Bioactive and immunoreactive FSH and immunoreactive inhibin concentrations in the ovine fetus.

The bioactive (B) and immunoreactive (I) pituitary contents/concentrations of FSH, together with the plasma concentrations of B-FSH, I-FSH and I-inhibin were determined in ovine fetuses at days 55, 75, 90 and 135 of gestation (day 145 = term). The pituitary contents and concentrations of B-FSH and I-FSH increased in both sexes with gestational age. The female fetuses had significantly (P < 0.01) higher pituitary contents/concentrations of B-FSH and I-FSH than the male fetuses at days 75 and 135. The pituitary B/I ratios of FSH were not significantly different with age or sex. The plasma concentrations of B-FSH remained relatively constant from days 75 to 135, with no significant differences between sexes or with age. In contrast, the plasma concentrations of I-FSH reached a peak at day 90 and then declined towards term in both sexes. At all gestational ages except day 55, the female fetuses had significantly (P < 0.05) higher plasma concentrations of I-FSH than the males. In both sexes, the plasma B/I ratios of FSH were lowest at day 90 and had increased again by day 135, with the male fetuses having significantly (P < 0.05) higher B/I ratios compared with the female group at days 75 and 135 but not at day 90. At all gestational ages, the plasma concentrations of I-inhibin declined throughout gestation in the female fetuses, whereas in the males they reached a nadir at day 75 and then increased towards term. The concentrations of I-inhibin were significantly (P < 0.01) higher in the male fetuses compared with the females.(ABSTRACT TRUNCATED AT 250 WORDS)     

Proceedings of Irish Association for Rheumatology and Rehabilitation and Society of Irish and American Rheumatologists: Combined Meeting

Irish Journal of Medical Science (1971 -) -     

The Impact of Trans-thoracic Ultrasound on Cardiac Injuries

Objective:

To determine the impact of trans-thoracic ultrasound (TTUS) in patients with chest trauma and potential cardiac injuries and to determine the outcome of patients with cardiac injury detected on TTUS.

Method:

Data were obtained from the Trauma Registry for all patients presenting alive to the University Hospital of the West Indies during the 10-year period commencing January 1, 2001 and who were subjected to a TTUS or emergency thoracotomy for cardiac injuries, or had cardiac injuries at postmortem. In addition to demographics, variables analysed included mechanism and site of injury and outcome.

Results:

Of 405 patients being subjected to a TTUS during the period, 12 (3%) had cardiac injuries. During the same period, 63 patients in the Trauma Registry had proven cardiac injuries. Transthoracic ultrasound was thus conducted on 19% of all patients with cardiac injuries. Three patients had positive TTUS but no cardiac injuries. Of the patients with injuries, the mean age was 30.4 years, 92.1% were male and 65% were as a result of stab wounds, while 22% were as a result of gunshot wounds. The right ventricle was the most common site of injury, accounting for 41% of cases, while the left ventricle, both ventricles and other sites accounted for 27%, 17% and 14%, respectively. Ninety per cent of the group was subjected to emergency thoracotomy; mortality of the entire group was 48%, including one patient who had TTUS.

Conclusions:

This review demonstrates that cardiac injuries remain lethal, diagnosis is largely clinical and TTUS may be over-utilized, having little impact on clinical outcome of patients presenting with this injury.     

Persistent polyclonal B lymphocytosis with Epstein-Barr virus antibodies and subsequent malignant pulmonary blastoma.

Persistent polyclonal B lymphocytosis (PPBL), a rare benign lymphoproliferative disorder, occurred in a 25 year old woman. The lymphocytes showed the phenotype cIgM+, FMC7+, CD19+, CD20+, which was similar to that seen in Waldenstrom's macroglobinaemia, but the proliferation was repeatedly shown to be polyclonal both immunologically and by immunoglobulin gene rearrangement studies. Eleven years after presentation the patient developed a malignant pulmonary blastoma, a rare pulmonary tumour of combined epithelial and mesenchymal origin. The failure to develop a lymphoid malignancy over 11 years together with immunological and genetic evidence of polyclonality confirms that PPBL is a benign lymphoproliferative disorder. The subsequent occurrence of a nonhaemopoietic malignancy suggests that benign lymphoid proliferations, like their malignant counterparts, may predispose to the development of neoplasia. A role for Epstein-Barr virus in the pathogenesis of one or both of these rare conditions is suggested by the finding of raised Epstein-Barr viral capsid antigen titres.     

Analyses of the potential oxygen transfer capability in placentae from infants succumbing to sudden infant death syndrome

BACKGROUND: Morphometric oxygen diffusive conductance (Dp) was estimated to assess the potential efficiency of oxygen transfer across the materno-fetal interface in placentae obtained from victims of sudden infant death syndrome (SIDS). STUDY DESIGN: SIDS placentae were retrieved from archived storage and classified into normal birth weight (NBW, n=16), or small for gestational age (SGA, n=9) and compared against control placentae (n=40) or SGA (n=24) placentae. A combination of stereological techniques and physiological constants were used to estimate total Dp. RESULTS: SIDS NBW cases showed a crucial reduction in fetal capillary surface area when compared with control placentae. SIDS SGA showed a number of deficiencies in basic volumetric and surface area parameters. Values for total and specific Dp in placentae in both SIDS groups were maintained at levels comparable with control and SGA cases, respectively. CONCLUSION: Since more reductions were observed in SIDS SGA group, this suggests that factors responsible for these reductions maybe associated with SGA rather than being SIDS-specific factors.     

Obstructive colitis. Ulceroinflammatory lesions occurring proximal to colonic obstruction

The term "obstructive colitis" refers to ulceroinflammatory lesions occurring in the colon proximal to an obstructing or potentially obstructing lesion. We studied nine cases identified over a 9-month period. The patients were predominantly female (only one was male), elderly (mean age, 73), and usually had hypertension, diabetes, or other prior chronic illness. The colonic obstruction was due to adenocarcinoma in seven cases and to diverticular disease in two cases. Areas of colitis occurred either as circumscribed ulcers 0.5-2 cm in diameter (three cases) or as confluent circumferential lesions 8-25 cm in length; they were always separated from the more distal obstructing lesions by a segment of normal colon measuring 2.5-35 cm (mean, 14.6 cm). The involved area of colon was usually only mildly dilated; it exhibited moderate thickening of the wall and had a granular luminal surface accentuated in areas by deeper longitudinal or transverse ulcers. Often there were scattered pseudopolyps, and the margin separating the lesion from normal mucosa was well demarcated and irregular. In one case, two distinct separate areas of colitis were present; in another, the appendix was acutely inflamed. Microscopically, the lesions were composed of granulation tissue with a mixed acute and chronic inflammatory infiltrate that replaced the mucosa and often the submucosa; sometimes it extended into the muscularis propria, with associated peritonitis and perforation. Many of the features of obstructive colitis suggest an ischemic origin, probably mainly due to hypoperfusion following raised intramural pressure, but altered fecal flora may have a synergistic effect. The features of the disease are usually sufficiently characteristic to distinguish it from Crohn's disease and other forms of colitis. Complications include peritonitis, perforation and breakdown of anastomoses made through involved segments of colon that may appear externally normal at surgery.