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MEASUREMENT OF FETAL pH IN THE GUINEAPIG BY NMR
1361 MEASUREMENT OF FETAL pH IN THE GUINEAPIG BY NMR
SiR,-Antenatal monitoring has considerably increased the safety of the fetus and the newborn. Cerebral palsy caused by hypoxia can be avoided to a considerable extent. Nevertheless today’s methods have shortcomings. Fetal heart rate monitoring is sensitive but not very specific and false positive results lead to many unnecessary terminations of labour. Fetal blood analysis is a reliable way of recognising imminent fetal hypoxia but the method requires that the membran’es be ruptured so it can only be done during labour. 31 P in-vivo nuclear magnetic resonance (NMR) spectroscopy permits the non-invasive determination of pH in fetal tissue from the chemical shift of inorganic phosphorus (P) with respect to phospho creatinine. We used a Bruker tomograph (BNT IS 24/30) at a field strength of 2-44 T. A series of cross-sections of the pregnant guineapigs with a gestational age of 56-59 days were obtained using the twodimensional Fourier transform technique to localise the fetuses. For technical reasons there is an interval between the tomography and the spectroscopy, during which the fetus can alter its position. So, after laparotomy and uterotomy under ketamine/xylazine anaesthesia, the head of the fetus was fixed to the abdominal wall to allow the maintenance of the position of the fetal brain ona surface coil (4 cm diameter). Such fixation of the fetal head will be superfluous in the near future when NMR equipment becomes available that will provide imaging and spectroscopy at the same time. Such NMR systems should permit the method to be applied to the human fetus. The guineapig fetuses were catheterised to permit withdrawal of arterial blood samples. 31 P scans were at 40 - 5 MHz, 100 scans being done with a scanning time of 2 s. We measured the pH level in this way directly in the brains of five guineapig fetuses.
pH VALUES
IN FETAL BLOOD SAMPLES AND BY MEANS OF
FETAL
i
P NMR IN
BRAIN* .,
-
"
m
-.-
i
SP= sugar phosphate, Pi = inorganic phosphate; PCr = phosphocreatinine. *More than
one measurement m
each animal.
SP
Fetal blood samples withdrawn from the catheters were analysed on pH meter (Radiometer PHM 72-BMS 2). pH calculated from the chemical shift of inorganic phosphate and pH in fetal blood are compared in the table. These data suggest that it is possible in high-risk pregnancies to measure the pH directly in the brain of the unborn infant without rupturing the membranes. a
D-1000 Berlin 44, West Germany
K. LANGNER S. SCHMIDT J. W. DUDENHAUSEN E. SALING
Bruker Co, Karlsruhe
H. FRIEDBURG D. HÖPFEL
Institute of Perinatal Medicine, Free University of Berlin,
Radiometer Co,
Copenhagen, Denmark
HTLV-POSITIVE T-CELL LYMPHOMA/LEUKAEMIA IN AN AIDS PATIENT
SIR,-Two T-lymphotropic retroviruses have been associated with acquired immunodeficiency syndrome (AIDS); one is human T-cell leukaemia virus (HTLV) type I and the other is lymphadenopathy-associated virus or HTLV type III. HTLV-I is the causative agent of adult T-cell lymphoma/leukaemia (ATL). We report here a case of ATL diagnosed 17 months after an episode of Pneumocystis carinii pneumonia in a previously healthy HTLV-I carrier. The patient was a 36-year-old Japanese woman who presented with P carinii pneumonia and scabies in April, 1982.1 She had no history of promiscuity, drug abuse, or blood transfusion. Her husband is healthy and heterosexual. She was successfully cured of both diseases but had severe herpes zoster in November, 1982. She subsequently did well until May, 1983, when she began to have intermittent fever. T-cell subset analysis in June, 1983, revealed ratio (0 - 64) with a decrease of reversal of the helper T-cells (0-47X 10 /1). Purified protein derivative skin tests were negative and the lymphocyte response to mitogens was reduced. Furthermore, she was found to be seropositive for HTLV-I antigens and HTLV-I particles were demonstrated in short-term cultures of peripheral blood lymphocytes.2Her mother was also seropositive but her husband and sister were seronegative. In July, 1983, swelling of the cervical lymph nodes was noted; biopsy was not diagnostic. In the beginning of September, 1983, the cervical lymphadenopathy became more pronounced and there was hepatosplenomegaly. A repeat biopsy of the cervical lymph nodes showed diffuse lymphoma of the pleomorphic type. She was given several courses of combination chemotherapy with cyclophosphamide, vincristine, and prednisolone but the response was transient and incomplete. On Jan 12, 1984, her white blood-cell count rose to 15x 109/1, with 40% abnormal lymphocytes with indented or lobulated nuclei. These lobulated lymphocytes were E+, Leu-1+, Leu-2a-, and Leu-3a+. Multiple skin nodules soon appeared on the trunk and biopsy revealed leukaemic infiltration in the dermis and subcutaneous tissue. Terminally, meningeal leukaemia developed and the patient died on March 20, 1984. The proviral DNA of HTLV-I was detected by Southern blot hybridisation in her peripheral blood leukaemic cells and in the lymphomatous tissues obtained by biopsy and at necropsy. The clinical and laboratory features of our patient are consistent with those of AIDS. However, this case is unusual in that opportunistic infections such as P carinii pneumonia and herpes zoster were followed by the development of ATL. ATL was diagnosed 17 months after the episode of P carinii pneumonia and during this period there was no evidence of smouldering ATL.3 The patient was a carrier of HTLV-I and her tumour cells contained the HTLV-I I genome. Although Kaposi’s sarcoma and B-cell lymphoma have
helper/suppressor
1. ...
2.
31
P NMR spectrum of brain of guineapig fetus. Spectrum
represents total of 100 scans, each of 2
s scanning-time.
N. HELLEDIE
Kobayashi M, Miyoshi I, Sonobe H, Taguchi H, Kubonishi I. Association of Pneumocystis carinii pneumonia and scabies JAMA 1982; 248: 1973. Miyoshi I, Kobayashi M, Yoshimoto S, et al. ATLV in Japanese patient with AIDS. Lancet
3.
1983; ii: 275.
Yamaguchi K, Nishimura H, Kohrogi H, et al. A proposal for smoldering adult T-cell leukemia: a clinicopathologic study of five cases. Blood 1983; 62: 758-66.
SiR,-Antenatal monitoring has considerably increased the safety of the fetus and the newborn. Cerebral palsy caused by hypoxia can be avoided to a considerable extent. Nevertheless today’s methods have shortcomings. Fetal heart rate monitoring is sensitive but not very specific and false positive results lead to many unnecessary terminations of labour. Fetal blood analysis is a reliable way of recognising imminent fetal hypoxia but the method requires that the membran’es be ruptured so it can only be done during labour. 31 P in-vivo nuclear magnetic resonance (NMR) spectroscopy permits the non-invasive determination of pH in fetal tissue from the chemical shift of inorganic phosphorus (P) with respect to phospho creatinine. We used a Bruker tomograph (BNT IS 24/30) at a field strength of 2-44 T. A series of cross-sections of the pregnant guineapigs with a gestational age of 56-59 days were obtained using the twodimensional Fourier transform technique to localise the fetuses. For technical reasons there is an interval between the tomography and the spectroscopy, during which the fetus can alter its position. So, after laparotomy and uterotomy under ketamine/xylazine anaesthesia, the head of the fetus was fixed to the abdominal wall to allow the maintenance of the position of the fetal brain ona surface coil (4 cm diameter). Such fixation of the fetal head will be superfluous in the near future when NMR equipment becomes available that will provide imaging and spectroscopy at the same time. Such NMR systems should permit the method to be applied to the human fetus. The guineapig fetuses were catheterised to permit withdrawal of arterial blood samples. 31 P scans were at 40 - 5 MHz, 100 scans being done with a scanning time of 2 s. We measured the pH level in this way directly in the brains of five guineapig fetuses.
pH VALUES
IN FETAL BLOOD SAMPLES AND BY MEANS OF
FETAL
i
P NMR IN
BRAIN* .,
-
"
m
-.-
i
SP= sugar phosphate, Pi = inorganic phosphate; PCr = phosphocreatinine. *More than
one measurement m
each animal.
SP
Fetal blood samples withdrawn from the catheters were analysed on pH meter (Radiometer PHM 72-BMS 2). pH calculated from the chemical shift of inorganic phosphate and pH in fetal blood are compared in the table. These data suggest that it is possible in high-risk pregnancies to measure the pH directly in the brain of the unborn infant without rupturing the membranes. a
D-1000 Berlin 44, West Germany
K. LANGNER S. SCHMIDT J. W. DUDENHAUSEN E. SALING
Bruker Co, Karlsruhe
H. FRIEDBURG D. HÖPFEL
Institute of Perinatal Medicine, Free University of Berlin,
Radiometer Co,
Copenhagen, Denmark
HTLV-POSITIVE T-CELL LYMPHOMA/LEUKAEMIA IN AN AIDS PATIENT
SIR,-Two T-lymphotropic retroviruses have been associated with acquired immunodeficiency syndrome (AIDS); one is human T-cell leukaemia virus (HTLV) type I and the other is lymphadenopathy-associated virus or HTLV type III. HTLV-I is the causative agent of adult T-cell lymphoma/leukaemia (ATL). We report here a case of ATL diagnosed 17 months after an episode of Pneumocystis carinii pneumonia in a previously healthy HTLV-I carrier. The patient was a 36-year-old Japanese woman who presented with P carinii pneumonia and scabies in April, 1982.1 She had no history of promiscuity, drug abuse, or blood transfusion. Her husband is healthy and heterosexual. She was successfully cured of both diseases but had severe herpes zoster in November, 1982. She subsequently did well until May, 1983, when she began to have intermittent fever. T-cell subset analysis in June, 1983, revealed ratio (0 - 64) with a decrease of reversal of the helper T-cells (0-47X 10 /1). Purified protein derivative skin tests were negative and the lymphocyte response to mitogens was reduced. Furthermore, she was found to be seropositive for HTLV-I antigens and HTLV-I particles were demonstrated in short-term cultures of peripheral blood lymphocytes.2Her mother was also seropositive but her husband and sister were seronegative. In July, 1983, swelling of the cervical lymph nodes was noted; biopsy was not diagnostic. In the beginning of September, 1983, the cervical lymphadenopathy became more pronounced and there was hepatosplenomegaly. A repeat biopsy of the cervical lymph nodes showed diffuse lymphoma of the pleomorphic type. She was given several courses of combination chemotherapy with cyclophosphamide, vincristine, and prednisolone but the response was transient and incomplete. On Jan 12, 1984, her white blood-cell count rose to 15x 109/1, with 40% abnormal lymphocytes with indented or lobulated nuclei. These lobulated lymphocytes were E+, Leu-1+, Leu-2a-, and Leu-3a+. Multiple skin nodules soon appeared on the trunk and biopsy revealed leukaemic infiltration in the dermis and subcutaneous tissue. Terminally, meningeal leukaemia developed and the patient died on March 20, 1984. The proviral DNA of HTLV-I was detected by Southern blot hybridisation in her peripheral blood leukaemic cells and in the lymphomatous tissues obtained by biopsy and at necropsy. The clinical and laboratory features of our patient are consistent with those of AIDS. However, this case is unusual in that opportunistic infections such as P carinii pneumonia and herpes zoster were followed by the development of ATL. ATL was diagnosed 17 months after the episode of P carinii pneumonia and during this period there was no evidence of smouldering ATL.3 The patient was a carrier of HTLV-I and her tumour cells contained the HTLV-I I genome. Although Kaposi’s sarcoma and B-cell lymphoma have
helper/suppressor
1. ...
2.
31
P NMR spectrum of brain of guineapig fetus. Spectrum
represents total of 100 scans, each of 2
s scanning-time.
N. HELLEDIE
Kobayashi M, Miyoshi I, Sonobe H, Taguchi H, Kubonishi I. Association of Pneumocystis carinii pneumonia and scabies JAMA 1982; 248: 1973. Miyoshi I, Kobayashi M, Yoshimoto S, et al. ATLV in Japanese patient with AIDS. Lancet
3.
1983; ii: 275.
Yamaguchi K, Nishimura H, Kohrogi H, et al. A proposal for smoldering adult T-cell leukemia: a clinicopathologic study of five cases. Blood 1983; 62: 758-66.