The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery: a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG).

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS.

Serum hCG decline following salpingotomy or salpingectomy for extrauterine pregnancy.

Twenty-five women with ectopic pregnancy were surgically treated, fifteen by conservative salpingotomy and ten by radical salpingectomy. All patients showed a clinically normal postoperative course. Serum human chorionic gonadotropin (hCG) levels were determined serially before and after the surgical procedure until non-pregnant values (< 5 mI.U./ml) were reached. Serum hCG decline was compared between patients treated by salpingotomy versus salpingectomy, using calculated hCG half-life times. We observed a significantly slower decline of serum hCG levels during the early phase of hCG disappearance in patients treated by salpingotomy versus patients treated by salpingectomy.

Preliminary results with the use of the ROM-check immunoassay in the early detection of rupture of the amniotic membranes.

The unequivocal presence of amniotic fluid in the vagina is an important clinical sign of rupture of amniotic membranes, entailing impending delivery or risk for chorioamnionitis. Commonly used methods for detection of amniotic fluid in the vagina include pooling, ferning, nitrazine paper, ultrasound measurement of amniotic sac dimensions, dye injection or measurement of prolactin in vaginal secretions. These results are either difficult to interpret or are obtained after an invasive or expensive procedure. Measurement of alphafetoprotein (AFP) in vaginal secretions has also been considered for this application, but has proven unreliable due to its similar concentration in maternal plasma and amniotic fluid in the third trimester of pregnancy. We have evaluated a recently introduced method, the ROM-check Immunoassay (Adeza Biomedical, Sunnyvale, CA, USA) which is based on the detection of a fetal isoform of fibronectin in vaginal secretions when amniotic fluid is present. Our aim was to establish the reliability and clinical efficacy of this test in a number of obstetrical situations with unequivocal or equivocal rupture of the membranes (ROM). We conclude that in cases of unequivocal rupture and/or intactness of membranes, results of the ROM-check Immunoassay correspond well with the clinical findings, whereas in clinically equivocal rupture of the membranes, the test may add proof to the clinical suspicion of ROM but has to be interpreted with caution along with other clinical and non-clinical parameters.

Innervation anomalies in upper and lower extremities: potential clinical implications. How to identify with electrophysiologic techniques.

In the course of an electrodiagnostic investigation of a peripheral nerve lesion, the examiner may be confronted with unexpected findings in contradiction with the clinical picture. Often these aberrant findings may be the result of an innervation anomaly. In this review article, a description is given of the most common innervation anomalies in upper and lower extremities: communications between the median and ulnar nerves in the forearm, communications between the median and ulnar nerves in the hand, innervation of the median nerve territory in the forearm and hand by branches of the musculocutaneous nerve, the existence of an accessory deep peroneal nerve. Useful electrodiagnostic tests to identify these anomalies are described along with the clinical situations where these anomalies may be a source of misinterpretation. A few clinical cases are reported were these tests were useful to recognize an anomaly. Note: in this study all recordings during nerve conduction studies were done with surface electrodes.