Evolution of gender options in multiple pregnancy management.

Objective: Fetal reduction (FR) in multiples dramatically improves outcomes. We prioritize FR decisions for health and historically declined to factor gender. As male preferences apparently diminished, our bioethicist encouraged a re-evaluation.

Plasma acetylcholinesterase activity correlates with intracerebral β-amyloid load.

Background: Previous studies have demonstrated alterations in the peripheral cholinergic system in Alzheimer's disease (AD), though results have been inconsistent and not linked to in vivo biomarkers of pathology. We examined the relationship between amyloid-beta (Aβ) plaques and plasma cholinesterase activity in a heterogeneous dementia population.

Methods: 29 participants with clinical AD and 35 with non-AD diagnoses underwent positron emission tomography (PET) with the amyloid ligand [11C] PIB and plasma measurements of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity.

Amyloid vs FDG-PET in the differential diagnosis of AD and FTLD.

Objective: To compare the diagnostic performance of PET with the amyloid ligand Pittsburgh compound B (PiB-PET) to fluorodeoxyglucose (FDG-PET) in discriminating between Alzheimer disease (AD) and frontotemporal lobar degeneration (FTLD).

Methods: Patients meeting clinical criteria for AD (n = 62) and FTLD (n = 45) underwent PiB and FDG-PET. PiB scans were classified as positive or negative by 2 visual raters blinded to clinical diagnosis, and using a quantitative threshold derived from controls (n = 25).

Distinct clinical and metabolic deficits in PCA and AD are not related to amyloid distribution.

Background/objective: Patients with posterior cortical atrophy (PCA) often have Alzheimer disease (AD) at autopsy, yet are cognitively and anatomically distinct from patients with clinical AD. We sought to compare the distribution of β-amyloid and glucose metabolism in PCA and AD in vivo using Pittsburgh compound B (PiB) and FDG-PET.

Methods: Patients with PCA (n = 12, age 57.

Genetic dosage compensation in a family with velo-cardio-facial/DiGeorge/22q11.2 deletion syndrome.

Cytogenetic studies of a male child carrying the 22q11.2 deletion common in patients with velo-cardio-facial/DiGeorge syndrome showed an unexpected rearrangement of the 22q11.2 region in his normal appearing mother.

Decreased neonatal jaundice readmission rate after implementing hyperbilirubinemia guidelines and universal screening for bilirubin.

Readmission rate for neonatal jaundice approximate 10 per 1000 live births. After applying hyperbilirubinemia guidelines and universal screening for bilirubin in term and near-term newborns, the readmission rate declined significantly from 24 to 3.7 per 1000 live births.

Cognition, glucose metabolism and amyloid burden in Alzheimer's disease.

The authors investigated relationships between glucose metabolism, amyloid load, and measures of cognitive and functional impairment in Alzheimer's disease (AD). Patients meeting criteria for probable AD underwent (11)C-labeled Pittsburgh Compound-B ([(11)C]PIB) and 18F-fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) imaging and were assessed on a set of clinical measures. The Pittsburgh Compound-B (PIB) Distribution volume ratios and fluorodeoxyglucose (FDG) scans were spatially normalized and average PIB counts from regions-of-interest (ROI) were used to compute a measure of global PIB uptake.

Increased metabolic vulnerability in early-onset Alzheimer's disease is not related to amyloid burden.

Patients with early age-of-onset Alzheimer's disease show more rapid progression, more generalized cognitive deficits and greater cortical atrophy and hypometabolism compared to late-onset patients at a similar disease stage. The biological mechanisms that underlie these differences are not well understood. The purpose of this study was to examine in vivo whether metabolic differences between early-onset and late-onset Alzheimer's disease are associated with differences in the distribution and burden of fibrillar amyloid-beta.

Long-term adherence to antihypertensive therapy: a survey in four primary care clinics.

Background: Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment.

Aim: To identify factors associated with poorer adherence to antihypertensive treatment.

Population meta-analysis of low plasma glucose thresholds in full-term normal newborns.

There is extreme variation in the definition of low plasma glucose levels in newborn infants in the first postnatal days, ranging from < 30 to < or = 60 mg/dL. The goal of the present study was to define low thresholds (< or = 5th percentile) of plasma glucose concentrations in full-term normal newborns during the first 72 hours of life. Population meta-analysis was performed on published studies of neonatal hypoglycemia ascertained by MedLine search.

Brain imaging findings in neonatal hypoglycemia: case report and review of 23 cases.

A hypoglycemic infant with secondary occipital brain injury defined by serial computed tomography and magnetic resonance imaging is described. An additional 22 similar cases were previously published in the English language literature. A total of 23 cases (including the present case) were reviewed.

Neurologic aspects of neonatal hypoglycemia.

Profound neonatal hypoglycemia is one of the leading causes of brain injury. Hypoglycemic encephalopathy is caused by lack of glucose availability to brain cells. Although sharing a similar pathogenesis with hypoxic-ischemic encephalopathy, hypoglycemic brain insult has distinctive metabolic, brain imaging, electroencephalographic and histopathologic findings.

Hemodynamic changes in anemic premature infants: are we allowing the hematocrits to fall too low?

Objective: Currently, many nurseries allow hematocrits to fall to <21% in apparently "stable" premature infants before considering a blood transfusion. We evaluated clinical changes and hemodynamic changes by echocardiogram in "stable" anemic premature infants before, during, and after transfusion.

Methods: "Stable" premature infants (< or =32 weeks' gestation) who were to receive transfusions (2 aliquots of 10 mL/kg packed red blood cells, 12 hours apart) were eligible for prospective enrollment.

Evaluation of neonates born with intrauterine growth retardation: review and practice guidelines.

Intrauterine growth retardation affects approximately 10% of live-born infants. Causes of intrauterine growth retardation are heterogeneous, and frequently the care of these infants poses a diagnostic and therapeutic challenge. Diagnosis of impaired fetal growth is an area in which close collaboration among the obstetrician, pediatrician, and dysmorphologist is essential for proper care of these newborns.

Evaluation of hypothalamic-pituitary-adrenal axis in premature infants treated with dexamethasone.

Results of a national survey of the current use of steroids in newborns in 1993 showed that 95% of the neonatologists in the United States have used dexamethasone for neonates at risk for chronic lung disease. Dexamethasone therapy for a period of a week or longer is associated with suppression of the hypothalamic-pituitary-adrenal axis (HPAA) in a substantial number of premature infants. A review of our current understanding of the biochemical tests evaluating HPAA function in premature infants and suggested guidelines for HPAA evaluation and management following dexamethasone therapy are presented.

Management of neonates born to mothers with group B streptococcus colonization.

Approximately 20% of pregnant women harbor group B streptococcus (GBS) in the lower genital tract at the time of delivery. Intrapartum chemoprophylaxis of mothers with GBS colonization who have risk factors for neonatal GBS at delivery improves the outcome of the neonates. The recommendations for treating newborn infants of mothers who receive intrapartum chemoprophylaxis for GBS colonization and the recommendations for those who do not remain empiric, because clinical studies to support such recommendations are not available.

Management of premature infants with extensive bowel resection with high volume enteral infusates.

To avoid long-term parenteral nutrition (PN), three premature infants with extensive bowel resections were fed high volume enteral infusates (HVEI). Following surgery an elemental hypo-osmolar gastric infusate was initiated. The infants were weaned of PN and were subsequently maintained on HVEI feeding.

Central venous line thrombosis in premature infants: a case management and literature review.

Increased risk of central venous line thrombosis in tiny premature infants occurs because the size of the catheter relative to the cross-sectional area of the vessel is large, decreased plasma levels of plasminogen and antithrombin III, and relative low flow of the infusate through the catheter, in comparison with larger infants. A potentially fatal complication of central venous catheters is an intracardiac thrombus. The yield of detecting right atrial thrombi by routine echocardiographic monitoring is very low.

The clinical utility of serum creatinine measurement vs calculated glomerular filtration rate in the assessment of renal function in the premature infant.

The ability to assess the glomerular filtration rate (GFR) without the necessity of collecting urine in premature infants would be of significant clinical benefit. In 1986, the modified Schwartz formula (MSF = 0.33 x length (cm)/plasma creatinine (mg/dL)) was developed.

Noninvasive medical management of fungus ball uropathy in a premature infant.

Unilateral renal obstruction secondary to fungus balls is described in a premature infant. Noninvasive medical management, which included amphotericin B and 5-flucytosine therapy and forced diuresis, resulted in disappearance of fungus balls and resolution of the obstruction.