Prenatal benzoate treatment in urea cycle defects

OBJECTIVE

In patients with severe urea cycle defects (UCD) metabolic decompensation with hyperammonaemia typically occurs during the first days of life resulting in severe neurological damage or death. Benzoate can eliminate nitrogen independent of the urea cycle. Usually, benzoate is started soon after birth, but prenatal administration might improve metabolic stability.

DESIGN

Two fetuses with a prenatal diagnosis of UCD (female: citrullinaemia; male: ornithine transcarbamylase deficiency) were loaded with benzoate prenatally via the placenta by infusing their mothers with benzoate. Benzoate concentrations were measured in umbilical cord blood and the blood of the mothers and their newborns.

RESULTS

Therapeutic concentrations of benzoate were found in umbilical cord blood and in the children's blood. Thus, benzoate transfer across the placenta was demonstrated. Plasma ammonia and glutamine levels in the postnatal period were within the normal range.

CONCLUSIONS

Benzoate infusion of the mother shortly before birth is safe and results in therapeutic levels of benzoate in umbilical cord blood.

[Gestational diabetes under clinical conditions in aspired normoglycemia: investigation for correlation of blood glucose daily profiles and fetometric ultrasound parameters]

BACKGROUND

One of the therapeutic aims in gestational diabetes (GDM) is to prevent the development of fetal hypertrophy by adaptation of maternal glycemic control. Relating to this context, maternal blood glucose daily profiles and fetal biometry ultrasound parameters were analysed for a possible correlation. A special focus was given to the question as to whether a latency period exists for this possible connection.

PATIENTS AND METHODS

152 pregnancies affected by GDM, without fetal malformations or aneuploidies, were enrolled. Altogether, 746 ultrasound examinations consisting of 7 fetometric parameters each and 1 288 blood glucose daily profiles originating from the 20 (th) to 40 (th) gestational week were systematically investigated for interrelation by correlation and multiple regression analysis.

RESULTS

No robust, constant correlation between the analysed parameters could be observed. However, marked differences between latency periods were noticed. Blood glucose parameters, which revealed significant regressions with fetal abdominal circumference, had an average time lag of 6.2 +/- 2.5 weeks, whereas the latency period for head circumference averaged 2.4 +/- 1.2 weeks. The overall small-for-gestational-age (SGA) rate was 20 %, pregnant women with a body mass index > 30 kg / m (2) revealed the highest rate of 28 %.

CONCLUSIONS

Therapeutic intervention depending on sonographically detected hypertrophy must be considered as being delayed. The currently valid therapeutic criteria including intended normoglycemia and regular fetometric ultrasound controls cannot prevent markedly high SGA rates, especially among obese women, in adequately treated GDM.

[Marfan syndrome in pregnancy: presentation of four cases and discussion]

The coincidence of Marfan syndrome and pregnancy means a high risk for mother and child, as it is associated with cardiovascular and obstetric complications. We report our experience of four pregnancies with the Marfan syndrome. The course of pregnancy, the peripartum management and both the maternal and neonatal outcomes of four pregnant women with the Marfan syndrome, who were treated in our department between 1995 and 2005, were retrospectively analysed. The pregnancies of two women were complicated by premature rupture of membranes (36 (th) gestational week) and premature uterine contractions with cervical incompetence (30 (th) gestational week), respectively. One patient developed class 3 (NYHA) heart failure in the 3 (rd) trimenon. Two out of four women had mild cardiovascular disease and could deliver vaginally. In the other two cases a primary Caesarean section was performed at the 36 (th) week of gestation because of severe cardiovascular morbidity. No patient had a progressive aortic dilatation, dissection or rupture. The neonatal outcome was uneventful in all cases. Three newborns underwent a genetic evaluation for the Marfan syndrome, in two of them mutations in the fibrillin 1 gene were detected. Women with the Marfan syndrome should be counselled pre-conception and observed by an interdisciplinary team during pregnancy. If the aortic root diameter is < 40 mm, without progression in pregnancy, and in the absence of severe valve insufficiency, then pregnancy is in most cases well tolerated and vaginal delivery can be performed.

[The concentration of carnitine in the last trimester of pregnancy subject to glucose tolerance]

OBJECTIVE

In this study the correlations between the concentration of carnitine and an increasing glucose intolerance in women with untreated, non insulin dependent gestational diabetes (GDM) were examined.

METHODS

129 pregnant women were challenged with an oral 75 gm glucose load in the last trimester. Patients were assigned to five different groups with increasing glucose intolerance depending on the maximal glucose level after glucose challenge. Blood samples for measurement of free and acyl carnitine (spectrophotometric method) were taken prior to glucose evaluation.

RESULTS

In correlation with increasing glucose intolerance concentration of acyl carnitine rose from 3.43 +/- 1.62 micromol/l (normal glucose tolerance) to 4.62 +/- 1.93 micromol/l (gestational diabetes) while free carnitine decreased from 12.17 +/- 2.71 micromol/l to 11.52 +/- 2.90 micromol/l (p > 0.05). The quotient of acyl carnitine/free carnitine was significantly higher in women with GDM than in women with normal glucose tolerance.

CONCLUSION

Due to the high overlap of results, carnitine isn 't suitable for further differentiation of glucose metabolism or to evaluate the efficacy of therapy in non insulin dependent GDM.

Healing of burns after treatment with 670-nanometer low-power laser light

Recent investigations have reported contradictory results on the influence of low-power laser light on wound healing. Low-power laser with a power output of 250 mW and an emitted laser light of 670 nm have been insufficiently investigated to date. The effect of a 250-mW/670-nm laser light on the healing of burning wounds in rats was investigated. Thirty rats were burned on both flanks. One wound was irradiated with 670-nm laser light (2 J/cm2), whereas the other side remained untreated. Macroscopic evaluation of the wounds was performed daily; 10, 20, and 30 days after burning, 10 rats were killed and the wounds histologically evaluated. Neither macroscopic nor histologic examination of the irradiated wound showed accelerated wound healing when compared with control wounds. In the present study, irradiation of burns with a 250-mW/670-nm laser light produced no beneficial effects on wound-healing processes.

[Status of alimentary iodine supply in the Potsdam area]

In the period from November 1995 to April 1996 we have collected 120 samples of 24-h-urine from volunteers of the "Brandenburger Ernährungs- und Krebsstudie". 108 persons--without iodine supplementation--showed an average iodine excretion about 99 micrograms I/g creatinine, and the median value showed 94.2. Only 45.4% of the samples indicated a sufficient iodine supply. In 43.5% an iodine deficiency grade I was registered, and in 11.1% grade II. An iodine deficiency grade III did not occur. Due to the increased use of iodized salt in meat- and cereal products, to intensive public education etc. it seems, that the individual iodine intake is better than some years ago. But the iodine deficiency prophylaxis should be further more continued.

[Chondrocalcinosis of the intervertebral disks]

Intervertebral discs removed in cases of disc herniation were investigated by polarized light microscopy. In about 4% of all cases crystalline deposits were detected. The crystals were characterized by different staining methods, scanning electron microscopy and X-ray diffraction. From the results it is concluded that the crystalline deposits are usually composed of calcium pyrophosphate dihydrate. With regard to the age of the patients it became obvious that there was an increased frequency of crystalline deposits with increasing age. Therefore it is assumed that calcium pyrophosphate deposits in intervertebral discs are an agerelated phenomenon as is known from chondrocalcinosis of other joints.