Showing papers by "Roberto Romero published in 1987"

Acute fatty liver of pregnancy. A reassessment based on observations in nine patients

Abstract: Acute fatty liver of pregnancy was diagnosed in nine patients over a 10-year period. Eight patients had severe hepatic dysfunction typical for this syndrome and one had subclinical disease but typical hepatic histologic findings. All patients survived with little fetal wastage; all had preeclampsia. Histologic findings included cholestasis, hepatocellular necrosis, and inflammation, as well as microvesicular fat. Histologic findings from biopsy specimens of four of seven patients were initially misinterpreted as hepatitis. This disorder may have both a broad clinical and histologic spectrum; it is probably not rare but often misdiagnosed, perhaps as viral hepatitis. The concurrence of this disorder with toxemia of pregnancy suggests that these entities may be pathophysiologically related.

Criteria for the Prenatal Diagnosis of Holoprosencephaly

Abstract: Holoprosencephaly is a congenital anomaly of the central nervous system whose prenatal sonographic appearance may to similar to that of ventriculomegaly. A clear differential diagnosis is extremely important because the two conditions have different prognoses and therefore require different obstetric management. Eight cases of prenatally recognized holoprosencephaly are analyzed and criteria for a specific diagnosis proposed. The specificity and limitations of ultrasound findings, such as identification of a holoventricle, presence of a dorsal sac, and facial anomalies are discussed.

Failure of endotoxin to cross the chorioamniotic membranes in vitro

Abstract: We have previously reported the detection of endotoxin in the amniotic fluid of patients with gram-negative intra-amniotic infection. Endotoxin or lipopolysaccharide (LPS) is a potent biologic product capable of inducing prostaglandin release from several cell types, and therefore may be involved in the onset of human parturition in the setting of intra-amniotic infection. The experiments outlined in this report were designed to determine whether endotoxin crosses chorioamniotic membranes in vitro. Chorioamniotic membranes obtained at the time of elective cesarean section were placed in Ussing chambers used for transport experiments. Endotoxin was placed in one chamber, and serial timed samples were taken from both chambers for endotoxin quantification, which was performed with the limulus amebocyte gel clot assay. Blue dextran was used to exclude the presence of large defects. Bromophenol blue was used to demonstrate membrane permeability to low-molecular weight substances. Endotoxin failed to cross the chorioamniotic membranes in all experiments (n = 11).

Ultrasound investigation of the posterior fossa in the fetus.

Abstract: One hundred and thirty normal pregnancies, ranging in gestational age from 15 to 40 weeks, were investigated to evaluate the capability of ultrasound to demonstrate the anatomy of the fetal posterior fossa. The cerebellum, including the cerebellar hemispheres, the superior and inferior vermis, the fourth ventricle, and the cisterna magna could be demonstrated easily. The ultrasound interpretation of the brain structures was verified by the anatomic dissection of the brains of 10 stillborn premature infants. A systematic approach to the prenatal ultrasound examination of the posterior fossa is described.

Do blood and meconium affect the detection of endotoxin in amniotic fluid with the limulus amebocyte gel clot assay

Abstract: The limulus amebocyte lysate (LAL), assay is the most sensitive technique for the detection of endotoxin in biological fluids. Because endotoxin is a component of gram-negative bacteria, the assay has been employed in the detection of gram-negative bacterial contamination of biological fluids. The LAL assay is rapid, inexpensive, easy to perform, and requires little laboratory expertise. When used in conjunction with the gram stain examination of amniotic fluid, it improves the detection of intra-amniotic infection before the availability of culture results. However, the usefulness of the LAL assay in the detection of endotoxin in other body fluids is limited by the presence of an inhibitor to the gelation of the assay. The studies reported in this communication were undertaken to establish if amniotic fluid contains such an inhibitor. Sterile amniotic fluid (AF) samples obtained from 93 patients by transabdominal amniocentesis before labor were used to determine the ED 50 dose of endotoxin necessary for a positive LAL result. The ED 50 dose of endotoxin required for gelation was significantly higher when AF--rather than pyrogen-free saline--was used as the diluent, implying that inhibitors are in fact present (ED 50 = 58.3 pgm/ml). The presence of blood or meconium in the AF did not enhance inhibition significantly: ED 50 doses were 58.3 pgm/ml and 56.2 pgm/ml, respectively. This is not significantly different from the ED 50 of clear amniotic fluid.

Acute fatty liver of pregnancy: A reassessment based on observations in nine patients

Abstract: Acute fatty liver of pregnancy was diagnosed in nine patients over a 10-year period. Eight patients had severe hepatic dysfunction typical for this syndrome and one had subclinical disease but typical hepatic histologic findings. All patients survived with little fetal wastage; all had preeclampsia. Histologic findings included cholestasis, hepatocellular necrosis, and inflammation, as well as microvesicular fat. Histologic findings from biopsy specimens of four of seven patients were initially misinterpreted as hepatitis. This disorder may have both a broad clinical and histologic spectrum; it is probably not rare but often misdiagnosed, perhaps as viral hepatitis. The concurrence of this disorder with toxemia of pregnancy suggests that these entities may be pathophysiologically related.