Trophoblast tissue culture of human intrauterine and ectopic pregnancies and treatment with methotrexate.

The application of drugs for conservative treatment of patients with ectopic pregnancy has been used worldwide for several years. In-vitro studies, however, are very few. We therefore examined the effects of methotrexate on trophoblast tissue cultures derived from intrauterine and ectopic pregnancies. Methotrexate was administered either 12 h or 6 days after initiation of the culture. Human chorionic gonadotrophin (HCG) levels were measured in the culture medium. All cultures showed secretion of HCG within the first 16 days. Methotrexate concentrations less than 3.8 x 10(-4) mol/l had no effect on HCG secretion. Cultures of ectopic pregnancies required a concentration about 10x higher to induce an equivalent reduction of HCG levels compared to intrauterine pregnancies. A few intrauterine and ectopic pregnancies showed no reduction of HCG values after treatment. These results suggest that data obtained from studies on intrauterine pregnancies may not be transferable to ectopic pregnancies in all instances. In some regimens approximately 8 days are required before the effect becomes measurable. In combination with our clinical data, we therefore recommend not to repeat a methotrexate dose too early in treatment of patients with ectopic pregnancies. The possibility that non-responding patients could exist should be kept in mind.

[Diagnosis in the aged from the pathologic-anatomic viewpoint]. / Diagnostik im Alter aus pathologisch-anatomischer Sicht.

The preciseness of clinical diagnostics for two different age groups was reviewed among 2033 unselected autopsies looking at eight single diagnoses. The younger age group was up to 59 years of age, the older one over 59 years. In the older age group myocardial infarction, hepatocirrhosis, bronchial and gastric carcinomas were less frequently diagnosed compared to the younger group. Pulmonary embolism, pulmonary tuberculosis, colon and breast carcinomas were almost evenly diagnosed before death in both groups. The multimorbidity in aged patients is discussed. Also in the geriatric diagnostic a high autopsy rate--86% in our collective--is important.

[Cytogenetic, endocrinological and immunological studies of tissue cultures from ectopic pregnancies]. / Cytogenetische, endokrinologische sowie immunologische Studien an kultiviertem Gewebe ektoper Schwangerschaften.

The world-wide increase in extrauterine pregnancies induced us to grow trophoblastic elements obtained from ectopic locations in tissue cultures in order to determine whether the tubal implantation of the blastocyst could be caused by chromosomal aberrations. In addition, we investigated for what period of time trophoblastic tissue from ectopic sites is capable of producing HCG in culture. This was done in view of an eventual use of this method as a model for the testing of the effect of antitrophoblastic agents in vitro. Finally, the concentration of several tumor markers in the culture medium was measured. The karyotype could be determined in 16 out of 20 tissue specimen subjected to tissue culture; in one case a chromosomal aberration was recognized, two times there was evidence of increased fragility of the chromosomes. The ratio of female to male karyotypes was 10 to 6. HCG was found to be produced for 6 to 9 days in the tissue cultures. The concentration of the tumor markers CEA, CA 19-9, CA 12-5 and CA 15-3 in the culture medium was low as compared to cultures containing additional tubal mucosa. We are concluding that chromosomal aberrations do not seem to play a causal role in the genesis of EUP. The assay of HCG production by trophoblastic cells in tissue cultures could eventually be used for the testing of agents which might ultimately be employed for the non-surgical treatment of certain cases of EUP.