[Cancerous disease & placenta substrate; observations on therapy with organ extracts].
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Placentas with hydropic change may be hydropic degeneration (HD) or gestational trophoblastic disease (GTD), partial (PM) or complete (CM) hydatidiform mole. The separation of HD from PM and PM from CM by histological findings may be problematic in some cases and can be clarified with ploidy analysis. Fluorescence in situ hybridization (FISH) using a probe to chromosome 7 (D7Z1) was applied to tissue cut from paraffin blocks from 10 histologically representative cases each of HD, PM, and CM on which ploidy had been previously confirmed by flow cytometry from paraffin embedded tissue. Villous stromal cells and nonproliferative trophoblast were examined for number of signals/cell and percentage of cells/placenta with three hybridization signals. The mean number of hybridization signals/cell was HD 1.14; PM 1.79; and CM 1.17, with statistical significance between HD and PM (P < .0001), and PM and CM (P < .0001). The mean percentage of cells/placenta with three hybridization signals was HD 1.10%, PM 23.1%, and CM 2.11%, with statistical significance between HD and PM (P < .0001), and PM and CM (P < .0001). In addition, there was no overlap in the mean percentage of cells with three hybridization signals between HD and PM, and PM and CM. Chromosome 2 probe (D2Z1) was applied to tissues that had three chromosome 7 signals to exclude trisomy, and in all cases three signals were present confirming triploidy in PM. FISH can identify diploid and triploid hydropic placentas in paraffin-embedded tissue to assist in differentiating HD from PM, and PM from CM.
Placentas were studied from three interrupted pregnancies of a mother whose first liveborn child had I-cell disease (mucolipidosis II). I-cell disease of the fetus was shown by investigation of the amniotic fluid, fetal cells and the aborted fetus in two pregnancies, but in the third case placenta was the only available product of conception. In every placenta extensive vacuolization of the syncytiotrophoblastic layer of the chorionic villi and chorionic mesenchymal cells was found. In electron microscopy the inclusions were identical to those of other tissues in I-cell disease. The importance of histological study of placenta in unexplained spontaneous abortions needs to be emphasized, since this may be the only way of detecing new cases of lysosomal storage diseases.
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Placentas and plasma from women with and without Chagas' disease and cultures of human placental villi with Trypanosoma cruzi, neuraminidase, phospholipase A2 and phospholipase C were analyzed in order to verify if the alterations in placental alkaline phosphatase (PLAP) enzyme activity are caused by T. cruzi as observed in previous works. As IgG receptivity happens to be one of the proposed functions of PLAP, general IgG binding ability of the placentas treated with the mentioned enzymes, which are present on the parasite's surface, were also tested. The phospholipases caused an increase of PLAP's enzyme activity in the supernatant of infected placentas and a decrease of enzyme activity in the membrane of cultured placentas, therefore suggesting the cleavage of PLAP by parasitic enzymes. Desialylation could also partially inhibit PLAP's enzyme activity in supernatant and membrane of placenta culture. Placentas from healthy patients presented higher IgG receptivity than those from patients with Chagas' disease. In vitro infection of healthy placentas with T. cruzi caused no difference in IgG receptivity in placental sections with respect to controls but the phospholipases and neuraminidase increased the IgG receptivity of cultured placentas. The IgG transference index was higher for patients with Chagas' disease than for those without it. Although binding to IgG does not completely inhibit the enzyme activity of PLAP, it interferes with the enzyme activity of PLAP. We concluded that the enzymes on the surface of T. cruzi trypomastigotes can not only affect PLAP's enzyme activity but also increase the IgG binding ability of the placenta and this can be related to the actions of neuraminidase-transsialidase, phospholipase A2 and phospholipase C on the parasite surface. The modification of PLAP from women with Chagas' disease should be considered as a result of multiple factors.
Preeclampsia is characterized by maternal hypercoagulable state and intravascular coagulation, microthromboses in several organs, and impairment of uteroplacental circulation. Excessive fibrin deposition occurs in the placenta, suggesting that disorders of placental coagulation and fibrinolysis physiologic systems may have a role in hemostasis activation. Term placentas were collected from 17 hypertensive/preeclamptic women and from 17 healthy pregnant women, and processed for both histologic and hemostasis studies. Placental fibrinoid deposition was visualized by cresyl-violet staining and quantified by histomorphometric analysis. The content in hemostasis factors was measured on extracts from homogenized placentas treated by a nonionic detergent. The percentage of villi with fibrinoid deposits was higher in the diseased placentas than in controls: 13.2 +/- 11.2 versus 6.75 +/- 2.7% (p < 0.001) for the total amount of deposits; 4.8 +/- 6.7 versus 1.5 +/- 1.0% (p = 0.04) for perivillous fibrinoid deposits, which are considered as histologic markers of intraplacental fibrin. The content in type 2 plasminogen activator inhibitor (PAI-2) antigen was higher in the diseased placentas than in controls: 124 +/- 8 versus 104 +/- 6 ng/mg placental protein (p = 0.046); there was a negative correlation between PAI-2 antigen and thrombomodulin activity (r = -0.57, p = 0.02) in the diseased placentas. No significant differences were found between the two groups for placental procoagulant tissue factor and anticoagulant thrombomodulin activities, and for the content in plasminogen activators and PAI-1 antigens. Placental antifibrinolytic potential is increased in pregnancy-induced hypertension and preeclampsia. This change, and the association of the highest PAI-2 placental concentrations with the lowest concentrations of thrombomodulin, may contribute to the prethrombotic state and to the excessive placental perivillous fibrin deposition observed in these situations.
Eleven placentae and one fibroblast cell culture from pregnancies complicated by various inherited metabolic disorders, together with five chorionic villus biopsies from pregnancies at risk, were examined for ultrastructural evidence of accumulation of metabolites. Abnormal ultrastructural features were present as early as 10 weeks gestation. Myelin bodies were found in all placental cell types in a case of Niemann-Pick disorder and stromal cells showed marked vacuolation in Hurler's disease. Membranous arrays were occasionally identified in the lysosomes of stromal cells in a case of Sandhoff's disease, together with some myelin body formation in the trophoblast and endothelium. In Pompe's disease, intralysosomal accumulations of glycogen were present in all cell types except syncytiotrophoblast, while in sialic acid storage disorder all placental cells were affected except for the cytotrophoblast. Collagen fibre disorientation and excess associated proteoglycan was seen in a formalin-fixed placenta with Sanfilippo mucopolysaccharidosis, and syncytial vacuolation, caused possibly by delays in fixation, was evident in many specimens. The specimens were collected from different centres and the fixation procedure varied significantly. The most satisfactory results were obtained from chorionic villus sampling in vivo and from pregnancies terminated using aspiration followed by immediate fixation. The importance of liaison with clinicians is stressed in order to obtain optimal preservation of the tissue. This is particularly vital in immature specimens of placenta where abnormal storage product material may not have had time to accumulate.
The clinical course of a pregnant patient with a variant form of von Willebrand's disease (type IIA) who was complicated with placenta previa totalis, breech presentation and premature delivery is described. Following whole blood transfusion, she underwent a cesarean section without postoperative hemorrhagic complications. Factor VIII/von Willebrand factor (FVIII/vWF)-related activities (factor VIII procoagulant activity [VIII:C], factor VIII-related antigen [VIIIR:Ag] and ristocetin cofactor [VIIIR:RCo]), Duke bleeding time and platelet retention to glass beads were monitored during pregnancy, labor and puerperium. Gradual increase in FVIII/vWF-related activities and shortening of bleeding time were found during her gestation. Platelet retention, however, remained low. Qualitative analysis of plasma FVIII/vWF with crossed immunoelectrophoresis and gel filtration on Sepharose 2B demonstrated that the large forms of FVIII/vWF, which is important for primary hemostasis, did not appear in the blood during gestation. Therefore, patients with type IIA von Willebrand's disease seem to be more susceptible to bleeding complications at delivery.
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Angiogenesis is the process of neovascularization from preexisting blood vessels, whereas vasculogenesis is the process of blood vessel generation from angioblast precursor cells. The human placenta undergoes high levels of angiogenesis and vasculogenesis during fetal development. Additionally, the placenta undergoes a process of vascular mimicry (also referred to as pseudovasculogenesis ) in which the placental cytotrophoblasts convert from an epithelial to an endothelial phenotype during normal fetal development. Failure of placental angiogenesis and pseudovasculogenesis during placental development has been linked to the pathogenesis of preeclampsia. It currently is believed that soluble factors released by the diseased placenta lead to clinical findings of preeclampsia. This article discusses placental vascular development in health and in disease, with a focus on accumulating recent evidence that the maternal clinical syndrome of preeclampsia is an antiangiogenic state resulting from an excess of anti-endothelial factors liberated by the diseased placenta.
BACKGROUND: Placenta growth factor (PlGF), a member of the vascular endothelial growth factor family, promotes neoarteriogenesis and triggers intraplaque inflammation thereby stimulating atherosclerotic plaque progression and plaque rupture. OBJECTIVE: To investigate prognostic significance of circulating placenta growth factor (PlGF) in coronary artery disease (CAD) patients. METHODS: 78 patients, aged 44-81 years (mean age 61.6+/-13.1 years) with acute myocardial infarction (AMI) (n=19), unstable angina (UA) (n=23), stable effort angina (n=23), and with no evidence of CAD (n=13) were followed-up for at least 48 months. Death, AMI, any revascularization, and hospitalization for UA or progressive effort angina were considered as end points. Plasma levels of PlGF, C-reactive protein (CRP), interleukin-6 (IL-6), neopterin, tumor necrosis factor alpha (TNF-a), haptoglobin and homocysteine were measured at primary admission. RESULTS: During follow up (617+/-263 days) 3 deaths, 1 nonfatal AMI, 4 UA, and 7 angina progression related hospitalizations occurred. Mean event-free survival periods differed significantly between subgroups of patients with low (<7.5 pg/ml), medium (7.5-20.5 pg/ml), and high (>20.5 pg/ml) PlGF levels (1038+/-56, 729+/-55, and 578+/-63 days, respectively). Logrank survival in patients with low PlGF was significantly better than in high PlGF subgroup (p=0.038). PlGF levels did not correlate with age, lipid levels, blood pressure and smoking. A significant positive correlation was found between PlGF and haptoglobin (r=0.34, p=0.028), homocysteine (r=0.455, p=0.044), neopterin (r=0.31, p=0.048), and carotid intima-media thickness. CONCLUSION: Elevated PlGF plasma levels predict worse prognosis in CAD patients; PlGF levels correlate with haptoglobin, neopterin, and homocysteine blood levels and with the carotid artery intima-media thickness.
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The etiology and pathogenesis of the pregnancy syndrome preeclampsia remain poorly understood. There is substantial evidence to suggest that the diverse manifestations of preeclampsia, including altered vascular reactivity, vasospasm, and discrete pathology in many organ systems, are derived from pathologic changes within the maternal vascular endothelium. With the theme of endothelial cell dysfunction emphasized, this review focuses on the role of oxidative stress (an imbalance favoring oxidant over antioxidant forces) in the pathogenesis of preeclampsia. Data are summarized regarding 1) the role of the placenta in preeclampsia; 2) evidence and mechanisms of oxidative stress in the preeclampsia placenta; 3) markers of oxidative stress in the maternal circulation; and 4) the potential role of maternal dyslipidemia in generation of oxidative stress. A recurrent theme is that free radical reactions, promoted by "cross-talk" between the diseased placenta and maternal dyslipidemia, promote a vicious cycle of events that make cause and effect difficult to distinguish but likely contribute to the progression of preeclampsia.
A retrospective longitudinal study of metritis was conducted in Denmark on data collected during 1993-1994. Data on herd size, breed, parity, and treatment of disease were obtained from the Danish Cattle Database. Management and production-facility data were collected using a questionnaire, conducted as a telephone interview in 1994. The study included 2144 herds from three regions in Denmark (102,060 cows). Herd-level variables included were: herd size, housing, flooring, grazing, calving measures, and calving supervision. Cow-level variables were: parity, breed, calving season and whether the cow had been treated by a veterinarian for dystocia or the diseases: retained placenta, reproductive disease, ketosis, milk fever, or dry cow mastitis. Marginal multivariable logistic-regression analyses were performed. The cow with highest odds of metritis was a first or greater than or equal to third parity cow, of large breed, that calved during November-April, in a zero-grazing herd. The cow had been treated for dystocia, retained placenta, and at least one other reproductive disease, but not for ketosis.
Involvement of the placenta by glycosphingolipid deposits in Fabry's disease has not been previously reported. We describe the presence of such deposits in the maternal half of a placenta obtained from a heterozygous carrier of the disease.
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