A Subset of Patients With Recurrent Spontaneous Abortion Is Deficient in Transforming Growth Factor β-2-Producing “Suppressor Cells” in Uterine Tissue Near the Placental Attachment Site

PROBLEM : To determine if patients with unexplained recurrent miscarriage have a deficiency of decidual immunosuppressor cells that produce transforming growth factor β type 2, as has been found in mice with abortion due to rejection and/or trophoblast failure. METHODS : Decidual biopsy specimens were taken as near to the placental attachment site as possible under ultrasound guidance from first trimester legal termination (control) patients with recurrent miscarriage and non-viable pregnancy, and from patients with sporadic missed abortion. The tissue was tested for TGFβ-2⁺ suppressor cells by in situ hybridization, immunohistochemistry, and analysis of supernatants. RESULTS : TGFβ-2-related suppressor molecules similar but not identical to those identified in pregnant mice were released by decidual lymphoid cells. Fifty percent of 14 recurrent miscarriage patients showed a lack of suppressor cells and 59% were subnormal in comparison to 20 controls and 5 sporadic miscarriage patients, where 80–85% of the patients had detectable suppressor cells. CONCLUSIONS : Suppressor cell deficiency is compatible with a role for rejection and/or trophoblast failure in some patients with recurrent miscarriage. Presence of suppressor cells in most patients with missed abortion (4/5) is compatible with an alternative cause of fetal death, similar to findings reported in genetic fetal death mice.     

Hemiplegia as a Complication of Therapeutic Embolisation of the Internal Maxillary Artery

A hemiplegia complicating a successfully treated angioma arising from the internal maxillary artery is described. The probable pathogenesis of the complication is discussed. A right common carotid arteriogram and a selective right external carotid arteriogram were carried out. The common carotid arteriogram showed that the intra-cerebral arteries were normal. The external carotid arteriogram showed an enlarged main stem and a greatly enlarged internal maxillary artery (Figure 1). A rapid series of films in the antero-posterior and lateral projections were taken and subtraction films prepared, to identify the feeding vessels to the arterio-venous malformation and to exclude any connections between the external and internal carotid arterial systems. The internal maxillary artery and its branches were the only feeding vessels demonstrated as supplying a large arterio-venous malformation situated in the pterygo-palatine fossa (Figure 2). Because of the anatomical site of the angioma and its wide ramification, it was decided that the most suitable method of treatment would be embolisation of the main feeding arteries rather than an attempt at surgical removal. Following embolisation the patient developed a hemiplegia. A C.T. Scan confirmed the presence of an area of infarction in the right hemisphere of the brain. The hemiplegia slowly improved over a period of four months but left a residual partial paralysis of the left arm. The embolisation therapy was successful in abolishing the bruit and the vascular hum complained of by the patient.     

The Angiographic Findings in a Haemophilic Pseudotumour of Bone

The angiographic findings in a patient with haemophilic pseudotumour of the femur are presented. The examination showed the position of the displaced femoro-poplited vessels, enabling these structures to be avoided at operation. Under anti-haemophilic globulin cover no complications occurred. It is suggested that angiography may be safely employed provided the coagulation defect is controlled. The examination may be useful in differentiating other bone lesions and in defining more clearly the extent of a haemophilic pseudotumour.     

EFFECTS OF NIMODIPINE ON CEREBRAL BLOOD FLOW AND NEUROPSYCHOLOGICAL OUTCOME AFTER CARDIAC SURGERY

Thirty-five patients undergoing cardiac surgery requiring cardiopulmonarybypass (CPB) were allocated randomly in a prospective double-blindstudy to receive either nimodipine 0.5 µg kg^–1 min^–1or placebo. Cerebral blood flow (CBF) was measured during andimmediately after CPB. Neuropsychological tests were performed6 months after surgery to determine any relationship betweenischaemic damage and CBF and administration of nimodipine. Therewere no differences in CBF between the nimodipine (n = 18) andplacebo groups (n = 17). Significant changes in neuropsychologicaltests were found in six patients tested 6 months after surgerybut there were no conclusive signs of ischaemic damage. Thenimodipine-treated group performed better in tests of verbalfluency and visual retention, suggesting that some memory functionswere preserved better in this group.     

Caring research and concepts: a selected review of the literature

• ? A selected review of the literature on caring in nursing is presented. The review relies on the work of the major theorists in this area.
• ? The major conceptualizations of caring are compared and contrasted, along with some of the research approaches which have been applied to investigate the phenomenon of caring in nursing.
• ? The outcome of quantitative and qualitative research on caring is described and the justification for an extension of the quantitative work, through the development of an appropriate inventory and the application of multivariate statistical analysis, is discussed.

     

Influence of carbamoylation on some analytical properties of basic polypeptides

The effect of carbamoylation on the assay or identification of histones and polylysine was investigated. Incubation with sodium cyanate decreased the positive charge on these polypeptides as judged by changes in the binding of methyl orange or the electrophoretic mobility. Histones in chromatin appeared less accessible to carbamoylation than isolated histones. Carbamoylation of proteins under conditions in which there was little or no effect on the Lowry procedure could affect their assay by methods utilizing metachromasia with Coomassie Blue G. The Bradford assay has low sensitivity for HI histone and polylysine but this can be increased by preincubation with sodium cyanate. More extensive carbamoylation of polylysine caused decreased sensitivity which was the only response seen with core nucleosomal histones and bovine serum albumin when preincubated with sodium cyanate. It was concluded that the sensitivity for HI histone and polylysine in assays dependent on metachromasia with Coomassie Blue G may be changed by factors which decrease the positive charge on these polypeptides.     

Freshly Isolated Tumour-Infiltrating T-Lymphocytes have a High Cytotoxic Potential, as Measured by their Ability to Induce Apoptosis in the Target Cell

To test if freshly isolated tumour-infiltrating lymphocytes (TIL) can induce apoptosis in a target cell, we have combined two previously described methods. Because TIL predominantly are T-lymphocytes. we have applied a redirected approach. When the target cells that express anti-human-CD3 monoclonal antibodies in their membranes bind to the T cell receptor-associated CD3-complex, signals are generated, which activate T cell effector mechanisms. This approach circumvents problems with MHC-restriction and allows for functional testing of all T cells, irrespective of their clonal specificity.
In order to assay for induction of DNA fragmentation, we have labelled the target cell nuclei with [³H]thymidine. Upon harvesting fragmented DNA are washed away. Electrophoretic analysis of the fragmented DNA demonstrated the characteristic 'ladder' pattern, consistent with apoptosis.
This rapid and simple assay monitors the capacity of different T cells to induce apoptosis in the target cell. It depends on intercellular interactions and clearly discriminates between different T cell subsets. With this assay we demonstrate the functional integrity of the cytotoxic effector arm of freshly isolated TIL.     

Serum Complement Activity in Pre-Term Pregnancies: Relationship to Duration of Ruptured Membranes and Clinical Infection

ABSTRACT: Physiologic changes occurring during the latent period of prematurely ruptured membranes (PRM) are poorly understood. Indicators predicting maternal and neonatal infectious morbidity do not correlate well with clinical outcomes. A previous report suggested that in vivo complement consumption occurred in response to the event of membrane rupture. In this prospective study, complement activity was measured serially throughout the latent period in cases of preterm PRM. In addition to total hemolytic complement activity (CH₅₀), C3-proactivator (C3PA), a primary component of the alternate complement pathway, was measured in maternal and cord sera. As with CH₅₀, cord serum C3PA levels are significantly less than those in matched maternal samples. Neither maternal nor cord serum complement activity correlated with either the duration of the latent period or maternal-neonatal infection.