The antigenic binding sites of autoantibodies to factor XII in patients with recurrent pregnancy losses.

Recently, numerous studies have suggested an association between factor XII (FXII) deficiency and recurrent pregnancy losses, and between autoantibodies to FXII and recurrent pregnancy losses. Autoantibodies to FXII rather than FXII deficiency may be a risk factor for recurrent pregnancy losses. To know the pathogenesis of autoantibodies to FXII, epitope mapping study was done. Seventeen anti-FXII antibody positive recurrent pregnancy loss patients were chosen for this study. We used synthetic peptides in inhibition and direct binding studies to identify the antigenic binding site of autoantibodies to FXII. Among plasmas from 17 recurrent pregnancy loss patients who were positive for autoantibodies to FXII, 13 patients (76.5%) recognized amino acids 1-30, the amino-terminal heavy chain region that is known as factor XII binding site to platelet glycoprotein Ibalpha.

Normal and abnormal diameter pulse waveforms in the fetal inferior vena cava.

OBJECTIVES: To study the diameter pulse waveforms (DPWs) recorded noninvasively from the fetal inferior vena cava (IVC) in human fetuses. METHODS: We studied 90 normal fetuses (20 to 40 weeks), ten fetuses with abnormalities of cardiac structure, and seven fetuses with arrhythmia. A paired ultrasonic phase-locked echo tracking system was used to follow the movement of diametrically opposite points of the IVC. RESULTS: The four component (A, X, V, Y) waves of the DPW were identified. In the normal group, there was an increase in the depth of X and Y nadirs. The abnormal group was divided into two subgroups. In 12 fetuses (five pulmonary stenosis, seven arrhythmia) there was a high pulsatile pattern with deep nadir from the A peak to X trough so that the pulsatility of the waveform appeared increased. The cause of the high pulsatility was due to a marked change of intraatrial pressure. In five fetuses with tricuspid regurgitation, this change was shallow and the pulsatility appeared reduced. Clinical outcome was significantly worse in the low pulsatile subgroup. CONCLUSION: The low pulsatility waveform may indicate depressed myocardial function. Measuring the DPW provides a simple method for obtaining important information about fetal cardiac performance.

Characteristic diameter pulse waveform patterns of the inferior vena cava in fetuses with abnormalities of cardiac structure.

BACKGROUND: Changes in the vessel lumen diameter pulse waveform closely follow changes in the transmural pressure pulse waveform. AIM: To study diameter pulse waveform recorded noninvasively from the fetal inferior vena cava (IVC) in fetuses with cardiac abnormality. STUDY DESIGN: A paired ultrasonic phase-locked echo tracking system with a high sampling frequency (3000 Hz) was used to follow the movement of diametrically opposite points of the IVC. The lumen was measured as the interval between these points. SUBJECTS: We studied 80 normal fetuses (20 to 40 weeks) and 11 fetuses with cardiac abnormality. RESULTS: The four component waves of the IVC diameter pulse waveform (A, X, V, Y) were identified and measured in the fetal recording. In the normal group, the A and V values increased linearly with advancing gestation. There was an increase in the depth of X and Y descents. Each cardiac abnormality produced characteristic changes in the A, X, V and Y waves of the IVC diameter pulse waveform. The most impressive IVC diameter pulse waveform pattern in fetal cardiac abnormality was the depth of the X descent from the A crest to X trough. In the circumstance of pulmonary stenosis, the A wave was large and prominent (deeper X descent, high pulsatility waveform). In the presence of a dilated right ventricle, or an incompetent tricuspid valve, the X descent was shallow (low pulsatility waveform). CONCLUSION: The fetal IVC diameter pulse waveform can be simply recorded. The high pulsatility waveform may result from increased end-diastolic pressure with a consequent increased resistance to flow into the ventricle from the atrium. The low pulsatility waveform may indicate depressed myocardial function.

Stiffness of systemic arteries in appropriate- and small-for-gestational-age newborn infants.

OBJECTIVE: The purpose of this work was to study the stiffness of systemic arteries in appropriate and small for gestational age newborn infants. The distance between diametrically opposite points of the arterial lumen was measured with a phase locked loop echo tracking system coupled to a B-mode ultrasonic imager. PATIENTS AND METHODS: A cross-sectional study of 51 appropriate for gestation age infants including 22 preterm infants was done to obtain normal data. We also studied 47 small for gestational age infants, who were identified antenatally by an umbilical artery Doppler flow waveform pulsatility index > 95th percentile. The stiffness index of the common carotid artery and abdominal aorta was calculated from the relationship between systemic blood pressure and arterial diameter during the cardiac cycle. RESULTS: In the appropriate for gestation age group, the systolic and diastolic diameters of the common carotid artery and abdominal aorta, as well as the stiffness index, increased with the gestational age at birth. In the small for gestational age group, the arterial diameters and blood pressure were also within the reference range. Using the arterial stiffness index values from the appropriate for gestation age group, the small for gestational age group was divided into 3 subgroups: 18 infants with normal stiffness index values for both arteries, 19 infants with a high stiffness index of the abdominal aorta, and 10 infants with a high stiffness index for both arteries. The clinical outcome was significantly worse in the latter 2 subgroups compared with the normal infants and was also worse in the infants with a high stiffness index for both arteries compared with the high abdominal aorta subgroup. CONCLUSION: The antenatal increase of afterload caused by a high placental vascular resistance was associated with a decrease of aortic distensibility in the compromised small for gestational age infants, suggesting that the structure of the aortic wall was altered. In the most profoundly compromised small for gestational age infants, the high stiffness index of both the common carotid artery and abdominal aorta may indicate more extensive arterial damage.

Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform.

Our purpose was to evaluate the hemodynamic significance of fetal inferior vena cava (IVC) flow velocity waveform indices during fetal development in relation to the diameter pulse waveform. Doppler ultrasound and a phase locked loop echo tracking system were used to measure flow velocity waveform and diameter pulse waveform, respectively. Twenty-seven normal singleton pregnancies were examined from 20 weeks until term at 4-week intervals. The diameter pulse waveform consisted of four waves (A, X, V, and Y waves). The A value (end-diastolic diameter) was associated with the end-diastolic pressure, which causes reverse flow during right atrial contraction. In normal fetuses, a weight-related lower end-diastolic diameter suggested that the end-diastolic pressure was decreased. Except for a positive correlation between the percent reverse flow during atrial contraction and the A value per unit fetal weight, no correlations were found between diameter waveform indices and blood flow velocity waveform indices. The peak velocity index of the velocity waveform significantly correlated with the umbilical artery flow velocity waveform systolic/diastolic ratio. The fetal IVC velocity waveform indices did not yield unequivocal information as to changes in central venous pressure, for which purpose the diameter pulse waveform analysis would seem to be the only available method.

Case of uterine cervical carcinosarcoma.

Carcinosarcoma (CS) is a rare neoplasm that is called a mixed epithelial and mesenchymal malignancy. CS of the uterine cervix is much less common than its counterparts in the uterine corpus. A 61-year-old, gravida 2, para 2 woman, who had undergone menopause 16 years prior to the presentation, was diagnosed with CS of the uterine cervix. A semiradical hysterectomy was carried out on the diagnosis of stage Ib1 cervical cancer. The patient underwent whole pelvic 45 Gy radiation as a postoperative additional treatment, but she died from multiple organ failure by metastasis 17 months after the operation. The tumor protruded from the cervix to the vagina and measured 4.5 x 3.0 cm. Histologically, the tumor was characterized as a squamous cell carcinoma and mesenchymal malignancy, represented by osteosarcomatous components. The stroma was largely composed of atypical spindle-shaped cells, which were immunohistochemically demonstrated to be of epithelial origin. Uterine cervical CS is one of the aggressive malignancies, and squamous cell carcinomas are common epithelial counterparts of cervical CS as well as adenocarcinomas.

Antiphosphatidylethanolamine antibodies in recurrent early pregnancy loss and mid-to-late pregnancy loss.

AIM: Associations have been reported between antiphospholipid antibodies (aPL), mainly anticardiolipin antibodies (aCL) and/or the lupus anticoagulant, and recurrent pregnancy losses (RPL). However, relatively few studies describing antiphosphatidylethanolamine antibodies (aPE) have been reported. We describe the prevalence of aPL to both cardiolipin and phosphatidylethanolamine in patients with RPL. METHODS: Patients with recurrent early pregnancy losses (n = 145) and mid-to-late pregnancy loss(es) (n = 26) were screened for aPE and aCL. RESULTS: In patients with recurrent early pregnancy losses, prevalence of immunoglobulin G (IgG) aPE (17.9%, P = 0.001) and immunoglobulin M (IgM) aPE (12.4%, P = 0.01) was significantly higher than in the control group. In patients with mid-to-late pregnancy loss(es), prevalence of IgM aPE (19.2%, P = 0.008) and IgG aCL (23.1%, P = 0.02) was significantly higher than in the control group. CONCLUSION: Our data suggest that aPE may be a risk factor in patients with mid-to-late pregnancy loss(es) as well as recurrent early pregnancy losses.