This article is reprinted from Why Mothers Die 1997-1999, the fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.

Nanotechnology is the application of nanotechnology within medicine. An illustration of this is the use of pegylation as a means of modifying naturally occurring proteins which may have clinical applications, in order to improve the pharmacodynamics of the protein resulting in an effective medication. An example of this is pegylated interferon. The purpose of this review is to examine the chemistry, clinical pharmacology, pharmacokinetics, pharmacodynamics, and clinical studies with 40 kDa pegylated interferon to illustrate the general principles of pegylated biological proteins. The use in clinical practice is reviewed along with the evidence for both effi ciacy, safety, and advantages over standard interferon.

BRITISH MEDICAL JOURNAL 15 FEBRUARY 1975 375 Technetium-99m-labelled pertechnetate is 90% bound to intravascular proteins and diffuses readily to extravascular spaces (Hays and Green, 1972). In normal subjects an equilibrium is reached in muscles 6-8 minutes between intravascular and extravascular pertechnetate. This time was more than doubled in our patient at the beginning of the disease, most probably because of the inflammatory processes involved in the angiitis, but it returned to normal under treatment.Furthermore, the scintigraphic changes correlated well with the clinical state and the changes in the biological values. The scan pattern and the delay in the equilibrium of the curve were still abnormal when the second biopsy was normal though one could infer from the clinical state and the E.S.R. that the disease was still active. After 13 weeks the only abnormalities were a raised E.S.R. and the scan pattern.Whether the appearance of the scan is pathognomic for periarteritis nodosa, as stated by Mintz et al. (1970), remains to be proved, but we feel that the combination of dynamic studies and scintigraphy provided a valuable and objective means of evaluating the extent of this disease and its response to treatment. The possibilities offered by this simple method in other collagen and muscle diseases are under investigation.We thank Mr. A. Dobbeleer for technical help and Professor S. Orloff for referring normal controls.

An 18 year old para1+0 was referred to our fetal medicine unit with an intraoral cystic structure (22mm×19mm) detected at routine anomaly scan. Fetal MRI confirmed a large thin walled cyst (25mm×24mm×18mm) in the midline filling the entire oral cavity and inseparable from the tongue. Differential diagnosis included congenital ranula, epidermoid cyst, unilocular lymphatic malformation and enteric duplication cyst. Multidisciplinary team counselling was performed involving fetal medicine specialists, neonatologists, paediatric ENT surgeons and paediatric anaesthetists and a management plan formulated. Ultrasound monitoring through the course of the pregnancy revealed no significant change in the size of the cyst. Development of polyhydramnios suggested that the cyst was beginning to interfere with fetal swallowing raising the possibility of potential problems with securing and maintaining airway at delivery. Hence delivery was arranged by elective caesarean section at 38+ weeks under steroid cover. Operation On Placental Support (OOPS) procedure was done at the time of delivery with the cyst being decompressed and intubation done while placental circulation was maintained. Excision of the lesion was performed on day 2 and histology confirmed a thyroglossal duct cyst. The baby did well in the neonatal period and was discharged home in the first week of life. With this case report we seek to highlight management of this extremely rare congenital cystic malformation of the oral cavity and the crucial role of combined imaging and multidisciplinary input to ensure a good outcome.

MRI for evaluating CNS anomalies detected on antenatal sonography has not become standard practice in our unit. This pilot study was carried out to determine the frequency at which MRI provides additional information in this setting. Going back from August 2010 a retrospective review of available case notes of 16 consecutive patients who attended our unit with fetal CNS abnormalities diagnosed on ultrasonography and then went on to have an MRI was done. The most common abnormality on sonography was ventriculomegaly (10 out the 16 cases) followed by cerebellar abnormality and suspected corpus callosum agenesis in 2 cases each. There was one case each of cortical cyst and megacisterna. Analysis of findings revealed that the MRI findings concurred with ultrasound findings in 10 of the 16 cases (62.5%) although additional information which did not influence counselling was obtained in 6 out of these 10 patients. In 6 of the 16 patients (37.5%) the MRI findings yielded information altered the counselling patients received. Magnetic resonance imaging findings not found by ultrasound included periventricular cavitation with subcortical white matter injury, agenesis of the corpus callosum, septum pellucidum agenesis, fine intraventricular adhesions suggestive of congenital CMV infection and cortical gyral abnormality. In conclusion when a CNS anomaly is detected by sonography, MRI findings might lead to altered diagnosis and patient counselling. Larger studies are needed to justify additional funding for fetal MRI examination to be made part of standard examination on sonographic diagnosis of a CNS abnormality.