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Notizen: Objective To assess the value of ultrasonography and Doppler to predict the severity of fetal haemolytic anaemia.Design Ultrasonographic measurements of the fetal liver, spleen, umbilical vein and placenta, and Doppler measurements of umbilical venous and fetal aorta flow velocities were performed before the first intrauterine blood transfusion. Multivariate regression models for the prediction of the fetal haemoglobin level were derived from the measurements.Setting National referral centre for management of alloimmunised pregnancies.Subjects Forty fetuses in 39 severe red cell alloimmunised pregnancies.Results A logistic regression model, incorporating the two Doppler parameters only, predicted the presence or absence of severe anaemia in nonhydropic fetuses with an accuracy of 90 %. Positive predictive value was 89% and negative predictive value was 100%.Conclusion In severe red cell alloimmunised pregnancies, Doppler blood flow velocity studies can be used to predict the severity of fetal anaemia. This may lead to a reduction of invasive diagnostic tests, to more accurate timing of intrauterine transfusions, and thus to a higher survival rate.

Notizen: Summary. First-trimester chorionic villus sampling (CVS) was performed in a series of 1250 pregnancies. The direct method of karyotyping was successful in 1205 (96.4%). Abnormal laboratory findings resulted in 60 terminations of pregnancy (4.8%). In addition, six unexpected balanced chromosome rearrangements were detected. False-positive cytogenetic findings occurred in 2.3%, comprising 22 with mosaicism confined to the trophoblast, and a further six non-mosaic false-positive discrepancies were detected, four after termination of pregnancy. The outcome of the first 1000 pregnancies is known in all but one. There were no false-negative findings. Of 947 pregnancies meant to be continued, 34 (3.6%) ended in pregnancy loss before 28 weeks gestation. However, obstetricians with an experience of over 150 procedures had a pregnancy loss of 1.3%.

Notizen: Objective To determine the proportional reduction per day in the number of fetal and donor red blood cells from the fetal circulation after intrauterine intravascular transfusions.Design A retrospective study of 302 transfusions in 101 fetuses.Setting The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands.Methods We measured the haematocrit in fetal samples both before and after repeated intravascular intrauterine transfusion in fetuses with alloimmune disease. The percentage of fetal erythrocytes was determined in Kleihauer-Betke stained smears. The decline of fetal, donor and mixed red blood cells was calculated by dividing the proportional decrease of the haematocrit values by the number of days between transfusions, also after correction for changes in fetoplacental volumes. Results (given as mean [SD]) are derived from the proportional changes of haematocrit per day.Results The interval between the first and second transfusion (15.5 days [SD 5.2]) was shorter than between subsequent transfusions (means ranging from 21.4 to 21.9 days; P〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:14700328:BJO818:les" location="les.gif"/〉 0.0001). The decline per day of mixed, and of donor red blood cells, calculated without corrections for volume changes did not differ from those corrected for volume changes resulting from the transfusion and from fetal growth (correction factor 1.1 [SD 0.4]). Since the coefficient of variance is smaller for the uncorrected decline values, this type of calculation is preferable for clinical purposes. The disappearance of fetal erythrocytes after the first transfusion (6.1 %/day [SD 2.9]) was faster than that of mixed fetal and donor red blood cells (3.2%/day [SD 1.2]; P 〈 0.0001) and of donor cells alone (1-4%/day [SD 1.6]; P 〈 0.0001). The decline of the mixed red blood cell population became the same as that of the donor cells (2.2%/day [SD 0.8]) after the second transfusion. This decline of donor cells was higher than after the first transfusion (1.4%/day [SD 1.6]; P 〈 0.05). After the first transfusion the fetal erythrocytes disappeared faster after transplacental puncture of the umbilical cord (6.6%/day [SD 2.8]) than after transamniotic punctures (5.4%/day [SD 2.7]; P= 0.05). The mixed red blood cell also decreased faster (3.5%/day [SD 1.3] versus 2.8%/day [SD 0.9]; P 〈 0.01).Conclusion The fast disappearance of fetal erythrocytes, especially after transplacental punctures, shows that the interval between the first and second transfusion needs to be shorter than that for intervals between subsequent transfusions. The number of donor erythrocytes declines by approximately 2% per day.

Notizen: Although the eradication of Helicobacter pylori infection benefits patients with gastric or duodenal ulcers, the value of eradicating the infection in the patients with functional dyspepsia (FD) remains controversial.〈section xml:id="abs1-2"〉〈title type="main"〉Aims:To determine whether eradicating H. pylori can prevent the subsequent development of ulcers or relieve the symptoms of functional dyspepsia patients.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:In a double-blind, placebo-controlled trial, 161 patients infected with H. pylori who had functional dyspepsia were randomly assigned to 7 days of treatment with a lansoprazole-based triple therapy or placebo and then followed for 1 year. The main outcome measures were the development of peptic ulcers and the resolution of symptoms.〈section xml:id="abs1-4"〉〈title type="main"〉Results: H. pylori was eradicated in 63 out of 81 patients (78%) in the treatment group and none of the 80 patients (0%) in the placebo group. During the follow-up period, two patients in the treatment group and six patients in the placebo group developed peptic ulcers at repeat endoscopy (2.5% vs. 7.5%; 95% CI: –12 to 2). The reduction in ulcer rates was statistically significant in the ‘ulcer-like’ sub-group (0% vs. 16.7%; 95% CI: –32 to –2), but not in the ‘dysmotility-like’ and ‘unclassifiable’ sub-groups. Regarding symptom response, the resolution rates of symptoms were similar between the treatment and placebo groups (58.0% vs. 55.0%, 95% CI: –12 to 18). Additionally, no significant differences existed in the symptom responses between the treatment and control arms in each of the dyspepsia sub-groups.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Eradicating H. pylori can prevent the subsequent development of peptic ulcers in the patients with ‘ulcer-like’ functional dyspepsia. However, this approach does not significantly reduce the symptoms of functional dyspepsia patients.

Notizen: Summary. Adequate factor substitution is a prerequisite for successful conservative or operative treatment of haemophilic synovitis. Subsequent prophylactic factor substitution can prevent further joint problems in the future. Orthopaedic treatment regimes are dependent on the classification of the synovitis and the stage of the arthropathy. Synovitis can be classified into acute and chronic forms. The arthropathy is classified according to Arnold and Hilgartner. When the synovitis has already become chronic, early arthroscopic synovectomy is recommended in order to prevent the otherwise inexorable progress of the arthropathy. Failure to treat in the early phase of the pathology causes problems in the correction of further stages. The progression of the joint disease can be shown both clincally and radiologically as the arthropathy develops, and influences the treatment.