ABSTRAm. Using four different digoxin kits, it was disclosed that the majority of various samples including amniotic fluid, cord blood, and serum from neonates contained substantial levels of digoxin-like immunoreactive substance. The differences in data seemed to be due to the range of epitopes which are recognized by antidigoxin antiserum. The day-to-day studies on sera serially obtained from infants at birth to 48 days old revealed that the level of the substance (0.31 f 0.12 ng/ml) in sera of the l-dayold neonates rapidly declined to the level of 0.1 ng/ml by the 2nd postnatal wk and thereafter gradually declined. The immunological specificity and accuracy of the detection of digoxin-like immunoreactive substance was confirmed by a sample dilution test, a recovery test for standard digoxin, and an absorption test with antidigoxin antiserum. The amniotic fluid and cord blood also contained Recent reports (1-3) renewed our attention toward the falsepositive digoxin measurements in the plasma of premature infants (4). From the clinical viewpoint, these observations raise some important questions. The first question is whether the falsepositive digoxin measurement really indicates the presence of a DLIS which leads to an erroneous judgment about the level of digoxin in monitoring of neonatal samples. The second question is whether there is any similarity in biochemical specificity between DLIS and the so-called "ouabain-like substances" detected in other organs or body fluids (5-13). It seems that previous reports (1-3) have not yet provided substantial evidence for their conclusion that the substance is not a product of technical or nonimmunological false positivity. Therefore, in this communication, we tried to confirm the previous findings using Received September 6, 1984; accepted August 19, 1985. Address for correspondence Hiroyoshi Ebara, M.D., Department of Pediatrics, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma-ken, Japan. amniotic fluid, cord blood, and serum specimen from neonates and also to evaluate immunological specificity of the reaction and presence of a DTLIS. MATERIALS AND METHODSThirty-one amniotic fluid and 53 cord blood samples were obtained from mothers who had not received any digitalis glycosides during pregnancy and labor. One hundred eleven sera were also obtained from 23 neonates over 35-wk gestational age who were delivered from healthy mothers who had not been on digitalis therapy. The mean and range of birth weight of the neonates were 3264 g and 20 16-4420 g, respectively. The investigation was approved by the ethical committee of the hospital and informed parental consent was obtained for blood sampling. All samples were stored at -20" C in separate small quantities to avoid unnecessary freezing and thawing, and analyzed at various intervals, always within 30 days of collection.For the detection of DLIS, one EIA kit and three RIA kits available in Japan were used: kit A (Markit Digoxin, DainipponSeiyaku, Osaka, Japan); kit B (Amerlex Digoxin RIA k...
High‐resolution chromosome analysis showed the karyotype 46,XX,del(1)(p13.3 p22.3) in a female infant with an extreme tetralogy of Fallot and multiple congenital anomalies. The patient showed characteristic features: upper and lower eyelids connected to each other by a string‐like epithelium, low hairline, epicanthal folds, saddle nose with a broad, flat root, micrognathia, short neck, high‐arched palate, prominent xiphisternum, wide‐spaced nipples, bilateral pes equinovarus, fifth toes that overlapped the fourth toes bilaterally, a deep fissure between the first and second toes bilaterally, and abnormal flexions of fingers and toes. Growth and psychomotor retardation were also noted. Cardiac catheterization revealed an extreme tetralogy of Fallot complicated by a patent ductus arteriosus. Ventricular tachycardia and ventricular premature beats developed during the neonatal period and did not respond well to anti‐arrhythmic drugs. She died of the anoxia caused by closure of the patent ductus arteriosus when she was 7 months old.
Using the scratch test with self-made chrysanthemum pollen extract of 32,700 PNU/ml, a positive response was elicited in 60 of 316 patients (18.9%) with allergic rhinitis and bronchial asthma, and was positive in 42.5% adults with allergic rhinitis. On the other hand, a 4.7% positive response was obtained in 84 non-allergic subjects. With the intracutaneous test, a threshold value was determined in 7 cases with 0.327 PNU/ml; 12 with 3.27 PNU/ml; 8 with 32.7 PNU/ml; and 8 with 327 PNU/ml, as opposed to one positive in 84 controls with 327 PNU/ml (1.3%). P-K tests were successfully done in 15 out of 16 cases. Furthermore, the results of in vitro neutralization tests using chrysanthemum and other compositae pollen extracts indicated the absence of sharing antigenic determinants between them. Provocation tests were conducted in 4 cases of allergic rhinitis and 3 cases of bronchial asthma with positive response in all the patients. From these results it was found that chrysanthemum pollinosis indeed exists in Japan, particularly in the mountainous districts.
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