Intrauterine laser photocoagulation for twin-twin transfusion syndrome (TTTS) needs accurate in-situ recognition of placental vascular anastomosis. Because the conventional procedure is highly dependent upon the operators' skill and experience, we developed a new way to visualize the placental vascular network by a rigid-type fluorescence endoscope coupled with intravenous administration of Indocyanine green (ICG). The feasibility of the fluorescence endoscope was examined with monkey placentas and pregnant rats. The ICG fluorescence endoscope can visualize the placental vascular network in detail even in the presence of turbid amniotic fluid. Thus, this method is potentially useful for in-situ definition of the placental vascular anastomoses during the treatment for TTTS. In addition, our rigid-type fluorescence endoscope will also be a useful tool for lymph node dissection using ICG by endoscopic surgery.
SUMMARY A 29-day-old infant born of consanguineous parents had type 1 hyperlipoproteinaemia associated with lipaemia retinalis. Biochemical analyses disclosed hypertriglyceridaemia, hyperchylomicronaemia, and lipoprotein lipase deficiency. Ophthalmoscopically all retinal vessels had the creamy appearance of lipaemia retinalis. The plasma lipoprotein levels and fundus condition became normal after her ingestion of fat was limited. To our knowledge this is the youngest patient reported with type 1 hyperlipoproteinaemia associated with lipaemia retinalis.Type 1 hyperlipoproteinaemia is an autosomal recessively inherited disorder characterised by hyperchylomicronaemia and hypertriglyceridaemia.' To date fewer than 100 cases of the disorder have been reported.) Lipaemia retinalis is peculiar in this disorder.'2 However, the fundus picture has been rarely shown.3 We describe lipaemia retinalis in a 29-day-old infant with type 1 hyperlipoproteinaemia.Case report An apparently normal baby was delivered on 12 July 1983 after a full-term uneventful pregnancy. Her birth weight was 3280 g. The parents, who were first cousins, and a 2-year-old brother were in good health (Fig. 1). The infant was breast-fed. When a blood sample was obtained from the cubital vein for newborn screening at 5 days of age, the patient's serum was observed to be milky. On 4 August she was referred to the Tohoku University Hospital for further examination.Biochemical analyses disclosed a slightly elevated serum cholesterol level (400 mg/dl (10-4 mmol/l); normal, 130-250 mg/dl (3.4-6-5 mmol/l)) and a markedly increased serum triglyceride concentration (3000 mg/dl (33-9 mmol/l); normal, 35-130 mg/dl (0.4-1.5 mmol)). During the examination serum triglyceride level sometimes increased to 15 000
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