Objective  To determine the expression of VEGF in the placental tissue from pregnancies complicated by hypertension disorders of different clinical severity. Design  Prospective cohort study. Setting  Polyclinic of Careggi, University of Florence, Italy. Sample  Placentas from women with gestational hypertension (n= 20), pre‐eclampsia (n= 20) and pre‐eclampsia with HELLP syndrome (n= 20) and from normotensive women (n= 20), as control group (gestational age comprised between 35 and 38 weeks). Methods  An immunohistochemical technique and a quantitative analysis to measure mRNA levels (RT‐PCR) were employed. Main outcome measures  Intensity of immunoreactivity and mRNA levels in the placental components. Differences between the data. Results  VEGF immunoreactivity was observable in all the placental components in the gestational hypertension cases as in the control ones. In the cases with pre‐eclampsia and pre‐eclampsia with HELLP syndrome, some placental components were not immunoreactive. However, the VEGF positive components of all the pathological groups showed a higher intensity of reactivity with respect to that of the control group. The levels of VEGF mRNA were higher in the gestational hypertension cases and lower in the cases of pre‐eclampsia with HELLP syndrome with respect to the control ones; in the cases of pre‐eclampsia, the levels were the same as the control ones. Conclusion  The different expression of VEGF in the placenta of the pathological cases is probably related to haemodynamic changes that take place in these disorders, in order to attempt restoration of a normal uteroplacental flow.

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BackgroundAll implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected.MethodsWe analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy.ResultsOur results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses.The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis.The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing.ConclusionsThe Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.

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