摘要:

Hemopoietic and immune capacities of fetal bone marrow (FBM) obtained from 2nd-trimester lost pregnancies and adult bone marrow (ABM) were compared. Progenitor cell assays for both sources were also enumerated. Our data showed ontogeny-related functional differences between hemopoietic cells, particularly in the ability to produce CD34+ cells (24.6% in FBM, 3.1% in ABM). The phenotypic composition of FBM and ABM were quite different. The clonogenic/proliferative potentials, as measured by CFU-C assays, were significantly higher in FBM when compared to ABM (202.5 vs. 73.5/105 cells). Moreover, FBM had a lower percentage of CD3+ T lymphocytes as compared to ABM (1.47 vs. 7.58), and there was a significantly decreased proliferative responsiveness in mixed lymphocyte reactions of FBM as compared to ABM. Thus, our data clearly showed distinct advantages of FBM over ABM, which include a higher number of stem cells, lower immunological reactivity, and higher clonogenic/proliferative potential. These characteristics provide optimal conditions for successful engraftment without graft-versus-host disease. These data support the possible advantages of FBM from these sources for hemopoietic stem cell reconstitution and gene therapy.

ISSN:1015-3837    

DOI:10.1159/000264350

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Objective: To discuss the necessity of close sonographic surveillance of small, isolated fetal pleural effusions as well as the selection criteria and benefits of in utero therapy utilizing thoracoamniotic shunts. Methods: High-resolution ultrasound, fetal echocardiography, amniocentesis for viral cultures, cordocentesis, and thoracocentesis were performed to evaluate the underlying etiology of a unilateral pleural effusion. A Rodeck Rocket shunt was placed following sudden, rapid progression of the effusion and onset of severe fetal hydrops. Results: Placement of the thoracoamniotic shunt resulted in near-complete drainage of the pleural effusion with normalization of intrathoracic anatomic relationships, subsequent complete resolution of fetal hydrops, and excellent postnatal outcome. Conclusions: Apparently stable, small pleural effusions can progress rapidly to severe hydrops and need to be followed closely. In appropriately evaluated and selected cases, thoracoamniotic shunt placement may result in resolution of fetal hydrops and prevent intrauterine fetal death.

ISSN:1015-3837    

DOI:10.1159/000264351

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

This paper describes our initial experience with laser-induced interstitial thermotherapy (LITT) for the treatment of the twin-twin transfusion syndrome (TTTS). This procedure was utilized in four pregnancies – three monochorionic twin pregnancies and one triplet pregnancy (20–26 weeks of gestation) – with severe TTTS with fetal dropsy, polyhydramnion of the acceptor, and anhydramnion of the donor. In vitro examinations of placental tissue had shown that laser coagulation can be monitored by sonography, hence we used this method for the first time in these four pregnancies. Blood vessels connecting the two umbilical cords were determined prior to the treatment using a new ultrasound color technique which is highly sensitive and capable of representing slow blood flow velocities. A 1.2 mm thick puncture needle was then directed to the shunt under on-line ultrasound control. All patients had an anterior wall placenta. The laser fiber was inserted via this thin needle. A coagulation time of 2–3 min was necessary at 3 W. In the one twin pregnancy the intrauterine fetal death of the smaller child occurred 10 weeks after LITT, the other child survived and is healthy. A cesarian section was necessary in another twin pregnancy 1 week after LITT due to the intrauterine death of the smaller child. In the third twin pregnancy, the donor, who had already had distinct bradycardia prior to the treatment, died immediately after LITT. The intrauterine fetal death of the donor in the triplet pregnancy occurred 3 days after LITT once the volume of amniotic fluid had basically returned to normal. The tragic intrauterine death of the uninvolved child occurred 13 weeks later as a result of umbilical cord strangulation, the surviving child is healthy. All four pregnancies were severe and advanced cases of TTTS with a very poor prognosis, leaving us with no other alternative to the described method of treatment. The instruments we used are a lot thinner than those utilized for fetoscopic laser treatment to date. Furthermore, it is not necessary to penetrate the amniotic sac in patients with an anterior wall placenta; intraplacental vessels can be coagulated, and the laser energy required for LITT is also much lower. In our opinion these advantages justify the utilization of LITT under more promising conditions than those describe

ISSN:1015-3837    

DOI:10.1159/000264352

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Cartilage-hair hypoplasia (CHH) is a rare autosomal recessive skeletal dysplasia characterized by short stature, sparse hair, and a variable degree of immunodeficiency. We describe here the prenatal diagnosis of CHH in a woman who was previously delivered of a similarly affected infant. In addition, we review the prenatal diagnostic implications of the localization, by linkage analysis, of the gene responsible for many cases of CHH.

ISSN:1015-3837    

DOI:10.1159/000264353

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000264354

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The in vitro fertilization technology coupled with the ability to amplify DNA from a single cell has been used for the preimplantation genetic diagnosis of Marfan syndrome. An intragenic FBNl gene marker has been used to track the inheritance of this disorder in a family. Marker genotyping was established following two rounds of amplification. Whenever possible, two blastomeres were separately assayed per embryo. The transfer of five embryos resulted in a singleton pregnancy and the birth of a full-term male infant.

ISSN:1015-3837    

DOI:10.1159/000264355

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Achondroplasia (ACH) is the most frequent form of shortlimb dwarfism. Recently, the gene mutation responsible for ACH has been identified in the transmembrane domain of the fibroblast growth factor receptor 3 gene. The cause of ACH is a point mutation at nucleotide 1138 of the cDNA, resulting in the substitution of an arginine residue for a glycine. For the purpose of prenatal diagnosis of ACH, we have used the nested polymerase chain reaction to ensure the gene amplification. Although the normal allele has no restriction site around the causative sequence, we have devised an unique method to incorporate a restriction site of Sp/I into the normal allele only using modified primer sets. We report here the use of this polymerase chain reaction methodology which can ensure the gene amplification and omit the complicated steps of sequencing for prenatal diagnosis.

ISSN:1015-3837    

DOI:10.1159/000264356

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background: Intrauterine infection with herpes simplex virus (HSV) has been associated with a significant number of neonatal HSV infections. When these infections begin in utero, the associated morbidity is more severe, and treatment regimens may be less effective. Case: A 24-year-old nullipara with an abnormal triple screen and multiple ultrasound abnormalities at 19 weeks’ gestation underwent amniocentesis and cordocentesis. Laboratory results were consistent with HSV infection. The patient elected to terminate the pregnancy, and on postmortem examination of the fetus, evidence of disseminated disease was present. Conclusion: We believe that this case documents a relationship between HSV infection and findings on ultrasound that have previously been described in association with other in utero infections. We suggest that general viral cultures of the amniotic fluid be done when in utero infection is suspecte

ISSN:1015-3837    

DOI:10.1159/000264357

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Five postmortem fetuses were scanned by magnetic resonance (MR) imaging. Of eight three-dimensional (3D) data sets reconstructed on an MGI workstation, five sets demonstrated detailed 3D fetal cardiac structures, and one depicted clear information regarding the disposition and compression of the heart and lungs in diaphragmatic hernia. This study has shown the potential of 3D MR imaging in support of postmortem examination and for interactive visual teaching of the fetal cardiac structures. The new technique may eventually be of significance in prenatal detection of cardiac abnormalities with the development of fast real-time MR imaging.

ISSN:1015-3837    

DOI:10.1159/000264358

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Endoscopic coagulation of placental and umbilical cord vessels has been suggested as a treatment for selected cases of twin-twin transfusion syndrome and of acardiac twin. The feasibility, safety and hemostatic effect of neodymium:yttriumaluminium-garnet (Nd:YAG) laser in an underwater environment were experimentally studied in an in vivo model, mimicking the in utero situation and fetoplacental vessels. In 10 male Wistar rats, immersed in normal saline at 38 °C, femoral vessels, carotid artery, abdominal aorta and vena cava were coagulated under endoscopic control. A 100-Watt Nd:YAG laser was used in continuous mode with a 600-μm fiber. Outcome measurements were vascular diameter, total energy (joules) used to obtain visual coagulation and subsequent vascular obliteration. Overall failure rate was 32% and perforation of the vessel occurred in 7.7% of case

ISSN:1015-3837    

DOI:10.1159/000264359

出版商:S. Karger AG    

年代:1996

数据来源: Karger