clinical features.