There is little information available concerning the ontologic development of the human hypothalamic-pituitary-adrenal (HPA) axis nor of the potential interactions among fetal, maternal and placental-derived HPA axis hormones. This study evaluated levels of these hormones in matched maternal and fetal pairs during the second half of uncomplicated pregnancies. Immunoassays were used to measure serum concentrations of corticotropin-releasing hormone (CRH), adrenocorticotropin (ACTH) and cortisol in 104 matched fetal and maternal blood samples. Fetal specimens were obtained by percutaneous umbilical blood sampling (PUBS) between 18 and 40 weeks in patients whose pregnancies resulted in healthy, term infants. Correlations among these hormones, and the effect of gestational age were assessed. Maternal CRH concentrations [median (range)] [1.10 ng/ml (0.15 to 23.69)] were significantly greater than fetal values [0.35 ng/ml (0.07 to 1.0)]. Levels of maternal CRH (r = 0.73; p < 0.001) but not fetal CRH (r = 0.01; p = 0.98) correlated with gestational age. Maternal ACTH decreased (r = -0.21; p = 0.04) while fetal ACTH increased (r = 0.35; p < 0.003) with gestational age. Both maternal (r = 0.45; p < 0.001) and fetal (r = 0.57; p < 0.001) cortisol levels increased with gestational age. Maternal serum CRH values correlated best with fetal cortisol (r = 0.40; p = 0.0002) and correlated modestly with maternal cortisol (r = 0.28; p = 0.01), fetal ACTH (r = 0.24; p = 0.03) and fetal CRH (r = 0.23; p = 0.04); but not with maternal ACTH (r = -0.12; p = 0.3). Maternal CRH concentrations increase in the third trimester and correlate with rising fetal cortisol levels.
Throughout the world the number of cases of renal pelvic and ureteral tumors has increased considerably during the last 2 decades. In Yugoslavia this increase has been exceptionally high since about 1953 or 1954. Many of our patients with these tumors come from regions where the population is affected by endemic nephropathy, the frequency of tumors in these regions being about 100 times higher than it is in other parts of Yugoslavia. In many cases these patients have renal failure and, therefore, conservative procedures are undertaken. Herein are reported the causes and results of therapy in 972 cases of renal pelvic and ureteral tumors collected in Yugoslavia. Particular attention has been paid to conservative operations (37 cases of renal pelvic and 64 cases of ureteral tumors), including their indications and possibilities. That many patients with renal pelvic and ureteral tumors have favorable conditions for a conservative procedure is confirmed by the comparatively good followup. However, in other cases a conservative operation is unreasonable and nephroureterectomy is mandatory.
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