Recognising placental steroid sulphatase deficiency

Immediate perinatal outcomes of postterm deliveries

OBJECTIVE

To investigate whether postterm pregnancy (≥42 0/7 weeks' gestation) increases the risk for adverse perinatal outcome.

STUDY DESIGN

In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks' gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses.

RESULTS

During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n = 217,544) were term and 4.1% (n = 9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p < .05 in all). Perinatal mortality rates were significantly higher at postterm as well. Using the GEE model, the association between postterm and total perinatal mortality persisted (OR = 1.73, 95%CI 1.2-2.4), as well as specifically intrauterine fetal death (OR = 1.76, 95%CI 1.1-2.7) and intrapartum death (OR = 3.71, 95%CI 1.3-10.4).

CONCLUSIONS

Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality.

A fatal case of neuroleptic malignant syndrome

A fatal case of Neuroleptic Malignant Syndrome (NMS) affecting a middle-aged woman is presented. Most of the signs and symptoms described for NMS were present and death occurred three hours after the onset of hyperpyrexia. Laboratory and postmortem findings were non-specific. The uses and risks of Haloperidol and Phenelzine on a patient with severe liver impairment are considered. Finally, the medico-legal implications in the context of sudden unexpected death are mentioned.

Clinical biochemistry of the neonatal period: immaturity, hypoxia, and metabolic disease

This review attempts to provide practical information on common problems in the laboratory medicine of newborn infants and also considers unresolved problems in achieving neonatal diagnoses. A common cause of upset in the newborn--intrapartum asphyxia--can now be positively diagnosed. This leaves a small group whom it is necessary to investigate because they may have metabolic disease. The initial investigation of metabolic disease at the district general hospital should be limited to the commoner conditions.

Prevalence and clinical features of epilepsy in a biracial United States population

A need for prevalence information emphasizing racial differences prompted a door-to-door survey of all residents of Copiah County, Mississippi. The fieldwork involved a complete census and an extensive screening questionnaire inquiring about diagnoses, signs, and symptoms of neurologic disease. Residents who lived in institutions or had screening responses suggestive of epilepsy were requested to have an examination by neurologists who used defined diagnostic criteria. Prevalence day was 1 January 1978, and the survey yielded prevalence ratios of 1,043/100,000 inhabitants for epilepsy and 678/100,000 inhabitants for active epilepsy. Age-adjusted prevalence ratios were somewhat higher for males and for blacks. Of the 246 identified cases of epilepsy, 37% were judged symptomatic. The leading (putative) cause was head trauma, especially among white males. About 57% of the 246 cases had been evaluated previously by a neurologist or neurosurgeon, while 7% had never been evaluated medically before the survey.

Risk of recurrence after an initial unprovoked seizure

A cohort of 424 patients was followed to determine the patterns of risk for recurrence after an initial unprovoked seizure. Overall, the risk of recurrence was 36% by 1 year, 48% by 3 years, and 56% by 5 years. The risk of subsequent seizures was lower for patients with idiopathic seizures than for those whose seizures had a presumed etiology. Among cases for which initial seizure was classified as idiopathic, EEG abnormalities, abnormal neurologic examination findings, and initial partial seizures were identified as significant independent predictors of higher recurrence risks.

Human placental steroid sulphatase--purification and monospecific antibody production in rabbits

Human steroid sulphatase was purified 43-fold from placental microsomes using a four step procedure: solubilization with Miranol H2M, Bio-Gel A 1.5 m chromatography, column chromatofocusing and Sephadex G-75 chromatography. The purified enzyme that appeared electrophoretically homogeneous was used to immunize rabbits. Protein blotting demonstrated that the resulting antiserum mainly reacted with a polypeptide of 63 000 dalton, which is about the size of placental steroid sulphatase. The antiserum was freed from minor impurities by absorbing it to Sepharose 4B with immobilized antigens prepared from a steroid sulphatase deficient placenta.

Steroid sulphatase deficiency associated with testis cancer

2 patients with recessive X-linked ichthyosis and steroid sulphatase (STS) deficiency were found to have testis cancer. It is suggested that STS deficiency may predispose both to cryptorchidism and to testis cancer.

Topical cholesterol treatment of recessive X-linked ichthyosis

In an open prospective half-side trial, creams containing 10% cholesterol or 10% urea were applied to lesions in 20 steroid-sulphatase-deficient male patients with recessive X-linked ichthyosis. In 18 there was a good response to the cholesterol cream. In 13 patients the response to cholesterol was better than that to urea. None showed a better response to urea than to cholesterol. A reduction in the cholesterol content of the stratum corneum may be responsible for abnormal cornification in recessive X-linked ichthyosis.