832
signs resemble those of our patient. In the severe skin reaction, which might be classified as a form of chronic G.v.H.D., was preceeded by mild and insignificant signs of G.v.H.D. Clinically and histologically the findings suggested scleroderma, except that the worst symptoms and signs resolved in less than 6 months. This case indicates the possibility of unpredictable long-term consequences after initially successful bone-marrow grafting.
deformities. The skin our
patient
Children’s Hospital, and Department of
quate substitute for outstanding academic for medical-school admission? Faculty of Medicine, University of Liverpool, Liverpool L69 3BX
EIJA JOHANSSON JUHANI RAPOLA
00290 Helsinki 29, Finland
Commentary from Westminster From Our Parliamentary
With Labour in ULTRASOUND DURING AMNIOCENTESIS
SiR,—Placental localisation with ultrasound can reduce the possibility of complications or failure of amniocentesis, and the demand for diagnostic amniocentesis (e.g., for antenatal diagnosis) warrants further effort to make the procedure safer and more reliable. Experience with 145 consecutive amniocenteses at this hospital shows that prior placental localisation is important but not sufficient. Placental localisation was done by ultrasonic biscan before amniocentesis in 69 patients (group A); in 76 cases (group B) the procedure was done under direct ultrasonic control with localisation of the placenta and exact positioning of the fetus and "pool" of liquor. Fetomaternal haemorrhage (microscopically and macroscopically) was the criterion’ for complications, haemorrhage being determined by modified Kleihauer techniquezand a-fetoprotein measurement.33 Groups A and B were not matched since in group A 57 patients (82%) were in the third trimester while in group B only 12 (17%) were in the third trimester; all the same the results were striking. There were 2 failures and 8 fetomaternal haemorrhages (together, 14%) in group A while group B had only 1 haemorrhage and 1 failure (P
signs resemble those of our patient. In the severe skin reaction, which might be classified as a form of chronic G.v.H.D., was preceeded by mild and insignificant signs of G.v.H.D. Clinically and histologically the findings suggested scleroderma, except that the worst symptoms and signs resolved in less than 6 months. This case indicates the possibility of unpredictable long-term consequences after initially successful bone-marrow grafting.
deformities. The skin our
patient
Children’s Hospital, and Department of
quate substitute for outstanding academic for medical-school admission? Faculty of Medicine, University of Liverpool, Liverpool L69 3BX
EIJA JOHANSSON JUHANI RAPOLA
00290 Helsinki 29, Finland
Commentary from Westminster From Our Parliamentary
With Labour in ULTRASOUND DURING AMNIOCENTESIS
SiR,—Placental localisation with ultrasound can reduce the possibility of complications or failure of amniocentesis, and the demand for diagnostic amniocentesis (e.g., for antenatal diagnosis) warrants further effort to make the procedure safer and more reliable. Experience with 145 consecutive amniocenteses at this hospital shows that prior placental localisation is important but not sufficient. Placental localisation was done by ultrasonic biscan before amniocentesis in 69 patients (group A); in 76 cases (group B) the procedure was done under direct ultrasonic control with localisation of the placenta and exact positioning of the fetus and "pool" of liquor. Fetomaternal haemorrhage (microscopically and macroscopically) was the criterion’ for complications, haemorrhage being determined by modified Kleihauer techniquezand a-fetoprotein measurement.33 Groups A and B were not matched since in group A 57 patients (82%) were in the third trimester while in group B only 12 (17%) were in the third trimester; all the same the results were striking. There were 2 failures and 8 fetomaternal haemorrhages (together, 14%) in group A while group B had only 1 haemorrhage and 1 failure (P
