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Lymphangiomas or cystic hygromas are malformations of the lymphatic vessels and are characterized by single or multiple cysts which have developed within the soft tissues. They occur most commonly in the neck (75 per cent of cases) and are often associated with hydrops or chromosomal abnormalities (Romero et al., 1988). Mediastinal or abdominal locations are rare and represent less than 5 per cent of cases in the literature (Singh et al., 1971). This paper represents the first reported case of prenatal diagnosis of a lymphangioma in the neck, mediastinum, and abdomen. Diagnosis was made before fetal viability, and allowed us to recommend termination of the pregnancy because of the poor prognosis.

Background: In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. Technique: The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. Experience: Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. Conclusion: This original technique was used for easy, safe, and rapid creation of neovaginas.

Three hundred and twenty-two percutaneous umbilical blood samplings were performed over 4 years in our prenatal diagnostic centre. A 3·5 MHz sector ultrasound transducer was used to guide a 22·5-gauge needle under local anaesthesia. Sampling was performed fcir rapid fetal karyotyping (within 72 h) in 120 cases, for diagnosis of fetal toxoplasmosis in 133 cases, for determination of the severity of Rh immunization in 15 cases, and for diagnosis of congenital rubella in 4 cases. Pure fetal blood was obtained in 98·7 per cent of the cases after two attempts. The approach to the cord was either transamniotic or trans-piacental. Puncturing was preferentially done at the placental insertion of the cord (72·2 per cent of the cases) and the mean blood sample volume was 3·5 ml. The rate of fetal death in utero was 1 9 per cent, including two cases of amnionitis, one trisomy 18, and one severe bradycardia. The failures were due to sampling at an early stage of pregnancy (before gestation week 18), to maternal obesity, oligohydramnios, and the inexperience of the operator.

A case of a large vascular lesion of the skull is reported. The lesion was discovered at 22 weeks' gestation and it rapidly increased in size, reaching 8 cm a month later. Tumor echogenicity was the same as that for soft tissues and colour Doppler examination revealed intense vascularization. Cordocentesis showed features of the Kasabach-Merritt syndrome and very high plasma levels of alpha-fetoprotein. A Caesarean section was performed to avoid dystocia and led to the birth of a baby with cardiac failure in the immediate neonatal period. Biopsies of the mass led to the diagnosis of a non-malignant haemangio-endothelioma. The mass was removed and plastic surgery performed. The baby is alive and well 9 months after the operation.

To define the diagnostic and therapeutic value of foetal urine sampling (FUS).Between 1996 and 2001, FUS was performed in 16 patients for three indications: assessment of renal function (Group 1, n = 12), diagnosis of a cystic mass (Group 2, n = 2), prevention of dystocia (Group 3, n = 2). The anomaly was detected by ultrasound. Urine was aspirated from the two renal pelves and/or bladder, or the cystic mass in the other cases. b2-microglobulin and urinary sodium were assayed and karyotyping was performed at the same time.20 FUS were performed In 4 cases, two samples were taken at an interval of 2 weeks. No complications were observed. Group 1: 9 pregnancies were terminated for potential renal failure (6 posterior urethral valves (PUV), 1 Prune Belly syndrome, 2 cases of recessive polycystic kidney disease (PKD). Three pregnancies were continued for 2 foetuses with normal renal function (1 PUV, 1 ureterocele) and one foetus died with severe renal failure (bilateral hydronephrosis). Group 2: one termination of pregnancy was performed in a case of hepatic cyst with portobiliary dysplasia and a giant bladder diverticulum was operated. Group 3: in both cases, evacuating aspiration allowed normal delivery of one live infant (left polycystic dysplasia), and one neonatal death from megabladder-megacolon syndrome.The value of FUS is controversial. We usually performed this examination for assessment of renal function. The results of FUS are useful for management decisions when they are in favour of potential impaired renal function. They usually confirmed the ultrasound results that already indicated a poor prognosis and they did not change the decision already based on ultrasound findings in any of our cases. For the diagnosis of cystic masses, after drainage of the mass, FUS facilitated investigation of the urinary tract and adjacent organs. When FUS was performed during labour, it reduced the size of the mass and the abdomen, allowing vaginal delivery with a better ventilatory adaptation of the infant.

We report a successful treatment of a B19 parvovirus-induced fetal hydrops diagnosed at 16 weeks of gestation. This disease could be corrected by means of a unique intraperitoneal blood transfusion performed at 18 weeks, once diagnosis was established. The delivery occurred at 36 weeks, leading to the birth of a healthy baby. This case suggests that transfusion should be attempted, as the spontaneous fetal recovery remains uncertain and shows that intraperitoneal blood transfusion is an effective therapeutic option of the B19 parvovirus-induced anemia, in the absence of a viral myocarditis.

Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. We present a case of fetal abdominal hemolymphangioma diagnosed by ultrasound at 27 weeks of gestation. The extensive fetal involvement, and the diagnosis before fetal viability led us to propose medical termination of pregnancy. This represents the second reported case of prenatal diagnosis of this malformation.

Several authors have already underlined chromium implication in glucose and lipids metabolism of humans. In this field, physiological chromium determination in serum could be helpful, but the discrepancies reported in numerous papers are confusing. Here we report some results obtained by Zeeman correction Graphite Furnace Atomic Absorption Spectrometry. This technique includes a dilution of serum with 12.5 mM ultrapure nitric acid and 0.25% Triton X-100 (final concentrations). Some main features can be outlined: (1) the contamination constitutes a serious drawback and (2) the sensitivity of the technique is critical (characteristic mass found: 1.76 pg/0.0044 A.s). Our results obtained from 27 healthy subjects (2.01 +/- 0.77 nmol/L) agree with most recent studies and indicate that serum chromium level does not seem to be sex-related.

Cumulative distributions of the number of doublings undergone by mixed megakaryocytic/erythroblastic colonies and by pure megakaryocytic colonies were determined from plasma clot cultures of bone marrow (from C57BL/6 mice) supplemented with erythropoietin. Analysis of these distributions suggests that these colonies are produced by three distinct progenitors. At days 7-14, progenitors of mixed megakaryocytic/erythroblastic colonies (BFU-ME) generate tri-exponential distributions and the mean (+/- SD) fraction of this progenitor pool ceasing to proliferate per doubling (FCP) increases stepwise from 0.07 +/- 0.06 to 0.27 +/- 0.07 and 0.73 +/- 0.07. In this interval, progenitors of pure megakaryocytic colonies (CFU-M) generate bi-exponential slopes whose FCP values are compatible with the two last slopes above. Finally, CFU-M at day 3 express only the last slope. From days 5 to 9, megakaryocytes generated by BFU-ME reach lower ploidy levels than do those generated by CFU-M. It is concluded that, in the culture system used, (i) megakaryocyte progenitors that do not switch to polyploidization mature through the three consecutive compartments indicated, (ii) each progenitor population has a probability of becoming polyploid that reflects the fraction that ceases to proliferate, (iii) the exponentially distributed mitotic reserve of progenitors is determined by the combination of maturing into the next compartment and the probabilistic switch to the pathway of polyploidization, and (iv) the ploidy distribution of megakaryocytes probably depends on the progenitor from which they originate.

To evaluate whether exposure of Tn determinants at the surface of human erythrocytes, platelets, and granulocytes could arise from a somatic mutation in a hemopoietic stem cell, burst-forming unit erythroid (BFU-E) colonies, colony-forming unit granulocyte-macrophage (CFU-GM), and colony-forming unit-eosinophil (CFU-Eo) were grown from a blood group O patient with a typical Tn syndrome displaying two distinct populations (Tn(+) and Tn(-)) of platelets, granulocytes, and erythrocytes. A large number of colonies was observed. Individual colonies were studied with a fluorescent conjugate of Helix pomatia agglutinin (HPA). A sizeable fraction of each of the erythroid and granulocytic colonies appeared to consist exclusively of either HPA-positive or HPA-negative cells, thereby demonstrating the clonal origin of those exhibiting the Tn marker. Similar results were obtained from a second patient. These findings establish that the HPA labeling of Tn cells is an accurate marker permitting assessment of the clonality of the human megakaryocyte (MK) colony assay. For the study of MK cultures a double-staining procedure using the HPA lectin and a monoclonal antiplatelet antibody (J-15) was applied in situ to identify all MK constituting a colony. Our results, obtained in studies of 133 MK colonies, provide definitive evidence that the human MK colony assay is clonal because all MK colonies were exclusively composed of Tn(+) and Tn(-) MK. Furthermore, the distribution of MK within a single colony was shown to be seminormal with a mean at 6 MK, isolated MK typically being absent in culture. Comparison of the proportion of mature Tn(+) cells in blood with their respective Tn(+) progenitors has also shown that no proliferative advantage occurs after the commitment; because Tn polyagglutinability is an acquired disorder, then the expansion of the Tn(+) clone must occur either during the proliferative stage of the pluripotent stem cell or during the commitment itself. This study therefore affords evidence that a blood group antigen plays a role in the differentiation of a pluripotent stem cell.