- Email: [email protected]
Confirmation of xeroradiography as an important postmortem fetal diagnostic technique
Correspondence 347
Volume 153 Number 3
hemoglobin that exceed 50% and they are designated as having SA rather than AS hemoglobin. Was this a possible factor in this patient's death? I have a comment regarding the autopsy finding of massive sicklemia in all organ systems. Although it was alluded to in your article, I would like to emphasize that such postmortem findings, even with sickle cell trait patients, is the rule rather than the exception. However, almost always they represent changes that occurred after death when, of course, there is total deoxygenation of both arterial and venous blood. Hence, one actually cannot ass ume that these postmortem sickle cell changes also preceded the agonal event. Lastly, it is interesting to note that your patient had premature rupture of the membranes. I am familiar with a single uncontrolled retrospective study in the literature which suggests that premature rupture ofthe membranes occurs more frequently in sickle cell trait patients than in the general population.' Perhaps this finding for sickle cell trait patients warrants further study. H enry W. Foster, Jr., M.D. Department of Obstetrics and Gynecology Meharry Medical College Nashville, Tennessee 37208
REFERENCE I. Rimer B. Sickle cell trait and pregnancy: a re view of a community hospital experience. AM .J OBSTET GV:'>JECOL 1975; 123:3.
Reply
To the Editors:
We appreciate Dr. Foster's comments regarding autopsy findings of massive sicklemia in patients with sickle cell trait. As we mentioned in the paper, this is far from conclusive evidence that a sicklemia is a direct cause of problems in these patients. We are making a clinical observation with the intention of arousing interest in this matter. Perhaps further case studies, including antemortem red cell morphologic studies will clarify this matter. We thank Dr. Foster for his clinical observation that premature rupture of the membranes may be associated anecdotally with sickle cell trait. We are currently engaged in a large multicenter cooperative study funded by the National Institutes of Health which ex-
amines prematurity, premature rupture of the membranes, etc., from the point of view of genital infectious etiology. However, once this study of 15,000 to 20,000 patients is completed, there should certainly be enough data to include sickle cell trait as a variable in patients with premature rupture of the membranes . Joseph C. Pastorek II, M.D. Section of Infectious Disease Department of Obstetrics and Gynecology Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, Louisiana 70112
Confirmation of xeroradiography as an important postmortem fetal diagnostic technique To the Editors:
We were delighted to see the recent report by Elejalde and associates stressing the importance of xeroradiographic imaging techniques for fetal material (Elejalde BR, Elejalde MM, Gilman M . AM J OBSTET GYNECOL 1985;151:666). Our program has been using this technique for the past 6 years, and we have also found it to be a useful approach for examining aborted fetuses.' In our study we emphasized the enhanced visualization of soft tissues with this technique and reported examples of stich fetal abnormalities as acardia, neural tube defects, nuchal cystic h ygro ma, and arthrogryposis. Using newborn kittens and chickens, we were able to compare images derived from standard radiographs, xeroradiographs, and alizarin staining. The quality of the xeroradiographic images is clearly superior. We were delighted to see this technique applied to skeletal dysplasias and also to witness the use of contrast media to better visualize hollow viscera. John M. Graham,Jr., M.D., Sc.D. Eileen F. Rawnsley, R.N. , B.S. G. Millard Simmons,Jr., M.D. Harte C. Crow, M.D. Dartmouth H itchcock Medical Center Hanover, New Hampshire 03756
REFERENCE J. Graham JM Jr, Crow HC, Rawnsley EF, Simmons GM Jr, Hoefnagel D. Enhanced visualization of soft tissues in the stud y of aborted fetuses through the use of xeroradiography. Teratology 1984;30: II .
Volume 153 Number 3
hemoglobin that exceed 50% and they are designated as having SA rather than AS hemoglobin. Was this a possible factor in this patient's death? I have a comment regarding the autopsy finding of massive sicklemia in all organ systems. Although it was alluded to in your article, I would like to emphasize that such postmortem findings, even with sickle cell trait patients, is the rule rather than the exception. However, almost always they represent changes that occurred after death when, of course, there is total deoxygenation of both arterial and venous blood. Hence, one actually cannot ass ume that these postmortem sickle cell changes also preceded the agonal event. Lastly, it is interesting to note that your patient had premature rupture of the membranes. I am familiar with a single uncontrolled retrospective study in the literature which suggests that premature rupture ofthe membranes occurs more frequently in sickle cell trait patients than in the general population.' Perhaps this finding for sickle cell trait patients warrants further study. H enry W. Foster, Jr., M.D. Department of Obstetrics and Gynecology Meharry Medical College Nashville, Tennessee 37208
REFERENCE I. Rimer B. Sickle cell trait and pregnancy: a re view of a community hospital experience. AM .J OBSTET GV:'>JECOL 1975; 123:3.
Reply
To the Editors:
We appreciate Dr. Foster's comments regarding autopsy findings of massive sicklemia in patients with sickle cell trait. As we mentioned in the paper, this is far from conclusive evidence that a sicklemia is a direct cause of problems in these patients. We are making a clinical observation with the intention of arousing interest in this matter. Perhaps further case studies, including antemortem red cell morphologic studies will clarify this matter. We thank Dr. Foster for his clinical observation that premature rupture of the membranes may be associated anecdotally with sickle cell trait. We are currently engaged in a large multicenter cooperative study funded by the National Institutes of Health which ex-
amines prematurity, premature rupture of the membranes, etc., from the point of view of genital infectious etiology. However, once this study of 15,000 to 20,000 patients is completed, there should certainly be enough data to include sickle cell trait as a variable in patients with premature rupture of the membranes . Joseph C. Pastorek II, M.D. Section of Infectious Disease Department of Obstetrics and Gynecology Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, Louisiana 70112
Confirmation of xeroradiography as an important postmortem fetal diagnostic technique To the Editors:
We were delighted to see the recent report by Elejalde and associates stressing the importance of xeroradiographic imaging techniques for fetal material (Elejalde BR, Elejalde MM, Gilman M . AM J OBSTET GYNECOL 1985;151:666). Our program has been using this technique for the past 6 years, and we have also found it to be a useful approach for examining aborted fetuses.' In our study we emphasized the enhanced visualization of soft tissues with this technique and reported examples of stich fetal abnormalities as acardia, neural tube defects, nuchal cystic h ygro ma, and arthrogryposis. Using newborn kittens and chickens, we were able to compare images derived from standard radiographs, xeroradiographs, and alizarin staining. The quality of the xeroradiographic images is clearly superior. We were delighted to see this technique applied to skeletal dysplasias and also to witness the use of contrast media to better visualize hollow viscera. John M. Graham,Jr., M.D., Sc.D. Eileen F. Rawnsley, R.N. , B.S. G. Millard Simmons,Jr., M.D. Harte C. Crow, M.D. Dartmouth H itchcock Medical Center Hanover, New Hampshire 03756
REFERENCE J. Graham JM Jr, Crow HC, Rawnsley EF, Simmons GM Jr, Hoefnagel D. Enhanced visualization of soft tissues in the stud y of aborted fetuses through the use of xeroradiography. Teratology 1984;30: II .