Vascular endothelial growth factor (VEGF) is an angiogenic protein which acts on both endothelial and trophoblast cells. In first trimester placenta, VEGF immunoreactive protein was detected in cytotrophoblast shell suggesting a role in the regulation of cytotrophoblast growth and differentiation as they also expressed VEGF receptor (flt-1) protein. VEGF and flt-1 immunoreactive proteins were expressed in Hofbauer cells within the villous mesenchyme, macrophages and in maternal decidual cells while weak VEGF immunoreactive protein was seen in syncytiotrophoblast surrounding the placental villi in first and second trimester placentae. At term, there was relatively weak VEGF and flt-1 immunostaining in the syncytiotrophoblast while intense VEGF immunostaining was seen in the Hofbauer and maternal decidual cells. Extravillous trophoblast showed immunostaining for flt-1 but no staining for VEGF. Both amnion and chorion expressed strong VEGF immunoreactivity throughout gestation. Smooth muscle cells surrounding the vein and arteries of the umbilical cord showed weak VEGF immunoreactivity while no immunoreactivity was localised in endothelial cells. VEGF stimulated parathyroid hormone-related protein (PTHrP) release (mean (+/- SD): basal, 0.96 +/- 0.03; 10 ng/ml VEGF165, 2.07 +/- 0.18 and 20 ng/ml VEGF165, 2.43 +/- 0.18 pmol/l/well of PTHrP1-86) in condition medium from immortalised first trimester trophoblast cell line. These results suggest that VEGF in addition to acting as an autocrine mitogen for trophoblast proliferation may also function as a paracrine mediator of vascular tone by releasing vasorelaxants from trophoblasts.

In a region where falciparum malaria is endemic and where pregnant women traditionally receive only curative treatment for parasitaemias and no chemoprophylaxis 65 placental biopsy specimens were examined histologically for malaria pigment. Twenty seven placentas had pigment, but parasitaemias had been diagnosed antenatally in only 12 of these women despite their frequent attendance at antenatal and other clinics.The incidence of parasitaemia in pregnant primigravidas was 17-7%, seven times greater than that in lactating primiparous mothers; pregnant primigravidas also had the highest incidence (67%) of pigmented placentas.

After prolonged parenteral nutrition a 12 month old infant died with pulmonary hypertension and granulomatous pulmonary arteritis. A review of necropsy findings in 41 infants who had been fed parenterally showed that two of these also had pulmonary artery granulomata, while none of 32 control patients who died from sudden infant death syndrome had similar findings. Particulate contaminants have been implicated in the pathogenesis of such lesions and these were quantified in amino acid/dextrose solutions and fat emulsions using automated particle counting and optical microscope counting respectively. Parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens were found to include approximately 37 000 particles between 2 and 100 pm in size in one day's feed, of which 80% were derived from the fat emulsion. In-line end filtration of intravenous infusions may reduce the risk of particle associated complications. A A 1000 g female infant born at 27 weeks' gestation developed necrotising enterocolitis after a period of respiratory distress and hypoglycaemia. Perforation of the terminal ileum led to laparotomy and formation of an ileostomy, which was closed five months later. Subsequently, an anastomotic stricture and adhesions caused small bowel obstruction requiring further surgery. Septicaemia, recurrent rotavirus infection, and protracted diarrhoea precluded full enteral feeding. She died suddenly and unexpectedly at 12 months of age, having been parenterally fed for much of her life. Striking features at postmortem examination were a granulomatous pulmonary arteritis with some of the arteries being occluded by fibrin, together with dilatation and hypertrophy of the right ventricle secondary to pulmonary hypertension.Identical lesions in drug offenders are thought to be related to intravenous injection of magnesium trisilicate dust used as a lubricant in drugs intended for oral administration.' 2 Granulomata have also been described in patients who have received large volumes of intravenous fluids,3 and they can be reproduced experimentally in rabbits by injection of saline containing particulate matter. 4 The aims of this study were, therefore, to establish how often pulmonary granulomata could be found at postmortem examination in both patients who had and those who had not received parenteral nutrition, and to determine the number and size of particles in parenteral feeding solutions. Subjects and methods NECROPSY STUDY SubjectsPostmortem material from all parenterally fed infants from a regional neonatal intensive care unit who had died between 1980 and 1989 were reviewed. Forty one such patients were identified, with a median (range) gestational age of 28 weeks (25-40) and weight 880 g (450-2820). The most common indication for parenteral nutrition was prematurity and failure to tolerate enteral feeding in association with respiratory distress requiring ventilatory support (n=38); indications in the three remaining patients were necrotising enterocolitis, isch...