Downfolding of the epiglottis into the laryngeal inlet after tracheal intubation using the McGRATHTM MAC videolaryngoscope: a case report

Background

Downfolding of the epiglottis into the laryngeal inlet is considered to be a rare complication of tracheal intubation. We describe a case of epiglottic downfolding during tracheal intubation using a McGrath videolaryngoscope (McGRATH^TM MAC).

Case presentation

A 44-year-old female was scheduled for breast reconstruction surgery. Intubation was performed using a McGrath videolaryngoscope. After intubation, videolaryngoscopy revealed that the epiglottis was inverted and folded down into the laryngeal inlet. We elevated the larynx anteriorly using the McGrath videolaryngoscope, enabling the downfolded epiglottis to be pulled out from the laryngeal inlet and restored to its original position. After surgery, the patient was extubated without any complications.

Conclusions

When using the McGrath videolaryngoscope, both glottic exposure similar to that achieved with the Macintosh laryngoscope and careful observation of the epiglottis should enable the prevention, detection, and treatment of epiglottic downfolding into the laryngeal inlet.

Review: Exploration of placentation from human beings to ocean-living species

This review covers four topics. 1) Placental pathology in Himalayan mountain people. To determine morphological changes of the placenta at high altitude, pathological examination was made of 1000 Himalayan placentas obtained in Nepal and Tibet and the results compared with Japanese placentas delivered at sea level. Characteristic findings in the placental villi of the Himalayan group included high incidences of villous chorangiosis and chorangioma. These processes were clarified by ultrastructural observation. 2) Placentation in Sirenians. The giant Takikawa sea cow, which lived 5 million years ago, was discovered on Hokkaido, Japan. It was an ancestor of the dugong as well as the manatees. Sirenia, the sea cow group, shares a common ancestor with Proboscidea, the elephants, even though they now inhabit quite different environments. A comparison was made of their zonary endothelial type of placentation. 3) Placentation in sharks and rays. The remarkable placentation of hammerhead sharks and manta rays is described. 4) Placentation in the Antarctic minke whale. Placental tissue samples of this whale were obtained from the Japan Institute of Cetacean Research. In an ultrastructural study of the utero-placental junction, microfilamental processes of the allantochorionic zone and crypt formation were visualized.

IFPA Meeting 2012 Workshop Report I: comparative placentation and animal models, advanced techniques in placental histopathology, human pluripotent stem cells as a model for trophoblast differentiation

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2012 there were twelve themed workshops, three of which are summarized in this report. These workshops related to various aspects of placental biology but collectively covered areas of models and technical issues involved in placenta research: 1) comparative placentation and animal models; 2) advanced techniques in placental histopathology; 3) human pluripotent stem cells as a model for trophoblast differentiation.

IFPA Meeting 2011 workshop report III: Placental immunology; epigenetic and microRNA-dependent gene regulation; comparative placentation; trophoblast differentiation; stem cells

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialised topics. At IFPA meeting 2011 there were twelve themed workshops, five of which are summarized in this report. These workshops related to various aspects of placental biology: 1) immunology; 2) epigenetics; 3) comparative placentation; 4) trophoblast differentiation; 5) stem cells.

Identification of Gaucher cells in the chorionic villi associated with recurrent hydrops fetalis

Recurrent non-immune hydrops fetalis has rarely been reported. In order to detect the risk of recurrence in a subsequent pregnancy, one should carefully consider the possibility of an inborn error of metabolism. In such cases, placental examination may be useful in detecting such metabolic storage disorders in the fetus, which usually present as vacuolization of placental cells. We describe a rare case of recurrent hydrops that was detected by placental examination. Through light microscopy, electron microscope (EM) studies and beta-glucocerebrosidase activity the disease was identified as Gaucher's disease.

A clinicopathological aspect of chorionic villous hemorrhage leading to formation of intervillous thrombosis

Recently it was reported that chorionic villous hemorrhage (CVH) had a significant association with retroplacental hemorrhage (RPH). In this study, to determine whether CVH has a correlation with RPH or intervillous thrombosis (IVT), placentas associated with CVH were clinico-histopathologically investigated and compared to those with IVT. Obstetric complications in 32 cases with CVH were compared with 258 cases with IVT. Placental abruption was significantly higher (18.7%) in the CVH group than in the IVT group (5.03%) and the incidences of intrauterine fetal death (IUFD) as well as intrauterine growth retardation (IUGR) were also significantly higher (18.7% and 9.37%) in the CVH group than in the IVT group (3.10% and 2.32%). Of the pathological characteristics of the placentas with CVH, IVT was found in 46.8%, but marginal or retroplacental hemorrhages were seen in 34.3%, compared to 14.2% of the IVT group. Premature infants with low birth weight (under 2000 g) and before 36 weeks of gestation were born in 53.1% and 34.3% of cases with CVH placentas. CVH was not only located near the basal plate of the placentas and decidual hemorrhages, but was also highly associated with chorangiosis in 75% of cases. Using histological and ultrastructural studies in CVH cases, villous stroma was filled with fetal erythrocytes and leakage of blood cells was observed through a disruption of the trophoblast layer of hemorrhagic villi. In conclusion, it is suggested that CVH may rather be related to formation of the intervillous thrombosis than to RPH.

Diagnostic relevance of abortion-associated human embryonic antigen expressed on the cell surface of tumour promoter-treated Bloom syndrome cells

We detected stable expression of human embryonic antigen associated with spontaneous abortion (HEAA) on the cell surface of a tumour promoter-treated B lymphoblastoid cell line (BS-SHY) originating from Bloom syndrome. We used indirect immunofluorescence and diluted serum from 44 patients who had recurrent spontaneous abortions. With the use of the panning procedure, we separated characteristic cells expressing strong HEAA. The BS-SHY-HEAA cells separated here would be useful for measuring serum antibody (against HEAA) produced by patients with recurrent abortions. It was also noted that aborters who received husbands' leukocyte immunization have lost this antibody, and have delivered successful pregnancies at term. Using HEAA proteins, we conducted Western blotting analysis for the amino acid sequencing (mol. wt 77 kDa). Amino acid sequencing data indicated that HEAA had 87.5% homology to the immunoglobulin (Ig) VHIII region in the framework. Recently, the protective value of high dose i.v. administration of immunoglobulin in the treatment of recurrent spontaneous abortions has been reported to be similar to that of leukocyte immunization. Therefore, the BS-SHY-HEAA cells appear to provide a valuable tool for rapid serological diagnosis and for evaluating the efficacy of immunotherapy with husbands' leukocytes in patients with recurrent spontaneous abortions.

Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet, and Japan

It has been reported that both chorangiosis and chorangioma are increased in placentas at high altitudes. In this study, 1.14% of 2448 Japanese placentas obtained at 30-300 m had chorangiosis or chorangioma, compared with 3.24% of the Nepalese placentas (1300-3000 m) and 9.09% of the Tibetan samples (3800-4200 m). The incidence of both pathologies was significantly higher in the Himalayan groups than those of the Japanese group (P < 0.05). Obstetric complications of the 28 Japanese placentas with chorangiosis and chorangioma included Caesarean section 16 (57.1%), abruptio placentae 2 (7.14%), intrauterine growth retardation 3 (10.7%), intrauterine fetal death 4 (14.2%) and placenta praevia 4 (14.2%). Four infants (14.2%) had Apgar scores ranging from 0 to 3. Among 48 Himalayan placentas with chorangiosis and chorangioma, incidence of marked subchorionic fibrin was significantly higher (25%) than in the Japanese group (3.57%) (P < 0.05). The incidence of abnormal insertion of the cord was significantly higher (14.2%) in the Japanese group than in the Himalayan group (5%) (P < 0.05). There was no significant difference in the frequencies of intervillous thrombosis and infarction between the two groups. These findings suggest that the incidence of pathological change such as chorangiosis and chorangioma may be increased in placentas at Himalayan altitudes.

Characteristic mucinous ovarian cancer antigen is expressed in malignantly transformed Bloom's syndrome cells

Using a double-antibody panning procedure, we separated a unique cancer antigen cell line (BS-SHI-4M OVC-MU) expressing a mucinous ovarian cancer (OVC) antigen from a malignantly transformed Bloom's syndrome cell line. In order to gain information concerning a mucinous OVC antigen, we tested this unique cell line in the reaction to sera from patients with various OVCs, Krukenberg (KR) tumor, and signet ring cell cancer of the stomach under immunofluorescence and Western blotting protocols and determined the mucinous OVC antigen band at M(r) 84,000. We also undertook an immune electron microscopic study to gain information concerning the antigen-antibody reaction [BS-SHI-4M OVC-MU cells-sera from patients with mucinous OVC and KR tumor] and concerning the antigenic determinant of the membrane using preembedding methods. Occasional protein A-gold particles were observed along the cell membrane of BS-SHI-4M OVC-MU cells, when treated with sera from mucinous OVC and KR tumor patients, but no labeling was observed in the cell membrane when treated with sera from normal patients and those with other cancers. Results of the immune electron microscopic study strongly support the data from the antigen-antibody reaction obtained by immunofluorescence and Western blotting analyses. The BS-SHI-4M OVC-MU cells separated here would be useful for serodiagnosis of mucinous OVC and KR tumors and for follow-up of patients after therapy.

Enhanced expression of stomach cancer antigen derived from malignantly transformed bloom syndrome cells previously labeled with bromodeoxyuridine

Bromodeoxyuridine (BrdU) greatly enhanced expression of stomach (ST) cancer antigen (CA) that originated from a malignantly transformed Bloom syndrome (BS) cell line (BS-SHI-4M), although the expression was suppressed with a decrease in sister chromatid exchange (SCE) in the presence of deoxythymidine (dT) or deoxycytidine (dC) and enhanced with an increase in SCE with deoxyguanosine (dG) or deoxyadenosine (dA). Although the exact mechanisms for enhancing CA by BrdU treatment are unknown, these findings appeared to be of special interest because of the parallelism of CA expression and SCE alterations. The finding that BrdU enhancement of the ST CA was effective not only in the immunofluorescence (IF) protocol but also in the band appearance of Western blotting would be worthwhile as a sensitive serodiagnosis of cancer. The 118-kd band obtained from proteins of ST CA cells previously labeled with BrdU was clearly more darkly stained than that from nonlabeled cells and enabled eight weak-positive ST CA to show strong-positive levels retaining complete negativity to nonmalignant sera. Some ST cancer sera (advanced cancer), which originally gave a negative reaction in the nonlabeled condition, still inhibited negative reaction even in BrdU-labeled ST CA cells, however. The inability to detect cancer antibody in our assay might be due to immunocomplexes. Acid dissociation and ultrafiltration of sera from six of seven advanced ST cancers (originally IF negative) have allowed detection of antibody responses to ST CA by Western blot assay with enhanced reactivity as compared with the negativity under native serum conditions. This technique provides a reasonable avenue for study of the mechanisms of CA expression and serodiagnosis.

Clinical experience with trophoblastic diseases in Nepal

The epidemiology of trophoblastic disease in Nepal remains unknown. In this study, the first data regarding patients with trophoblastic disease were collected from two hospitals in Kathmandu, Nepal. We found 68 molar pregnancies during 1986 to 1987 at the Maternity Hospital, there. The incidence of molar pregnancies during two years ranged 2.84 per 1000 pregnancies and 3.24 per 1000 deliveries, while the total number of trophoblastic diseases from 1985 to 1988 at Teaching Hospital, Tribhuvan University, Kathmandu, numbered 26. The incidence of trophoblastic disease ranged from 7.07 per 1000 pregnancies to 8.04 per 1000 deliveries. As a result, the rate of trophoblastic disease in Nepal seems to be higher than expected, and it indicates a incidence similar to that other Asian countries at sea level.

Cancer antigens are expressed in a carcinogen-transformed Bloom syndrome B-lymphoblastoid cell line

We have cloned malignant cells carrying specific antigens associated with ovarian cancer (OVC) and malignant lymphoma (ML) from BS-SHI-4M cells, a line derived from a 1-methyl-3-nitro-1-nitrosoguanidine-treated B-lymphoblastoid cell line isolated from a patient with Bloom syndrome. Since BS-SHI-4M cells react with sera from various individual cancer patients at relatively low frequencies (2-9%), as detected by an indirect immunofluorescence technique, cell clones that specifically react with sera from patients with OVC and ML were separated by the "panning" method in which polystyrene dishes were coated with sera from OVC and ML patients and cells with the corresponding antigens bound to the dishes. Subsequent cloning by limiting dilution provided cell clones highly enriched for OVC- and ML-associated antigens. Karyotype analyses revealed that cell clones with OVC and ML antigens had common marker chromosomes, der(14)t(14;14) (p11;q11),t(6;?)(p25;?) and t(9;?)(q34;?), besides t(17;?) (q25;?) found in the OVC-antigen-positive clones and t(5;?) (p13;?),t(7;?)(q36;?) found in the ML-antigen-positive clones. Interestingly, in cell clones with a strong OVC antigen response, the distal part of the Y chromosome (Yq11) was missing in 100% of the cells. Therefore the cell line BS-SHI-4M appears to be a reservoir of cell clones each of which carries a specific tumor antigen and thus provides a potential tool for rapid serological diagnosis of cancer.

Placental protein 21. Localization in human placenta and concentrations in the body fluids of men and nonpregnant and pregnant women

The immunohistochemical localization of placental protein 21 (PP21) was marked in the syncytial brush border and basal membrane during the 1st and 2nd trimesters of pregnancy and also in the chorionic epithelial brush border and basement membrane at term. A weaker stain was found in the cell membranes of amniotic epithelial and chorionic trophoblast cells. Neither heparin nor changes in temperature significantly influenced PP21 concentration. Relatively high serum PP21 concentrations were measured during the follicular and luteal phases in healthy nonpregnant women and in healthy men whose seminal plasma also showed a high PP21 concentration. Serum PP21 levels in normal pregnancy rose from a median of 29.1 ng/ml at 6-7 weeks of gestation to 82.0 ng/ml at 36-37 weeks of gestation. Although maternal urine showed low PP21 levels during pregnancy, amniotic fluid PP21 levels were higher at 7-21 weeks of gestation than at term. Cord blood sera showed almost the same PP21 concentration as maternal sera, but retroplacental blood showed much higher levels. Maternal serum PP21 levels in hydatidiform mole patients did not differ from the normal pregnancy range, although their molar vesicular fluids contained higher PP21 concentrations. These results suggest an extraplacental source for PP21.

Characteristic differences in immunohistochemical localization of new placental proteins (PP1, PP19, PP21) in the human placenta

The immunohistochemical localization in the human placenta of new placental proteins PP1, PP19, and PP21 was clarified using modified indirect enzyme-labeled antibody method and compared with that of pregnancy-specific beta 1-glycoprotein (SP1). The major results are as follows: positive staining for PP1 was seen at the nucleus and cytoplasm of villous cytotrophoblasts, the X cells at the basal plate, and of chorionic trophoblasts, while the decidua cells and amnion were not stained. PP19 was characteristically seen in the nucleus and cytoplasm of syncytiotrophoblasts. X cells in basal plate, chorionic trophoblasts, and maternal leukocytes. The villous cytotrophoblasts, decidua cells, and amnion were not stained. PP21 localization was found at the microvilli and basal membrane of syncytiotrophoblasts and at the cytotrophoblast plasma membrane of the chorionic villus in early gestation. In late gestation, increased staining was seen at the syncytiotrophoblast microvilli and the villous basement membrane, and moderate staining at plasma membrane of the amniotic epithelium and chorionic trophoblasts. SP1 was found only at the syncytiotrophoblast cytoplasm of chorionic villi. Studies using these four placental proteins simultaneously may therefore provide a new key learning about unknown metabolic functions of trophoblasts.

[Clinical study of cefotetan in complicated urinary tract infections]

Clinical effectiveness and safety of Cefotetan were evaluated in 28 patients with complicated urinary tract infections. The results were excellent in 12 patients (42.9%), moderate in 10 patients (35.7%) and poor in 6 patients (21.6%), and the effectiveness rate was 78.6%. Bacteriologically, 24 (75%) out of 32 strains were eradicated. Subjective side effects, nausea and abdominal discomfort, were observed in one patient. Abnormal laboratory findings were observed in 6 patients, eosinophilia in 3 patients and slight elevation of transaminase in 3 patients.

[Results of fetoscopic examinations at our hospital]

From 1983 to 1985, antenatal diagnosis by fetoscopy under ultrasound guidance has been performed at our institute for 17 pregnant women between 15 and 34 weeks of gestation. Indications for fetoscopy were visualization of the fetus, placenta, and amniotic membrane for morphological anomaly and fetal blood sampling for coagulation disorder. The diagnosis, made by visual observation of the fetus, blood coagulation tests, and karyotyping revealed 12 normal fetuses and 5 abnormal fetuses (one having chromosome abnormality, one amniotic band syndrome, one cephalothracopagus, one Beckwith-Wiedemann syndrome, and one sacral tumor). Courses of pregnancy following fetoscopy resulted in four normal full-term deliveries, six premature deliveries due to four hydramnions and two spontaneous ruptures of the membrane more than 14 weeks after fetoscopy. Three other pregnancies were interrupted due to intrauterine fetal death 11 weeks after fetoscopy in one case and to therapeutic abortion for maternal complications such as toxemia of pregnancy in two cases. The outcome of one case was unknown because the mother had moved away. The other pregnancy is still under observation at the third trimester. Although no complications in the fetuses were seen following fetoscopy, complications in the mothers included two cases of genital bleeding, one case of amniotic fluid leakage, and one cases of abruption of the fetal membrane. Symptoms in all four cases disappeared during several days of bed rest. These results demonstrate the importance of fetoscopy in prenatal diagnosis.

Clinical evaluation of antithrombin III concentrate (BI 6.013) for disseminated intravascular coagulation in obstetrics. Well-controlled multicenter trial

Antithrombin III (AT III) is known to be the most important inhibitor of serine protease in the coagulation system. In the presence of heparin, AT III is converted from its progressive activity state to an immediate activity state. In disseminated intravascular coagulation (DIC) in the field of obstetrics, the treatment has to be initiated very early. Heparin treatment, on the other hand, is critical since frequently postpartal or postoperative wound bleeding is present. We, therefore, established diagnostic criteria for the early diagnosis of DIC and investigated the clinical efficacy of a therapy with AT III in a well-controlled comparative study versus the injectable synthetic protease inhibitor FOY. The results of the trial showed that the AT III group (92%; n = 24) was significantly (p less than 0.001) superior in clinical efficacy to the FOY group (60%; n = 15). No side effects whatsoever were observed after treatment with AT III concentrate (Behring Institute). From these results, it could be concluded that a single therapy with AT III concentrate can sufficiently control the symptoms of DIC in the field of obstetrics without the risk of increased bleeding.

Clinical use of CA 125 and its combination assay with other tumor marker in patients with ovarian carcinoma

The serum levels of CA 125 and CA 19-9 were determined by an immunoradiometric assay employing the monoclonal antibody OC 125 and anti-CA 19-9 antibody in 88 patients with ovarian carcinoma. When a cut-off value of CA 125 was set below 35 U/ml in the control group, serum elevated levels of CA 125 were found in 86.7% of the patients with surgically demonstrable ovarian serous cystadenocarcinoma, in 100% (4/4 cases) of clear-cell carcinoma, in 50% (2/4 cases) of endometrioid carcinoma, in 100% (5/5 cases) of undifferentiated carcinoma, and in 80% of the recurrent cases. Using a cut-off value of 37 U/ml, serum elevated levels of CA 19-9 were detected in 68.2% of mucinous cystadenocarcinoma, in 28.9% of serous cystadenocarcinoma, in 75% (3/4 cases) of metastatic ovarian carcinoma, and in 37.5% of the recurrent cases. A statistical analysis of the combination assay using CA 125, CA 19-9, tissue polypeptide antigen (TPA), immunosuppressive acidic protein (IAP), ferritin and CEA was carried out by multivariate method (discriminatory analysis) in 45 patients with ovarian carcinoma and 50 healthy subjects. As a result before treatment, positive rates of a single tumor marker were 79.7% with CA 125, 42.7% with CA-19-9, 73.1% with IAP, 61.7% with TPA, 64.3% with ferritin and 25.4% with CEA, respectively. A combination assay of these markers was useful for detecting identification of ovarian carcinoma, by which it gave a higher accuracy of ovarian cancer detection.

Diagnostic reliability of simultaneous measurements of beta human chorionic gonadotropin and pregnancy-specific beta-1-glycoprotein in serum of patients with trophoblastic disease

Serum levels for beta-human chorionic gonadotropin (beta-hCG) and pregnancy-specific beta 1-glycoprotein (SP1) in patients with trophoblastic disease were measured by radioimmunoassay and enzyme-linked immunosorbent assay. The beta-hCG:SP1 ratios were below 1.0 in all 22 cases of complete hydatidiform mole and in 8 of 9 cases of partial hydatidiform mole. Two (10.5%) of 19 cases of invasive mole involving metastasis had ratios that rose above 1.0 during chemotherapy. Ratios ranged from 1.6 to 29 in 11 of 15 cases of choriocarcinoma before chemotherapy. The remaining 4 cases, diagnosed within 3 months of antecedent pregnancy, had ratios below 0.99. Thus, the difference between choriocarcinoma and nonchoriocarcinoma beta-hCG:SP1 ratios may be due to trophoblastic differentiation based on the developmental stage and with trophoblast age, or due to the mass and potential activity of trophoblastic cells.

Serum concentration of placental proteins (PP5 and PP10) in toxemia of pregnancy as related to intrauterine growth retardation

Maternal serum concentrations of placental proteins 5 (PP5) and 10 (PP10) were measured by radioimmunoassay in 568 samples obtained from 308 healthy pregnant women and 63 women having toxemia of pregnancy. Below-normal PP5 values were more widely distributed in the mild than in the severe toxemia group, while the incidence of above-normal PP5 values was found only in the severe toxemia group. The incidence of below-normal PP10 values was higher in the severe than in the mild toxemia group. Our study thus suggests that simultaneous measurement of PP5 and PP10 concentrations in maternal serum in toxemia of pregnancy is a useful monitoring technique for predicting progressive pathological change and placental dysfunction related to IUGR.

Outcome of the surviving cotwin of a fetus papyraceus or of a dead fetus

Serial ultrasound examinations have demonstrated that one of two gestational sacs in a twin pregnancy may often disappear. When it disappears at an early stage of gestation, the pregnancy may advance without any disturbance and the cotwin can be delivered well developed and lively. When the intrauterine death occurs in the second trimester, the dead fetus usually results in a fetus papyraceus and the cotwin continues to be alive near term. However, when death occurs in the last trimester, the viable twin may be spontaneously delivered soon and be premature. In some cases of late fetal death, the dead fetus may induce intravascular thromboses in many organs of the surviving cotwin, so that the living infant may develop cerebral palsy later after birth.

Abnormally large placenta associated with Beckwith-Wiedemann syndrome

A 37-year-old G1-P1 was diagnosed by ultrasonography at 26 weeks of gestation as having an abnormally large placenta with hemangiomas and a fetus associated with exomphalos. Placental protein 5 levels were relatively high in placental protein levels in maternal serum. The infant, delivered by cesarean section at 34 weeks, had the typical clinical features associated with Beckwith-Wiedemann syndrome. The abnormally large placenta weighed 1,492 g, measured 25 X 25 X 5.1 cm, and featured multiple hemangiomas. Microscopic placental features included edematous villi, increased fibrin deposition, intervillous thrombi, and multiple angiomatous and cellular chorangiomas.

A study of twin placentation in Tokyo

A total of 178 placentas of twins born in Tokyo in 1961-1982 were examined. Only just over one third were dichorionic, 110 being monochorionic and DZ twins were estimated to account for 24.7% of the pairs. The lower frequency of DZ twinning in Japan is attributed to lower gonadotropin values in Japanese women as compared to European, American, or African women. High fetal morbidity was found in monochorionic twins and this is attributed to a frequent occurrence of vascular anastomoses.

Notes on the morphology of the chimpanzee and orang-utan placenta

The placentae of 11 chimpanzees and five orang-utans were collected from Japanese zoos immediately after delivery and were examined according to the methods routinely used for the human placenta. Placenta extrachorialis (circumvallate and circummarginate placenta) occurred in 80 per cent of the specimens collected from each species. In both groups, the placental vessels were distributed predominantly in the magistral pattern, and the umbilical cord was eccentrically inserted. Subchorionic fibrin, sometimes marked, was seen in all 16 placentae, and there was a high incidence of small intervillous thrombi and deposits of intervillous fibrin. These observations, together with the histological and ultrastructural findings, confirm the previously reported similarity between the placentae of the great apes and the human placentae.

Possible relationship between the ratio of Factor VIII complex and placental insufficiency in preeclampsia

The ratios of Factor VIII-related antigen (FVIIIR:Ag) to Factor VIII clotting activity (FVIIIC) were measured in 50 women during normal pregnancy and in 20 patients with preeclampsia and with intrauterine fetal growth retardation (IUGR). The mean ratios of FVIIIR:Ag to FVIIIC ranged from 0.6 +/- 0.22 to 0.8 +/- 0.58 (mean +/- SD) from the 28th to 40th week of normal pregnancy. On the other hand, the mean ratios of FVIIIR:Ag to FVIIIC in patients with preeclampsia and IUGR were 1.40 +/- 0.69 and 1.59 +/- 0.78 (mean +/- SD), respectively. This finding suggests that FVIII complex ratio may be considered an index of endothelial damage in preeclampsia and IUGR. This ratio test could be a more sensitive and reliable indicator of placental insufficiency if applied with non-stress test during late pregnancy.

The chromosomes of Muntiacus feae

The karyotype of a female Muntiacus feae is described. It comprises 13 chromosomes, three submetacentrics, and ten acrocentrics. Chromosome 1 is the sex chromosome. This individual was heterozygous for a Robertsonian translocation between chromosomes 2 and 7.

Circulating levels of placental protein 5 in normal and abnormal pregnancies

Serum concentrations of PP5 were measured by radioimmunoassay in 219 women with normal pregnancies and 163 women whose pregnancies were complicated. PP5 in serum disappeared rapidly after delivery, with a half-life of 5-10 min in the first 10 min. Serum PP5 levels were higher in uterine than in antecubital venous blood. In normal pregnancies, PP5 was detectable at 7-8 weeks of gestation; its mean concentration rose gradually to a maximum of 17.8 +/- 10.2 ng/ml at 34-35 weeks of gestation. Elevated serum PP5 concentrations were noted in patients whose pregnancies were complicated by toxemia of pregnancy with appropriate-for-date baby or by twin pregnancy. Low serum PP5 concentrations tended to be found in patients whose pregnancies were complicated by abortion, intrauterine fetal death, and hydatidiform mole. Marked abnormal PP5 levels were not found in patients with maternal diabetes and placenta previa. These findings suggest that the assay of serum PP5 concentrations can be a useful parameter in determining the prognosis of abnormal pregnancies.

Concentrations of SP1 and beta-hCG in serum and cerebrospinal fluid and concentrations of hCG in urine in patients with trophoblastic tumour

Using immunological techniques urinary hCG, pregnancy-specific beta 1-glycoprotein (SP1) and beta-subunit of hCG (beta-hCG) levels were measured in the serum and cerebrospinal fluid of patients with trophoblastic tumours. After removal of hydatidiform moles, urinary hCG, beta-hCG and SP1 levels were similar, but SP1 levels tended to exceed serum beta-hCG levels. SP1 usually disappeared first. In patients with metastatic choriocarcinoma, SP1 levels appeared to be lower than beta-hCG values in serum and cerebrospinal fluid, but urinary hCG, beta-hCG and SP1 concentrations all decreased during chemotherapy. Measurements of SP1 levels may well be useful in the monitoring of patients being treated for trophoblastic tumours.

Radioimmunoassay of hCG as an early diagnosis of cerebral metastases in choriocarcinoma patients

To determine the early cerebral involvement of choriocarcinoma, the following studies were employed. By comparing hCG titers in measurements of serum and cerebrospinal fluid (CSF) hCG-beta through radioimmunoassay (RIA), serum/CSF ratios of titers were calculated in patients with normal pregnancies and in those with trophoblastic neoplasia. In normal pregnancies, the mean ratio of serum/CSF hCG was more than 45.5 +/- 6.0 (mean +/- SEM):1. In neoplasia without metastases to the brain, the ratio was more than 41.0:1. However, 2 patients with cerebral choriocarcinoma showed low ratios of 23.0:1 and 20.9:1, respectively. This suggests that determination of the beta-hCG concentration ratio of serum to CSF using RIA might give a more reliable evaluation for the early detection of choriocarcinoma metastasized to the brain.

Treatment of advanced ovarian cancer with fibrinolytic inhibitor (tranexamic acid)

A patient with inoperable advanced ovarian cancer with metastases and ascites who had received several courses of radiotherapy and chemotherapy is presented. On her 6th admission, therapy with the fibrinolytic inhibitor tranexamic acid was followed by arrest of ascites and tumor growth; then at exploratory laparotomy, examination of tumor cells revealed encapsulation of fibrinoid substance and proliferation of connective tissue. The patient, still receiving tranexamic acid, is now free from noteworthy symptoms.