Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies

Article Abstract:

The rate of spontaneous miscarriage has been reported to range from 20 to 62 percent. A recent study has identified the rate of spontaneous miscarriage within the first trimester of pregnancy at 31 percent of confirmed pregnancies. Approximately 9 percent of these miscarriages occur after the mother became aware that she was pregnant. With miscarriage rates of this magnitude, there is interest in developing a diagnostic screening test to determine at-risk pregnancies. One approach has been to consider the fetus as a transplant into the mother's body. The basis of this strategy derives from the fact that the genetic makeup of the fetus is different from that of the mother, and that the immune system of the mother may identify the fetus as a foreign body and trigger an immune reaction to eliminate the fetus. The blood of 552 pregnant women was screened for the presence of antibodies directed against the thyroid gland (thyroid autoantibodies). Other measures of thyroid hormone physiology were also collected and used in the statistical analysis of the results. In all, various forms of thyroid autoantibodies were found in 19.6 percent of the women studied. The rate of spontaneous miscarriage in the group of women in whom autoantibodies were found was 17 percent, as compared with 8.4 percent in women who lacked these antibodies. This difference was evident even when women with abnormal thyroid hormones were eliminated from consideration. The data strongly suggest that the presence of thyroid autoantibodies is a separate and independent risk factor for spontaneous miscarriage. Although the identification of at-risk pregnancies remains difficult for the clinician, the early detection of some may improve the possibility of clinical intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Autoantibodies, Risk factors, Autoimmune diseases, Miscarriage

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Unsuspected osteomyelitis in diabetic foot ulcers: diagnosis and monitoring by leukocyte scanning with indium In 111 oxyquinoline

Article Abstract:

Next to accidents, the most common cause of amputation of the foot and leg is foot complications caused by diabetes. Foot ulcers are often followed by bone infection (osteomyelitis), which, if not properly treated with antibiotics, leads to amputation. Bone biopsy, an invasive procedure, may cause complications in patients with circulatory complications, and is usually avoided if patients have no symptoms of bone infection. Nuclear imaging with a substance containing a radioactive isotope of indium, In 111 oxyquinoline, and bone scanning was used to determine whether osteomyelitis was present in 54 diabetic patients, 35 of whom had a total of 41 foot ulcers. Osteomyelitis was present in 28 the 41 ulcers, but only nine had been diagnosed clinically. Because unsuspected bone infection was found in over two thirds of the ulcers, a noninvasive diagnostic test is clearly needed. Leukocyte scanning is a safe, noninvasive and reliable method of detecting osteomyelitis, and can also be used to monitor the progress of antibiotic treatment. All patients with diabetic foot ulcers should undergo leukocyte scanning, unless bone is exposed. All patients with exposed bone have osteomyelitis, therefore further diagnostic techniques are not needed. Early diagnosis and treatment of osteomyelitis that is not clinically suspected will reduce the high number of amputations among diabetic patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Prevention, Ulcers, Diagnostic imaging, Amputation

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Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients

Article Abstract:

Probing for bone in a foot ulcer may be useful in the diagnosis of osteomyelitis in persons with diabetes. Ulcerated foot infections are a common complication of diabetes, and they can lead to osteomyelitis, or bone inflammation. Researchers evaluated 76 foot ulcers in 75 diabetic patients using a sterile, blunt probe to feel for bone at the base of the ulcer. Other diagnostic tests, such as wound and blood cultures and x-rays, were also performed for all patients, and some patients had additional tests, including bone scan and biopsy. Osteomyelitis was diagnosed in 50 of the 76 ulcer cases. The bone-probe test was positive in 33 of the 50 osteomyelitis cases, versus four of 26 cases without osteomyelitis. Feeling bone at the base of a foot ulcer during initial evaluation may permit more rapid identification and treatment of osteomyelitis.

Foot, Foot ulcer

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