Academic literature on the topic 'Mort foetale'

La drépanocytose SC constitue le second des syndromes drépanocytaires majeurs. La grossesse chez cette catégorie de la population est associée à une morbi-mortalité materno-foetale élevée. Nous présentons un cas de grossesse chez une femme drépanocytaire hétérozygote composite SC compliquée de pré-éclampsie sévère avec mort foetale in utero et décès maternel dans un tableau de syndrome thoracique aigu. L’évolution fatale montre parfaitement le caractère gravissime de cette pathologie et l'importance d'une prise en charge multidisciplinaire.

Des examens bactériologiques et sérologiques ont été menés sur 3 413 dromadaires provenant de différentes régions du Soudan, où se trouvaient des élevages intensifs de bovins, de moutons et de chèvres, afin de détecter la présence de la brucellose. Parmi les dromadaires, 3 275 ont appartenu à 110 troupeaux, 35 ont été élevés individuellement ou avec du bétail et 103 avaient été abattus à l'abattoir de Nyala. L'infection a été présente dans 50 (45,5 p. 100) des 110 troupeaux, avec des taux de prévalence qui ont varié de 1,4 à 89,5 p. 100; elle a également été présente chez 72 (7,3 p. 100) des 993 mâles et chez 196 (8,1 p. 100) des 2 420 femelles. Soixante-quinze pour cent des dromadaires positifs ont été des adultes de plus de 4 ans d'âge et les 25 p. 100 restants ont été des jeunes de 6 mois à 4 ans. Les taux d'avortement associés à la maladie chez les troupeaux infectés ont varié de 3,1 à 72,7 p. 100 entre les régions. Les autres conditions liées à la maladie ont été la rétention du placenta, la mort foetale et la momification, le retard de l'âge de la monte et l'infertilité. Il n'a pas été mis en évidence que la brucellose était à l'origine d'hygromas et de cas d'orchite. La maladie a paru plus atténuée chez les dromadaires que chez le bétail. Les anticorps de Brucella abortus ont varié de 31 à 1 969 UI/mI (2/20 à 2/1280) chez les dromadaires infectés. L'ajout de lait de bovin négatif pour la brucellose au lait de dromadaire a rendu plus précise l'épreuve d'agglutination en anneau du lait. Les dromadaires mâles utilisés pour la reproduction ont été négatifs pour la brucellose, montrant ainsi qu'ils n'ont pas joué de rôle dans la transmission de la maladie. Des recommandations pour la lutte contre la brucellose sont proposées.

Foetal exposure to phthalates is known to adversely impact male reproductive development and function. Developmental anomalies of reproductive tract have been attributed to impaired testosterone synthesis. However, species differences in the ability to produce testosterone have been noted; e.g., following foetal exposure, abnormal clustering of Leydig cells or decreased production of testosterone that is manifested in rats does not occur in mice or humans. Nonetheless, other facets of testicular dysgenesis occur in both rats and mice as well as in some other species tested. We recently published a comprehensive evaluation of the foetal rat testis proteome, following in utero exposure to diethylhexyl phthalate (DEHP), which revealed changes in individual proteins that are known to be factors in cellular differentiation and migration or related to the capacity of the foetal Leydig cell to produce testosterone and fit a pathway network in which each is regulated directly or indirectly by oestradiol. Plasma oestradiol indeed was found to be elevated approximately twofold in 19-day-old DEHP-exposed foetal male rats. In this brief review, we discuss our new findings vis-à-vis ‘oestrogen hypothesis’ as a cause for testicular dysgenesis syndrome.

Abstract Background and aim: Foetal adrenal gland is an important factor which determines neonatal survival. Adrenal hypoplasia can result in respiratory distress and neonatal death. Due to many reasons, incidence of congenital anomalies is increasing but scientific advancement makes most of them correctable. So we found it important to assess the foetal adrenal glands in various congenital anomalies. Materials and methods: 72 human foetuses [stillborn and aborted] of 12-40 weeks of gestational age were autopsied to find out the presence of congenital anomalies, and their adrenal glands were collected for analysis. Autopsies were done in the Department of Pathology, Govt. Medical College, Thiruvananthapuram. Morphological and histological examinations of the glands were done in The Department of Anatomy, Govt. Medical College Thiruvananthapuram. Out of 72 foetuses, 33 were normal and 39 were having various congenital anomalies. Statistical analysis of data was done using ANOVA table, graphs and bar diagrams. Result: Gross adrenal hypoplasia was noted in Cystic hygroma, Anencephaly and Erythroblastosis foetalis. Microscopically, miniature types of adrenal glands were found in Cystic hygroma and in Anencephaly. Morphological variations like disc shaped adrenal glands were noted in Omphalocoele and Renal agenesis. Adrenal hypoplasia was a constant feature in Cystic hygroma and became more evident with increasing gestational age. The observations were statistically significant. Conclusion: Adrenal hypoplasia is frequently associated with congenital anomalies especially cystic hygroma and may increase neonatal morbidity and mortality in such cases.

Objective: To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. Design: A descriptive study.Place and duration of study: The study was carried out at Mugda Medical College Hospital from March 2017 to June 2017.Materials and Methods: A total of 50 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented.Results: Out of 50 primigravidae, with high foetal head there was foetal malpresentation 17(34%), Cephalopelvic disproportion 13(26%) , Foetal distress 12(24%). Lower segment caesarian section was the management of choice in more than half of the patients with high foetal head.Conclusions: Foetal malpresentation & Cephalopelvic disproportion were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in more than half of the patients with high foetal head.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 122-125

Background: Hypertension is one of the common complications in pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. The aim of the present study was to study placental grading by grading by ultrasonography in pregnancy complicated with hypertension and normotensive gravidas. To compare the foetal outcome regarding placental grading and its correlation pattern of placental grade distribution, type of delivery, foetal distress, birth asphyxia, foetal maturity, perinatal morbidity and mortality.Methods: The present study was conducted for a period of 12 months, which included 200 patients who attended OPD at PDRMC, Udaipur. Inclusion criteria was hypertensive pregnant women with BP >140/90 mmHg. Exclusion criteria was Pregnancy associated with other medical disorders, twin gestation, renal and cardiovascular disease and diabetes mellitus.Results: 100 pregnant women with preeclampsia as study group. The most common age group in study group is 22-23 Years. The grade III placenta was found early third trimester in study group. Caesarean delivery was more common mode of delivery in grade III placenta. In foetal outcome small for gestational age was more among the grade III placenta. Foetal distress, birth asphyxia, perinatal mortality, morbidity more among the grade III placenta among the study group.Conclusions: Foetal complications were significantly more in study group compared to control group. Ultrasound placental grade III was statistically significant in correlating with foetal complications like foetal distress, birth asphyxia, perinatal morbidity and mortality.

To investigate how macrosomia affects foetal-maternal birth outcomes, we conducted a retrospective cohort study of singleton pregnant women who gave birth at gestational age ≥37+0 weeks. The patients were divided into three groups according to birth weight: “macrosomia” group, ≥4500 g, n=285; “upper-normal” group, 3500–4499 g, n=593; and “normal” group, 2500–3499 g, n=495. Foetal-maternal and delivery outcomes were compared among the three groups after adjustment for confounders. Caesarean section was more frequent in the macrosomia group than in upper-normal and normal groups. The duration of labour (p < 0.05) and postpartum care at the hospital (p < 0.001) were the highest in the macrosomia group. Increased birth weight was associated with higher risks of shoulder dystocia (p < 0.001), increased bleeding volume (p < 0.001), and perineal tear (p < 0.05). The Apgar score at 5 minutes (p < 0.05), arterial cord pH (p < 0.001), and partial pressure of O2 (p < 0.05) were lower, while the arterial cord partial pressure of CO2 was higher (p < 0.001), in the macrosomia group. Macrosomia has potentially serious impacts for neonate and mother as a result of a complicated and occasionally traumatic delivery.

La mort subite inexpliquée du nourrisson (MSIN) est la cause principale de mortalité chez les enfants âgés d’un mois à un an. Différentes observations font soupçonner des épisodes hypoxiques préalables à la mort, dus à un dysfonctionnement des chémorécepteurs et à un retard de maturation et / ou d’une anomale du contrôle cardiorespiratoire. La neurotensine (NT) et les opioïdes, deux neuropeptides sédatifs et apnéisants, semblent impliqués dans le contrôle cardiorespiratoire au cours de l'ontogénèse et du développement du système nerveux central. Dans ce travail, nous avons testé l'hypothèse d’une relation entre l’hypotrophie (considérée comme un facteur de risque de la MSIN) et une anomalie des réponses cardiorespiratoires à l’hypoxie, liée à une surexpression ou un retard de maturation des systèmes neurotensinergiques et opioïdes dans le tronc cérébral…

Les pertes foetales inexpliquées constituent un sujet de préoccupation pour médecins et couples, tant au plan des investigations que des traitements. Par analogie avec le syndrome des antiphospholipides, l’étude des déterminants thrombophiliques génétiques connaît un vif succès depuis une dizaine d’années. Néanmoins, leur implication est controversée. Ont été initiés 3 projets de recherche complémentaires: 1/ Une étude cas témoins incidente pour étayer l’hypothèse d’un état prothrombotique et explorer d’autres pistes étiologiques, dont le rôle d’un dysfonctionnement endothélial. Les cas (311 femmes/284 couples) ont eu au moins une mort in utero après la 21ème semaine d’aménorrhée ou au moins deux pertes consécutives plus précoces, sans cause identifiée. Les témoins (600 femmes!297 couples) avec enfant, sans perte foetale ont été recrutés à partir des listes électorales. Aucune association n’est retrouvée entre perte foetale et -facteur V Leiden ou mutation G20210A de la prothrombine chez l’un des membres du couple, -I’inactivation préférentielle d’un X chez la femme. Génération de thrombine, microparticules endothéliales, lipoprotéine(a), forme soluble de l’adhésine endothéliale CD146et de la chémokine fractalkine sont significativement augmentées chez les femmes cas alors que les microparticules plaquettaires sont diminuées. 2/ Une enquête de cohorte des femmes incluses dans l’étude 1/. Des antécédents familiaux d’hypertension artérielle et des taux élevés de microparticules leucocytaires sont des facteurs prédictifs de récidive. 3/ Un essai thérapeutique multicentrique randomisé eu double insu, énoxaparine versus placebo dans les fausses couches spontanées inexpliquées est en cours depuis mars 2007
There are no clear guidelines for investigations and therapeutic interventions in unexplained pregnancy loss. A parallel has been drawn with the antiphospholipid syndrome. Thus, since the 1990s, inherited thrombophilias have been explored with great enthusiasm. However, since an initial impressive impact, a critical] appraisal of this issue is steadily growing. We successively initiated 3 studies: 1/ an incident case-control study designed to support the implication of a prothrombic state and to explore other mechanisms such as an endothelial dysfunction. 311 women (284 couples) have been referred for unexplained pregnancy losses (2 or more consecutive losses at or before 21 weeks of gestation, or at least one later loss): 600 control women (297 couples) with no pregnancy loss and at least one living child have been recruited using electoral lists. We did not find any association between unexplained pregnancy loss and - maternal or paternal factor V Leiden and Prothrombin G20210A mutations, - highly skewed X chromosome maternal inactivation. The thrombin generation, the endothelial microparticules, the plasma level of lipoprotein(a), CD 146 soluble form (endothelial adhesin) and fractalkine (CX3 chemokine) are ah significantly increased in female cases whereas platelet microparticles are lower than in controls. 2/ a prospective cohort study of the women included in 1/. Familial hypertension and high levels of leukocyte microparticles are risk factors for miscarriage recurrence. 3/ a double-blind placebo-control trial, studying enoxaparin in unexplained recurrent miscarriages (since March 2007)

Critical illness in pregnancy is a rare, but potentially catastrophic event for the mother and foetus. A thorough understanding of the effective management practices for the most common obstetrical reasons for ICU admission is essential for providing effective critical care to women in the ante-partum and immediate post-partum period. Some of the most common reasons for the need for critical care in the peripartum and post-partum period include venous thromboembolism, post-partum haemorrhage, amniotic fluid embolism, ovarian hyperstimulation syndrome, and obstetric sepsis. Management of these conditions should focus on choosing the most effective diagnostic and therapeutic measures for the mother, while focusing on minimizing foetal harm, accounting for physiological changes that may affect diagnostic strategies and pharmacokinetics.

Renal colic is the most common non-obstetric cause for abdominal pain and hospitalization during pregnancy. Ureteric stones occur in about 1 in 2,000 pregnancies, most (>80%) in the second and third trimesters. Primary management concerns are diagnostic foetal radiation exposure and the potential for adverse perinatal events arising either from the stone or from intervention. Indications for intervention are the same as for the non-pregnant patient, but are influenced by obstetric circumstances. Active treatment options may be temporizing (stent or nephrostomy) or definitive (ureteroscopic stone extraction). Historically, temporizing measures were the only recommended treatment option. However, potential problems associated with temporary drainage mechanisms include recurrent obstruction, infection, nephrostomy displacement, encrustation, infection, and pain. These factors may impact on pregnancy. In recent years, advances in surgical technology and technique have permitted definitive ureteroscopic management of stones during pregnancy.

Pregnancy outcomes in Type 1 diabetes have progressively improved, but are not yet at background population level. Insulin requirements increase early in pregnancy, followed by a nadir at 16–18 weeks, consistently climbing nearly to delivery. Everyone who sees Type 1 patients of childbearing years should be able to deliver concise and practical advice on pre-pregnancy management, including contraception advice. About one-third of UK pregnancies are unplanned. Even where formal counselling is readily available, most women do not access it. Maternal risks during pregnancy include exacerbation of pre-existing complications, hypoglycaemia, and pre-eclampsia; foetal risks include pregnancy loss, fetal malformation, prematurity, macrosomia, stillbirth, and neonatal death. Ideal preconception A1C is 6 to 7% (42 to 53 mmol/mol). Most insulin preparations are safe during pregnancy. Continuous glucose monitoring and insulin pump therapy are increasingly used, but evidence of definite benefit is awaited. Women are usually highly motivated to optimize glycaemic control during pregnancy.

Scotus’ estimate of the female gender is shaped by his view that Mary is pre-eminent among merely human saints. Because Mary must be a real mother, he rejects the Aristotelian view that mothers are merely passive causes in reproduction. Christ’s most perfect saving act preserves Mary for immaculate conception, freedom from original sin, not just from birth but from the moment of foetal animation. Gender-justice is important in the marriage contract, even though God never dispenses from life-long indissoluble monogamy to allow polyandry or to permit women to divorce. The Franciscan distinction between dominion and use allows Mary and Joseph to be really married even though both vowed chastity. Gender-justice means that right reason would never permit merely human institutions from restricting ordination to men. The command must come from Christ himself.

The Oxford Textbook of Sjögren’s Syndrome is an authoritative textbook, rich with valuable illustrations and figures, providing a practical guide to diagnosing and managing all aspects of this condition. Sjögren’s syndrome is a chronic, immune-mediated condition typically presenting in women in their fifth or sixth decade. With increased awareness and improvement in diagnostic tests, younger women and occasionally men are now being diagnosed with this condition. Frequently, Sjögren’s syndrome occurs in association with other autoimmune diseases, usually rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. The hallmark of this condition is dryness of the eyes and mouth, but many patients have systemic effects that can be debilitating, including fatigue, peripheral neuropathy, and lung damage. It has potentially serious long-term complications, including a higher risk of developing lymphoma and foetal congenital heart block. Diagnosis of the condition can be challenging as the presenting symptoms are variable. Management of the condition can be complex as the course of the disease is unpredictable and the available therapy is mainly symptomatic, with no known cure as yet. Experts in the condition from around the world have contributed to this book to provide the most up-to-date information on pathophysiology, classification criteria, diagnostic tests, systemic manifestations of the disease, and emerging therapeutic options. The publication of this book coincides with a period of increased interest in Sjögren’s within the scientific, medical, and pharmacological worlds.

Low birthweight (LBW) infants constitute a major public health concern in developed and developing countries. LBW infants includes those that were born early (preterm births), those that were born with intrauterine growth restricted (IUGR), or a combination of both. IUGR as a result of chronic malnutrition is more prevalent in developing countries and usually shows more long-term consequences. IUGR infants as a result of acute foetal malnutrition predominate in developed countries and usually have more complications immediately after birth but lower long-term consequences. The WHO 2025 global target is to achieve a 30% reduction in LBW infants. Research should focus on: testing evidence-based interventions starting before pregnancy to improve women’s nutrition in order to stop the vicious circle of malnutrition; treating pregnancy associated conditions such as pre-eclampsia; providing adequate perinatal care and social support; and Identifying risk factors of spontaneous preterm birth, as most causes are unknown.

A variety of autoantibodies associated with Rheumatic diseases have been associated with adverse maternal and foetal pregnancy outcomes. For instance, pregnancy morbidity in women with antiphospholipid antibodies (aPL) include unexplained consecutive recurrent 1st trimester pregnancy loss (<10 weeks’ gestation), any 2nd or 3rd trimester pregnancy loss, premature birth <34 weeks due to conditions associated with placental insufficiency including severe pre-eclampsia, eclampsia, placental abruption, foetal growth restriction, and intrauterine death. Moreover, antibodies against extractable nuclear antigens (ENA), such as anti-Ro/SSA and/or anti-La/SSB antibodies, have been associated with the development of congenital heart block (CHB) and neonatal lupus in the offspring. More recently, antibodies against U1-ribonucleoprotein (U1RNP) are suggested to be associated with adverse foetal and maternal pregnancy outcomes. In general, women with rheumatological diseases should receive pregnancy counselling. Moreover, women require follow up during pregnancy in order to maximize their chance to have a successful pregnancy.

Uterine fibroid is the most encountered benign tumour in women of reproductive age. It causes spontaneous abortions, missed abortions, painful red degeneration or infarction of the fibroids, abnormal foetal presentation, obstructed labour, and an increased likelihood of premature deliveries, caesarean deliveries, postpartum haemorrhage in pregnancy, whereas, in the non-pregnant women it is associated an irregular menstrual cycle sometimes associated with heavy menstrual bleeding, infertility, constipation, urinary incontinence, and leiosarcoma transformation. Till date is pathophysiology and management both in the non-pregnant and pregnant woman have not been well described. In this chapter, we present contemporary evidence to help elucidate this enigma.

Feminist ethics approaches to abortion have a tendency to be critical of the methodology employed by mainstream philosophical treatments of the abortion problem. In particular, they impugn the latter’s reliance on abstract theorizing and general principles, advising that only a focus on the particular and concrete details of real-life ethical problems such as abortion can direct us towards the truth of the matter. This chapter attempts to defend so-called ‘traditional’ abortion ethics from such criticisms. More fully, it sets out to explain and vindicate the aim of mainstream abortion ethics to discern and apply more general moral principles to the particular case of abortion, as well as the centrality of foetal moral status to many of those accounts. It also works towards showing that mainstream and feminist ethical approaches are more aligned in both their methods and their claims than might first appear.

For most women, pregnancy is suspected when the symptoms of early pregnancy develop—these include breast soreness or tenderness, fatigue, nausea, and missed menses. Human chorionic gonadotropin (hCG) is first detectable using sensitive tests in the urine and blood of pregnant women 8–10 days after conception (day 22–24 of a 28-day menstrual cycle). Concentrations of hCG rise rapidly in early pregnancy, peak at 9–10 weeks, and decline thereafter to a nadir at 20 weeks. Understanding embryo-foetal development and maternal physiological accommodation to pregnancy is required for the optimal management of pregnancy in women with autoimmune diseases. This chapter reviews the important developmental and physiologic aspects of normal pregnancy and both common and unique obstetric complications associated with selected rheumatic conditions.

A cohort study is one in which the outcome (usually disease status) is ascertained for groups of individuals defined on the basis of their exposure. At the time exposure status is determined, all must be free of the disease. All eligible participants are then followed up over time. Since exposure status is determined before the occurrence of the outcome, a cohort study can clarify the temporal sequence between exposure and outcome, with minimal information bias. The historical and the population cohort study (Box 9.1) are efficient variants of the classical cohort study described above, which nevertheless retain the essential components of the cohort study design. The exposure can be dichotomous [i.e. exposed (to obstetric complications at birth) vs. not exposed], or graded as degrees of exposure (e.g. no recent life events, one to two life events, three or more life events). The use of grades of exposure strengthens the results of a cohort study by supporting or refuting the hypothesis that the incidence of the disease increases with increasing exposure to the risk factor; a so-called dose–response relationship. The essential features of a cohort study are: ♦ participants are defined by their exposure status rather than by outcome (as in case–control design); ♦ it is a longitudinal design: exposure status must be ascertained before outcome is known. The classical cohort study In a classical cohort study participants are selected for study on the basis of a single exposure of interest. This might be exposure to a relatively rare occupational exposure, such as ionizing radiation (through working in the nuclear power industry). Care must be taken in selecting the unexposed cohort; perhaps those working in similar industries, but without any exposure to radiation. The outcome in this case might be leukaemia. All those in the exposed and unexposed cohorts would need to be free of leukaemia (hence ‘at risk’) on recruitment into the study. The two cohorts would then be followed up for (say) 10 years and rates at which they develop leukaemia compared directly. Classical cohort studies are rare in psychiatric epidemiology. This may be in part because this type of study is especially suited to occupational exposures, which have previously been relatively little studied as causes of mental illness. However, this may change as the high prevalence of mental disorders in the workplace and their negative impact upon productivity are increasingly recognized. The UK Gulf War Study could be taken as one rather unusual example of the genre (Unwin et al. 1999). Health outcomes, including mental health status, were compared between those who were deployed in the Persian Gulf War in 1990–91, those who were later deployed in Bosnia, and an ‘era control group’ who were serving at the time of the Gulf war but were not deployed. There are two main variations on this classical cohort study design: they are popular as they can, depending on circumstances, be more efficient than the classical cohort design. The population cohort study In the classical cohort study, participants are selected on the basis of exposure, and the hypothesis relates to the effect of this single exposure on a health outcome. However, a large cohort or panel of subjects are sometimes recruited and followed up, often over many years, to study multiple exposures and outcomes. No separate comparison group is required as the comparison group is generally an unexposed sub-group of the panel. Examples include the British Doctor's Study in which over 30,000 British doctors were followed up for over 20 years to study the effects of smoking and other exposures on health (Doll et al. 1994), and the Framingham Heart Study, in which residents of a town in Massachusetts, USA have been followed up for 50 years to study risk factors for coronary heart disease (Wolf et al. 1988). The Whitehall and Whitehall II studies in the UK (Fuhrer et al. 1999; Stansfeld et al. 2002) were based again on an occupationally defined cohort, and have led to important findings concerning workplace conditions and both physical and psychiatric morbidity. Birth cohort studies, in which everyone born within a certain chronological interval are recruited, are another example of this type of study. In birth cohorts, participants are commonly followed up at intervals of 5–10 years. Many recent panel studies in the UK and elsewhere have been funded on condition that investigators archive the data for public access, in order that the dataset might be more fully exploited by the wider academic community. Population cohort studies can test multiple hypotheses, and are far more common than any other type of cohort study. The scope of the study can readily be extended to include mental health outcomes. Thus, both the British Doctor's Study (Doll et al. 2000) and the Framingham Heart Study (Seshadri et al. 2002) have gone on to report on aetiological factors for dementia and Alzheimer's Disease as the cohorts passed into the age groups most at risk for these disorders. A variant of the population cohort study is one in which those who are prevalent cases of the outcome of interest at baseline are also followed up effectively as a separate cohort in order (a) to study the natural history of the disorder by estimating its maintenance (or recovery) rate, and (b) studying risk factors for maintenance (non-recovery) over the follow-up period (Prince et al. 1998). Historical cohort studies In the classical cohort study outcome is ascertained prospectively. Thus, new cases are ascertained over a follow-up period, after the exposure status has been determined. However, it is possible to ascertain both outcome and exposure retrospectively. This variant is referred to as a historical cohort study (Fig. 9.1). A good example is the work of David Barker in testing his low birth weight hypothesis (Barker et al. 1990; Hales et al. 1991). Barker hypothesized that risk for midlife vascular and endocrine disorders would be determined to some extent by the ‘programming’ of the hypothalamo-pituitary axis through foetal growth in utero. Thus ‘small for dates’ babies would have higher blood pressure levels in adult life, and greater risk for type II diabetes (through insulin resistance). A prospective cohort study would have recruited participants at birth, when exposure (birth weight) would be recorded. They would then be followed up over four or five decades to examine the effect of birth weight on the development of hypertension and type II diabetes. Barker took the more elegant (and feasible) approach of identifying hospitals in the UK where several decades previously birth records were meticulously recorded. He then traced the babies as adults (where they still lived in the same area) and measured directly their status with respect to outcome. The ‘prospective’ element of such studies is that exposure was recorded well before outcome even though both were ascertained retrospectively with respect to the timing of the study. The historical cohort study has also proved useful in psychiatric epidemiology where it has been used in particular to test the neurodevelopmental hypothesis for schizophrenia (Jones et al. 1994; Isohanni et al. 2001). Jones et al. studied associations between adult-onset schizophrenia and childhood sociodemographic, neurodevelopmental, cognitive, and behavioural factors in the UK 1946 birth cohort; 5362 people born in the week 3–9 March 1946, and followed up intermittently since then. Subsequent onsets of schizophrenia were identified in three ways: (a) routine data: cohort members were linked to the register of the Mental Health Enquiry for England in which mental health service contacts between 1974 and 1986 were recorded; (b) cohort data: hospital and GP contacts (and the reasons for these contacts) were routinely reported at the intermittent resurveys of the cohort; (c) all cohort participants identified as possible cases of schizophrenia were given a detailed clinical interview (Present State examination) at age 36. Milestones of motor development were reached later in cases than in non-cases, particularly walking. Cases also had more speech problems than had noncases. Low educational test scores at ages 8,11, and 15 years were a risk factor. A preference for solitary play at ages 4 and 6 years predicted schizophrenia. A health visitor's rating of the mother as having below average mothering skills and understanding of her child at age 4 years was a predictor of schizophrenia in that child. Jones concluded ‘differences between children destined to develop schizophrenia as adults and the general population were found across a range of developmental domains. As with some other adult illnesses, the origins of schizophrenia may be found in early life’. Jones' findings were largely confirmed in a very similar historical cohort study in Finland (Isohanni et al. 2001); a 31 year follow-up of the 1966 North Finland birth cohort (n = 12,058). Onsets of schizophrenia were ascertained from a national hospital discharge register. The ages at learning to stand, walk and become potty-trained were each related to subsequent incidence of schizophrenia and other psychoses. Earlier milestones reduced, and later milestones increased, the risk in a linear manner. These developmental effects were not seen for non-psychotic outcomes. The findings support hypotheses regarding psychosis as having a developmental dimension with precursors apparent in early life. There are many conveniences to this approach for the contemporary investigator. ♦ The exposure data has already been collected for you. ♦ The follow-up period has already elapsed. ♦ The design maintains the essential feature of the cohort study, namely that information bias with respect to the assessment of the exposure should not be a problem. ♦ As with the Barker hypothesis example, historical cohort studies are particularly useful for investigating associations across the life course, when there is a long latency between hypothesized exposure and outcome. Despite these important advantages, such retrospective studies are often limited by reliance on historical data that was collected routinely for other purposes; often these data will be inaccurate or incomplete. Also information about possible confounders, such as smoking or diet, may be inadequate.

Few specific markers of the endothelial cells are available. Von Willebrand factor has been recognized as the most specific but we have shown that its intracellular content and extracellular release varies largely along the vascular tree of the pig. Synthesis is maximal in capillaries and in pulmonary artery endothelial cells. Synthesis is almost nil in the aorta. Intermediary values are encountered in the inferior vena cava. We studied the distribution of angiotensin converting enzyme (ACE) in endothelial cells along the vascular tree, as synthesis, storage, membrane expression and release of this enzyme is totally different from that of von Willebrand factor. Primary culture of endothelial cells from various origin of the vascular tree were studied. ACE was assessed by a functional radiometric assay using a specific substrate, cellular expression depends : 1 - on culture conditions (medium with serum, adult pig serum, foetal calf serum, medium without serum), 2 - on time in culture and 3 - on the degree of cellular confluency. ACE is easily measured both in cellular extract and in the medium. After cellular fractionation, ACE is concentrated in membrane fractions. Changes were found between the arterial and venous endothelial cells but no significant variation in the distribution between intracellular and released ACE were noted. Arterial endothelium (aortic and pulmonary artery) behaved similarly while in venous endothelium (inferior vena cava) both the cellular and the releasable ACE decreased. A specific antibody to the cellular form of the porcine ACE is being raised to complete these functional studies by antigenic dosages and immunolocalization.