Antenatal diagnosis of Niemann-Pick disease in a twin pregnancy

An Ashkenazi Jewish woman had a child with Niemann-Pick disease in her first marriage. She subsequently remarried a man who was also heterozygous for the condition and conceived twins. Prenatal diagnostic tests were performed and one twin was shown to be homozygous and the other heterozygous for Niemann-Pick disease. The problems of prenatal diagnosis and counselling in twin pregnancies are discussed.

Identification of congenital cardiac malformations by echocardiography in midtrimester fetus

Fetal echocardiograms were performed in 21 pregnancies before midtrimester termination. All fetal heart specimens were collected and studied morphologically. Eighteen had been diagnosed as normal echocardiographically and this was confirmed anatomically. Deficiency of the atrial septum was suspected in one, and primum and secundum atrial septal defects were found anatomically. Coarctation of the aorta was suspected in another and this was confirmed anatomically. A ventricular septal defect was suspected in one which proved to be normal on dissection.

Reduced prevalence of rickets in Asian children in Glasgow

As judged by admissions to a children's hospital, the prevalence of Asian rickets in Glasgow increased from 1960 to 1973 and then decreased gradually. 400 children born of Indian or Pakistani parents (200 in 1974 and 200 in 1979), from two schools, were examined for clinical, biochemical, and radiological evidence of vitamin-D deficiency. In 1974 there were 10 children with florid rickets and 15 with subclinical rickets, whereas in 1979 no child had florid rickets and only 9 had subclinical rickets. Most Asian children now receive vitamin-D supplements. In the short term, general practitioners, physicians, and obstetricians in the United Kingdom must try to ensure vitamin D supplementation not only by children but also by young adults (aged 13-18 years) of Asian origin. A particular target should be pregnant Asian women, to prevent osteomalacia, fetal hypovitaminosis, and congenital rickets. The long-term answer to Asian probably lies in health education and a change towards the Western diet and life-style.

Interrelations of calcium-regulating hormones during normal pregnancy

Profound changes in calcium metabolism occur during pregnancy. The mother has to make available extra calcium for fetal requirements while ensuring that her plasma and bone calcium concentrations are satisfactorily maintained. In a cross-sectional study plasma concentrations of the major calcium-regulating hormones--namely, calcitonin, parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and 1,25-dihydroxyvitamin D (1,25-(OH)2D)--were measured to establish their interrelations during normal pregnancy. The major changes observed were increases in the circulating concentrations of 1,25-(OH)2D and calcitonin. Concentrations of parathyroid hormone and 25-OHD remained within the normal range. The increased concentrations of 1,25-(OH)2D enable the increased physiological need for calcium to be met by enhancing intestinal absorption of this element. The simultaneous rise in calcitonin opposes the bone-resorbing activities of 1,25-(OH)2D, thereby protecting the integrity of the maternal skeleton. Maternal calcium homeostasis is thus maintained yet the requirements of the fetus are fulfilled.

Fatal ingestions in Edinburgh 1974-78

A retrospective survey of 275 fatal ingestions in Edinburgh is reported. There was only one accidental death in a child; the remainder comprised 113 men and 161 women. There were significant differences as to sex and age relationship. Single men and divorced or separated persons of both sexes were most strongly represented. Barbiturates comprised the group of drugs most often responsible for death, but common analgesics caused as many deaths as did tricyclic antidepressants and tranquillizers combined. The significance of alcohol was less than was anticipated, as was the association of significant organic disease. At least half of those who died were under treatment for psychiatric disease, and the evidence is that toxic ingestion is the commonest mode of suicide in the area. The limitations of a retrospective study are stressed and it is suggested that a central review of potential suicidal deaths as they occur would be useful.

Structural analysis of an electrophoretically cryptic alcohol dehydrogenase variant from an Australian population of Drosophila melanogaster

The existence of geographically widespread clines in genetic polymorphisms is persuasive evidence that the distribution of such genetic variance is determined by natural selection. However, when comparing clines it is important to be certain that identical structural genes are involved. We report a structural difference (proline-214 to serine) between the product of AdhF and an electrophoretically cryptic heat-stable variant isolated from an Australian natural population, ADH-FCh.D. ("fast" Chateau Douglas). The biochemical properties of this new variant must be taken into consideration when attempting to formulate a causal explanation of the maintenance of the three identified Adh alleles. Our data also show that the products of an AdhF and an AdhS allele in Drosophila melanogaster in an Australian population are identical over 70% of their amino acid sequences with their North American counterparts.

Normal fetal cardiac anatomy--a basis for the echocardiographic detection of abnormalities

Real-time examination of the fetal heart in 350 pregnancies has allowed a composite picture of normal fetal cardiac anatomy to be established and echocardiographic interpretation has been confirmed by anatomical studies. Two echocardiographic sections are readily obtainable and are suggested as applicable to routine scanning but the specialist nature of interpreting abnormalities is stressed. Six abnormalities have been suspected during the study and five confirmed anatomically or at cardiac catheterization. In view of the low incidence of congenital heart disease in a normal obstetric population, high risk groups should perhaps be selected for cardiac scanning at the present time. These include mothers of previously affected babies, diabetic mothers and certain abnormalities of pregnancy. Fetal ascites is particularly important, being present in three of four proven cases of cardiac abnormality.

Fetal ascites associated with congenital heart disease. Case report

Fetal ascites occurs for many reasons and has been diagnosed more frequently following the introduction of routine ultrasound scanning during pregnancy. We report the diagnosis of fetal ascites associated with an isolated congenital heart malformation.

Calcitonin and the calcium-regulating hormones in postmenopausal women: effect of oestrogens

In man, the major function of calcitonin appears to be prevention of excessive or unwanted bone resorption. There is a striking sex difference in circulating levels, with a relative deficiency in women. Calcitonin secretion in young adults is increased by oestrogens and therefore long periods of oestrogen lack, such as after the menopause, may be associated with a more pronounced calcitonin deficiency. This exaggerated deficiency could be an important factor in the pathogenesis of postmenopausal bone loss, especially since the latter may be due to excessive bone resorption. In a study of the effects of oestrogen treatment on circulating levels of calcitonin, parathyroid hormone, and vitamin-D metabolites in postmenopausal women, the most striking change was a sharp rise in plasma-calcitonin. Oestrogens prevent postmenopausal bone loss, and it is suggested that this effect could be mediated, at least in part, through control of calcitonin secretion. Calcitonin may prove effective in the prevention of postmenopausal bone loss, and it is suggested that this effect could be mediated, at least in part, through control of calcitonin secretion. Calcitonin may prove effective in the prevention of postmenopausal bone loss. Its place in the treatment of postmenopausal osteoporosis warrants further evaluation.

Assessment of gestational age in the second trimester by real-time ultrasound measurement of the femur length

Proposed is a new method for the prediction of gestational age in the early second trimester by ultrasound measurement of the femur length. A growth curve of the calcified section of femur was constructed which indicated that gestational age could be predicted with 95% confidence limits to +/- 6.7 days. This hypothesis was tested on 47 "blind" studies and found to be reliable. The femur length measurements proved to be reproducible with a mean standard deviation in 30 experiments of 0.8 mm and compared with a radiologic model. This adds a new parameter for estimating fetal age by ultrasound which would appear to be as accurate as that of biparietal diameter. Although this is not intended to replace the present parameters, it may be useful as an additional measurement to ensure the accuracy of estimated fetal age.

Ultrasound measurement of fetal limb bones

A study was made of 41 patients with known menstrual dates in whom the duration of gestation, as determined by physical examination and ultrasound scan, corresponded with those dates. Examination of the fetal limb lengths was done every 1 to 3 weeks, starting at 8 weeks' gestation. A Kretz Combison 100 ultrasound sector scanner with a 2.5 MHz transducer (velocity = 1,540 meters per second) was used. A freeze frame was used when the full bone length was visualized, and then electronic calipers were employed to measure its full length. Serial measurements of the humerus and femur and the radius-ulna and tibia-fibula complexes were made. The values were expressed as means +/- 2 standard deviations for each week of gestation. The growth of the fetal limb bones was linear from 12 through 22 weeks' gestation, but the various bones appeared to grow at different rates. The femur was the first to be well defined and the easiest to measure with reproducibility. All of the limb bone lengths correlate with gestational age and may serve as indicators of skeletal dysplasia. A patient who was delivered of an infant affected with diastrophic dwarfism syndrome was diagnosed at 16 weeks' gestation to have a fetus affected with this problem. Two other patients whose pregnancies were at risk for skeletal dysplasias were correctly diagnosed to be normal.

Echocardiographic and anatomical correlates in the fetus

Fetal cardiac anatomy was studied in 200 pregnancies between 14 weeks' gestation and term using real time two-dimensional echocardiography. Eight scan planes were chosen as contributing valuable and distinct information on the establishment of cardiac normality. To confirm the echocardiographic interpretation, 25 fetal specimens between 12 and 28 weeks' gestational age were sectioned to imitate echocardiographic scan planes and the echocardiographic and anatomical pictures obtained were correlated with each other. The number of patients in whom each plane was recognized was tabulated in the first and second hundred, the second hundred having been studied after the anatomical studies were made. One longitudinal and one transverse plane could be seen in nearly all patients and considerable improvement in the frequency of recognition of other planes was made in the second hundred patients with increasing experience and anatomical understanding. The tricuspid-pulmonary and four-chamber planes alone, however, showed four cardiac chambers, two atrioventricular valves, and two arterial valves within their respective outflow tracts.

Ultrasound scanning of ovaries to detect ovulation in women

Healthy volunteers with regular ovarian function, women taking oral contraceptives, and infertile patients being treated with clomiphene were studied longitudinally from day 7 of the cycle to menstruation. The main objective was to determine whether ovulation or failure to ovulate could be detected accurately by the use of ultrasound. The ovaries were scanned with a Kretz Combison 100 sector scanner every 1 to 3 days for morphologic changes consistent with follicle development, ovulation, and development of the corpus luteum. The morphologic changes were correlated with daily urinary hormone profiles. The estimated times of ovulation according to ultrasound and luteinizing hormone peak overlapped by 24 hours in 19 of 23 normal cycles and in 5 of 6 cycles of patients treated with clomiphene. Both techniques indicated that three of three women taking oral contraceptives did not ovulate. The ultrasound studies indicated a wide range in the diameter of the preovulatory follicle, which precludes follicular diameter as a single index for prediction of ovulation. However, by measuring the maximal diameter of the follicle and observing the morphologic changes within the ovary from follicle to corpus luteum, it was possible to detect ovulation in more than 80% of cycles studied. This technique was found to be quick, inexpensive, and efficient.

Fetal activity in 100 normal third trimester pregnancies

The incidence of fetal breathing movements (FBM), fetal trunk movements (FTM), and total fetal activity (TFA) was assessed in 100 normal pregnancies between 28 weeks and term. One 30-minute recording was made from each patient between 0900 and 1700 hours. The mean incidences of FBM, FTM and TFA were respectively 37 +/- 26 (SD) per cent, 18 +/- 10 per cent, and 53 +/- 24 per cent. The mean breathing rate was 48 +/- 12 per minute, and the mean nunber of movements per 30-minute study period was 29 +/- 15. There was a slightly higher incidence of FBM postprandially, but this failed to reach statistical significance. The mean incidence of FBM was lower before 31 weeks and after 40 weeks, compared to that between 31 and 40 weeks, when the values of FBM and FTM were constant. The breathing rate was directly related to gestational age. The mean number of movements per 30-minute study period was inversely related to gestational age, but the duration of movements increased progressively towards term, so that the incidence of FTM was constant throughout the third trimester. There was only one recording of TFA below 10 per cent.