Biomedical subjects
Publications and source records attributed to T Agorastos.
A case of a 66-year-old obese woman with type II diabetes mellitus and a 4 year history of virilism is presented. After removal of the ovaries the raised testosterone levels returned to normal and signs of virilism gradually receded. The histological finding of nodular hyperthecosis of the ovaries is discussed in relation to hyperinsulinaemia.
The purpose of this study was to determine if plasma thrombomodulin levels, a glycoprotein found on the surface of the endothelial cell, are elevated in pregnant women with mild preeclampsia and if these levels correlated with other features of disease severity. Parameters were compared in three groups of women: (I) 30 pregnant women with mild preeclampsia, (II) 30 normotensive pregnant women of similar lengths of gestation, and (III) 30 normotensive healthy young women. Thrombomodulin levels were significantly elevated in women with preeclampsia as compared with those of gestation-matched pregnant and non-pregnant controls. There was no correlation between plasma thrombomodulin levels and creatinine and uric acid blood levels. It is thus suggested that plasma thrombomodulin levels are elevated in preeclampsia, even in its mild stage, reflecting a vascular endothelial damage.
In an attempt to estimate the prevalence of human papilloma virus (HPV) positivity among asymptomatic, cytologically normal Greek women, and the possible associations between HPV infection and other demographic, sexual, behavioural and sociological parameters, we undertook an epidemiological study of 226 clinically normal women from an outpatient gynaecological clinic in Northern Greece. The polymerase chain reaction was used for detection of HPV DNA and dot blot hybridization analysis for HPV typing (only for the high-risk types 16 and 18). Eighty-two of the 226 women examined (36.3%) were positive for HPV DNA, 6.6% (15/226) were positive for HPV-16 DNA and only 1.3% (3/226) were positive for HPV-18 DNA. From all epidemiological correlates, age and residence showed a negative correlation with risk of HPV infection, whereas use of contraceptive intrauterine device, class II or III result of the last Papanicolaou cytological examination, history of painful inflammatory disease of inner genitals and frequent washing of the genital area, particularly during the menstrual period, were positively correlated with increased risk of HPV infection. No association was found between HPV DNA positivity and other well-known risk factors for cervical cancer, confirming the observations of other authors that sexual behaviour, a significant risk factor for cervical cancer, is not inevitably correlated with risk of HPV infection.
The polymerase chain reaction (PCR) was applied for the detection of human papilloma virus (HPV) infection, in samples obtained from the uterine cervices of 202 asymptomatic women with normal cytology in Northern Greece. About 41.8% of the women with microscopically and cytologically normal cervices were found to be infected with HPV. Typing of HPV revealed that 6.9% and 1.5% of the women were infected with HPV16 and HPV18, respectively.
Minimal deviation adenocarcinoma (MDA) of the uterine cervix is an extremely well-differentiated adenocarcinoma arising from the endocervix, with minimal morphological deviation from normal endocervical columnar epithelium. We performed DNA cytometric investigation using DNA image analysis in three cases of MDA. For the diagnosis of DNA aneuploidy, we used a combined method of single cell and stemline interpretation of DNA histograms. The most significant finding is that DNA image analysis of all three cases of MDA revealed a hypodiploid stemline DNA value in the histograms of the measured cells and consequently the diagnosis of DNA aneuploidy (DNA index: 0.63, 0.88, and 0.63, respectively). On the basis of our results, we believe that DNA image analysis is useful as a diagnostic aid in doubtful cases of MDA. We find MDA is an aneuploid tumor with a hypodiploid stem cell subpopulation.
The DNA ploidy of Feulgen-stained cell nuclei of in vivo preimplantation rabbit embryos was assayed by cytophotometry. DNA ploidy abnormalities were detected in single-cell nuclei readings by the criterion of > or = 5C DNA. These hypermodal DNA contents are referred as to DNA aneuploidy. Two, 4 and 6 days old rabbit embryos, all of normal gross morphology, were investigated. The incidence of embryos with DNA ploidy abnormalities increased from 17% in 2-day-old cleavage stages to 51% in 6-day-old expanded blastocysts. All these embryos were mosaics and the percentage of DNA aneuploid nuclei per embryo did not usually exceed 9%. Fifteen percent of the expanded blastocysts, however, contained up to 23% abnormal nuclei. Throughout the embryonic stages studied, the DNA content of abnormal nuclei was remarkably constant and averaged 5.8C. DNA aneuploid and euploid blastocysts did not differ in size. A maternal FSH treatment did not influence the DNA ploidy. This is the first report on the DNA ploidy pattern in preimplantation rabbit embryos. Our results indicate that DNA aneuploidy of single blastomeres is common in this species and occurs more often than generally assumed. The embryonic viability does not seem to be affected by the presence of DNA aneuploid blastomeres supporting earlier findings that a limited number of abnormal blastomeres is compatible with normal preimplantation development.
In an attempt to collect more information about the features of the vernix caseosa (VC), a relatively unstudied material, some of the histochemical, ultrastructural, and immunological characteristics of VC cells have been investigated. Histochemistry and light microscopy was used to demonstrate the activity of acid and alkaline phosphatase in VC cells, enzymes with a marked increase in activity in the amniotic fluid toward term. Acid phosphatase activity was strongly present either as intracytoplasmic granules or as amorphous material between the cells; alkaline phosphatase activity was absolutely nonexistent. The ultrastructural morphology of the VC cells was analyzed by scanning and transmission electron microscopy (TEM). Significant differences can be demonstrated in the individual surface patterns of the VC keratinocytes. TEM showed irregularly flattened cells in various stages of keratinization. The ultrastructural findings confirm the dissimilarity, which exists between the individual VC cells. Finally, immunofluorescent staining tests of frozen VC smears showed that only immunoglobulin G conjugate gives strong positive reaction at the antigen sites of the VC cells. The special finding in this study is the polymorph appearance of the surface pattern and the cytoplasma structure of the VC cells, as well as the lack of uniform appearance of the acid phosphatase activity in and between the cells. All these suggest that the status of the individual VC cell is not similar in regard to their keratinization and desquamation activities.
During the process of 'maturation' of the fetal skin, detachment of the layer of vernix caseosa takes place from the fetal epidermis into the amniotic fluid, in the course of the last weeks of pregnancy. This results in: (a) a change of the cytological image of the amniotic fluid followed by a considerable increase in the proportion of the keratinized epidermic cells, (b) a simultaneous increase in the turbidity of the amniotic fluid and (c) a parallel increase in the quantity of sediment which remains after centrifugation of the amniotic fluid. The data presented in this paper, measured in 87 samples of amniotic fluid from normal, eutrophic, uncomplicated pregnancies, indicate the difference between the values of the various parameters before and after the main detachment of the vernix caseosa. Since the fetal skin is the organ reflecting most accurately the general status of the fetal maturity at the end of pregnancy, we consider that an overall examination of findings from the amniotic fluid indicating the condition of the fetal skin supplies us with reliable results for making a prenatal prediction of the maturity status of the fetus.
It has been shown, that apart from the mass of non-vital squamous epithelial cells, there also exist vital cells in the amniotic fluid. In this study, two types of amniotic fluid cells, which upon examination based on morphological characteristics gave rise to conclusions concerning their vitality, are presented, described and correlated with morphologically similar cells with known origin. Probably one type of these amniotic fluid cells are macrophages or Hofbauer-cells and the other types could be amnion-cells.
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The surface layer of fetal epidermis in early pregnancy, the Periderm, is progressingly replaced by the final keratinization process during fifth to sixth month of gestation. Then the peridermal cells are shed into the amniotic fluid. It is still controversial, whether complete peridermal cells or just their globular protrusions are separated. Formation of mikrovilli and invaginations of plasma membrane, the numerous smaller and larger vacuoles and the cytoplasmatic meshwork of fine filaments without production of keratohyaline, are characteristics of peridermal cells, and are described in detail by electron microscopical investigations on cells suspended in the amniotic fluid, which are most likely of peridermal origin.
The ultrastructural morphology of epidermal keratinocytes, which at the end of pregnancy and after shedding of vernix represent the majority of amniotic fluid cell population, is analysed by electron microscopy. Special attention is focused on the morphological characteristics of epidermal keratinization according the changes of the cell's ultrastructure during this process: The transformation of the cytoplasma into keratin, the formation of the typical cell membrane of the keratinized squamous cells, and the findings concerning the intercellular space, especially of the zones of intercellular contact - desmosomes - and their changes.
Until desquamation of vernix caseosa near the end of gestation the large, non-keratinizing squamous cells, which have their origin mostly from upper intestinal tract, vagina and urinary tract, form the majority of the population of cells in amniotic fluid. Their structure, as seen by electron microscopy is described, especially it's changes during the process of degeneration after the cell has been desquamated into amniotic fluid: dissolution or condensation of the nucleus, cytoplasmatic changes with appearance of filaments and vesicular corpuscles, and decreasing glycogen content.
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In 152 amniotic fluid samples, derived either from amniocentesis or amniotomy, smears have been performed for cytological investigation (staining after Harris-Shorr). The per cent amount of different cell-shapes has been determined. Polygonal, anucleate, transparent cells, representing desquameted fetal keratinocytes, are seen more frequently in late pregnancy and have been registered separately. These data have been compared to the postnatal determination of gestational age after Dubowitz et al, as well as Farr et al. This mode of investigation allows a safe and objective determination of maturity in the last weeks of pregnancy and thereby an exclusion of a presumed fetal prematurity. This method seems very useful in differential diagnosis between fetal hypotrophy and prematurity in the latter part of pregnancy.
In a retrospective study performed at the university department of pediatrics at Aachen the development of the mortality rate of extreme low birth weight infants (less than or equal to 1000 grams) born from 1976 to 1987 has been under investigation. During this period a decline of the neonatal mortality rate from 79.5% to 29.8% could be observed. Sex, gestational age, birthweight, place of birth and delivery mode were important factors influencing the outcome of the patients. Premature babies who were born by caesarean section had a significantly higher survival rate than babies who had been delivered vaginally. Premature babies born in the university hospital at Aachen (inborns) had a remarkably lower neonatal mortality rate than infants who postpartum had been transferred to the intensive care unit from surrounding hospitals (outborns). A second aspect of this study was the development of neonatal morbidity. For some diseases like intracranial hemorrhage a decrease in frequency could be noticed. Especially high-graded intraventricular hemorrhage (IVH greater than or equal to III degrees) occurred significantly less frequent between 1985 and 1987. The comparison of morbidity rates between inborns and outborns revealed a lower incidence of hyaline membrane disease, pneumothorax and intracranial hemorrhage in inborn patients. The results of this study imply that the intensive care of extreme low birth weight infants is justified. To achieve even lower mortality and morbidity rates the importance of regionalization has to be emphasized.
The alveolar lamellar bodies (LB), being the main source of the Surfactant-phospholipids, are produced by the alveolar cells of type II and excreted, during the development of the fetal lungs, in the alveolar space. Hence the LB move free, isolated or in groups, to the amniotic fluid, where they could be found as multilamellar structures. It is already being observed that the LB may be present in the amniotic fluid at the 32th or at the 26th week of pregnancy at the earliest. The method of centrifugation, which is very important for the evaluation of the LB, should always be considered. According to TEM research on the morphological development of the fetal alveolar epithel, there is also disagreement about the first production of Surfactant or LB from the alveolar cells of typ II. Our TEM-observations on two sediments of amniotic fluid from the 19th week of pregnancy (after centrifugation of the AF in 6000 revs/min) showed the presence of the alveolar lamellar bodies already in this week. A lot of different types of LB were observed, ranging of the most "immature" to types being empty at the interior with some peripheral membranes ("mature"). Occasionally osmiophilous nucleus was noticed inside the LB.
The maturation of the fetal lungs, that is to say the adequate production of surfactant in the fetal alveoli, as it is well known reaches to its end about the 35.-36th week of gestation. Even more closely to the date of delivery, about the 37.-38th week of gestation, the maturation of the fetal skin takes place, so to say the detachment of the Vernix caseosa from the fetal skin into the amniotic fluid. The above mentioned means that the children with "mature skin" should have mature lungs too, so that those children have about nothing to fear from the RDS. That can be proved by the comparison of the values which were measured in 38 cases of the L/S Ratio (as a criterion of the lung-maturity), to those of the turbidity of the amniotic fluid and average quantities of the keratinocytes of the amniotic fluid cell population (as a criterion of the skin-maturity); that observation becomes stronger with the comparison of all those values to a Vernix-Score, which can be completed after delivery.