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The timing of perinatal hypoxia/ischemia events in term neonates: a retrospective autopsy study. HSPs, ORP-150 and COX2 are reliable markers to classify acute, perinatal events.

Riezzo I, Neri M, De Stefano F, Fulcheri E, Ventura F, Pomara C, Rabozzi R, Turillazzi E, Fineschi V - Diagn Pathol (2010)

Bottom Line: COX2 reaction exhibited the strongest positive reaction in the neuronal cell bodies of acute cases, while a immunolabeling was prominent in the glial cytoplasm in the non-acute cases.Chaperones HSP70 and 90, ORP-150 reaction, and COX2 protein, have provided very interesting results.These results would suggest to the clinicians to extend the differential diagnosis of a too large perinatal hypoxic-ischemic insult category to delineate a more accurate chronological judgement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Forensic Pathology, University of Foggia, Foggia, Italy.

ABSTRACT

Background: The understanding of the cellular responses implicated in perinatal brain damages and the characterization of the various mechanisms involved might open new horizons for understanding the time of onset of a brain hypoxic-ischemic lesion and for effective therapeutic strategies.

Methods: We performed an immunohistochemical investigation on brain and brainstem sections of 47 peripartum deaths. The gradation and localization of the expression of antibodies such as TNFalpha, IL-1beta, IL-6, HSPs, beta APP, anti-TrypH, GAP43, GFAP, COX2, ORP-150, could be correlated with an hypoxic-ischemic damage to document a significant correlation between response and the time of onset acute (/=8 hs

Results and discussions: In non-acute cases HSP70 reaction was prominent in the neuron cytoplasm, while in acute cases a mild reaction was evident in sporadic fields. HSP90 exhibited a similar pattern of positivity as HSP70. In acute group, ORP150 expressed an intense reaction showing a granular pattern in the cytoplasm of the neurons in the cortex of the infarcted areas. In non-acute group the positive reaction was more intense in astrocytes and less extended in neurons. COX2 reaction exhibited the strongest positive reaction in the neuronal cell bodies of acute cases, while a immunolabeling was prominent in the glial cytoplasm in the non-acute cases.

Conclusions: Chaperones HSP70 and 90, ORP-150 reaction, and COX2 protein, have provided very interesting results. These results would suggest to the clinicians to extend the differential diagnosis of a too large perinatal hypoxic-ischemic insult category to delineate a more accurate chronological judgement.

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Related in: MedlinePlus

(A) CTG tracing. Sudden decelerations (arrow) that do not recover: urgent delivery ("rescue") is indicated. This tracing permits the diagnosis that the fetus (40ws.) suffered an acute, rather profound, ischemic event just prior to delivery due to the mother's prolonged cardiac arrest. (B-C) Same case as in (A): CT (midventricular level) appearance with enlarged lateral ventricles and generalized brain swelling at autopsy. (D) Histology of the cortical layer shows it to be oedematous with nuclear pyknosis.
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Figure 2: (A) CTG tracing. Sudden decelerations (arrow) that do not recover: urgent delivery ("rescue") is indicated. This tracing permits the diagnosis that the fetus (40ws.) suffered an acute, rather profound, ischemic event just prior to delivery due to the mother's prolonged cardiac arrest. (B-C) Same case as in (A): CT (midventricular level) appearance with enlarged lateral ventricles and generalized brain swelling at autopsy. (D) Histology of the cortical layer shows it to be oedematous with nuclear pyknosis.

Mentions: The pathological findings are summarized in Figure 1. In the acute group necrosis of the basal ganglia (8 cases) and of the thalamus (6 cases) were observed; intraventricular haemorrhages (4 cases), necrosis of tegmentum (3 cases) and two cases of infarction of the cerebral cortex were described. Three cases of necrosis of the basal ganglia, 12 cases of subcortical leukomalacia with infarction of the cerebral cortex and 8 cases without infarction were observed in the non-acute group. In acute insult the microscopic study of the brain samples, typically showed massive brain oedema (Figure 2), bleeding into the choroid plexus with massive intra-ventricular haemorrhages, sub-pial haemorrhages involving the cerebrum or cerebellum. Neuronal apoptosis and necrosis were observed. Frank infarction affected the cerebral cortex and white matter, in which glial cells had vesicular nuclei and fine fibrillary cytoplasmic processes. Necrosis was observed in the basal ganglia, thalamus, internal granular layer of the cerebellar cortex, inferior colliculi, inferior olivary nucleus and brainstem tegmentum.


The timing of perinatal hypoxia/ischemia events in term neonates: a retrospective autopsy study. HSPs, ORP-150 and COX2 are reliable markers to classify acute, perinatal events.

Riezzo I, Neri M, De Stefano F, Fulcheri E, Ventura F, Pomara C, Rabozzi R, Turillazzi E, Fineschi V - Diagn Pathol (2010)

(A) CTG tracing. Sudden decelerations (arrow) that do not recover: urgent delivery ("rescue") is indicated. This tracing permits the diagnosis that the fetus (40ws.) suffered an acute, rather profound, ischemic event just prior to delivery due to the mother's prolonged cardiac arrest. (B-C) Same case as in (A): CT (midventricular level) appearance with enlarged lateral ventricles and generalized brain swelling at autopsy. (D) Histology of the cortical layer shows it to be oedematous with nuclear pyknosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914029&req=5

Figure 2: (A) CTG tracing. Sudden decelerations (arrow) that do not recover: urgent delivery ("rescue") is indicated. This tracing permits the diagnosis that the fetus (40ws.) suffered an acute, rather profound, ischemic event just prior to delivery due to the mother's prolonged cardiac arrest. (B-C) Same case as in (A): CT (midventricular level) appearance with enlarged lateral ventricles and generalized brain swelling at autopsy. (D) Histology of the cortical layer shows it to be oedematous with nuclear pyknosis.
Mentions: The pathological findings are summarized in Figure 1. In the acute group necrosis of the basal ganglia (8 cases) and of the thalamus (6 cases) were observed; intraventricular haemorrhages (4 cases), necrosis of tegmentum (3 cases) and two cases of infarction of the cerebral cortex were described. Three cases of necrosis of the basal ganglia, 12 cases of subcortical leukomalacia with infarction of the cerebral cortex and 8 cases without infarction were observed in the non-acute group. In acute insult the microscopic study of the brain samples, typically showed massive brain oedema (Figure 2), bleeding into the choroid plexus with massive intra-ventricular haemorrhages, sub-pial haemorrhages involving the cerebrum or cerebellum. Neuronal apoptosis and necrosis were observed. Frank infarction affected the cerebral cortex and white matter, in which glial cells had vesicular nuclei and fine fibrillary cytoplasmic processes. Necrosis was observed in the basal ganglia, thalamus, internal granular layer of the cerebellar cortex, inferior colliculi, inferior olivary nucleus and brainstem tegmentum.

Bottom Line: COX2 reaction exhibited the strongest positive reaction in the neuronal cell bodies of acute cases, while a immunolabeling was prominent in the glial cytoplasm in the non-acute cases.Chaperones HSP70 and 90, ORP-150 reaction, and COX2 protein, have provided very interesting results.These results would suggest to the clinicians to extend the differential diagnosis of a too large perinatal hypoxic-ischemic insult category to delineate a more accurate chronological judgement.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Forensic Pathology, University of Foggia, Foggia, Italy.

ABSTRACT

Background: The understanding of the cellular responses implicated in perinatal brain damages and the characterization of the various mechanisms involved might open new horizons for understanding the time of onset of a brain hypoxic-ischemic lesion and for effective therapeutic strategies.

Methods: We performed an immunohistochemical investigation on brain and brainstem sections of 47 peripartum deaths. The gradation and localization of the expression of antibodies such as TNFalpha, IL-1beta, IL-6, HSPs, beta APP, anti-TrypH, GAP43, GFAP, COX2, ORP-150, could be correlated with an hypoxic-ischemic damage to document a significant correlation between response and the time of onset acute (/=8 hs

Results and discussions: In non-acute cases HSP70 reaction was prominent in the neuron cytoplasm, while in acute cases a mild reaction was evident in sporadic fields. HSP90 exhibited a similar pattern of positivity as HSP70. In acute group, ORP150 expressed an intense reaction showing a granular pattern in the cytoplasm of the neurons in the cortex of the infarcted areas. In non-acute group the positive reaction was more intense in astrocytes and less extended in neurons. COX2 reaction exhibited the strongest positive reaction in the neuronal cell bodies of acute cases, while a immunolabeling was prominent in the glial cytoplasm in the non-acute cases.

Conclusions: Chaperones HSP70 and 90, ORP-150 reaction, and COX2 protein, have provided very interesting results. These results would suggest to the clinicians to extend the differential diagnosis of a too large perinatal hypoxic-ischemic insult category to delineate a more accurate chronological judgement.

Show MeSH
Related in: MedlinePlus