Host specificity in the fungal plant parasite Anthracoidea sempervirentis (Anthracoideaceae, Ustilaginales) reveals three new species and indicates a potential split in the host plant Carex sempervirens.

The smut fungal genus Anthracoidea contains more than 100 species that parasitize hosts predominantly in the sedge genus Carex. Anthracoidea species are mainly found in the boreal zones of the Northern Hemisphere and many species have an arctic-alpine distribution. Recent re-organization of the taxonomy of the main host genus Carex questions current understanding of host associations in Anthracoidea. Host specificity for many of the species in this genus is considered to be quite broad and a host spectrum of over 10 host species is common. One aim of the study is to understand the potential influence that host taxonomy has on the evolutionary patterns of Anthracoidea. Additionally, by including more specimens, we clarify host specificity and species delimitation in Anthracoidea sempervirentis, a prevalent species occurring on different host species in different Carex subgroups using molecular data. Host colonization patterns within Anthracoidea are complex, and different subclades of Carex have been colonized several times independently, whereas clades of related Anthracoidea species often occur on Carex species from the same host clade. Parasites previously thought to be Anthracoidea sempervirentis occurring on the different Carex host are shown to be at least four distinct species that are restricted to individual host species. Three new species, Anthracoidea ferrugineae on Carex ferruginea from the Alps and the Carpathians, A. firmae on Carex firma from the Alps, and A. kitaibelianae on Carex kitaibeliana from mountains in the Balkan Peninsula, are described and illustrated. An emended description of Anthracoidea sempervirentis is also provided. Anthracoidea sempervirentis in its emended circumscription consists of two clades that correspond to respective clades within Carex sempervirens. The study shows that host colonization in Anthracoidea is more complex than current host taxonomy suggests. Further, including several specimens per host species results in a much higher diversity within Anthracoidea than previously assumed. Citation: Kemler M, Denchev TT, Feige A, Denchev CM, Begerow D (2024). Host specificity in the fungal plant parasite Anthracoidea sempervirentis (Anthracoideaceae, Ustilaginales) reveals three new species and indicates a potential split in the host plant Carex sempervirens. Fungal Systematics and Evolution 13: 91-110. doi: 10.3114/fuse.2024.13.04.

Differential diagnosis of sonographically detected tumours in the fetal cervical region.

Differential diagnosis of sonographically detected fetal neck tumours is difficult. The sonographic criteria for encephalomyelocele, lymphangioma/hygroma, teratoma, sarcoma, haemangioma, neuroblastoma and goitre are given on the basis of the authors' own observations and information from the literature. Elevation of alpha-fetoprotein in the amniotic fluid is a frequent but non-specific finding. Chromosome analysis after amniocentesis can be a useful supplementary procedure for assessing the prognosis and deciding upon the delivery procedure. Sonographic detection of a tumour in the fetal neck region enables preparations to be made for dystocia and postnatal dyspnoea of the newborn. The obstetrician must cooperate closely with paediatricians, neurologists, surgeons and ENT specialists.

[Breech presentation in obstetrics in Germany--an assessment of current status]. / Beckenendlagengeburtshilfe in Deutschland--eine Bestandesaufnahme.

Nowadays, the CS seems to be the most favourite way of delivery in case of breech presentation. Our opinion is that the vaginal delivery has no disadvantage for the physical and mental development of the newborns [11, 12]. The outcome depends on the set-up and organisation of each department. The most important condition to reach a good outcome by breech presentation is a well-established practical training of the whole team, a careful risk selection and a well structured perinatal centre. In our opinion the CS is the second choice to deliver a pregnant woman with a breech presentation at term. High CS-rates as well as a increased perinatal morbidity at vaginal breech delivery are a sign for insufficient training of the staff and insufficient organisation in small departments not being perinatal centres. Not the breech presentation is the real risk factor, but the unqualified Obstetrician and the insufficient set-up in the most of OB/Gyn-departments. We have a very high ethic responsibility against young women resultating from our profession. It's our duty to decide and recommend the best way to save the wellbeing of the mother and the unborn child. It's also our duty to avoid surgical manoeuvers resulting from economic reasons. Therefore a complete, sufficient practical training concerning breech delivery technics is absolutely needed. In future the answer of the question: "Delivery of breech presentation--vaginally or through CS?" will depend on, if we will be able to change this politic and professional undesirable trend.

Dapoxetine for premature ejaculation.

Premature ejaculation (PE) is the most common form of male sexual dysfunction, with an estimated worldwide prevalence of 20­30%.1 Although PE is not life threatening, it has significant impact on quality of life. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)defines PE as "persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it" that "causes marked distress or interpersonal difficulty" and "is not due exclusively to the direct effects of a substance."2 The International Society for Sexual Medicine, which recently modified the definition to include the threshold ejaculatory latency time, defines PEas "male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within 1 min of vaginal penetration; the inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy."3 The lack of ejaculatory control is consistent among all clinical definitions of PE and is a highly sensitive predictor of the condition.

[Shoulder dystocia from a legal standpoint]. / Die Schulterdystokie im Spannungsfeld medicolegaler Auseinandersetzungen.

Even though a shoulder dystocia occurs very seldom it plays an important part in obstetrical medical opinions since it is quite often associated with infant plexus brachialis injuries. In legal medical discussions it is necessary to determine whether there were certain antepartal risks, if diagnosis and therapy were carried out correctly and whether a shoulder dystocia resp. plexus brachialis injury could have been prevented. In general one is looking for answers to prevent both serious complications. In the past a great number of articles were published referring to these answers. Especially in Anglo-American literature of the last few years one can find more and more indications that a clear cause-effect between shoulder dystocia and plexus brachialis injuries does not exist in every case. Also the value of typical or historical factors concerning association between the two are criticised in different publications. In addition the therapy strategies for shoulder dystocia treatments are momentarily analyzed in scientific discussions. Which treatment should be used first? Which ones are actually effective or do they even increase the risk of plexus brachialis injuries? Answers to these questions are given in the following abstract.

[Damage to the brachial plexus in vaginal delivery from breech presentation--correlation with reducing the extended arm]. / Schädigung des Plexus brachialis bei vaginaler Beckenendlagengeburt--Zusammenhang mit einer Armlösung?

BACKGROUND: Brachial plexus injuries in foetuses delivered spontaneously by breech presentation is very rare. The aim of this study was to evaluate the frequency of brachial plexus injuries in connection with the rate of the reduction of the extended arm. MATERIALS AND METHODS: In our retrospective study we examined 1194 vaginally intended breech deliveries (> 32 completed weeks) for the frequency of extended arms and subsequent plexus brachialis palsies. RESULTS: One brachial plexus injury occurred in 796 vaginally delivered newborns (1.2@1000). The outcome corresponds with the frequency of brachial plexus palsy in spontaneous deliveries with cephalic presentation (1@1000). The mean frequency of reduction of the extended arm in vaginal deliveries in breech is 10-20%. CONCLUSION: We found that the rate of reduction of the extended arm was not associated with an increase in morbidity of newborns. DISCUSSION: Many reports in the literature demonstrate that a higher rate of caesarean section does not prevent these severe foetal injuries. Noxious factors already occurring during the prenatal phase of development can be suspected as possible causes.

[Value of sonography in extrauterine pregnancy]. / Der Stellenwert der Sonographie bei Extrauteringravidität.

Out of 106 treated cases of ectopic pregnancy (e.p.) at the woman's university hospital Würzburg from 1980 to 5/1984 ectopic gestation was strongly presumed in 40 patients (38%) after physical examination. Out of 71 patients additionally undergoing sonography with a clinical diagnosis of suspected e.p. in 25%, a solid-cystic tumor was described in 22 cases and an extrauterine gestational sac in four cases, thus providing a sonographic suspicion of e.p. in 37%. Totally the part of cases with presumed e.p. before operation was doubled to 51% (36 patients) by the combined use of physical and sonographic examinations. Generally interpretation of the sonographic image is only possible in relation to the clinical findings because the ultrasound appearance of e.p. is mostly non-specific and visualization of the extrauterine gestational sac with a pulsating fetal heart that solely produces evidence, is very rare. Equally the reliable exclusion of e.p. by ultrasound remains problematic. In 13 cases (18%) of the scanned group rupture of tubal pregnancy could not be avoided.

[Mortality and morbidity of small premature infants (<1,500 g) in relation to presentation and delivery mode]. / Mortalität und Morbidität kleiner Frühgeborener ( < 1500 g) in Abhängigkeit von Poleinstellung und Entbindungsmodus.

It is generally recommended in the literature that small premature babies with an expected weight of < 1500 g or < 32 WOP be delivered by cesarean section. The development of some of these small babies from the uterine muscle is very time-consuming and rough. For this reason, we have established the mode of the delivery at the Nuremberg Women's Hospital on the basis of the criteria which also applies to the delivery of mature term babies irrespective of the gestational age and irrespective of their presentation. Of a total number of 10542 babies delivered, 219 babies < 1500 g in weight (2.07%) were born from 1987 to 1991. The extent to which differences in the mode of deliveries spontaneous/cesarean section result from the presentation of the small premature babies was investigates after five years. The mortality and morbidity were calculated separately for babies the weighing between 1500 g and 1000 g and for babies of < or = 999 g. Besides the perinatal and neonatal mortality, the mortality after the 29th day of life was also determined. The following parameters of early morbidity were established: 1. Respiratory distress syndrome++ (none/grade I-grade IV) 2. Intracranial hemorrhages (none/grade I-grade IV) Furthermore, the following parameters of late infant morbidity were determined after the first year of life. 1. Movement capacity (normal/hyperkinetic/apathic) 2. Development of the baby (corresponding to age/ slightly/severely retarded) Severely retarded fetuses with a gestational age of more than 32 weeks and a birth rate of < 1500 g were excluded from all calculations, so that ultimately 176 babies were included in the overall analysis. The total mortality of the children < 1500 g in weight was 14.3%, 15.7% were in the group between 1500 g and 1000 g and 25% were the mortality with regard to the presentation and the mode of delivery. The morbidity results indicate that only the group of babies between 1500 g and 1000 g in weight with breech presentation benefit from cesarean section. In the group of babies < or = 999 g, there are no differences in morbidity with regard to the mode of delivery and the presentation. The results found show that frequencies of cesarean section in excess of 40% improve neither the mortality nor the morbidity of small premature babies. The decision to carry out cesarean section is based more on individual influences and the situation in the hospital in which the delivery takes place than on mortality of the baby or the mother.

[Sonographically diagnosed subependymal intraventricular hemorrhage in clinically inconspicuous newborn infants and their relation to perinatal factors]. / Sonographisch diagnostizierte subependymale-intraventrikuläre Blutungen bei klinisch unauffälligen Neugeborenen und ihre Beziehung zu perinatalen Faktoren.

With an intracranial ultrasound screening at the University Clinic of Obstetrics and Gynaecology, Wuerzburg, a subependymal/intraventricular haemorrhage (SEH/IVH) was observed in 37 cases (5.5%). Of the analyzed maternal, obstetric and neonatal variables as possible risk factors of SEH/IVH, SEH/IVH was significantly more frequent in male newborns, first- and secondborn children and in infants of very young mothers, whereas it was significantly less frequently found after rupture of the membranes with the cervix fully dilated and in large-fordates infants. Factors like mode of delivery, presentation, duration of labour, drugs sub partu, maternal injuries, oligohydramnios, meconium staining, coiling of the umbilical cord, birth weight and size, post-maturity, hypotrophy, umbilical cord blood gas analysis, and Apgar score did not show a significant correlation to SEH/IVH. Multivariate analysis only substantiated an independent association between gender and SEH/IVH. Newborns with an umbilical artery pH less than or equal to 7.19 together with an one-minute Apgar score less than or equal to 8 had a four times higher bleeding rate than infants with normal pH and/or Apgar score. The mentioned parameters, however, are not appropriate to predict SEH/IVH in asymptomatic newborns. The appearance of SEH/IVH is usually due to a combination of events rather than to a single factor. The role of raised head compression and intrapartual hypoxia in the causation of SEH/IVH in term newborns has to be clarified in further studies.

[Behavior of glycosylated hemoglobin (HbA1) in normal and pathologic pregnancy]. / Das Verhalten des glykosylierten Hämoglobins (Hb-A1) in normaler und pathologischer Schwangerschaft.

Glycosylized hemoglobin (Hb-A1) was measured in 314 gravidae with normal kidneys and metabolism from the tenth to the 41st week of pregnancy. From the first to the second trimester of pregnancy a significant drop in Hb-A1 occurs, from 6.93% to 6.66%, toward the third trimester there is a significant increase to 6.86%. Post partum the Hb-A1 was also significantly lower (6.82%) than in the nonpregnant control group (7.23%). In patients with the histories and findings of risk factors influencing carbohydrate metabolism the same, though nonsignificant course was found (probably because of the lower number of cases), with a drop in Hb-A1 in the second trimester. A possible cause of this is the accelerated metabolism of glucose during pregnancy, which leads to an improvement in carbohydrate tolerance and thus lowers the Hb-A1 level, or the increased erythropoetic activity of the bone marrow during the second trimester, leading to a "thinning" and thus a reduction of the Hb-A1 concentration due to the increased volume of erythrocytes. Knowledge of the kinetics of Hb-A1 in normal pregnancy is important in order to permit correct interpretation of concentrations measured in pregnant diabetics.

["Facing"--a preliminary parameter in diagnosis of fetal skeletal abnormalities]. / "Facing"--Ein Einstiegsparameter in die Diagnostik fetaler Skelettfehlbildungen.

Four cases with abnormalities of foetal faces are demonstrated--thanatophoric dwarfism, cheilognathopalotoschisis, osteogenesis imperfecta, achondrogenesis (Type I). A relationship to skeletal dysplasia was shown. We think, that the representation of foetal faces and their profile plays an important part in second trimester ultrasound screening between 18 and 22 weeks of gestational age.

[What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?]. / Welchen Einfluss hat die Stellung der Beine bei der Beckenendlage auf den Entbindungsmodus und die neonatale Frühmorbidität?

The objective of the present study is to establish whether the position of the legs in breech presentation deliveries affects the vaginal or abdominal mode of surgical delivery and the early neonatal morbidity. The patient population investigated (n = 266) comprised 163 primiparae (61.3%) and 103 multiparae (38.7%). Of the 266 term infants (more than 37 complete WOP) with breech presentation, 71.3% (127/178) could be delivered vaginally from a simple pelvic presentation and 55.3% (42/76) from an incomplete or complete footling presentation. The average duration of labor was 460 minutes in a pelvic presentation delivery, and 400 minutes in a footling presentation delivery. The rate of acidosis (pHNA < 7.20) was 26% in the neonates delivered from the pelvic presentation as compared to 11.9% in the footling presentation deliveries. The number of neonates with a 5/10 minute APGAR score of seven points was 0/0% in pelvic and 4.8/2.4% in footling presentation. Of the neonates delivered from pelvic presentation, 10.2% (13/127) were moved to the neonatology department as compared to 14.3% (6/42) babies delivered from footling presentation. A secondary Cesarean section was indicated in 28.7% of pelvic presentation deliveries commenced vaginally (51/178) and in 44.7% of the footling deliveries (34/76). The rate of acidosis was 49% (25/51) in the babies with pelvic presentation and 21% (7/34) in the babies with footling presentation. The percentage of neonates with respiratory depression (5/10 minute APGAR score < 7 points) was 3.9/2.9% in the babies delivered from pelvic presentation and 2/0% in the babies delivered from footling presentation. Correspondingly, the rate of transfer to the neonatology ward was extremely high: 33.3% (17/51) of the pelvic presentation babies and 8.8% (3/34) of footling babies. In 11 pregnant women (5.8%) with a fetus in pelvic presentation, a primary Cesarean section was indicated, in half of these cases (n = 5) because of "suspicion of a discrepancy", three times at request of the patients and three based on fetal and on maternal indication. Because she had rejected vaginal delivery, primary Cesarean section was performed in one pregnant mother (1.3%) with a fetus in footling presentation. Fetuses with simple pelvic presentation at term were more frequently delivered vaginally than fetuses in footling presentation (71.3% compared to 55.3%). The rate of respiratory acidosis was higher in the neonates with pelvic presentation than those with footling presentation (26% as compared to 11.9%). They compensated this acidotic metabolism within a short time, so that the transfer to the neonatology ward was only temporary. The same applied to the babies delivered by secondary Cesarean section.

[Deciding criteria for vaginal delivery from breech presentation--effect on neonatal early and late morbidity]. / Entscheidungskriterien zur vaginalen Beckenendlagengeburt--Einfluss auf die kindliche Früh- und Spätmorbidität.

In the past 20 years, breech presentation obstetrics has been characterised mainly by the work of Kubli (1975): "The safest and most simple way to prevent the foetal obstetric risk of breech presentation is the systematic Caesarean section." In the past, this resulted in judicial decisions in which due to vaginal delivery a child has been damaged and the doctor has been reproached for not performing a Caesarean section. In the report of the "Standardkommission BEL" (1983) as well as in the Guidelines for the Management of Breech Delivery (FIGO 1993), subtile criteria of decision were demanded for the vaginal delivery method. To an increasing extent clinics lack the necessary training for vaginal-operative delivery for breech presentation, followed by economic obligations and, as a result, in 1994 the frequency of Caesarean sections in cases of breech presentation was 86.9% in Bavaria. Investigations should be made as to whether it is actually necessary, for the benefit of the child, to subject a mother of a breech baby to such high-risk operations. From 1988 to 1995, 1116 breech babies were born in the Gynaecological Clinic Nürnberg, Dept. of Obstetrics. The case history of 650 children with a period of gestation > 32 weeks of pregnancy were evaluated: parity, period of gestation, method of delivery, condition after Caesarean section, premature rupture of the foetal membranes, position of legs, weight of child, Apgar score, umbilical artery pH, base excess in umbilical artery mval/l, transfer ratio to paediatric clinic, reason of transfer to paediatric clinic, rate and duration of intubation, cranial sonogram and electroencephalogram.

[Breech presentation--information, anxiety and pattern of expectations of established obstetricians and pregnant patients. 2: Results of a survey of women with breech presentation]. / Beckenendlage--Informations-, Angst- und Erwartungsmuster von niedergelassenen Frauenärzten und Schwangeren. Teil 2: Ergebnisse einer Umfrage unter Frauen mit einer BEL-Schwangerschaft.

The frequency of caesarean section is increasing. A corresponding reason for this development is the increasing quota of primary caesarean section in patients with breech presentation. The aim of this study was to extend the expectation- fear- and information-profile in these patients and therefore the influence on the caesarean section rate. 100 patients with breech presentation were randomized and prospectively questionnaired. In summary, the study shows that women with breech presentation prefer primary caesarean section as the favourite delivery mode. Fears experienced before the delivery were focused accordingly on the condition of the child were in conflict to the higher incidence of maternal risk factors. Only an objective clearing of the obstetrical conditions and risk factors of the delivery modes (vaginal delivery mode, caesarean section) can induce patient's compliance which is the presupposition for a vaginal delivery mode of breech presentation.

[Incidence of conspicuous ultrasound findings in the brain in clinically asymptomatic newborn infants]. / Häufigkeit von auffälligen Ultraschallbefunden des Gehirns bei klinisch asymptomatischen Neugeborenen.

With an intracranial ultrasound screening at the University Clinic for Obstetrics and Gynaecology Wuerzburg, an abnormal finding was seen in 88 out of 673 clinically asymptomatic usually mature newborns (13.1%). It concerned 37 subependymal/intraventricular haemorrhages (5.5%), sequelae of an old intrauterine bleeding in 9 cases (1.3%), 38 ventricular asymmetries (5.7%), 5 choroidal plexus cysts (0.7%), 6 arachnoidal cysts (0.9%) and 1 infratentorial tumour (0.2%). Only mild cerebral haemorrhages were observed. Follow-up studies of children with an abnormal cerebral finding are desirable to determine its clinical significance and long-term prognosis.

[The use of sonography as a complementary procedure in the orthopedic hip diagnosis in newborn infants (a pilot study)]. / Der Einsatz der Sonographie zur Ergänzung der orthopädischen Neugeborenenuntersuchung der Hüften (Eine Pilotstudie).

In this study we tried to complete the clinical Newborn-control by sonographically investigation at the Newborn-ward. The routine clinical and sonographical combination seems to be successful. Further investigation will be necessary for the sonographic analysis of the physiologic and dysplastic acetabulum. Here we must discuss, if radiological signs can be partially translated for sonography. At last the study checked further technical-sonographical details.

Prenatal diagnosis of bilateral cystic adenomatoid malformation of the lung.

Bilateral cystic adenomatoid malformation of the lung (CAML), solid type (Stocker III), is a rare malformation that we observed sonographically in two fetuses at 23 weeks. The ultrasonic image showed an echogenic mass compressing the heart and occupying the whole thoracic cavity. Massive ascites, probably as a result of heart failure, was apparent. The prognosis is fatal. Prenatal diagnosis enables termination of pregnancy and saves the mother from invasive procedures in case of fetal distress. In unilateral, more favorable lesions, the managing physician is prepared for respiratory distress of the newborn and an emergency operation.

[Breech presentation--information, anxiety and expectations of established obstetricians and pregnant patients. 1: Results of a survey of established obstetricians]. / Beckenendlage--Informations-, Angst- und Erwartungsmuster von niedergelassenen Frauenärzten und Schwangeren. Teil 1: Ergebnisse einer Umfrage unter niedergelassenen Frauenärzten.

In a anonymous questionnaire we studied the advise of gynecologists to breech presented pregnant women in the area around Nürnberg-Fürth-Erlangen in Germany. 61.5% of gynecologists participated the study, 71.2% of them (n = 57) prefer primary caesarean section in primapara. 13.8% (n = 11) of the questioned doctors favour a vaginally delivery procedure. Advise to multiparas for primarous caesarean section was given in 8.8% (n = 7) and for vaginally delivery mode in 80.0% (n = 64). Reasons for caesarean section was a decreased fetal delivery risk (90%, n = 72) and the possibility of prospective delivery planing (26.3%, n = 21). Other reasons were various obstetrical risk factors and forensic aspects. Benefits of vaginally delivery mode in multiparas was a low fetal delivery risk (72.5%, n = 58) and a low maternal morbidity (66.3%, n = 53). Results of actual studies are suggesting, that there is a controlled fetal risk of vaginally delivery mode in breech presented labour. According to these studies a change of labour procedure is essential.