Analysis of chromatin proteins from human placenta.

Low-salt extracts of chromatin from human term placenta have been examined for the presence of the high mobility group (HMG) proteins. Based upon salt-dissociation characteristics, solubilities in trichloroacetic acid and electrophoretic behaviour on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and non-equilibrium pH gradient gel electrophoresis (NEPHGE), each of the HMG proteins is present, including HMG-1, -2, -E, -14, and -17. A remarkably large amount of HMG-E is present in term human placenta. Additionally, a protein not previously recognized, which we designate HMG-PL, is present in term placenta. Electrophoretic comparison of the HMG proteins from placentae of varying gestational age, using NEPHGE, demonstrates that all of the placental HMG proteins exhibit multiplicity, reminiscent of chicken erythrocyte HMG proteins. Specifically, we found HMG-E to be unaltered in amounts relative to HMG-1 and -2 in placentae varying from 20 to 40 weeks of gestation. HMG-PL, however, is differentially expressed, increasing in amounts as gestation proceeds past 34 weeks. HMG-PL was purified and subjected to amino acid analysis. Its composition supports the notion that HMG-PL is a member of the HMG-1 family.

Nucleolar canalicular structure in extrauterine endometriosis.

Under the influence of progesterone the unique intranuclear structure known as the nucleolar canalicular structure (NCS) develops in the human endometrium. This organelle was not described previously outside the uterus. In this report the cases of two patients in whom the NCS appeared in extrauterine endometriosis are presented.

The nuclear channel system in endometrial adenocarcinoma exposed to medroxyprogesterone acetate.

The nuclear channel system (NCS), giant mitochondria and subnuclear glycogen form a triad of ultrastructural features observed in normal human endometrial epithelium in response to progestational steroids. Both the giant mitochondria and subnuclear glycogen have been described in endometrial adenocarcinoma, but the NCS has not. This article reports the development of the NCS in adenocarcinoma treated with medroxyprogesterone acetate. Previous studies suggest that the NCS in normal tissue is a response to the acyl group in the 17-beta position of the D-ring of some progestational steroids, such as medroxyprogesterone acetate. Medroxyprogesterone acetate was administered to 12 postmenopausal women with endometrial adenocarcinoma. Hysterectomies were performed 8 to 20 days after treatment. Pretreatment specimens were also obtained on 8 of the 12 patients. Using standard electron microscopy procedures, light microscopy on plastic semithin sections was first used to confirm the presence of tumor. Thin sections of malignant endometrium were prepared and evaluated ultrastructurally for progestational alterations. Abnormal giant mitochondria and subnuclear glycogen were found both before and after treatment. The third element of the triad, the NCS, was not observed in any of the available pretreatment biopsies, but was seen in three of the treated specimens. Thus it appears that the NCS is a response to the given progesterone therapy.

Intercellular contacts between stromal cells in the normal human endometrium throughout the menstrual cycle.

Increasing differentiation in the human endometrium is associated with an apparent decrease in intercellular contacts between endometrial stromal cells

Interaction of epithelial and stromal cells in vaginal adenosis.

Two types of direct contact between epithelial and stromal cells in patients with vaginal adenosis are documented in electron micrographs. In the first type, epithelial cells send cytoplasmic extensions through the basal lamina to achieve, at times, complete fusion with fibroblasts in the stromal compartment. In the second type, mast cells act as intermediaries between the epithelial and stromal compartments.

Malignant melanoma metastatic to the endometrium.

A case of malignant melanoma metastatic to the endometrium is presented along with a review of the literature on metastatic melanoma, showing its rarity. Malignant melanoma metastasizes to many sites, including the lung, bone, liver, skin, and pancreas. Four cases of melanoma metastatic to the endometrium have been reported. The purpose of the present report is to describe the clinical picture of another patient with malignant melanoma metastatic to the endometrium as well as the general histologic and prognostic features of the disease.

Dysgerminoma in the differential diagnosis of hydatidiform mole.

Serum measurements of beta-human chorionic gonadotropin (beta-hCG) for pregnancy tests are now positive at very low levels (25 mIU/mL). Sonography is the diagnostic method of choice for patients with the possibility of intrauterine trophoblastic disease. A case is reported in which ultrasound confused an ovarian neoplasm for a hydatidiform mole; a low level of hCG produced by the dysgerminoma corroborated the diagnosis. The tumor with syncytiotrophoblastic giant cells is described, and a differential diagnosis for minimally elevated hCG is discussed. This case represents an example of dysgerminoma presenting with ascites (stage IC).

Nuclear and nucleolar areas: a quantitative assessment of endometrial neoplasia.

Quantitative methods were used to determine ultrastructural area differences in nuclei and nucleoli of normal proliferative endometrium as well as grades 1, 2, and 3 adenocarcinomas. Nuclear area distribution curves differed significantly among all groups. No significant differences were observed between nucleolar area distribution curves of normal proliferative and grade 1 adenocarcinomas. However, significant differences were found among distribution curves of all other groups. The computer-assisted high resolution ultrastructural examination provides a sensitive means of evaluating differences in nuclear and nucleolar areas of cells in normal and cancerous states.

Retrospective, longitudinal, and cross sectional study of visual acuity impairment in choroideraemia.

BACKGROUND/AIMS: Few studies have reported on the change in visual acuity (VA) in patients with choroideraemia. In order to determine the degree and rate of VA impairment associated with this disease, the central VA was analysed in a large group of patients with choroideraemia. METHODS: The authors completed a retrospective, cross sectional review of 115 patients with choroideraemia from three tertiary care centres. A longitudinal analysis was performed on 45 of these patients who met the inclusion criteria of at least three visits over a minimum period of 4.5 years. Multiple linear regression analysis was used to explore the 5 year rate of VA change while controlling for initial VA and initial age. Multiple logistic regression was also used to investigate VA impairment. RESULTS: In the cross sectional group (n = 115), 84% (87/103) of patients under the age of 60 had a VA of 20/40 or better while 33% (4/12) of patients 60 years of age or older had a VA of 20/200 or worse at their most recent visit. The majority of the patients (93%) in the longitudinal subgroup of 45 patients had a VA of 20/30 or better at their initial visit. The mean 5 year rate of VA change was 0.09 logMAR equivalent (approximately one line on the Lighthouse chart). CONCLUSION: In this cohort of patients with choroideraemia, there was typically a slow rate of VA loss and the prognosis for central VA retention was, as a group, favourable until the seventh decade.

Rat luminal cell nuclear area changes correlated with uterine growth responses induced by a low dose infusion or injection of estradiol-17 beta.

Rat uterine luminal epithelial cells (LEC) responded differently when exposed to an injection of 1.0 microgram estradiol-17 beta (E2) compared to a continuous infusion of E2 at the rate of 1.0 microgram/24 hours. After injection or beginning infusion, LEC mean nuclear area significantly decreased by 4 h, then increased thereafter. After injection, nuclear area distributions were determined at each time point. The percentage of large nuclei (greater than 40 mu 2) decreased by 4h postinjection and remained a relatively small proportion of the population, while the percentage of nuclei of 20-30 mu 2 areas increased throughout the experiment. During infusion, the percentage of large nuclei decreased by 4h after pump implantation, then increased. Only infusion induced sustained, increased uterine protein content, DNA synthesis and ornithine decarboxylase activity. This study suggests that E2 treatment modality induces differences in nuclear size in target cells as well as in biochemical parameters.

Induction of nucleolar changes in rat luminal cells by single injection or low-dose infusion of estradiol.

The nucleolar area of rat uterine luminal epithelial cells was measured for 41 h after beginning either of two dosage regimens of estradiol (E2): a single injection of 1.0 microgram E2 or a continuous infusion of E2 at a rate of 1.0 microgram/24 h. In response to a single injection of E2, mean nucleolar area was significantly elevated above control levels by 10 h. Nucleolar morphology showed slight changes, but the fibrillar component was always associated with 2-3 fibrillar centers by 10 h. In response to a continuous infusion of E2, mean nucleolar area was elevated by 10 h, reached a maximum by 18 h, and remained relatively constant thereafter. Nucleolar morphology showed significant changes by 10 h; the fibrillar component was commercially denser. Bivariate histograms of nuclear versus nucleolar areas showed a bimodal distribution after both injection and infusion, suggesting that two size classes of nuclei existed after estrogen stimulation. The results suggest that: 1) a continuous infusion of E2 at a rate of 1.0 microgram/24 h was more effective in inducing larger increases in nucleolar area and transcription than a single injection of 1.0 microgram E2 at time 0; 2) using analysis of nuclear and nucleolar areas two subpopulations of cells were identified; and 3) continuous infusion of E2 produced a steady state of ribosome production and cytoplasmic transport by 18 h.

Uterine growth responses of the mature castrate rat to estradiol-17B.

To examine estrogen-stimulated uterine growth we have monitored changes in uterine DNA synthesis, ornithine decarboxylase (ODC) activity and protein content as well as luminal epithelial (LE) cell mitotic index and ultrastructural changes. We have utilized this model to examine castrate mature rat uterine growth as a function of time between 18 and 40 hours following a single injection of 25.0 ug of estradiol-17B. LE cell mitotic index and protein content increases were maximally elevated as early as 18 hours postinjection while uterine ODC activity was maximal at 28 hours; uterine DNA synthesis increases continued throughout the experiment. In addition, the infusion of either 1 or 2 ug E2 plus progesterone over a 24 hour period, stimulated elevated ODC activity under both treatment regimens and LE cell mitotic index which was inversely related to E2 dose.

Scanning electron microscopy of the multifilament IUD string.

Fifteen multifilament strings on Dalkon Shield IUDs removed from patients were evaluated with scanning electron microscopy. All fifteen showed deterioration of the sheath which encloses the smaller inner filaments. The greatest area of deterioration was at the attachment knot which is usually intrauterine. Deterioration of the sheath also occurs when the device is within the uterine wall or intraperitoneal. The risk of pelvic infection may be attributed to this deterioration of the sheath and contamination from that site.

PIP: 15 multifilament strings on Dalkon shield IUDs removed from patients were evaluated with scanning electron microscopy. All 15 showed deterioration of the sheath which encloses the smaller inner filaments. The greatest area of deterioration was at the attachment knot which is usually intrauterine. Deterioration of the sheath also occurs when the device is within the uterine wall or intraperitoneal. The risk of pelvic infection may be attributed to this deterioration of the sheath and contamination from that site.

Validation of a rapid urine screening assay for cocaine use among pregnant emergency patients.

OBJECTIVES: To determine the accuracy of the OnTrak rapid urine latex agglutination immunoassay (AIA) for testing pregnant ED patients for the cocaine metabolite benzoylecgonine (BE), and to determine the frequency of urine BE in pregnant ED patients and the association of test results with patient demographics. METHODS: A test performance evaluation was conducted using an inception cohort of pregnant patients at an urban teaching hospital ED. Patients with positive urine chorionic gonadotropin tests who had adequate remaining urine samples were studied. Patient demographics, ED diagnoses, and assay results were recorded without patient identifiers. Urine was tested using the rapid AIA. The first 150 samples were confirmed using a second immunoassay and gas chromatography with a nitrogen phosphorus detector. All positive samples also were confirmed with thin-layer chromatography, and quantification by gas chromatography-mass spectrometry. RESULTS: Twenty of 342 (5.9%, 95% CI 3.4-8.4%) pregnant patients had urine samples positive by AIA testing for BE. Confirmation testing demonstrated no false-positive or -negative AIA result. Positive test results were not associated with specific patient diagnoses or demographics. CONCLUSIONS: ED screening for cocaine use among pregnant patients can be accurately performed using the OnTrak AIA for BE. In the ED population screened, 5.9% of the pregnant women had urine samples positive for BE.

The inheritance of the pigment dispersion syndrome in blacks.

PURPOSE: Evidence has indicated that pigment dispersion syndrome (PDS) is inherited as an autosomal dominant disorder in white patients, often with a high degree of penetrance. Because heredity patterns in blacks are unknown, an investigation was carried out to study inheritance of PDS in this population. METHODS: Six unrelated black adults (5 women, 1 man, age range 43-60 years) with PDS were identified from a primary eye care population at an inner city teaching clinic in Chicago, Illinois. Nineteen first-degree relatives (all siblings or children; age range 18-52 years) of these patients subsequently underwent thorough eye examination to look for signs of PDS. RESULTS: Among the relatives, two (12%) showed evidence of the condition (these two patients belonged to different families): one was a 42-year-old daughter of a 60-year-old proband, and the other was the 49-year-old sister of a 47-year-old proband. Both exhibited definite signs of PDS in one eye only. CONCLUSION: Evidence of expression of PDS among family members of black probands with PDS is provided. Incomplete penetrance of PDS among the black pedigrees may be suggested by these data.

Current status of magnetic resonance in radiologic diagnosis of foot and ankle injuries.

Magnetic resonance imaging can provide unique advantages in evaluation of foot and ankle disorders. Among these advantages are lesion localization, sensitivity in differentiation, and evaluation of ligaments, tendons, and osseous abnormalities.

The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives.

We examined the phenomenon of dyspnea during the last weeks of life as it is experienced by patients with cancer and understood by the nurses providing their care. The literature on late-stage cancer suggests a discrepancy between the prevalence of this symptom and the degree to which it is considered clinically significant. Using a range of descriptive and interpretive approaches, we sought to interpret that discrepancy through an understanding of how patients and nurses interpret the nature and meaning of this serious and distressing symptom. Data sources included a pencil-and-paper survey of late-stage cancer patients, chart audit of a population of late-stage cancer patients in a metropolitan home-care hospice program, and intensive interviews with selected patients and nurses. The findings showed that although dyspnea seems to be a significant clinical problem for patients in late-stage cancer, and although effective intervention and management strategies are available, dyspnea often goes unreported by patients and unnoticed by healthcare professionals.

CO2 laser laparoscopy. A potential alternative to danazol in the treatment of stage I and II endometriosis.

Most clinicians currently agree that stage I and II pelvic endometriosis, as determined by the American Fertility Society classification, is best treated with danazol when there are no significant peritubal or periovarian adhesions. This therapy offers excellent pregnancy rates and avoids the risk of pelvic adhesions, which can occur after conservative laparotomy. However, the significant disadvantages of danazol include androgenic side effects, breakthrough bleeding, prolonged treatment time and high cost. It is not unheard of for a patient to choose laparotomy over danazol because of these disadvantages. An ideal form of therapy would avoid these disadvantages and be accessible at diagnostic laparoscopy, when the disease is detected. We have worked with such a treatment, the CO2 laser, for one year. With the CO2 laser adapted to the operating laparoscope we have treated stage I and II pelvic endometriosis at the time of the original diagnostic laparoscopy. Due to the precise control the operator has over the laser, implants on the peritoneum over the bladder and bowel or near the ureters can be treated safely. There is little danger of damaging adjacent structures, as one might experience with electrocautery. Ovarian endometriomas of less than 1 cm and mild adhesions can also be removed safely by tissue vaporization.

Fertility after metroplasty of the septate uterus.

Congenital uterine anomalies are well known to affect a woman's fertility and ability to deliver a viable infant. A retrospective chart review with recent follow-up was performed for 38 women who underwent a modified Tompkin's metroplasty. All septate uterine configurations were proven by hysterosalpingography and laparoscopy. We examined the preoperative and postoperative fertility and pregnancy salvage rates. An examination to exclude other absolute infertility and pregnancy wastage factors was completed before surgery. Of 38 women studied, 30 (78.9%) had conceived before surgery, for a 6.2% pregnancy salvage rate. Of the 36 women operated on at least one year previously, 24 (66.7%) had become pregnant, for a 77.8% pregnancy salvage rate. Fertility after metroplasty is dependent on many individual factors, and efforts must be made to maximize them. Metroplasty improves the pregnancy salvage rate in women with septate uteri.