The hypothalamic-pituitary-adrenal axis in infantile malnutrition.

We studied the circadian rhythm and the response of the hypothalamic-pituitary-adrenal (HPA) axis to ovine corticotrophin releasing hormone (oCRH) stimulation and dexamethasone suppression in 32 children with grade II-III marasmus. Children were studied prior to and after nutritional rehabilitation. Mean baseline plasma cortisol concentrations were elevated at admission and decreased significantly after nutritional rehabilitation.

Thrombocytopenia at delivery: a prospective survey of 6715 deliveries.

Thrombocytopenia occurred in 513 (7.6%) of 6715 consecutive deliveries that occurred in our hospital over a 3-year interval. The patients with thrombocytopenia could be divided into three groups.

Heparin therapy during pregnancy. Risks to the fetus and mother.

The true maternal and fetal risks of heparin therapy during pregnancy are unknown, because most published studies are small and do not report consecutively treated patients. In order to address these issues, we performed a retrospective cohort study of 100 pregnancies in 77 women treated with heparin during pregnancy. In 98 pregnancies heparin therapy was given for the prevention or treatment of venous thromboembolism; in the remaining 2, because of prosthetic heart valves.

Platelet specific alloantigens on the platelet glycoprotein Ia/IIa complex.

The majority of platelet alloantigens are located on platelet glycoproteins IIb/IIIa. This report describes a codominant allelic system carried on the glycoprotein Ia/IIa complex, which we originally designated as Zava/Zavb but which is identical to the Bra/Brb system. Furthermore Zava was found to be identical to Hca.

[Hypogonadotrophic hypogonadism and anosmia: Kallman's syndrome].

Three male adolescents with hypogonadotropic hypogonadism and anosmia (Kallmann Syndrome) and treated with testosterone enantate are presented. The type of inheritance, the importance of others clinical signs and symptoms in an early diagnosis, variations in the response of gonadotropins and prolactin to LHRH and chlorpromazine. The optimal treatment schedule with testosterone for these patients seems to be intramuscular testosterone enantate 200 mg at two weeks intervals.

Risks to the fetus of anticoagulant therapy during pregnancy.

The use of anticoagulants during pregnancy is problematic because of the potential adverse effects to the mother and the fetus. Heparin does not cross the placenta, and thus, it was surprising that a recent report concluded that heparin therapy during pregnancy was as risky as oral anticoagulant therapy. Therefore, we performed a literature review of fetal/infant outcomes following anticoagulant therapy during pregnancy.

Early operative management of chylothorax by thoracic duct ligation.

Chylothorax following mediastinal mobilisation for carcinoma of the oesophagus can be devastating, especially in malnourished, debilitated patients. Early surgical management in significant chylothorax (+ 500 ml/d) is suggested before nutritional degeneration occurs. Conservative management should be reserved for those patients who drain less than 500 ml/d.

[Etiology of growth retardation in children of adolescent mothers].

The influence of some nutritional and hormonal factors in the growth failure detected in children of teenage mothers belonging to medium-low socioeconomic level (SEL) was studied. They were compared with children of mothers older than twenty years of the name SEL. Only growth retarded children of teenage mothers had significant delay in bone age, compared with chronological age (14.

Incidentally detected thrombocytopenia in healthy mothers and their infants.

The unexpected discovery of thrombocytopenia in an asymptomatic pregnant woman--often considered to be equivalent to the diagnosis of idiopathic thrombocytopenic purpura--leads to a variety of interventions, including delivery by cesarean section. However, the actual risk to mothers and their infants posed by incidentally noted thrombocytopenia is not known. To investigate this issue, we performed a prospective study of a group of normal women who delivered at our medical center and their infants during a period of one year.

Neonatal alloimmune thrombocytopenia: spontaneous in utero intracranial hemorrhage.

Neonatal alloimmune thrombocytopenia is an uncommon but important cause of thrombocytopenia in infants. Because of the severity of the thrombocytopenia, some of these infants will have intracranial hemorrhage with resultant long-term disability. Obstetricians and neonatologists have recommended delivery by caesarean section and the rapid institution of appropriate treatment for the infant; however, it is theoretically possible that a hemorrhagic event could precede the delivery and consequently not be prevented by these perinatal interventions.

Cholesterol synthesis in rat liver peroxisomes. Conversion of mevalonic acid to cholesterol.

The key regulatory enzyme of cholesterol, dolichol, and isopentenyl adenosine biosynthesis, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase) is a 97-kilodalton transmembrane glycoprotein which was believed until recently to reside exclusively in the endoplasmic reticulum of mammalian cells. However, several recent publications have shown that the enzyme in liver cells is present not only in the endoplasmic reticulum but also within peroxisomes. In an effort to clarify the role of peroxisomal HMG-CoA reductase, highly purified (95%) rat liver peroxisomes from cholestyramine-treated rats were incubated with RS-[2-14C]mevalonic acid plus cytosolic proteins and then tested for the presence of newly synthesized cholesterol.

A prospective study investigating the mechanism of thrombocytopenia in preeclampsia.

Hemostatic and platelet function studies were performed prospectively on 61 preeclamptic patients and 24 healthy pregnant control patients to delineate possible causes of thrombocytopenia in preeclampsia. Thrombocytopenia occurred in 50% of the preeclamptic patients, and was accompanied by qualitative platelet defects as shown by an increased bleeding time and decreased biosynthesis of thromboxane A2. All patients had normal routine coagulation and protamine sulphate paracoagulation assays.

Hemoglobin barts hydrops fetalis syndrome.

A 25 year old Vietnamese-Canadian pregnant woman was referred to our regional perinatal center at 31 weeks gestation after a routine ultrasound examination showing fetal ascites. A diagnosis of non-immune hydrops fetalis was made, and a Caesarean section was performed two days after hospital admission. An infant with Hb Barts hydrops fetalis was delivered who expired one hour after birth.

Sociocultural characteristics of pregnant and nonpregnant adolescents of low socioeconomic status: a comparative study.

The objective of this study was to compare the sociocultural characteristics of pregnant adolescents of low SES with a nonpregnant adolescent group from the same area of Santiago, Chile. The sample was composed of 229 adolescents, 129 of whom were pregnant for the first time (group A), and 100 who were not pregnant (group B). Each pregnant girl was matched with a nonpregnant girl of the same age and from the same neighborhood.