Significado perinatal del trazo sinusoidal en la isoinmunización al factor Rh / perinatal meaning of the sinusoidal trace

Se estudiaron 74 pacientes Rh negativas isoinmunizadas. En todos los casos se practicó aminocentesis para espectrofotometría, extrapolando el resultado a la gráfica de Liley y cardiografía semanalmente, a partir de las 28 semanas de embarazo. Los registros fueron interpretados por un mismo observador y la presencia de trazo sinusoidal (TS) se definió de acuerdo a los criterios de Manseou, formándose dos grupos en telación al hallazgo cardiotocográfico, grupo I casos sin TS y grupo II con TS. En el recién nacido se determinaron grupo sanguíneo, Rh, isoglutinas directas, bilirrubinas y hemoglobinas. Se correlacionó la presencia o ausencia de TS con la zona en la gráfica de Liley, hemoglobina al nacimiento y tratamiento neonatal, encontrándose p = .005. La mortalidad perinatal fue del 42.3%y el análisis estadístico demostró una diferencia altamente significativa entre ambos grupos p = .001. Se concluye que la presencia de TS asociado a la isoinmunización es potencialmente ominoso en el resultado perinatal.

Concentraciones de fármacos en sangre. Utilidad clínica en el embarazo y recién nacido / Drug concentration in blood: clinical utiliry during pregnancy and in the new born

En elpresente trabajo se analizan los resultados de 2,168 exámenes de laboratorio que se realizaron en 50 pacientes (78 en mujeres embarazadas y 26 en recién nacidos) para determinar los niveles de teofilina, fenobarbital, difenilhidantoína o digoxina. El 62.7%(1,359) de las concentraciones estuvieron entre los niveles terapéuticos recomendados para cada fármaco; el 21.8%(472) presentaron concentraciones subterapéuticas; y el 15.5%(337) fueron altas. En algunos pacientes se determinó la vida media de eliminación del medicamento. Estas actividades tienen como objetivo evaluar los resultados de las concentraciones con la información clínica para recomendar ajuste de dosis cuando es necesario, lo que permite controlar con mayor eficacia los esquemas de dosificación y aumentar el beneficio clínico de fármacos con índice terapéutico reducido y/o de aquellos en que la respuesta terapéutica es muy variable por factores diversos que afectan su cinética.

Padräo cardiotocográfico em relaçäo a hemoglobina do cordäo, de pacientes isoimunizadas pelo fator Rh / Correlation between fetal heart rate patterns and fetal hemoglobin level in isoimunized pregnancies by Rh factor

Foram acompanhadas 38 gestantes sensibilizadas pelo fator Rh, realizando-se cardiotocografias precedendo o parto e comparando-se aos níveis de Hb do cordäo umbilical. Foram considerados anêmicos fetos com Hb < 11 g%. As cardiotocografias foram classificadas em reativos, hiporreativos e näo-reativos. O valor preditivo negativo da cardiotocografia foi de 78% e a sensibilidade de 64,28%

Dating the early pregnancy by sequential appearance of embryonic structures.

A total of 97 transvaginal scans were performed from 4 to 12 weeks' gestation in normal and accurately dated gestations. The sequential appearance of six structures were examined: (1) the gestational sac only was present during week 4; (2) the yolk sac appeared in week 5; (3) the fetal pole with detectable heart motion was first seen in week 6; (4) the single unpartitioned ventricle in the brain marked week 7; (5) the falx cerebri appeared during week 9; and (6) the appearance and the disappearance of the physiologic midgut herniation were seen in week 8 and week 11, respectively. Inasmuch as the time in gestation at which these structures appear characterizes the gestational age more than any measurement at this age, we propose a practical method to determine the correct gestational age in early first-trimester pregnancy.

Umbilical cord is the major source of prostaglandin E2 in the gestational sac during term labor.

The umbilical cord is an amniotic structure histologically resembling amnion lining the basal plate and reflected chorion. Prostaglandin E2 is secreted by amnion and is present in amniotic fluid. This study measured prostaglandin E2 production by amnion from all three locations to determine the relative contributions of prostaglandin E2 to amniotic fluid at term. Total surface areas and weights of umbilical cord, basal placental plate, and reflected chorionic amnion were measured in afterbirths from 20 normal patients delivered at term by elective repeat cesarean section before the onset of labor or vaginally after spontaneous onset of labor. Subsequently, 2 cm lengths of umbilical cord and 8 cm2 disks of basal placental plate and reflected chorionic amnion were incubated in perfusion chambers, and prostaglandin E2 production was measured by radioimmunoassay. Umbilical cord accounted for the least surface area (16% to 17%) but greatest tissue mass (75% to 76%). Both basal placental plate and reflected chorionic amnion increased prostaglandin E2 production 2.3-fold and 4.1-fold, respectively, after labor versus before labor, whereas umbilical cord prostaglandin E2 output was unchanged. However, umbilical cord accounted for 66% and 44% of the total prostaglandin E2 output before labor (697 +/- 169 ng/hr) versus (1201 +/- 380 ng/hr) after labor. Thus, of the three amniotic locations, umbilical cord represents the principal site of prostaglandin E2 production within the gestational sac.

Distribution of the beta 1 subgroup of the integrins in human cells and tissues.

We studied the distribution of the beta 1 integrin subfamily in human tissues and cells by light microscopy, electron microscopy, and immunoblotting, using monoclonal antibody DH12, previously shown to react with the beta 1 subunit of the human fibronectin receptor. Crossreaction with the other beta subunits of the integrin family, which have 45% and 47% primary amino acid sequence identity with the beta 1 subunit, was excluded, as MAb DH12 did not react with the beta 2 subunit in granulocytes and the beta 3 subunit in thrombocytes. Reactivity with the anti-beta 1 antibody was found in skin, lung, heart, striated and smooth muscle, blood cells, liver, kidney, intestine, spleen and placenta. Thus, cells of mesodermal, ectodermal, and entodermal origin express the beta 1 subunit. In skin fibroblasts cultured in vitro, beta 1 subunit was also detected intracellularly. The wide distribution of the beta 1 family, originally detected in activated T-lymphocytes after prolonged culture in vitro, contrast with the restricted distribution of the beta 2 integrins on leucocytes.

Lactoferrin in human amniotic fluid.

The concentration of human lactoferrin (LF) was measured by radioimmunoassay or non-competitive avidin--biotin assay in amniotic fluid, cord blood and in the decidua, trophoblast, fetal membranes and umbilical cord. Amniotic fluid was obtained by amniocentesis, and cord blood and tissue samples were taken after delivery or elective Caesarean section. No detectable concentration of LF was found in amniotic fluid before week 20 of pregnancy. A significant increase in the LF concentration was observed around week 30 and it remained high until term. In cord blood, an undetectable or low concentration of LF was measured. In tissue specimens the amount of LF was highest in the decidua (9-95 micrograms/g), a moderate concentration was assayed in the amniotic (2-37 micrograms/) and chorion (2-26 micrograms/g) membrane and in the trophoblast (5-35 micrograms/g). In the umbilical cord, the concentration was less than 1 microgram/g. These results suggest a decidual origin of LF. The role of LF during pregnancy is discussed.

Plasma concentrations of vitamin K1 and PIVKA-II in bottle-fed and breast-fed infants with and without vitamin K prophylaxis at birth.

Plasma vitamin K1 and proteins induced by vitamin K absence (PIVKA) were assayed simultaneously 1-4 days and 29-35 days after delivery in three groups of infants: breast-fed not receiving vitamin K at birth (n = 12), bottle-fed without vitamin K administration at birth (n = 7) and breast-fed receiving 1 mg vitamin K1 administered by intramuscular injection at birth (n = 13). The bottle-fed infants had a significantly higher vitamin K1 plasma level than breast-fed infants who did not receive vitamin K1 at birth. Extremely high levels of vitamin K were obtained 1-4 days after intramuscular administration. At the age of 1 month, breast-fed infants had the same plasma vitamin K1 concentration whether or not they had received vitamin K1 supplements. Decarboxy prothrombin (PIVKA-II) a reliable indicator of biochemical vitamin K deficiency, was found in 5 out of 12 breast-fed and in 2 out of 6 bottle-fed infants who had not received supplemental vitamin K1 after birth. In a separate study, we followed up to 90 days after birth a larger group if infants. PIVKA-II was found with significantly greater frequency in breast-fed infants receiving no vitamin K than in breast-fed infants receiving 1 mg vitamin K intramuscularly at birth, or in bottle-fed infants without extra vitamin K1. These data form a strong argument for routine vitamin K prophylaxis after birth for all breast-fed infants. The optimum dose and manner of administration require further study.

Investigación de anticuerpos del sistema ABO en sangre de cordón de recién nacidos: cuantificación de anti-A / Detection of ABO system antibodies in umbilical cord blood from newborn infants: quantitation of anti-A

El objetivo de este trabajo fue determinar la presencia de anticuerpos del sistema ABO em 119 muestras de sangre de cordón de recién nacidos de grupo 0, cuyas madres presentaban el mismo grupo. Posteriormente se titularon los anticuerpos anti-A mediante un método manual de cuantificación de la aglutinación, relacionándolos con los anticuerpos presentes en la madre respectiva. Los resultados obtenidos demuestran la presencia de anticuerpos del sistema ABO en sangre de cordón umbilical en un 93,3% de las muestras (n = 111). Del total de estas muestras con reacción positiva, el 96,4% (n = 107) permaneció activo después del tratamiento con 2-mercaptoetanol, evidenciando su naturaleza de iunmunoglobulina G. La cuantificación de los anticuerpos anti-A demostró una menor concentración en los bebés que en la madre respectiva. Además, se observó que los bebés con títulos altos correspondían a las madres que presentaban títulos mayores. El análisis estadístico (r de Spearman) indicó que existe una asociación entre ambas variables

Investigación de anticuerpos del sistema ABO en sangre de cordón de recién nacidos: cuantificación de anti-A / Detection of ABO system antibodies in umbilical cord blood from newborn infants: quantitation of anti-A

El objetivo de este trabajo fue determinar la presencia de anticuerpos del sistema ABO em 119 muestras de sangre de cordón de recién nacidos de grupo 0, cuyas madres presentaban el mismo grupo. Posteriormente se titularon los anticuerpos anti-A mediante un método manual de cuantificación de la aglutinación, relacionándolos con los anticuerpos presentes en la madre respectiva. Los resultados obtenidos demuestran la presencia de anticuerpos del sistema ABO en sangre de cordón umbilical en un 93,3% de las muestras (n = 111). Del total de estas muestras con reacción positiva, el 96,4% (n = 107) permaneció activo después del tratamiento con 2-mercaptoetanol, evidenciando su naturaleza de iunmunoglobulina G. La cuantificación de los anticuerpos anti-A demostró una menor concentración en los bebés que en la madre respectiva. Además, se observó que los bebés con títulos altos correspondían a las madres que presentaban títulos mayores. El análisis estadístico (r de Spearman) indicó que existe una asociación entre ambas variables (AU)

Zinc sérico en embarazadas durante el parto, en cordón umbilical y recien nacidos sanos / Serum zinc in pregnant women during labor, umbilical cord and healthy newborn

Los autores estudian con el Método de Espectrofotometría por Absorción Atómica los niveles séricos de Zinc, en 100 embarazadas de diferentes edades gestacionales en trabajo de parto, simultáneamente en cordón umbilical y en arteria femoral de los 100 neonatos respectivos, durante los primeros 4 días de vida. El material biológico se dividió en dos grupos: A, constituido por 30 embarazadas y por sus 30 neonatos pretérminos entre 34 a 37 semanas de duración y B, por 70 gestantes y 70 recién nacidos a términos de 37 a 42 semanas, todos normales. En el primero los promedios fueron: X: 47,12ug/dl DS: ñ 12 en madre; X: 40,25 ug/dl DS: ñ 10,0 en cordón umbilical; X: 43,65ug/dl DS: ñ 11,0 en femoral antes de 24 horas y X: 45,25ug/dl DS: ñ 12,0 entre las 72 a 120 horas de vida. En el segundo se reportaron: X: 41,27ug/dl DS: ñ 10,0 en suero materno; X: 50,58ug/dl DS: ñ 12,5 en cordón umbilical y X: 44,95ug/dl DS: ñ 13,0 y X: 47,10ug/dl DS: ñ 13,0 para las 24 y entre las 72 a 120 horas de nacer. Se comprobó descenso de la concentración sérica del metal durante la gestación. Se demostró diferencias estadísticamente significativas entre los promedios maternos y del cordón; en los pretérminos del A, a favor de la madre por ser más alto y en los a términos del B, al cordón al resultar superior. No se reportaron diferencias estadísticamente significativas entre los recién nacidos de ambos grupos, a pesar de las cifras absolutas diferentes. El estudio comparativo entre ambos grupos A y B, arrojó diferencias estadísticas evidentes a favor del promedio materno con menos de 37 semanas de gestación; mientras que en cordón umbilical..

Immunohistochemical study of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA125) in the human and cynomolgus monkey placenta, umbilical cord and decidua.

Tissue polypeptide antigen (TPA) and cancer antigen 125 (CA125) were studied immunohistochemically by the avidin-biotin immunoperoxidase technique in human and cynomolgus monkey placentae, membranes, umbilical cords and decidua. In early human placentae, TPA was localized mainly in the cell membranes of villous syncytio- and cyto-trophoblast. The cytoplasm of those trophoblastic cells were weakly stained with TPA. The membrane of basal chorionic trophoblast cells was strongly stained with TPA and the cytoplasm stained weakly. In early cynomolgus placentae, similar immunostaining results were obtained. However, the positive stainings for TPA was more marked in the cytoplasm of villous syncytiotrophoblast and basal chorionic trophoblast, and less marked in the cell membrane of villous cytotrophoblast. In early human and cynomolgus placentae, CA125 was not demonstrated immunohistochemically in the villi and basal chorion. In human and cynomolgus term placentae, the villous syncytiotrophoblast and basal and reflected chorionic trophoblast showed similar immunostaining as the early placentae. In addition, TPA was found in the amniotic epithelium in both sorts of placentae. TPA was not detected immunohistochemically in the umbilical cord and decidual cells. While weakly positive stains for CA125 were observed in decidual cells, CA125 was localized mainly in the membrane and cytoplasm of amniotic epithelium in both human and cynomolgus term placentae. TPA and CA125 are thus oncoplacental antigens and the monkey could serve as a model for their investigation.

Immunohistochemical localization of 6-keto-prostaglandin F1 alpha and prostaglandin E2 in the human umbilical cord before and after labor.

In this report immunohistochemical localization of 6-keto prostaglandin (PG)F1 alpha (the stable metabolite of prostacyclin (PGI2], PGE2, and its stable metabolite bicyclic PGE2 in umbilical amnion and vasculature is described. Umbilical cords were obtained at cesarean section from women who were not in labor (N = 7) and from women (N = 6) who went through normal labor and delivery at term. Study of both groups of umbilical cords allowed assessment of differential prostanoid metabolite localization pre- and post-labor. Formalin fixed, paraffin-embedded sections were stained by the avidin-biotin peroxidase complex method. PGE2, bicyclic PGE2, and 6-keto-PGF1 alpha localized to the amniotic cells covering the umbilical cord as well as to the endothelium of the umbilical veins in both groups (pre- and post-labor). No immunostaining was identified in the umbilical arteries. These findings suggest that amniotic cells and endothelial cells of the umbilical vein but not arteries are sites of synthesis or storage for the prostanoids 6-keto-PGF1 alpha and PGE2.

The immunocytochemical localization of new soluble placental tissue proteins (PP14, 16, 17, 19, 20 and PP21) in human and cynomolgus monkey placentae.

Apparently Placenta-specific placental tissue proteins (PP14 and PP17) and solitary tissue proteins (PP16, 19, 20 and PP21) were investigated by avidin-biotin immunoperoxidase technique in the human and cynomolgus monkey placentae, membranes, decidua and umbilical cords. In human early placentae, PP14, 16, 17, 19 and PP21 were localized mainly in the cytoplasm of villous syncytiotrophoblast. PP20 was localized in the cytoplasm of basal chorionic trophoblasts. In human term placentae, positive stainings for PP16, 19 and PP21 were observed mainly in all kinds of trophoblastic cells, while positive stainings for PP14, 17 and PP20 were weakened in the trophoblastic cells. PP20 was clearly localized in the cytoplasm of Hofbauer-like cells in the villous stroma. The membrane of villous syncytiotrophoblast showed strongly positive stainings for PP21. PP21 was also localized in the membrane of amniotic and umbilical epithelium. The umbilical epithelium was cytoplasmically positive for PP14, 16 and PP20. Clear positive stainings for PP14 and PP21 were found in the cytoplasm of fetal polymorphonuclear neutrophils. All of the placental proteins were immunocytochemically positive in the decidual large cells. In the cynomolgus monkey placentae, similar immunostaining results were obtained. The monkey could, thus, serve as a model for the investigation of the placental proteins.

Polyol accumulation in human placenta and umbilical cord.

Ultrafiltrable metabolites in human term placenta and umbilical cord were analysed by means of 13C-NMR spectroscopy and gas-liquid chromatography. In these tissues, existing in a very reduced redox state, lactate and polyols (sorbitol, myoinositol and xylitol) were found to be the major accumulated intermediates of the glycolytic pathways. The cord tissue preferentially took up myoinositol.

Feedback control of selected biosynthetic activities of chondrocytes in culture.

The syntheses of proteoglycans and proteins by chondrocytes from the Swarm rat chondrosarcoma in primary cultures were modulated on the addition of matrical molecules. In the presence of hyaluronan, collagen or proteoglycan aggregates the synthesis of proteoglycans was depressed. The synthesis of collagen was also depressed in the presence of hyaluronan or collagen. In the presence of proteoglycan monomers, the incorporation of 35S-sulfate was enhanced in proportion to the concentration of the additive in the medium; the synthesis of protein was unaffected. The proteoglycan monomers synthesized in the presence of proteoglycan monomers were larger than those synthesized in their absence. In combinations, the exogenous macromolecules did not affect the selected biosynthetic activities to an extent greater than that which they exerted separately. The data suggest, however, that the proteoglycan monomers can counteract the inhibitory effects of the macromolecules which are inhibitory. The data, moreover, suggest that the chondrocytes of the Swarm rat chondrosarcoma have the potential to discriminate between proteoglycan monomers produced by self and those produced by chondrocytes of hyaline cartilages.

Zinc concentration in umbilical cord tissue and cord plasma in appropriate-for-gestational-age babies.

Zinc concentration in cord plasma was determined in 148 healthy appropriate-for-gestational-age babies delivered at various gestational ages. Zinc concentration in cord tissue was also determined in 62 of these babies. There was a significant rise in the cord tissue zinc concentration just after the 35th week of gestational age; thereafter the levels remained relatively unchanged. The cord plasma zinc concentration decreased slightly with increasing gestational age, but these changes were not significant. There was a statistically significant positive correlation between cord tissue zinc concentration and birth weight. No correlation was found between cord plasma zinc concentration and birth weight or cord tissue zinc concentration.

Collagen type III predominance in newborns with congenital dislocation of the hip.

The collagen content and the relative distribution of collagen Types I and III were measured in umbilical cords from newborns with congenital dislocation of the hip (CDH) and healthy controls. The total content of collagen per mg dry tissue tended to be reduced. In newborns with CDH the collagen III/I ratio was higher than in the controls. If generalized, these alterations in collagen metabolism may explain the joint hypermobility seen in CDH. It is suggested that the redistribution of collagen Types III and I during normal fetal development and early infancy may be delayed in CDH.