János Aranyosi

Placental macrophage contact potentiates the complete replicative cycle of human cytomegalovirus in syncytiotrophoblast cells: Role of interleukin-8 and transforming growth factor-β1

Although syncytiotrophoblast (ST) cells can be infected by human cytomegalovirus (HCMV), in vitro studies have indicated that ST cells do not support the complete viral reproductive cycle, or HCMV replication may occur in less than 3% of ST cells. The present study tested the possibility that placental macrophages might enhance activation of HCMV carried in ST cells and, further, that infected ST cells would be capable of transmitting virus to neighboring macrophages. For this purpose, we studied HCMV replication in ST cells grown alone or cocultured with uninfected placental macrophages. Our results demonstrated that HCMV gene expression in ST cells was markedly upregulated by coculture with macrophages, resulting in release of substantial amounts of infectious virus from HCMV-infected ST cells. After having become permissive for viral replication, ST cells delivered HCMV to the cocultured macrophages, as evidenced by detection of virus-specific antigens in these cells. The stimulatory effect of coculture on HCMV gene expression in ST cells was mediated by marked interleukin-8 (IL-8) and transforming growth factor-beta1 (TGF-beta1) release from macrophages, an effect caused by contact between the different placental cells. Our findings indicate an interactive role for the ST layer and placental macrophages in the dissemination of HCMV among placental tissue. Eventually, these interactions may contribute to the transmission of HCMV from mother to the fetus.

Assessment of cerebral hemodynamics during roll over test in healthy pregnant women and those with pre-eclampsia.

Objective To compare cerebral autoregulatory responses obtained during roll over tests in healthy pregnant women and those with pre‐eclampsia in order to assess the middle cerebral artery velocity changes in relation to the roll over test in normotensive and pre‐eclamptic women.

Fetal arterial redistribution indicating true umbilical cord knot

True umbilical cord knot often remains undiscovered prenatally due to a lack of characteristic clinical or ultrasound signs. We present a pregnancy with favorable outcome in which a non-stress test (NST) found non-reassuring fetal status. Abnormal Doppler blood flow patterns in the descending aorta and in the middle cerebral artery revealed fetal arterial redistribution with normal circulation in the umbilical artery despite a true cord knot. The benefit of fetal Doppler assessment is discussed. Increased aortic-cerebral ratio may reflect acute hypoxic compromise caused by the transitory constriction of the true umbilical cord knot with unrecognized morphologic and circulatory signs.

Open mitral commissurotomy in pregnancy:A Case Report

Correction of severe mitral stenosis by open commissurotomy during the second trimester of pregnancy is reported. The further course of the pregnancy was uneventful and at 34 weeks a healthy boy was vaginally delivered. Mother and child were in good health on discharge from hospital one month later.

Comparison of Cerebral Blood Flow Velocity as Measured in Preeclamptic, Healthy Pregnant, and Nonpregnant Women by Transcranial Doppler Sonography

Aim: To test the hypothesis that the middle cerebral artery blood flow velocity (MCAV) is altered in preeclamptic pregnant women as compared with healthy pregnant and nonpregnant women. Methods: Preeclamptic (n = 21) and healthy pregnant (n = 17) as well as healthy nonpregnant (n = 29) women underwent transcranial Doppler MCAV measurements. The mean MCAV values were compared between the different groups. Anova combined with Bonferroni correction was used for statistical analysis. Results: The MCAV was significantly higher in nonpregnant women (mean ± SE 73.0 ± 2.12 cm/s) as compared with healthy pregnant women (67.0 ± 1.8 cm/s, p = 0.0356). Preeclamptic women showed significantly higher MCAV values (83.5 ± 2.1 cm/s) as compared with nonpregnant females (73.0 ± 2.12 cm/s, p = 0.0014). Similar to nonpregnant women, healthy pregnant women showed lower MCAV values (67.0 ± 1.8 cm/s) as compared with preeclamptic women (83.5 ± 2.1 cm/s, p = 0.001). After Bonferroni correction the MCAV values in patients suffering from preeclampsia were still statistically significantly higher as compared with the two other groups. Conclusions: We detected increased resting MCAV values in pregnant women with preeclampsia. In our opinion, this finding refers to arteriolar dilation of the resistance vessels of the brain. Further studies are needed to prove altered vasoreactivity responses of the brain resistance arterioles in preeclampsia.

Intracardiac operation with the use of cardiopulmonary bypass

Study Methods: Quantitative and qualitative methods were combined to provide depth and numerical credence to the data. In the qualitative component, a broad spectrum of society, including compliers and noncompliers, were purposively selected. 22 focus group discussions, 7 key informants, 8 critical incidents and 6 Venn diagrams provided data and guided questionnaire development. The survey was subsequently conducted with 244 recently delivered women attending under 5 clinics. Only women referred during their pregnancy for delivery at the district hospital were included. Results: 54% (CI 47.3 60.6%) of high risk women complied with referral advice. Primagravidas and grand multiparas demonstrated highest non-compliance. 32% expressed fear of cesarean section, 17% cited distance and transport as problems, and 14% claimed poor provision of information. Other issues affecting compliance included fear of pain, altered body image and sexual pleasure following episiotomies, and enforced tubal ligation. Husbands played an important role and contributed to non-compliance fearing that absence of wives would lead to sexual infidelities. Educational status had a strong association with non-compliance as did attitude of staff (p=O.OOl). Women suggested that improved staff attitude and interpersonal communication were critical to referral compliance. Conclusions: The accuracy and utility of the high-risk approach has provoked much international debate. Unless significant efforts are primarily directed towards addressing user perspectives of quality, efforts to improve high-risk identification cannot impact upon maternal mortality irrespective of issues of sensitivity and specificity.

P3.19.01 Comparison of maternal middle cerebral artery blood flow velocity as measured in preeclamptic, healthy pregnant and non-pregnant women by transcranial Doppler sonography

Objective: Establishment of a following-up system for squamous intraepithelial lesion (SIL) of the uterine cervix by retrospective study. Method: Between 1984 and 1994, we have been mass-screened 177,340 subjects for uterine cervical cancer, and detected 798 cases of low SIL and high SIL (excluding cases of CIS) of the uterine cervix at the Tokyo Metropolitan Cancer Detection Center (detection rate 0.45%). We followed 860 cases, including cases that were referred to us. The following criteria were used in evaluating the outcome of SIL. Cases in which both cytological and colposcopical results were negative at least 3 times and continuously for at least 2 years were evaluated as regressing. Cases in which intraepithelial carcinoma or worse was confirmed histologically were evaluated as progressing. Cases which did not progress nor regress during at least 2 years of follow-up were evaluated as persisting. The average follow-up period for SIL was 49.8 months. Results: 1) Out of 383 cases of low SIL, 12 cases (3.1%) progressed, 97 cases (25.3%) persisted and 274 cases (71.4%) regressed. 2) Out of 194 cases of high SIL, 39 cases (20.1%) progressed, 68 cases (35.1%) persisted and 87 cases (44.8%) regressed. 3) Of the 361 cases that regressed, 301 did so within 2 years of follow“P. 4) Of the 51 cases that progressed, the operative histologic diagnosis was established in 44 cases. The breakdown was; CIS, 31 cases; MIC, 5 cases; SCC lb, 4cases. Conclusion: High SIL is a lesion that progresses at a rate of approximately six times that of low SIL. Closely controlled follow-up of high SIL is possible, but medical treatment is indicated if there is no regression within 2 years.

CHANGES IN SERUM CYCLIC NUCLEOTIDE CONCENTRATION DURING OPEN-HEART SURGERY

Changes in serum cyclic AMP and GMP concentrations were studied in 14 patients undergoing open-heart surgery with cold cardioplegia. Blood samples were taken on total bypass from the radial artery and from the coronary sinus before aortic cross-clamping and 1 and 9 min after declamping. The samples were analyzed for cyclic nucleotides. The cAMP levels showed no pronounced change in the arterial samples, but were significantly increased in the coronary sinus samples after declamping of the aorta. The cGMP values showed the same trend of change in the arterial and the coronary sinus samples, viz. significant fall after aortic release, and after 9 min an increase. The cAMP/cGMP ratio after clamp removal showed pronounced increase in the first minute and some reduction at 9 min. All the changes were statistically significant. Beating recommenced spontaneously in seven hearts. The cAMP levels were lower in this group than in the patients without spontaneous recovery. The outset cGMP levels and the cAMP/cGMP ratio were higher in the latter group. Absence of increase in the cGMP level may be due to effectiveness of cardioplegia in reducing the energy requirements of the ischemic myocardium. The study indicates that hearts without spontaneous recovery of beating react more sensitively to hypoxia and have to use up more of their energy resources for restoration of function.