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Spectrophotometric amniotic Rh evaluation
Volume Number
130 4
Correspondence
sponsiveness in the normal physiologic duced pathologic state are analogous, interchangeable? Ronald Pregnancy National Bethesda,
Research Branch Institute of Child Health Maryland 2001-f
and
state and the inequivalent, and A. Chez,
M.D.
Human Development
Reply to Dr. Chez To the Editors:
We agree with Dr. Chez that the studies we have done and the statement made in the abstract tend to imply some reference to human conditions, for it is from this clinicopathologic pool that we draw our interests and ideas. However, we do not accept his philosophical objections regarding the lack of scientific reliability stemming from interspecies comparison. Dr. Chez must certainly agree that the frontiers of cardiovascular and renal physiology exist in the animal research laboratory and that the knowledge gained in these laboratories forms the foundations for much of our current medical practice and management. In regard to his specific question of the cardiovascular behavior in the normal and pathologic states, we would like to point out the following: (1) the principles that govern the circulation of blood or hemodynamics follow very closely the physical laws established many years ago for hydrodynamics; (2) the bulk of our knowledge regarding the behavior of the cardiovascular system in health and diseases, including the laws of the heart, were established through studies on heartlung preparations; these laws have been found applicable to human heart failure; (3) there are enough data available now which show that the circulatory changes that occur in human pregnancy are very similar to those of the sheep; this is particularly true in regard to the control of vasomotor tone and its response to autonomic blocking agents; (4) the limited information on the behavior of regional hemodynamics in human hypertension shows a strong similarity to those occurring in our experimental, hypertensive sheep model; and (5) the doses, blood levels, and arterial pressure response to magnesium sulfate in the sheep are similar to those observed in the pregnant human subject. Perhaps the major problem between ourselves and Dr. Chez is our interpretation of the purpose of an abstract which, in our view, is to convey in a concise form the major results and conclusions of the paper. If the reader is interested or stimulated by the abstract, then he will read the entire paper, as did Dr. Chez.
Department of Obstetrics School elf Medicine University of California-Los Los Angeles, California
A. Dandavino, C. R. Brinkman III, N. S. Assali, Gynecology
and
14ngeb
90024
M.D. M.D. M.D.
503
Aplasia cutis congenlta To the Editors:
Brown and associates, in the October 1, 1977, issue of THIS JOURNAL (129: 351, 1977), described two instances of aplasia cutis congenita. Their purpose was to put us on notice that this defect should not be confused with injuries attributable to the placement of electrodes in the fetal scalp. They also pointed out that this anomaly is inherited as an autosomal dominant trait. ‘4 25-year-old woman cared for on our service dramatized this latter phenomenon. She had the characteristic unscarred, hairless area of skin near the crown of the head. She stated that her mother had an identical defect, but she did not knoM of other instances in the family. At birth, her male infant had an identical defect. Her second child, a girl, does not. The late scarring observed occasionally after the application of Willett’s forceps mimics this defect, but of course the familial history is lacking. Irwin
H.
Kaiser,
M.D.
Department of’ Gynecology and Obstetrics Albert Einstein College of Medicine of Yeshiva University 1300 Morris Park Avenue Bronx, New York 10461
Spectrophotometric amnbtk Rh ewbtion To the Editors:
We were given the opportunity of reading the interesting report of Caritis, Mueller-Heubach, and Edelstone (AM. J. OBSTET. GYNECOL. 127: 529, 1977) about the probable correction of corticosteroid treatment in the spectrophotometric reading of the amniotic bilirubin. The article received our particular interest, as we were preparing the publication of a similar case. It involved evident diminution at 460 rnp in several subsequent spectrophotometric curves in the amniotic fluid in a case of hemolytic perinatal disease (Rh sensitization) in such a way that the first curve was included in the superior part of the prognoses of Liley and the last one in the inferior part (Fig. 1). Therapy of 10 mg. of dexamethasone had been prescribed to the pregnant patient for 15 days, this period being much longer than the habitual one. The female infant, delivered at 39 weeks of pregnancy and weighing 2.440 kilograms, required two exchange transfusions after analysis of the cord blood (type A, Rh positive, Coombs positive), in which the hemoglobin level was 11.8 Cm. px- 100 ml. and the total bilirubin was 5.2 mg. per 100 ml. Twenty-four hours after birth and after phototherapy, it was observed that the bilirubin values had gradually diminished, and the infant was allowed to leave on the fifth day. In our opinion the important function of this case is
504
February Am. J, Obstet.
Correspondence
15, 1978 Gynecol.
Table I. Uptake of lz5 I -labeled hCG by human lymphocytes, fibroblasts, amniotic fluid cells, and rat testicular Leydig cells (number of cells used per experiment and mean values 2 standard errors)
a
0.021 25
is
31
33
35
q
39 40 4lrrc
weeks
gestation
Fig. 1. Logarithmic change in optical density of amniotic fluid at 450 ny~ prior to and following administration of hetamethasone to mother. (---) indicates time of betamethasone administration. to stimulate interest in revising the criteria to evaluate how much the fetus can be compromised by Rhhemolytic disease based on study of the amniotic fluid whenever corticosteroids are prescribed to the gravid patient. L. Pereira Leite Belmiro Patricia Services of Obstetrics Faculdade de Medicina do Port0 Portugal
Human lymphocytes, fibroblasts and amniotic fluld cells are not endowed with human chorlonlc gonadotropin receptors To the Editors: In contrast to purified human chorionic gonadotropin (hCG), crude hCG has been found to exert a modulating effect on the stimulation of cultured lymphocytes by mitogens. This effect was attributed to contamination of the hormone and not to the hCG itself. However, Beck and associates,’ using a phenol- and immunoglobulin-free hCG preparation, recently reported a modulating influence of the hormone on lymphocyte blastogenesis in culture. The authors speculated that the hCG effect on the lymphocytes is mediated by the activation of the adenyl cyclase-cyclic adenosine monophosphate system. The prerequisite for the activation of this system in a cell depends on the binding of the hormone to a specific receptor in the cell membrane. Thus, the question arises if lymphocytes are endowed with specific hCG receptors. Until the present time, hCG receptors have been demonstrated only in testicular and ovarian cells.2 Supported in part by the Deutsche Forschungsgemeinschaft (SFB 46). Reprint requests: Dr. Jan W. Siebers, Universitlts-Frauenklinik, D-7800 Freiburg, Hugstetterstrabe 55, FRG
Lymphocytes (6 x 106) Lymphocytes with PHA (2 x 106) Fibroblasts (2 x 106) Amniotic fluid cells (2 x 106) Leydig cells (2 x 106) Cultivated Leydig cells (2 x 106)
534 _’ 31
4952
471 t 25
435 7?r32
692 -c 36
691 + 40
832 2 20
796 i. 35
2.1962
13
155
644 2 65
2,214 + 132
1,005 ? 83
Human lymphocytes from adult male donors were isolated by Ficoll Isopaque gradient centrifugation and studied for hCG binding either immediately or after three days in culture with phytohemagglutinin* (PHA). PHA was reconstituted with 10 ml. of sterile distilled water and then used at a concentration of 10 ~1 per milliliter of culture. For comparison, single-cell suspensions of routinely cultured human fibroblasts and amniotic fluid cells as well as rat testicular Leydig cells were prepared. Leydig cells are endowed with hCG receptors.* The cells were obtained by rinsing the decapsulated adult testis in collagenase. They were used for the binding studies immediately after the preparation or after cultivation for three days in Eagle’s minimum essential medium supplemented with 10 per cent fetal calf serum.* For each experimental point, at least three preparations of 2 to 6 x lo6 cells were incubated in Tris-hydrochloric acid buffer (0.04 mole per liter, pH 7.4) containing magnesium sulfate (0.005 mole per liter), 0.1 per cent bovine serum albumin and 8 ng. of 1251-labeled hCG (biological activity 11.000 I.U. per milligram, specific radioactivity 30 to 50 &i per microgram, 1 ng. = 35,000 c.p.m.). The nonspecific binding was determined in the presence of a 1 ,OOO-fold excess of unlabeled hCG. The reaction was stopped by the addition of 1 ml. of ice-cold buffer and the incubates were washed three times. After the pellet was dissolved with Soluene-350,f the radioactivity was determined in a gamma counter.t As can be seen from Table I in contrast to Leydig cells, iz51-labeled hCG is not specifically bound by lymphocytes from the peripheral blood, cultured lymphocytes stimulated with PHA, fibroblasts, or amfiiotic fluid cells, clearly indicating that these cells are not en*Difco Labs., Detroit, Michigan. tPackard, Frankfurt, Germany.
130 4
Correspondence
sponsiveness in the normal physiologic duced pathologic state are analogous, interchangeable? Ronald Pregnancy National Bethesda,
Research Branch Institute of Child Health Maryland 2001-f
and
state and the inequivalent, and A. Chez,
M.D.
Human Development
Reply to Dr. Chez To the Editors:
We agree with Dr. Chez that the studies we have done and the statement made in the abstract tend to imply some reference to human conditions, for it is from this clinicopathologic pool that we draw our interests and ideas. However, we do not accept his philosophical objections regarding the lack of scientific reliability stemming from interspecies comparison. Dr. Chez must certainly agree that the frontiers of cardiovascular and renal physiology exist in the animal research laboratory and that the knowledge gained in these laboratories forms the foundations for much of our current medical practice and management. In regard to his specific question of the cardiovascular behavior in the normal and pathologic states, we would like to point out the following: (1) the principles that govern the circulation of blood or hemodynamics follow very closely the physical laws established many years ago for hydrodynamics; (2) the bulk of our knowledge regarding the behavior of the cardiovascular system in health and diseases, including the laws of the heart, were established through studies on heartlung preparations; these laws have been found applicable to human heart failure; (3) there are enough data available now which show that the circulatory changes that occur in human pregnancy are very similar to those of the sheep; this is particularly true in regard to the control of vasomotor tone and its response to autonomic blocking agents; (4) the limited information on the behavior of regional hemodynamics in human hypertension shows a strong similarity to those occurring in our experimental, hypertensive sheep model; and (5) the doses, blood levels, and arterial pressure response to magnesium sulfate in the sheep are similar to those observed in the pregnant human subject. Perhaps the major problem between ourselves and Dr. Chez is our interpretation of the purpose of an abstract which, in our view, is to convey in a concise form the major results and conclusions of the paper. If the reader is interested or stimulated by the abstract, then he will read the entire paper, as did Dr. Chez.
Department of Obstetrics School elf Medicine University of California-Los Los Angeles, California
A. Dandavino, C. R. Brinkman III, N. S. Assali, Gynecology
and
14ngeb
90024
M.D. M.D. M.D.
503
Aplasia cutis congenlta To the Editors:
Brown and associates, in the October 1, 1977, issue of THIS JOURNAL (129: 351, 1977), described two instances of aplasia cutis congenita. Their purpose was to put us on notice that this defect should not be confused with injuries attributable to the placement of electrodes in the fetal scalp. They also pointed out that this anomaly is inherited as an autosomal dominant trait. ‘4 25-year-old woman cared for on our service dramatized this latter phenomenon. She had the characteristic unscarred, hairless area of skin near the crown of the head. She stated that her mother had an identical defect, but she did not knoM of other instances in the family. At birth, her male infant had an identical defect. Her second child, a girl, does not. The late scarring observed occasionally after the application of Willett’s forceps mimics this defect, but of course the familial history is lacking. Irwin
H.
Kaiser,
M.D.
Department of’ Gynecology and Obstetrics Albert Einstein College of Medicine of Yeshiva University 1300 Morris Park Avenue Bronx, New York 10461
Spectrophotometric amnbtk Rh ewbtion To the Editors:
We were given the opportunity of reading the interesting report of Caritis, Mueller-Heubach, and Edelstone (AM. J. OBSTET. GYNECOL. 127: 529, 1977) about the probable correction of corticosteroid treatment in the spectrophotometric reading of the amniotic bilirubin. The article received our particular interest, as we were preparing the publication of a similar case. It involved evident diminution at 460 rnp in several subsequent spectrophotometric curves in the amniotic fluid in a case of hemolytic perinatal disease (Rh sensitization) in such a way that the first curve was included in the superior part of the prognoses of Liley and the last one in the inferior part (Fig. 1). Therapy of 10 mg. of dexamethasone had been prescribed to the pregnant patient for 15 days, this period being much longer than the habitual one. The female infant, delivered at 39 weeks of pregnancy and weighing 2.440 kilograms, required two exchange transfusions after analysis of the cord blood (type A, Rh positive, Coombs positive), in which the hemoglobin level was 11.8 Cm. px- 100 ml. and the total bilirubin was 5.2 mg. per 100 ml. Twenty-four hours after birth and after phototherapy, it was observed that the bilirubin values had gradually diminished, and the infant was allowed to leave on the fifth day. In our opinion the important function of this case is
504
February Am. J, Obstet.
Correspondence
15, 1978 Gynecol.
Table I. Uptake of lz5 I -labeled hCG by human lymphocytes, fibroblasts, amniotic fluid cells, and rat testicular Leydig cells (number of cells used per experiment and mean values 2 standard errors)
a
0.021 25
is
31
33
35
q
39 40 4lrrc
weeks
gestation
Fig. 1. Logarithmic change in optical density of amniotic fluid at 450 ny~ prior to and following administration of hetamethasone to mother. (---) indicates time of betamethasone administration. to stimulate interest in revising the criteria to evaluate how much the fetus can be compromised by Rhhemolytic disease based on study of the amniotic fluid whenever corticosteroids are prescribed to the gravid patient. L. Pereira Leite Belmiro Patricia Services of Obstetrics Faculdade de Medicina do Port0 Portugal
Human lymphocytes, fibroblasts and amniotic fluld cells are not endowed with human chorlonlc gonadotropin receptors To the Editors: In contrast to purified human chorionic gonadotropin (hCG), crude hCG has been found to exert a modulating effect on the stimulation of cultured lymphocytes by mitogens. This effect was attributed to contamination of the hormone and not to the hCG itself. However, Beck and associates,’ using a phenol- and immunoglobulin-free hCG preparation, recently reported a modulating influence of the hormone on lymphocyte blastogenesis in culture. The authors speculated that the hCG effect on the lymphocytes is mediated by the activation of the adenyl cyclase-cyclic adenosine monophosphate system. The prerequisite for the activation of this system in a cell depends on the binding of the hormone to a specific receptor in the cell membrane. Thus, the question arises if lymphocytes are endowed with specific hCG receptors. Until the present time, hCG receptors have been demonstrated only in testicular and ovarian cells.2 Supported in part by the Deutsche Forschungsgemeinschaft (SFB 46). Reprint requests: Dr. Jan W. Siebers, Universitlts-Frauenklinik, D-7800 Freiburg, Hugstetterstrabe 55, FRG
Lymphocytes (6 x 106) Lymphocytes with PHA (2 x 106) Fibroblasts (2 x 106) Amniotic fluid cells (2 x 106) Leydig cells (2 x 106) Cultivated Leydig cells (2 x 106)
534 _’ 31
4952
471 t 25
435 7?r32
692 -c 36
691 + 40
832 2 20
796 i. 35
2.1962
13
155
644 2 65
2,214 + 132
1,005 ? 83
Human lymphocytes from adult male donors were isolated by Ficoll Isopaque gradient centrifugation and studied for hCG binding either immediately or after three days in culture with phytohemagglutinin* (PHA). PHA was reconstituted with 10 ml. of sterile distilled water and then used at a concentration of 10 ~1 per milliliter of culture. For comparison, single-cell suspensions of routinely cultured human fibroblasts and amniotic fluid cells as well as rat testicular Leydig cells were prepared. Leydig cells are endowed with hCG receptors.* The cells were obtained by rinsing the decapsulated adult testis in collagenase. They were used for the binding studies immediately after the preparation or after cultivation for three days in Eagle’s minimum essential medium supplemented with 10 per cent fetal calf serum.* For each experimental point, at least three preparations of 2 to 6 x lo6 cells were incubated in Tris-hydrochloric acid buffer (0.04 mole per liter, pH 7.4) containing magnesium sulfate (0.005 mole per liter), 0.1 per cent bovine serum albumin and 8 ng. of 1251-labeled hCG (biological activity 11.000 I.U. per milligram, specific radioactivity 30 to 50 &i per microgram, 1 ng. = 35,000 c.p.m.). The nonspecific binding was determined in the presence of a 1 ,OOO-fold excess of unlabeled hCG. The reaction was stopped by the addition of 1 ml. of ice-cold buffer and the incubates were washed three times. After the pellet was dissolved with Soluene-350,f the radioactivity was determined in a gamma counter.t As can be seen from Table I in contrast to Leydig cells, iz51-labeled hCG is not specifically bound by lymphocytes from the peripheral blood, cultured lymphocytes stimulated with PHA, fibroblasts, or amfiiotic fluid cells, clearly indicating that these cells are not en*Difco Labs., Detroit, Michigan. tPackard, Frankfurt, Germany.