Tapio Ranta

Distribution of placental protein 14 in tissues and body fluids during pregnancy

Summary. Placental protein 14 (PP14) levels were measured in serum samples from non‐pregnant and pregnant women. amniotic fluid, cord blood, and extracts of placenta, decidua and fetal membranes. The levels were low (15–40 μg/l) in serum of non‐pregnant women. In four pregnancies following in‐vitro fertilization, the serum PP14 levels started to rise 2–12 days after embryo replacement. In normal pregnancy, the highest serum PP14 concentrations (up to 2200 μg/l) were detected between 6 and 12 weeks. After 16 weeks the level decreased and plateaued at 24 weeks to around 200 μg/l. In amniotic fluid, the highest PP14 levels (232 mg/l) were found between 12 and 20 weeks, being considerably higher than those in maternal serum throughout pregnancy. In cord blood, the levels were low (15–22 μg/l) or undetectable. In early pregnancy decidua. the PP14 content was higher (41–160 mg/g total protein) than in late pregnancy decidua (60–2700 μg/g total protein). In amnion and chorion laeve, the PP14 concentration varied from 50 to 750 and 50 to 1000 μg/g protein, respectively. Early pregnancy placenta contained 0‐25‐15 mg/g and late pregnancy placenta 3–430 μg/g protein of PP14. These results show that the levels of PP14 in pregnancy serum have a similar profile to hCG, but in contrast to other placental proteins, the amniotic fluid PP14 levels are remarkably high. This may be explained by suggesting that decidua is a source of PP14.

Invasive Group B Streptococcal Infections in Finland: A Population-based Study

We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2–3.0/100,000 population). We found 32–38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6–0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease.

In vitro recovery of human chorionic gonadotropin-stimulated cyclic adenosine 3′,5′-monophosphate production in desensitized human granulosa-luteal cells*

Human granulosa-luteal cell production of cyclic adenosine 3,5-monophosphate (cAMP) and progesterone (P) were studied in response to purified human chorionic gonadotropin (hCG) in cultured cells from hyperstimulated follicles of in vitro fertilized patients. The hCG injection given to the patients 36 hours before laparoscopy caused partial desensitization of adenylate cyclase of these cells to gonadotropins. Preincubation of the cells in hormone free medium for 2 to 3 days significantly increased their cAMP responsiveness to hCG. P production was stimulated initially by hCG and showed no desensitization. In the cells preincubated for 72 hours without hCG, a subsequent stimulus of 50 ng/ml of hCG elicited maximal cAMP response, whereas 1 ng/ml of hCG was sufficient to bring about maximal P secretion. Time-course studies indicated that maximal cAMP response to hCG was obtained in 1 to 3 hours. Both basal and hCG-stimulated P accumulation continued to rise for up to 24 hours. Preincubation of granulosa-luteal cells from hyperstimulated follicles improves the cells cAMP responsiveness to hCG, whereas P response remains unaltered.

Placental protein 10 (PP10) in normal pregnancy and cholestasis of pregnancy

Summary. The circulating concentrations of placental protein 10 (PP10) were measured by radioimmunoassay in 288 women with normal pregnancy and ten women (55 samples) with cholestasis of pregnancy. Serum PP10 levels were not affected by changes in incubation and storage temperature, and no diurnal variation was observed. The highest PP10 levels (36–85 μg/1) in normal pregnancy were found at 34 weeks. The postpartum decline of serum PP10 concentration corresponded to an average half‐life of 18h. In cholestasis of pregnancy at 32–39 weeks, the serum PP10 levels were found to be lower than normal. Negative correlation was observed between aminotransferase and PP10 levels in serum and between the bile acid levels and the PP10 concentration. These results suggest that the severity of maternal liver disorder is reflected in the circulating PP10 concentration.

THE EFFECTS OF PROTAMINE ON SERUM LEVELS OF PLACENTAL PROTEIN 5 (PP5) IN NORMAL AND ABNORMAL PREGNANCY: A POSSIBLE RELATION TO COAGULATION ABNORMALITIES

The levels of placental protein 5 (PP5) in pregnancy serum show an apparent increase after the addition of protamine sulphate. The difference of the apparent concentrations of serum PP5 in the presence and absence of protamine (ΔPP5) was determined in 345 normal and abnormal pregnancies. A positive ΔPP5 was less frequent in diabetic pregnancy (45 per cent) and pre‐eclampsia (57 per cent) than in normal pregnancy (80 per cent). These findings provide further evidence that PP5 may be involved in the coagulation system, and in particular may relate to abnormal coagulation processes at the placental site.

Pelvic inflammatory disease caused by Salmonella panama and its treatment with ciprofloxacin (case report)

A 40-year-old nulliparous woman, last menstrual period 8 October 1987, was admitted as an emergcncy on 15 October 1987. She gave a 1-week history of diffuse abdominal pain and flatulence. During the 12 h preccding admission she had intense colicky abdominal pain localized in the lower right quadrant with nausea and chills. A t no time had she expcrienced diarrhoea. She had been on a holiday trip to France 1-5 weeks earlier. On examination, she presented with tenderness in the lower right quadrant of the abdomen. She had a regular radial pulse of 100 bea tsh in , blood pressure of 130180 mmHg, and axillary temperature of 37.3C. Pelvic examination revealed tenderness in the right side. Laboratory investigations disclosed a white blood cell count of 8.0 x 10y/l, haematocrit 40%, pregnancy test negative. C-reactive protein (CRP) 78 mgA, and erythrocyte sedimentation rate (ESR) 16 mm/h. Because acute appendicitis could not be excluded she underwent surgery. The appendix was normal, but bilateral salpingo-oophoritis was confirmed and thcre was pus in the culde-sac. P a r e n t e d cefuroxime-metronidazole treatment was commenced. Bacteriological cult ure of abdominal pus yielded growth of a Gramnegative rod which was identified as Salrnonellu punatnu by standard microbiological methods (Kelly et ul. 1985). The organism was susceptible to ampicillin. piperacillin, cefuroxime, chlo-

Characterization of gonadotrophin receptors in a testosterone‐producing ovarian androblastoma. Case report

Case report A 22-year-old woman of normal habitus (weight 63 kg, height 163 cm) and female karotype was examined because of primary infertility. Menarche had occurred at the age of 14, and since then the menstrual period had varied from 14 to 90 days. The right ovary was slightly enlarged on pelvic examination and ultrasonography revealed an enlarged (35 X 31 X 38 mm) right and normal left ovary. No adrenal tumour was found by computerized tomography. At laparotomy an intracapsular yellowish solid tumour (3 x 3 cm) was excised from the right ovary. The left ovary, uterus and fallopian tubes were normal.

Testosterone-Secreting Virilizing Adrenal Adenoma with Human Chorionic Gonadotrophin Receptors and 21-Hydroxylase Deficiency

A 60-year-old woman was evaluated for persistently elevated serum testosterone concentrations after bilateral ovariectomy. Her serum cortisol, androstenedione, dehydroepiandrosterone sulphate and 17-hydroxyprogesterone levels were normal, and decreased after dexamethasone administration. Those of testosterone (17.8-18.4 nmol/l) were remarkably high (normal range 0.7-2.8 nmol/l), were not suppressed by dexamethasone, but clearly increased after hCG administration (up to 128 nmol/l). Computed tomography revealed an adenoma in the right adrenal gland and adrenal scintigraphy under dexamethasone suppression visualized this adenoma. A right adrenalectomy was performed. (1) The tumour was histologically and ultrastructurally adrenocortical adenoma of zona reticularis cell type. (2) The adenoma tissue contained hCG receptors (198 fmol/g). (3) During tissue culture both ACTH and hCG were capable of maintaining its testosterone production, which was attenuated with time without stimulation. (4) The adenoma tissue did not elaborate 21-hydroxylated steroids in contrast to normal adrenal tissue. Thus the aberrant endocrine behaviour of this gonadotrophin-responsive testosterone-secreting adenoma of adrenal zona reticularis cell origin can be explained by ectopic functional hCG receptors and the lack of 21-hydroxylase activity.