Cytomegalovirus (CMV) DNA levels were measured by quantitative-competitive polymerase chain reaction (PCR) in weekly leukocyte samples from 50 renal transplant recipients, including 23 with symptomatic and 27 with asymptomatic CMV infection. Peak and week 4 CMV DNA levels were higher in symptomatic subjects (P = .07 and .02, respectively). In a logistic regression model, the logarithm of the week 4 level independently predicted symptomatic infection (odds ratio, 1.78 for a 1 log10 increase; 95% confidence interval, 1.14-2.78; P = .01). All subjects whose week 4 level exceeded 1000 copies/100,000 leukocytes developed symptoms. In subjects with adequate samples for analysis, CMV levels declined exponentially with ganciclovir treatment, with an average half-life of 3.3 days. Levels exceeding 10,000 copies were associated with prolonged time to clearing of CMV DNA. Potential clinical applications of quantitative CMV PCR include predicting occurrence of symptomatic first episodes after transplantation and individualizing duration of antiviral therapy.

OBJECTIVE:To assess the rate of antepartum and intrapartum complications of fetuses with antenatally diagnosed gastroschisis managed in a center that advocates a trial of labor. STUDY DESIGN:A retrospective review. The medical records of 49 fetuses (1988 to 1997) who were prenatally diagnosed with gastroschisis by a sonologist in the Ultrasound Genetic Unit, Department of Obstetrics and Gynecology at Washington University, were reviewed. RESULTS:Oligohydramnios and intrauterine growth restriction were diagnosed in 23% and 49% of the pregnancies, respectively. A total of 22 women underwent induction of labor: nine for nonreassuring fetal testing, four for premature rupture of membranes, five for marked bowel dilatation, one for preeclampsia, and three for other reasons. Cesarean section (CS) was performed in 16 of 43 (37%) of women. The indications for CS were fetal distress (9 of 16 women), chorioamnionitis (2 of 16 women), breech presentation (3 of 16 women), and physician discretion (2 of 16 women). No significant differences in Apgar scores were observed between the fetuses. Fetuses who were delivered by CS for fetal distress were more likely to have undergone an induction of labor (91% versus 44%), and they were smaller than fetuses with no evidence of fetal distress (2220 Ϯ 105 gm versus 2613 Ϯ 80 gm, p Ͻ 0.05). CONCLUSION:The incidence of antepartum and intrapartum complications in fetuses with gastroschisis is high. The rate of CS can reach 37%. These data may aid clinicians in counseling patients with gastroschisis.

Cytomegalovirus (CMV) infectious titers and DNA levels were determined by quantitative shell vial culture and quantitative-competitive PCR with blood samples from 10 renal transplant recipients with active CMV infection. Blood samples were stored at either room temperature or 4°C and were processed at intervals of 0, 6, 24, 48, and 72 h. All samples were culture and PCR positive at baseline. Whereas the sensitivity of shell vial culture progressively declined, with only 55% positive at 24 h and 10% positive at 48 h, all samples remained PCR positive at all time points. Furthermore, the infectious titer diminished by 83 to 91% by 24 h compared to that at baseline (P < 0.0001), but quantitative DNA levels did not decline over time. Storage temperature had no significant effect on either infectious titer or DNA levels.