Motilin levels in term neonates who have passed meconium prior to birth

Motilin levels were measured by radioimmunoassay from umbilical cord blood obtained at birth from 38 term neonates (median gestational age 40 weeks, range 39-42 weeks). Birth weights of these neonates ranged from 2,840 to 4,593 G (median 3,600 G). Forty-two percent (16/38) of these neonates passed antenatal meconium. The median motilin level was 177 fmol/ml in those neonates who passed antenatal meconium and 111.5 fmol/ml in those neonates who did not pass meconium prior to birth (p less than 0.01). Although fetal distress has been found to be associated with elevated motilin levels at birth, such an association was not found in this study. These data support an association between elevated motilin levels at birth and antenatal meconium passage.

Implications of the placental structure compatibility for interspecies embryo transfer

Comparative histological features of the chorionic villi in placental cotyledons of the common eland (Taurotragus oryx ) and bongo (Boocercus euryceros ) antelopes and okapi (Okapia johnstoni ) and giraffe (Giraffa camelopardalis ) were examined. The chorionic villi in both antelope species showed only moderate branching and/or surface corrugation and their cross-sections were polygonal to oval. The close similarity in the structure of cotyledons has been apparently a contributing factor for success in mutual interspecies embryo transfer. The chorionic villi in okapi and giraffe had very different structures. In okapi the villi on cross-section were round and filled with thin connective tissue. They showed minimal branching and surface corrugation. In giraffe the villi showed extensive surface corrugation, had multiple fine branches, and were filled with a more dense connective tissue. Prospect for materno-fetal compatibility in mutual embryo transfer between these species is guarded.

The umbilical cord twist: origin, direction, and relevance

The purpose of this study was to evaluate the origin, direction, and relevance of the umbilical cord twist. We initially hypothesized that the direction of the helix or twist of the human umbilical cord at birth correlated with the eventual handedness of the child. Among 2801 singleton placentas in this study, only 5% had no twist, and the left twist outnumbered the right twist by 7 to 1, a ratio that is strikingly similar to the predominance of right-handed persons to non-right-handed persons in the general population. Forty-five 3- and 4-year-old children with previously documented cord twists were evaluated with respect to hand preference and performance. The direction of the cord twist was independent of the handedness of the child as well as the mother. We have documented an increased incidence of absent twist and right twist in association with single umbilical artery, suggesting that the impetus for the cord twist is independent on hemodynamic forces in the umbilical cord itself. We further document an increased incidence of absent twist among intrauterine fetal deaths and twins, suggesting that decreased fetal movement can impede the forces leading to normal twisting of the umbilical cord. Absence of cord twist may be associated with adverse prognosis.

Functional anatomy of the brachial plexus sheath: implications for anesthesia

Anatomical study of the brachial plexus of 18 cadavers was undertaken to confirm the presence and significance of "septa" dividing the brachial plexus or axillary sheath. Dissection demonstrated that the sheath consists of multiple layers of thin connective tissue surrounding the various elements of the neurovascular bundle. These septa are incomplete, however, forming small bubble-like pockets when solution is injected. Single injections of methylene blue and Latex solutions into the axillary sheath resulted in immediate dye staining of median, radial, and ulnar nerves, despite the presence of septa. These data demonstrate that there are connections between compartments within the sheath and, therefore, do not support the need for multiple injections when performing an axillary block.

Demonstration of immunoreactive eosinophil granule major basic protein in the plasma and placentae of non-human primates

A protein immunologically identical to the major basic protein (MBP) of eosinophil granules is present in the plasma of pregnant women and has been localized to human placental X cells using immunofluorescence. This study demonstrates the presence of similar immunoreactive molecules in the placental X cells from several non-human primates. We also describe the presence of increased plasma levels of MBP in the pregnant gorilla and in pregnant cynomolgus and rhesus monkeys as compared to non-pregnant counterparts. Such findings suggest that non-human primates are a suitable animal model for the study of the X cell function and in particular the physiological importance of MBP in pregnancy.

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Transplacental hemorrhage associated with placental neoplasms

We report a case of choriocarcinoma in situ arising from a term placenta in an otherwise normal pregnancy that resulted in fetal hydrops and intrauterine fetal death from chronic fetal-maternal hemorrhage (FMH). The clinical and pathologic features are described and compared with the few similar cases reported and with an additional placental choriocarcinoma found in our files. We also describe the clinical and pathologic observations of two chorangiomas that caused massive FMH and led to fetal death.

Serology and virology of the bowhead whale (Balaena mysticetus L.)

Sera from four bowhead whales (Balaena mysticetus L.) were examined for the presence of specific antibodies, and tissue and swab samples from six and four animals respectively were processed for isolation of viruses and for initiation of bowhead whale cell cultures. All sera were negative for antibodies to nine serovars of Leptospira interrogans and to 21 orthomyxovirus subtypes and a paramyxovirus (Newcastle disease virus). All sera were positive, however, for neutralizing antibodies to one or more calicivirus serotypes. Two untyped adenoviruses were isolated from colon samples of two different whales, but neutralizing antibodies to the agents could not be demonstrated in any sera. Three primary bowhead whale cell cultures were derived from kidney (two cultures) and testis (one culture), from three individual whales.

Hydrops due to myocarditis in a fetus

At 18 weeks of gestation a fetus was studied sonographically because of advanced maternal age and found to have hydrops of unknown etiology with ascites, pleural, and pericardial effusions. An abortion was performed and in the fetal/placental material myocarditis and thyroiditis were documented. Maternal antibodies to Coxsackie virus B5 showed a onefold rise. Tentatively, the hydrops is assigned to Coxsackie virus myocarditis, a lesion not previously identified in fetuses.

Intrauterine latent herpes simplex virus infection: I. Spontaneous abortion

Herpes simplex virus (HSV, probably type 2) antigen was detected in nonpregnant and pregnant endometria, placentae, umbilical cords, and neonatal tissues (companion paper) by avidin-biotin complex immunohistochemical studies. HSV cytologic abnormalities were not detected in any of the 380 cases examined: included were specimens from therapeutic and spontaneous abortions (200 cases) and endometrial curettage (180 cases). The presence of inflammation was not correlated with HSV positivity. Endometrial HSV positivity was significantly correlated with normal late secretory phase (40 per cent of specimens positive), abnormal secretory phase (67 per cent positive), and therapeutic (33 per cent positive) versus spontaneous (26 per cent positive) abortions. Placental HSV positivity was significantly correlated with spontaneous (39 per cent positive) versus therapeutic (14 per cent positive) abortions and with blighted ova (67 per cent positive). No significant correlation was found between HSV positivity and a clinical history of oral or genital HSV infection in either the patient or the male partner. The data support the concept of a subclinical latent intrauterine endometrial HSV infection that is hormonally regulated and can produce transplacental infection of the embryo or fetus, with variable consequences.

Intrauterine latent herpes simplex virus infection: II. Latent neonatal infection

Herpes simplex virus (HSV, probably type 2) antigen has been detected in endometria and abortion tissue (companion paper) and in placentae, umbilical cords, and fetal and neonatal organs by avidin-biotin complex immunohistochemical studies. HSV cytologic abnormalities were not detected in any of the 12 normal and 64 abnormal cases analyzed, nor was HSV detected by culture or electron microscopy in selected cases. Antigen was present in single epithelial and, rarely, mesenchymal cells of various organs. Clinically unexplained fetal or neonatal problems associated with HSV antigen positivity included intrauterine death, fetal growth retardation, cystic brain degeneration, hydrops, interstitial pneumonitis, necrotizing enterocolitis, hepatitis, encephalitis, myocarditis, and renal failure. Maternal floor infarct of placenta and calcifying funisitis are the manifestations of intrauterine HSV infection in most cases. Maternal history of HSV infection was uncommon. It is concluded that intrauterine HSV infection may persist in the fetus and neonate in a latent fashion without cytologic abnormalities or detectable virus. This latent infection may be associated with intrauterine and neonatal death, organ damage, and neonatal disease.

Supradiaphragmatic liver in the lung

Heterotopic liver tissue has only been rarely described, and then usually in the immediate vicinity of and in communication with the liver or extrahepatic biliary tree. We studied a case of an isolated heterotopic nodule of liver in the lung of an infant in which no connection to the hepatobiliary system was present, and in whom the diaphragm was intact.

Cryptosporidial infections in captive wild animals

Neonatal diarrhea was an important cause of morbidity and mortality in a hand-rearing facility for exotic ruminants at the San Diego Wild Animal Park. Studies undertaken to determine the causes of the problem revealed that oocysts of Cryptosporidium sp. were demonstrable in auramine O stained fecal smears from 52 of 183 (28.4%) animals examined. Cryptosporidial infection was identified in 21 of 40 species of exotic ruminants with diarrhea. In addition, cryptosporidia were associated with gastroenteric disease in two primates and two reptiles. It was observed also that auramine O stained coccidial oocysts of the genus Eimeria, which were present in five of 183 (2.7%) of the specimens examined.

Prophylactic treatment of very premature infants with human surfactant

We undertook a randomized, controlled trial to determine whether human surfactant administered endotracheally at birth to very premature infants (gestational age, 24 to 29 weeks) would prevent the respiratory distress syndrome or reduce its severity. Thirty-one treated infants (birth weight, 938 +/- 286 g) were compared in a blinded fashion with 29 control infants (birth weight, 964 +/- 174 g). The lecithin/sphingomyelin ratio was less than 2 in all infants, and phosphatidylglycerol was not present in amniotic fluid or tracheal fluids at birth, indicating a deficiency of surfactant in the lungs. The principal dependent variables were neonatal death, the incidence of bronchopulmonary dysplasia, and the infant's requirement for respiratory support (and its complications). The surfactant-treated group had significantly fewer deaths than the control group (16 percent vs. 52 percent, P less than 0.001), fewer cases of bronchopulmonary dysplasia (16 percent vs. 31 percent), and significantly fewer cases of pulmonary interstitial emphysema (P less than 0.001) and pneumothorax (P less than 0.02). Prophylactic treatment with human surfactant also substantially reduced the period of neonatal intensive care. We conclude that treatment with human surfactant offers promise for improving the survival of very premature infants with a surfactant deficiency and for reducing the pulmonary sequelae of the respiratory distress syndrome.

Vascular steal: the pathogenetic mechanism producing sirenomelia and associated defects of the viscera and soft tissues

Dissection of the abdominal vasculature in 11 cases of sirenomelia has demonstrated a pattern of vascular abnormalities that explains the defects usually found in this condition. The common feature is the presence of a single large artery, arising from high in the abdominal cavity, which assumes the function of the umbilical arteries and diverts nutrients from the caudal end of the embryo distal to the level of its origin. The steal vessel derives from the vitelline artery complex, an early embryonic vascular network that supplies the yolk sac. Arteries below the level of this steal vessel are underdeveloped and tissues dependent upon them for nutrient supply fail to develop, are malformed, or arrest in some incomplete stage. In contrast to the prevailing view that sirenomelia arises by posterior fusion of the two developing lower limbs, these studies suggest that the single lower extremity in sirenomelia arises from failure of the lower limb bud field to be cleaved into two lateral masses by an intervening allantois.

Congenital tracheal stenosis with associated cardiopulmonary anomalies: report of two cases with a review of the literature

We present two infants with congenital tracheal stenosis with complete tracheal rings. Both had associated congenital anomalies. The first case showed cardiac malformations, and the second case had agenesis of the right lung. We review the literature, in particular with reference to tracheal stenosis and pulmonary agenesis. We also propose that the constellation of anomalies may result from defects in the cervical mesenchyme and, as such, may represent one end of a spectrum of cervical mesenchymal field defects.

Prenatal ultrasonographic diagnosis of congenital adenomatoid malformation of the lung. Correlation with pathology and implications for pregnancy management

Congenital cystic adenomatoid malformation of the lung is an uncommon malformation. The solid type III variety is the rarest and carries the poorest prognosis. This report describes the prenatal diagnosis of a case of congenital cystic adenomatoid malformation type III at 24 weeks' gestation. The pathologic features of the malformation and the etiology and prognostic significance of hydramnios and anasarca are discussed. This case indicates that the malformation can be diagnosed early enough to allow for therapeutic intervention.

Dating the time interval from meconium passage to birth

The gross and microscopic effects of exposing placenta and umbilical cord to meconium were studied in vitro. Gross staining begins with one hour and is a surface phenomenon proportional to length of exposure and meconium concentration. Pigment penetration into the membranes with subsequent uptake by macrophages is dependent primarily on exposure length. Eight of 11 placentas exposed to various meconium solutions were found to have meconium pigment-laden macrophages in the amnion after one hour. These were seen in the chorion somewhat later. Although only three of 11 placentas showed chorionic pigmented macrophages at one hour, 12 of 12 exhibited this finding after three hours. Amniotic epithelial degeneration also showed a time correlation. These findings, especially the microscopic changes described, permit more accurate determination of the defecation-to-birth interval.

Calicivirus isolation from three species of primates: an incidental finding

Calicivirus isolations were made from 3 species of subhuman primates. Viruses were recovered from gingival lesions associated with periodontal disease in a spider monkey, from the oropharynx of a healthy silver leaf langur, and from the spleen of a lowland gorilla that had died of systemic coccidioidomycosis. Based on the results of cross-neutralization tests, all 3 isolates were serologically indistinguishable from a primate calicivirus Pan paniscus type 1. These isolations appeared to be incidental in nature and could not be associated causally with any specific disease entity.