Hypophysitis in surgical and autoptical specimens

We present the clinical and histological findings of 11 cases of inflammatory anterior pituitary lesions, 8 of which were obtained during surgery and 3 of which were obtained from autopsies. Additionally, we extended the conventional classification of pituitary inflammatory disease by the new entity " secondary hypophysitis". Of the surgically obtained specimens 5 consisted of inflammatory extension into the pituitary gland out of the surrounding tissue. In all of these patients the inflammation originated from an additional tumor in the sellar region (4 craniopharyngiomas, 1 prolactinoma). These will be referred to as "secondary hypophysitis", an entity which has not yet been mentioned in the literature. Of the remaining 6 cases, 2 were granulomatous hypophysitis, 2 pituitary abscesses, 1 lymphocytic hypophysitis, and 1 showed extensive scarring of the anterior pituitary lobe due to preceeding lymphocytic hypophysitis. At histological examination the basic structure of the anterior pituitary was maintained in all cases. Relative counts of hormone-producing cells were normal. In secondary hypophysitis, the affected area was composed of fibrous tissue and granulation tissue. B and T lymphocytes were present in equal amounts. Granulomas were not found. Inflammatory infiltrates, granulation tissue and fibroses were seen in different proportions. Based on our results and three other cases reported in the literature so far, we think that the presently used classification of pituitary inflammatory diseases lacks an entity which describes a non-abscess-forming inflammation of the pituitary gland originating from an associated pathological process. Therefore, we introduced the term secondary hypophysitis to describe this fourth entity of pituitary inflammatory disease.

Glycosphingolipid expression on murine L1-fibrosarcoma cells: analysis of clonal in vivo and in vitro selected sublines with different lung colonisation potential

The patterns of acidic and neutral glycosphingolipids (GSLs) were examined in a syngeneic tumour system in Balb/c mice consisting of closely related cell lines with different colonisation potentials directed to the murine lungs (in vivo selected highly metastatic sublines of L1-fibrosarcoma cells and their WGA-resistant mutants with low metastatic potential). GSLs were analysed by high-performance thin-layer chromatography and structurally identified by fast atom bombardment mass spectrometry combined with compositional analyses and exo-glycosidase digestion. The results suggest that highly metastatic sublines L1-LM and L1-LM12 derived by in vivo selection from mouse fibrosarcoma cells (cell line L1) exhibit a drastic increase of polar ganglioside expression and a restriction to globo-series GSLs. Contrasting with this the low metastatic mutant cells (L1-LM13WGA) express a reduced portion of acidic GSLs and exhibit a shift to less polar ganglioside components. Total cellular and plasma membrane-integrated GSLs were demonstrated to exhibit largely identical patterns. Concomitant with a significant decrease in LacCer expression a substantial reduction of GM2 and a complete lack of GM3 expression can be assigned to the highly metastatic sublines of L1-cells. On the other hand, the more polar gangliosides GM1a and, to an even greater extent, GD1a (exceeding 70% of total gangliosides) accumulate on L1-LM and their clonal sublines. The shift to acidic GSLs of higher polarity is less pronounced on the low metastatic WGA-resistant mutant cells (L1-LM13WGA) showing a preponderance of GM1a. The portion of GD1a within the fractions of acidic GSLs does not correspond to the cellular activities of CMP-NeuAc/GM1 (alpha 2-3) sialyltransferase measured for high and low metastatic cell variants. Total sialic acid content of the various cell lines differs, but is not associated with the metastatic potential. Gangliosides on L1-cells exhibit a significant substitution of N-glycolyl for N-acetylneuraminic acid (13%) compared to their metastatic sublines and to mutant cells (less than 1%). A conversion of surface exposed GD1a to GM1a on membranes of metastatic cells by in situ treatment with Vibrio cholerae sialidase is associated with a significant reduction of tumour cell colonisation directed to the murine lungs.

A rare case of 68,XX triploidy diagnosed by amniocentesis

68,XX triploidy was found in the amniotic fluid cell culture of a 40-year-old patient. Elective termination of the pregnancy revealed a fetus with multiple congenital anomalies. While this case does show some common features with monosomy X, a greater similarity to the triploidy syndrome is observed.

Partial monosomy 13q and partial trisomy 18p: case report with necropsy findings

We describe a stillborn female infant with severe intrauterine growth retardation and multiple congenital anomalies. She was found to have a deletion of 13q22----qter and trisomy of 18p11.2----pter, resulting from a maternal balanced translocation.

alpha-Thalassemia hydrops fetalis: clinical and ultrasonographic considerations

Five pregnant Southeast Asian women presenting during a 14-month period with microcytic anemia, preeclampsia, and size-date discrepancies were all ultimately diagnosed as carrying fetuses with homozygous alpha-thalassemia hydrops fetalis. The perinatal complications of this hemoglobin disorder are unique to persons of this ethnic background and include uniform fatality for the affected infant, maternal preeclamptic morbidity, and retained placenta. In this report the obstetric ultrasound findings are presented and the clinical manifestations are discussed, with recommendations made to reduce this emerging public health problem in the United States.

The effect of ouabain on placental transport of 86Rb

Human placental fragments concentrate 86Rb 10--20-fold during a two-hour incubation period. Inhibition of ouabain is dose-dependent, reaching 90 + per cent at a concentration of 5 x 10(-5) M. The clearance index of 86Rb across the perfused human placenta is 0.34 +/- 0.08, comparing to previously reported indices for Na22 and Cl36 of 0.28 and 0.41, respectively. Ouabain in concentrations up to 5 x 10(-5) M had no detectable effect on transfer across the placenta. The clearance index of ouabain is low, averaging 0.07 in 3 experiments. 3H-ouabain is not detectably bound to albumin or placental homogenate.

Hair root analysis in X-linked ichthyosis

Hair roots have been analysed in a large kindred with X-linked ichthyosis associated with steroid sulphatase deficiency. Enzyme activity in individual hair roots was assayed for the steroid sulphatase:neutral alpha-glucosidase ratio, the latter serving as an indicator of the general metabolic activity of the hair root. The distribution of the enzyme ratios in the individual hair roots in the heterozygotes described a normal curve suggesting origin from a single population of cells. The results differed strikingly from the irregular distribution of enzyme activities in hair roots of Lesch-Nyhan disease, where mosaicism occurs. It is suggested that the maternal and paternal genes for steroid sulphatase remain active in vivo in each cell in the hair root in apparent contradiction to the Lyon hypothesis. The observation is consistent with that previously reported for skin fibroblasts in vitro. Sulphatase activity in female controls was minimally greater than in males but the difference was not statistically significant.

Transfer of urea, sodium, and chloride across the perfused human placenta

Clearance indices (clearance of experimental material: clearance of antipyrine, CI) across the perfused human placenta were determined for urea, sodium, and chloride. The selected materials are of relatively small molecular weight and are water soluble. Clearance of urea was determined under conditions of net transfer and of exchange and no difference was detected. Sodium and chloride clearances were measured as exchange rates. The CI were: urea, 0.32 and 0.38 toward fetus and mother, respectively); sodium, 0.28; and chloride, 0.41 (measured toward the fetus). Recalculation of data as the diffusion limitation (LD) facilitated comparison with data in the literature on the monkey, rabbit, and sheep. LD for urea was comparable among the four species whereas the sheep placenta differed, sharply limiting the diffusion of sodium and chloride. The discrepancy in the sheep between urea and sodium indicates that the low transfer rate of the latter cannot be explained by the "thickness" of the syndesmochorial placenta, as is often stated. Inferences concerning nitrogen metabolism in the fetus have been derived by others from data on transplacental urea gradients and urea clearance. Available data in the human are incomplete but are consistent with amino acids providing approximately 10% of fetal energy needs, with glucose serving as the predominant substrate.

Characterization of the (rnunz) nude rat. Morphological characteristics of the lymphoid system

A nude mutant (rnunz) arose spontaneously in a colony of Wistar albino rats (the wild-type strain) in Wellington, New Zealand. On gross examination no thymus could be found in the mediastina of young animals, whereas in older mutants lobules of fatty tissue mimicked the appearance of the thymus of the wild-type strain. Lymph nodes from the rnunz strain showed a marked lymphocyte depletion in the thymus-dependent para-cortical region of the node. Peyer's patches from the nude animals also showed a reduced density of small lymphocytes in the interfollicular zones. In the spleen, tissue from the reticular framework surrounding individual arterioles was sometimes completely empty of lymphocytes but the degree of depletion varied. Total leucocyte numbers in the rnunz strain were 28% lower than the wild-type strain. In 10 out of 13 animals T cells were less than 3% of the lymphocytes present (wild-type 35% T cells). The findings are in agreement with studies of the Rowett nude rat (rnu) and the nude mouse.

Placental transfer of steroids: effect of binding to serum albumin and to placenta

The transfer rates and placental retention of a series of steroids were measured using an in vitro perfusion system of an isolated cotyledon of human placenta. The steroids were added to the maternal inflow and rates of appearance in maternal and fetal outflows were measured, from which data were calculated the transfer rate and placental retention. With a low concentration of albumin (0.01 g/dl) in the maternal and fetal perfusates, transfer rates of diethylstilbestrol and ethynylestradiol were initially low, with considerable retention of the steroids within the placenta. Transfer rates increased with duration of perfusion. With high concentrations of albumin (1 g/dl), placental retention was greatly reduced and transfer rates very rapidly reached high levels. Albumin in the fetal circulation was the effective factor in increasing transfer rate; maternal albumin reduced it. The results with estrone and progesterone were qualitatively similar but not as striking, posssibly because of the large endogenous concentrations of these two hormones. Placental retention of dexamethasone, a more polar steroid that does not bind to placenta and binds poorly to albumin, was low and there was little difference between transfer from low- and high-protein perfusates.

Secretory proteins in the perfused human placenta

A relatively simple perfusion technique of human placenta has been applied to the study of secretory proteins. Preferential secretion into the maternal circulation of human chorionic gonadotropin (HCG), human chorionic somatomammotropin (HCS), follicle-stimulating hormone (FSH), and placental alkaline phosphatase has been demonstrated, contrasting with the bidirectional secretion of progesterone. Evidence is presented for the net synthesis of HCS during perfusion. The technique offers advantages in the study of synthesis and secretion of placental materials.

The transfer and metabolism of corticosteroids in the perfused human placenta

The transfer and metabolism of cortisol, prednisolone, betamethasone, and dexamethasone were investigated in vitro in the perfused human placenta. Maternal and fetal circuits were established but the steroid was added to the former only. The clearance expressed as a fraction of the antipyrine transfer rate varied from 0.27 to 0.50, but there were no significant differences among the four steroids. All the steroids were metabolized extensively to their respective 11-ketosteroids and again there were no material differences among the steroids. The metabolic conversions of dexamethasone and betamethasone were far greater in the perfused placenta than in minced placenta. From the standpoint of placental transfer and metabolism, as observed in the perfusion studies, none of the four corticosteroids offers a decisive advantage in the antepartum maturation of the fetal pulmonary surfactant system.

Effect of protein binding on transfer and metabolism of cortisol in perfused human placenta

The transfer and metabolism of cortisol and cortisone and the effect of protein binding on these processes have been investigated in vitro in the perfused human placenta. The clearance of cortisol in buffer, expressed as a fraction of the antipyrine transfer rate (clearance index), was 0.50 +/- 0.05 SEM in either direction. Extensive conversion to cortisone (85%) occurred during transfer. Addition of corticosteroid-binding globulin (CBG) in amounts sufficient to bind 50% of the cortisol reduced the clearance (0.40 +/- .026) insignificantly, whereas human serum albumin (HSA) in amounts sufficient to bind 50% of the cortisol reduced the clearance to 0.28 +/- 0.012 (P less than 0.001) even though the association constant for albumin is approximately 1000-fold less. The percent of conversion to cortisone did not change significantly with protein binding. The clearance index of cortisone from a protein-free perfusate was 0.74. With CBG and albumin in the same concentrations as used in the cortisol experiments, the binding of cortisone to CBG was 23% and its clearance was 0.70; with albumin, the binding was 45% and the clearance index was 0.45. The addition of albumin and CBG to the same perfusate resulted in a cortisol clearance equal to that obtained with perfusate containing only albumin. Binding to albumin may be more significant than binding to CBG in controlling the transfer rate of cortisol to the fetus.

Treatment of hypoplastic anemia in mice with placental transplants

A genetic mutation in mice (W/Wv) causes an autosomal recessive disease characterized by hypoplastic anemia which lasts throughout life. Double-dominant W/Wv anemic mice were sublethally irradiated to facilitate repopulation of marrow with transplanted cells and were injected intravenously with suspensions of 5-10 million placental cells of 15 days gestation derived from normal, isogeneic donors. Red cell counts fell promptly after irradiation and then rose progressively over a period of weeks, reaching normal levels of the nonmutant. Mean corpuscular volume and hemoglobin electrophoresis patterns of red cells in recipient W/Wv mice resembled those of normal donor animals. The therapeutic effect lasted for the duration of the observation period, in some instances over 9 mo. W/Wv mice that were administered Hanks' solution or fetal blood, instead of placental transplants, remained anemic. Late gestation placentas (18 days) were also ineffective.

Transfer across perfused human placenta. IV. Effect of protein binding on free fatty acids

The effect of protein binding on the rate of placental transfer of hexanoic (C 6) and decanoic (C 10) acids was investigated in an in vitro perfusion system of human placenta. As much as 30% of transferred C 6 was converted to more polar compounds, so that the observations related to the combined effects on transfer and metabolism. Less than 10% of C 10 was similarly metabolized. Both fatty acids are soluble in buffered salt solutions at the concentrations used (40 muM) and both are bound to serum albumin, C-10 having higher association constants (K' for C 6, 1.48 X 10(4); for C 10, 1.03 X 10(5). When the placenta is perfused with buffered salt solution, the transfer of C 6 is 22% more rapid than that of C 10. It is suggested that binding within the placenta retards C 10 more than C 6. The addition of 1 g/100 ml bovine serum albumin to the maternal perfusate reduces the transfer rate of C 10 by 80%, whereas 2 g/100 ml serum albumin has a more moderate effect on C 6 (a reduction of 50%). The addition of 1 g/100 ml serum albumin to the fetal perfusate increases transfer rate of both free fatty acids (FFA), C 6 by 25% and C 10 by about 250%. With equivalent concentrations of serum albumin in maternal and fetal perfusates, the transfer rate of C 10 was reduced by 65%, whereas there was no detectable effect on transfer of C 6 in two of three experiments. The transfer rate of FFA increase logarithmically with progressive shortening of the carbon chain from C 16 to C 8 when maternal and fetal perfusates contain serum albumin. Protein binding is apparently the determining factor. The rate of transfer falls off at C 6 and C 4, 4ven though protein-binding continues to decrease. The determining factor may be the hydrophilic nature of these molecules.