Pathologic changes in the basement membrane (BM) of postcapillary venules (PCV) and capillaries in rheumatoid arthritis (RA) synovium were studied by immunoelectron microscopy, using a monoclonal antibody against human type IV collagen, C(IV)22, and by electron microscopic morphometric analysis. The sublining region of RA synovium was classified into lymphocyte‐rich areas, transitional areas, and interstitial areas, according to their pattern of cellular infiltration. In lymphocyte‐rich areas, the BM of the PCV and capillaries were minimally thickened; disruption of the lamina densa was seldom seen. Transitional areas, which contained macrophages, lymphocytes, and plasma cells, had numerous PCV and capillaries. The BM was markedly thickened and partially multilamellated, and there were many disruptions in the lamina densa. The BM contained degenerated endothelial cells and cell debris. On immunostaining of this BM with monoclonal antibody C(IV)22, type IV collagen stained heavily, mainly in the disrupted lamina densa; this indicates that the thickening was, at least in part, the result of an increase in BM collagen. In uninfiltrated interstitial areas, BM were moderately thickened and multilamellated, and showed few disruptions of the lamina densa; there were similar increases in type IV collagen, but cell debris was seldom observed. Measurement of the BM width, the ratio of BM width to vessel diameter, and the fraction of vascular cross‐sectional area occupied by BM demonstrated that the thickness of the BM of both PCV and capillaries was greatest in transitional areas and was smallest in lymphocyte‐rich areas (P <0.01). Since macrophages and macrophage‐derived factors have been found to promote synthesis of BM collagen type IV, and since transitional and interstitial areas are rich in macrophages and histiocytes, respectively, it is suggested that these mononuclear cells and the factors secreted by them play a significant role in the thickening of the BM of PCV and capillaries in RA synovitis.
Case I. Imperforate Anus.-Recto-Vaginal Canal.-Operation_ Ihis was the case ol a female infant. The accouchement of the mother was at the end of the ordinary period, of her first child, easy, and presenting nothing worthy of record. The child was of the usual size, healthy, and exhibited no malformation, except the one *A trial lor infanticide, tinder circumstances somewhat similar to the above occurred in this city before Judge Woodworth, in 1819. Mary Gardner was in¬ dicted for murdering her infant child, which was foundsoon after birth wrapped np in rags, and concealed in an old chest. The child was living when found but died after a few hours. There were marks of violence on its head and neck' and three fractures on the centre of one of the parietal bones, diverging in a radi¬ ated manner, and considerable extra vasated blood near the coronal suture. Dr. Bliss testified that great violence had been committed, such as would follow a Mow from a poker, and that in his opinion it could not have resulted from any accident at birth, as a fall, &c. It was argued that there was no evidence of actual violence on the part of the mother, that the appearances might have re¬ sulted from accident, and notwithstanding the opinion of the physician, it would be wrong to draw the inference that she murdered her child, as the fact of con¬ cealment might be fair!}-attributed to a motive consistent with her innocence. Verdict, Net Guilty. There is no statute lav.-against infanticide in this slate, but such cases are decided by the principles of common law, and accessory circum¬ stances are only considered as proving the intent. There must be actual, not rresumptive proof that the child was bom alive. The legal presumption is, that the child was bom dead, and the law does not, as in England, throw the burden of proof upon the mother. She is not required to prove that it was bom dead, but the government must show that it was born alive. This we believe to be placing the mother on the only just ground. The same evidence ought to be re¬ quired in cases of infanticide, as necessary to convict in cases of homicide *6
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