OBJECTIVES:To evaluate the feasibility of a serologic screening program in pregnant women to detect neonates at risk for a congenital cytomegalovirus infection.STUDY DESIGN:Unselected mother-infant pairs (n = 7140) were studied. In the mother, serologic screening consisted of the testing for cytomegalovirus antibodies at the first prenatal visit and at birth. In the neonate, cytomegalovirus urine culture was performed to diagnose congenital infection.RESULTS:Serologic screening showed evidence of past infection in 3850 women (53.9%); 192 (2.7%) women had both immunoglobulin (Ig)G and IgM antibodies when first tested during pregnancy. Seroconversion was detected in 44 seronegative women (1.4%). Forty-four congenital infections were diagnosed (0.62%): 8 in women with past infections, 22 in women who seroconverted, and 14 in women who initially had positive IgM antibodies.CONCLUSIONS:Screening at the first prenatal visit and at birth defines two major risk groups for congenital cytomegalovirus infection: women with seroconversion during pregnancy and women with IgM antibodies in their first prenatal serum sample (0.6% and 2.7%, respectively, of the pregnant population). In these selected babies (3.3% of the study group), cytomegalovirus urine culture should be performed. This type of screening allows the detection of 82% of all congenital cytomegalovirus infections.

Amiodarone, an anti-arrhythmic drug that contains 39% iodine, is rarely known to cause negative effects on fetal thyroid function after gestational exposure, when given orally to a pregnant woman. Two cases of fetal hypothyroidism after gestational exposure to amiodarone by direct fetal intravenous route are described here.

OBJECTIVE: Congenital CMV infection (cCMV) is the most frequent cause of intrauterine infection.In this study we evaluated the feasibility, of a serological screening program for detecting neonates at risk for a cCMV infection. STUDY DESIGN:The study was conducted on 5181 unselected motherinfant pairs.The screening consisted in a serological detection of CMV-antibodies (IgG and IgM) in the mother at the first prenatal visit and at delivery, combined with a urine culture for CMV from each livebom child.Congenital infection was diagnosed when CMV was isolated from the newborn urine collected within 7 days after birth.RESULTS: Serological screening showed evidence of past infection (IgG positive and IgM negative) in 2710 women (52.3%); 2297 (44.3%) women had no antibodies in their first serum sample, and 174 (3.4%) women had both IgG and IgM antibodies when first tested during pregnancy.Seroconversion was detected in 43 (1.9%) seronegative women.Forty-one (0.79%) of the 5181 women delivered a congenitally infected infant.Congenital infection was detected in 6 infants born to a mother with evidence of past infection (0.22%), in 23 (53.5%) out of the 43 infants from mothers with CMV seroconversion during pregnancy and in 12 out of the 174 (6.9%) infants from women with IgM antibodies in their first serum sample.CONCLUSION: Screening pregnant women for CMV IgG and IgM antibodies at the first prenatal visit and at birth, can detect a selected group of pregnant women with a high risk of delivering a child with congenital CMV infection (women with seroconversion during pregnancy, and women with IgM antibodies in their first prenatal serum sample).In this selected group of neonates, (4.2% of all livebom children) urine culture should be performed in the neonatal period.Such a screening allows the detection of 85% of the cCMV infected newborns.

We evaluated a screening program for the detection of congenital cytomegalovirus in 3075 unselected pregnant women. From each live-born child urine for CMV culture was collected within 7 days after birth. Each fetus expelled after a spontaneous second trimester abortion and each stillborn infant were also evaluated for a possible congenital CMV infection. For each congenital infection stored maternal sera were analysed to determine whether maternal infection was primary or recurrent. Fifteen out of the 3075 pregnancies studied resulted in a congenitally infected infant (0.49%). Nine maternal CMV infections were primary infections; five were recurrent infections, and in one case the type of infection could not be determined. Three congenital infections resulted in severe sequelae, leading to the termination of pregnancy in two instances and to neonatal death in one case. One of these severe fetal infections was due to a recurrent maternal infection. Follow-up of the other 12 neonates demonstrated hearing disorders in two children. One was born after a primary maternal infection and one after a recurrent maternal infection. We conclude that congenital CMV infections occurs in 0.49% of all pregnancies in the population studied. Twenty percent of the congenitally infected infants present severe sequelae at birth or during pregnancy, and an additional 17% have audiological deficits at 1 year of age. Severe sequelae may occur after both primary and recurrent maternal CMV infection.

Background: Primary retroperitoneal serous cystadenomas (PRSCs) are extremely rare, and their pathogenesis is not well understood. Differentiating these tumors from other cystic or tumorigenic lesions can be challenging given the unusual retroperitoneal location and varied symptomatology. Case Presentation: An 83-year-old female was evaluated for vaginal prolapse symptoms, fecal incontinence, and intermittent mixed urinary incontinence symptoms. Magnetic resonance imaging showed a large space-occupying cystic structure closely associated with the rectum. After exploratory laparotomy with excision of the retroperitoneal mass, biopsy showed a simple cyst filled with serous fluid and lined by a single layer of cuboidal epithelial cells consistent with serous cystadenoma. On follow up visit, she reported improvement in stress urinary incontinence, but continued to have difficulty with urinary and bowel urge incontinence. Conclusion: PRSCs should be considered during evaluation of retroperitoneal space-occupying lesions despite the rarity of serous cystadenomas being found in this location. The pathophysiology of how PRSCs arise is still not well understood but establishing better techniques to distinguish these lesions from other cystic and tumorigenic lesions should be investigated.

The results of 24 h oesophageal pH monitoring, performed in 129 infants aged 6-10 weeks, were compared to those in the same patients after shorter periods (3, 6, 9 and 12 h). In the investigated population there was no significant difference between the reflux index (percentage of time with a pH < 4.0) after 12 or 24 h. Moreover, the correlation coefficient between the reflux index after 12 and 24 h was excellent (r 0.95). However, the intra-individual difference in reflux index after 12 and 24 h was 5% in 19% of the infants, and even exceeded 10% in more than 5% of the infants, making the interpretation of the results unreliable. Even in this particular population of infants in whom a 24-h period could be divided into almost identical periods (including a feeding and a sleeping period), 24-h registrations provided the most reliable results. However, if for some reason the investigation had to be interrupted after a minimum of 12 h, the risk for erroneous interpretation of the data appeared to be acceptable. The results of this study must not be extrapolated to older children.