Summary The predictive value of various biochemical methods for monitoring early risk pregnancies has been compared in 65 cases of threatened abortion. Estimation of human chorionic gonadotropin (HCG), human placental lactogen (HPL), progesterone, oestradiol and alpha‐fetoprotein (AFP) in serum were made by radioimmunoassays. Values below the normal range predicted abortion in 79, 81, 89, 92 and 38 per cent of patients, while normal values confirmed continuation of pregnancy with an accuracy of 71, 61, 60, 68 and 30 per cent respectively. Thus predictions from oestradiol and progesterone were at least as reliable as those from the protein hormones, while AFP proved to be unsuitable for this purpose. Combination of two variables gave even more reliable results. Due to individual and diurnal variation, however, abortion in the third and fourth month could not be definitely assumed at values above 5 IU HCG/ml, 5 ng progesterone/ml or 200 pg oestradiol/ml.

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Flow cytometry and monoclonal antibodies are promising tools for HLA-antigen detection. Previous approaches have been hampered by the lack of a carefully standardized system for calibration and sample analysis. A new system for HLA-B27 screening was developed using a FACScan flow cytometer, software for automated calibration and analysis, calibration beads, and the anti-HLA-B27-FITC/anti-Leu4-PE (CD3) monoclonal antibodies. The median fluorescence channel result for the HLA-B27-FITC signal of CD3+ T lymphocytes is compared to a decision marker. Values lower than this threshold are read as HLA-B27 negative and those above are recommended for retesting with the classic microcytotoxicity assay on the presumption of HLA-B27 positivity. The anti-HLA-B27 antibody reacts with all six HLA-B27 subtypes and shows a weaker binding to HLA-B7. The screening test results were compared with those from the microcytotoxicity assay for HLA-typing in studies involving several European centers. The observed sensitivity was 100% (95% CI: 98.6-100) and the specificity was 97.4% (95% CI: 96.4-98.3). Other performance studies verified the reproducibility and reliability of results obtained with the screening system. o 1994 Wiley-Liss, inc.

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The early recognition of fetal maldevelopment due to chronic placental insufficiency is of decisive importance if perinatal mortality and morbidity are to be further reduced. This can be achieved by direct and indirect methods, i.e. cephalometry and thoracometry using ultrasound on the one hand, and biochemical tests of the function of the fetoplacental unit, on the other. Estriol, pregnandiol and HPL levels and some placental enzymes are here of special interest. In this investigation an attempt was made to asses the diagnostic value of the various parameters and to suggest when they should be used. Jürg KUNZ, born 1942, Zürich, Studied medicine at University of Zürich, 1962-69 Curriculum vitae l Material and methodA total of 83 patients presently, or with a case history of risk hospitalised because of suspect placental insufficiency, was investigated. Twin pregnancies and those with doubtful duration were excluded. In the third trimester of pregnancy the following determinations were made: An average of 4 determinations of the biparietal head diameter using the B-scan method (Vidoson), 10 determinations of estriol and 3 of pregnandiol in urine [13,50] and 6 HPL determinations in the semm [49], 7 determinations of heat stable alkaline phosphatase (HSAP) [9], all per individual case. Biparietal head diameter values were transferred to a Standard curve that was in agreement with the one reported by HOLLÄNDER [42]. Growth retardation was assumed if the last two values showed the same trend with the date being certain and were below two Standard deviations or showed decreased progress. Biochemical parameters were considered to be pathological if they were below 95% of the normal values, with two values being outside this normal ränge or with 3 or more values being continuously below the 95% normal ränge. Maturity was assessed after birth from neurological and somatic signs of maturity according to D u BÖ-WITZ [25]. Infants were diagnosed äs small for date if their birth weight was below the lOth percentile on the LUBCHENKO curve [62]. ResultsFifteen of the 83 newborn were small for dates. Five had a gestational age of less than 37 weeks, 4 in the 35/36 week and one in the 30.5 week. A further 11 prematures was in the group of 68 normotrophic children. However, only 3 out of the 15 small for date infants were below the lower limit of the norm. The remaining 81 (98%) were within nonnal limits, 71 % below the curve for mean values. In twelve SGA infants the head diameter was normal prenatally and increased normally. Fig. 2 shows a very good correlation between weight percentile and the percentage deviation from the normal mean of estriol excretion. In all SGA cases values were found to be decreased. Ten were outside the 95% normal limits and 5 were still at least 40% below those limits. In infants with body weights between the lOth and 50 th percentile estriol values were below, the normal mean in 44%.Weight percentiles and HPL concentration in maternal serum ( Fig. 3) also correlated well. In 8 out of 15 SGA inf...

The present study investigates the incidence of human rotavirus excretion in neonates of two hospitals. From April 1, 1983 to March 31, 1984, rotaviruses were detected with Rotazyme in the feces of 57 (15%) of 383 neonates at the Department of Pediatrics, University of Berne, in a total in 71 (5.2%) of the 1369 stool samples tested. Of the 57 neonates with Rotazyme-positive stool samples, 53 (93%) were asymptomatic. The problems of the specificity of Rotazyme in neonatal feces and the possibility of rapid testing on neonatology wards are discussed. In a prospective study carried out in April 1986 at the "Schweizerische Pflegerinnenschule in Zurich", rotaviruses were detected with genome gel electrophoresis in the feces of 15 (63%) of 24 risk neonates in the premature baby ward and in 36 (46%) of 79 neonates from the infant nursery, in a total in 63 (34%) of the 188 stool samples tested. In this rotavirus outbreak all rotaviruses detected showed the same band pattern, and therefore had an identical electrophorotype. Symptoms and hospital hygiene aspects of this outbreak will be dealt with in subsequent papers.

This report describes the peri- and postoperative management of a patient with a critical blood loss (hemoglobin of 22 g/l) as a consequence of a surgical intervention, i.e. a radical resection of an advanced malignant gynecological tumor. The patient refused autologous and homologous blood transfusions for religious reasons (Jehovah’s Witness). During surgery, hemodilution and cell salvage were used. Postoperatively she developed coagulopathy and hemorrhage with the lowest hemoglobin value of 22 g/l. The patient recovered under a therapy regimen of recombinant human erythropoietin and parenteral iron. The hemoglobin values returned to the lower normal range within 4 weeks. Consequences of hypoxia could not be seen.

In the context of a prospective study for detection of rotavirus infections, an outbreak in neonates was observed in April 1986 at the Schweizerische Pflegerinnenschule in Zurich. Altogether, 103 neonates were investigated by means of genome gel electrophoresis for rotaviruses (HRV, human rotavirus) in the feces in the course of April 1986. Of these 103 neonates, 51 (49%) were HRV-positive and 52 (51%) were HRV-negative. Of the 51 HRV-positive neonates, 42 (82%) showed clinical symptoms, especially a typically altered pathological quality of the feces and an increased frequency of fecal passage. Vomiting and fever were observed less frequently. The pathological quality of the feces proved to be significantly correlated with the infection of rotaviruses in the neonate at risk. Besides this, reduced feeding behavior, circulatory signs and in one neonate a convulsive state of unclear etiology were also observed. This has only been rarely described up to now in rotavirus infections in neonates. This study confirms that rotavirus may cause frequently slight symptoms in neonates, but sometimes also symptoms of a clinically significant extent.