804

showed a 2 cm left choroid cyst; abdominal ultrasound was reported normal. Cytogenetic studies showed a karyotype of 45,XX,-20/46,XX. 100 cells were analysed; 4 showed monosomy 20. 96 were normal with no other structural or numerical changes. The baby required ventilatory support and blood transfusions. Repeat blood chromosome studies were therefore impossible, and she died before we could do a skin biopsy for confirmation of cytogenetic findings. Monosomy-20 mosaicism has not been previously reported. Most autosomal monosomies are thought to be non-viable,3 and the prematurity and poor course of this child supports such a conclusion. as

Genetic Counseling Service, Mercer Medical Center, Trenton, New Jersey 08607, USA; - and Robert Wood Johnson School of Medicine, New Brunswick, New Jersey

DONNA F. WALLERSTEIN ROBERT WALLERSTEIN CAROLEE WATKINS

R, Kahn E, eds. Clinical genetics handbook. New Jersey: Medical Economics Books, 1987: 47-48. 2. Kaloustian VM, Vekemans M, Coates A, Allen H, Garami A. Clinical features of an 1. Berini

infant with partial monosomy 20. Am Hum Genet 1988; 43: A46. J 3. Boue J, Boue A, Lazar L. Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratology 1975; 12: 11-26.

Coronal computed

tomographic scan of cavernous sinuses.

18-year-old girl presented with a complete right ptosis after days of cough and cold, and five days of headache and vomiting. She had a history of nasal stuffmess that required repeated nose-blowing. Friends commented that she made a "trumpeting" sound. On examination she was febrile and drowsy, with neck stiffness, photophobia, right ptosis, and intermittent diplopia on looking to the right. There was mild right proptosis with no redness or tenderness. Computed tomography showed diffuse meningeal enhancement. The right cavernous sinus was enlarged, with slight convexity of its lateral margin (figure). Small filling An

Cardiac malformations in babies born after assisted

conception

SIR,-Although in large series of babies born after assisted conception no association with congenital malformations has been clearly shownl,2 (an increased frequency of some malformations is referred to only by Lancaster3), our experience indicates that there is an

increased risk of cardiac malformations in such babies.

Between Jan 1,1985, and Dec 31, 1990, we have seen 104 babies bom after 69 assisted conceptions (67 by in-vitro fertilisation or embryo transfer and 2 by gamete intrafallopian transfer). In our centre congenital malformations are diagnosed according to EUROCAT criteria. The prevalence of major congenital malformations at birth was 6 73% (cardiac malformations 4, hydrocephaly 1, clubfoot 1, rhizomelic dwarfism 1), which is significantly higher (one-sided Poisson 95% confidence interval [CI] 271-1256) than the 203% reported for the Italian population.4 The prevalence of cardiac malformations (3 ventricular septal defects and 1 ventricular and atrial septal defect) was 38% (CI 0’65-12’11) compared with 047% of the general neonatal population of our unit and 039% reported for northern Italy.’ We hope to hear others’ observations of cardiac malformations in babies born after assisted conception. DOMENICO LICATA ETTORE GARZENA BARBARA STASIOWSKA Department of Pediatrics, MICHAEL MOSTERT University of Turin, CLAUDIO FABRIS I-10126 Turin, Italy 1. Medical Research

International, American Fertility Society.

In vitro fertilisation/ embryo transfer in the United States: 1987 results from the National IVF-ET Registry. Fertil Steril 1989; 51: 13-18. 2. Cohen J, De Mouzon J. Outcome of IVF pregnancies in Europe. Proceedings of the second joint meeting of the European Society of Human Reproduction and Embryology and the European Sterility-Congress Organisation. Milan: ESHRE

and ESCO, 1990: 35. 3. Lancaster PAL. Congenital malformation after in-vitro fertilisation. Lancet 1987; ii: 1392-93. 4. Mastroiavco P, Spagnolo A. Sistema di sorveglianza sulle malformazioni congenite attuato dall’IPIMC (Indagine Policentrica Italiana sulle Malformazioni Congenite) negli anni 1978-84. Roma: Istituto Superiore di Sanità, 1987; Rapporti ISTISAN no 87/43. 26-27.

Nose-blowing and CSF rhinorrhoea SIR,-Mr Tolley and Mr Schwartz (Feb 2, p 302) reported CSF rhinorrhoea associated with nose-blowing. We describe a case of septic cavernous sinus thrombosis and meningitis, which we suggest was associated with forceful blowing of the nose leading to introduction of air and infection.

seven

defects indicated thrombus and a small bubble of air was seen in the sphenoid sinus was opaque, with a small defect in the bone of the lateral wall adjacent to the cavernous sinus. Haemophilus influenza meningitis was diagnosed after examination of the cerebrospinal fluid. She was treated with antibiotics, and her symptoms and signs subsequently resolved. Repeat computed tomography at three weeks showed no enlargement of the cavernous sinus, and no bubble of air. Cavernous sinus thrombosis is a rare but dangerous condition,’ and is often associated with paranasal, especially sphenoid, sinusitis.2 The finding of air in the cavernous sinus is unusual,3 and, in the absence of gas-forming organisms, we believe that the most likely cause was heavy nose-blowing. The walls of the sphenoid sinus are often thin, and gaps may exist in bone where mucosa is in immediate contact with the dura mater/ as shown by the bony deficiency in this case. Heavy blowing of the nose, especially if musical, should be discouraged. upper part of the sinus. The

RICHARD W. ORRELL Departments of Neurology and Neuroradiology, Leeds General Infirmary, Leeds LS1 3EX, UK

J. ASHLEY GUTHRIE JOHN T. LAMB

1. DiNubile MJ. Septic thrombosis of the cavernous sinus. Arch Neurol 1988; 45: 567-72. 2. Lew D, Southwick FS, Montgomery WW, et al Sphenoid sinusitis. N Engl J Med 1983; 309: 1149-54. 3. Curnes JT, Creasy JL, Whaley RL, Scatliff JH. Air in the cavernous sinus: a new sign of septic cavernous sinus thrombosis. AJNR 1987, 8: 176-77. 4. Williams PL, Warwick R, Dyson M, Bannister LH, eds. Gray’s anatomy. Edinburgh Churchill Livingstone, 1989 1179.

CORRECTIONS Detection of antibody to HIV- in urine.-Mr S. Desai and his colleagues draw attention to an incorrect dilution factor in their letter (Jan 19, p 183). In paragraph 3, line 1 should have read... 9 parts of urine were added to 1 part of proprietary "noise-reduction" buffer, and not urine was diluted I in 10 in

...

buffer.

Cytomegalovirus encephalitis and ganciclovir- In this letter by Dr P. Iannetti and colleagues (Feb 9, p 373), the first author’s name should be Paola.

Nose-blowing and CSF rhinorrhoea.

804 showed a 2 cm left choroid cyst; abdominal ultrasound was reported normal. Cytogenetic studies showed a karyotype of 45,XX,-20/46,XX. 100 cells w...
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