Differential gene expression analysis of ovarian cancer in a population isolate.

Gene expression products represent candidate biomarkers with the potential for early screening and therapy of patients with ovarian serous carcinoma. The present study, using patients that originate from the population isolate of South Tyrol, Italy, substantiates the feasibility of differential gene expression analysis in a genetically isolated population for the identification of potential markers of ovarian cancer. Gene expression profiles of fresh-frozen ovarian serous papillary carcinoma samples were analyzed and compared to normal ovarian control tissues using oligonucleotide microarrays complementary to 14,500 human genes. Supervised analysis of gene expression profiling data identified 225 genes that are down-regulated and 635 that are up-regulated in malignant compared to normal ovarian tissues. Class-prediction analysis identified 40 differentially expressed genes for further investigation as potential classifiers for ovarian cancer, including 20 novel candidates. Our findings provide a glimpse into the potential of population isolate genomics in oncological research.

Thromboembolism in gynecologic oncology.

The risk of thrombo-embolic complications increases in surgical gynaecological oncology as a consequence of difficult and long-lasting interventions. In gynaecologic operations without any drug prophylaxis thrombosis has been reported by 24-29%, whereas in operations of progressed oncological findings thrombo-embolic complications arise in almost every second case. Such complications have to be taken seriously due to difficulty treatable sequelae (post-thrombic syndrome) and due to potentially lethal pulmonary embolism. Furthermore, they are important causes of postoperative early mortality. Diagnosis of a deep thrombosis is insecure even for experienced clinicians. We have various diagnostical means at our disposal, such as phlebography, sounding and 125-iodine-fibrinogen-testing. Differentiated drug medication for the prevention and therapy of thrombo-embolism is definitely indicated. There are also different kinds of physical and drug-aided means, which can be applied according to the individual situation.

[Beta 2-microglobulinuria and lysozyme-uria. Their role as diagnostic and therapeutic indicators in dilatation of the upper urinary tract during pregnancy]. / Beta 2-microglobulinuria e lisozimuria. Importanza come marker diagnostico e terapeutico nella dilatazione delle alte vie urinarie in gravidanza.

In a prospective clinical trial the diagnostic and therapeutic validity of beta 2-microglobulinuria (as an indicator of tubulointerstitial damage) and lyzozymuria (as an indicator of granulomonocytic activity in urinary tract) was studied in pregnant women with dilatation of the upper urinary tract and its possible complications (urinary tract infections, acute pyelonephritic episodes). A pathologically increased beta 2-microglobulinuria (greater than 300 micrograms/l) was found in all of the infectious episodes of upper urinary tract: pyelonephritis (PN) with concomitant tubulointerstitial lesions. Asymptomatic PN-episodes could also be recognized by increased beta 2-microglobulinuria. A normal beta 2-microglobulinuria (less than 300 g/l) in pregnant women can--inspite of dilatation of the pyelon--be considered as primary or secondary (after chemotherapy) absence of infection of the upper urinary tract. Furthermore, any functional damage of the tubulointerstitial tissue, possibly caused by the pyelondilatation during pregnancy, can be excluded. A positive lysozymuria (less than 0.3 mg/dl) indicates the infection of the lower and/or upper urinary tract; also asymptomatic infectious episodes may be detected. A negative lysozymuria (less than 0.3 mg/dl) proves the absence of any infection in the lower and upper urinary tract. Pseudo-infections, caused by contamination, can also be revealed. The determination of beta 2-microglobulinuria and lysozymuria increases the diagnostic and therapeutic potency in the evaluation of dilatation of upper urinary tract and its complications during pregnancy.

[Intrapartum sonographic study in clinical suspicion of cephalopelvic disproportion]. / Intrapartale sonographische Untersuchung bei klinischem Verdacht auf Missverhältnis.

The realisation of a clinical disproportion is--still nowadays--a high demand for obstetricians. The ultrasonic examination of pelvis represents an intermediate stage between clinical and radiological examination. Description of pelvis by measuring the true conjugate and intrapartal diagnosis of abnormalities of adjustment and bearing of the fetus. It enables in many cases to set the indication of caesarean section earlier and safer.

[Endometriosis of the ureter]. / Die Endometriose des Ureters.

In this report two cases of hydronephrosis caused by an isolated ureter endometriosis are shown. The symptoms were few and not typical. The function of one kidney was severely diminished.

[Sonographic demonstration of a via falsa formation with imminent uterine rupture in uterus duplex unicollis]. / Sonographische Darstellung einer Via-falsa-Bildung mit drohender Uterusruptur bei Uterus duplex unicollis.

The diagnosis of a via falsa abnormality of uterus duplex unicollis by ultrasound is reported in a case of unclear gynecological examination finding.

[Obstetrical management in dysfibrinogenemia]. / Geburtshilfliches Management bei Dysfibrinogenämie.

Dysfibrinogenaemia is an inherited disorder, characterised by a plasmafibrinogen in normal concentration, but of abnormal quality due to impaired release of fibrinopeptides and/or impaired aggregation of fibrinomonomers. The typical abnormalities of the laboratory findings will be demonstrated by presenting the case reports of 4 patients with 5 pregnancies (1 ectopic pregnancy); the importance of clinical exploration is emphasized. Newborn infants must be subjected to careful clinical and biochemical examination, because of factors of Mendelian dominant inheritance.

[Intraplacental hematoma following chorionic villi biopsy]. / Intraplazentares Hämatom nach Chorionzottenbiopsie.

One of the most typical complications following chorionic villae sampling (CVS) is vaginal bleeding shortly or some days after the intervention, resulting in abortion in some cases. We report on a case of intraplacental haematoma (pathology: massive subtotal acute haemorrhagic placental infarct), followed by acute placental insufficiency in the 29th week of pregnancy. Therefore, we decided on an emergency caesarean section.

[Comparison of the effectiveness of prostaglandin E2 gel in evening and morning induction of labor]. / Vergleich der Wirksamkeit von Prostaglandin E2-Gel bei abendlicher und morgendlicher Geburtseinleitung.

100 women participated in an open randomised study. 50 of them received 0.5 mg PGE2 in 2.5 ml Triacetin gel (Prepidil) intracervically in the morning (6.00 a.m.) and 50 at night (10.00 p.m.). The success rate was 74% (37 of 50) in the treatment group of the night compared with 52 (26 of 50) in the group of morning labor induction. A second dose after 8 hours was necessary in 26% (13 of 50) in the night group and in 48% (24 of 50) of the morning labor induction. Labor induction failed completely in 32% of the morning and in 12% of the night group. The induction time for contractions was 2 hours shorter after night labor induction, in primiparae the duration of first stage was 2 hours shorter but in multiparae there was no difference between the groups. There was also no difference in intrapartum and postpartum complications between the groups. In conclusion the induction of labor with intracervical PGE2 at night seems to be more effective without increasing the rate of complications.

[Maternal mortality, its definition and assessment. Report of maternal mortality at the Bamberg Gynecologic Clinic 1963-1988]. / Zur Frage der mütterlichen Mortalität, ihrer Definition und Erfassung. Bericht über die Müttersterblichkeit an der Frauenklinik Bamberg in den Jahren 1963-1988.

During the period of observation from 1963-1988 (26 years) 16 maternal deaths during pregnancy, birth and post partum were registered among 59,681 births at the Departm. of Obstetr. and Gynaec. Bamberg. This corresponds to a maternal mortality ratio of 0.26%. Thirteen of the deaths were direct material deaths, three cases of death belong in the category of indirect deaths. In this timeframe 4,257 (7.13%) C-sections were done. The rate of C-sections has almost tripled during the last 26 years, increasing from 3.6% in 1963 to 10.1% in 1988. In 10 cases maternal death followed a C-section. Taking the complete period of observation into account, the mortality rate after C-section of 2.34% is about 20 times higher than the mortality risk after vaginal delivery. This heightened mortality risk after C-section is clearly diminishing. In the years 1973-1982 the C-section mortality rate was only 6 times higher than maternal deaths after vaginal deliveries.

[Peritoneal deciduosis: cause for mechanical ileus in pregnancy]. / Peritoneale Deziduose: Ursache für einen mechanischen Ileus in der Schwangerschaft.

Decidual transformation of the peritoneum is a frequent occurrence during pregnancy. Incidence and pathogenesis are vague. Complications like bleeding, suspicion of cancer and adhesions are rare. We present a case of mechanical ileus, followed by acute prerenal failure of the kidney caused by decidual transformation of the peritoneum.

[Stillbirth--an analysis of 354 cases 1966-88]. / Die Totgeburt--eine Analyse von 354 Fällen aus den Jahren 1966-1988.

A study was conducted on the collection of stillbirths occurring during the last 23 years in the Gynaecological Hospital in Bamberg. The data were taken from the birth reports and the recorded course of each pregnancy. The results of the first 22 years were divided into 2 groups, the first 11 years and the subsequent 11 years, to enable better judgement of trend changes. A total number of 354 children died antepartum or subpartum, the larger group (249) being that in the first 11 years of the observation period. The number of stillborn babies decreased from 40 per year (15%) to 3 per year (1.1%) in the first period. In the collective group the regular participation in prenatal visits increased from 24% to 56%. The percentage of single mothers (9%) remained constant. The number of foreign mothers, who are non-German citizens rose from 2% to 8%. As expected, the rate of stillbirths for twins was almost 4 times higher (5.3%) than for the single pregnancies. The percentage of multiparous women decreased from 66% to 48%. The number of stillbirths, preceded by a miscarriage and abortion in the patient's clinical history, remained constant at 17%. The age distribution of the mothers was almost the same for both observation periods. The usual age of the pregnancy at the time of the stillbirth shifted from the 39th-42nd week to the 35th-38th week. The main complication for the entire group was pre-eclampsia, at the rate of 30%. Amnion infection syndrome (4%) and diabetes mellitus (2%) were rare. The primary cause of foetal death was related to placental dysfunction (40%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Bulimia, induced vomiting, hypochloremic-hypokalemic alkalosis and fetal distress in the 33rd week of pregnancy. Obstetric and anesthesiologic management]. / Bulimie, provoziertes Erbrechen, hypochlorämisch-hypokaliämische Alkalose und fetaler Distress in der 33. Schwangerschaftswoche. Geburtshilflich-anaesthesiologisches Vorgehen.

A 39-year-old primigravida was admitted to the hospital in the 33rd week of pregnancy due to fetal retardation and placental insufficiency, malnutrition, decreased cutaneous turgor, and cardiotocographic (CTG) fetal distress. Body weight had increased subnormally through the 29th week of gestation and had since decreased by 2.5 kg. The following laboratory tests were obtained (normal values for pregnant women in parentheses): serum bicarbonate 50.9 (20-24) mmol/l, pH 7.61 (7.4), PCO2 52.4 (31) mmHg, SaO2 89-91 (greater than 95%); serum sodium 125 (137-145), potassium 1.8 (3.6-5.5), chloride 55 (94-111) mmol/l; colloid osmotic pressure 20.7 (19-22) mmHg. A decompensated hypochloremic-hypokalemic acidosis together with hypovolemic, isotonic hyponatremia was diagnosed and bulimic vomiting that had existed for two decades was discovered as the underlying cause. The acute therapy was aimed at normalization of the fluid-electrolyte status, oxygenation, utero-placental perfusion, and placental-fetal O2 transfer and was carried out under close clinical, biochemical, and CTG surveillance. In addition to the basic measures (lateral tilt position, nasal O2 application, isotonic electrolyte solutions, parenteral nutrition), 158 mmol H+, 240 mmol K+, and 414 mmol Na+ ions were administered. This therapy improved the maternal and fetal parameters continuously (Table 3, Fig. 1). Twenty-six hours following the initiation of treatment, a cesarean section was performed after induction of catheter-epidural anesthesia.

[The Kartagener syndrome]. / Das Kartagenersyndrom.

A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility. Kartagener's syndrome is a rare disorder involving the combination of situs inversus, bronchiectasis and sinusitis. A dynein deficiency leads to ciliary dyskinesia. When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind: ascertainment of the preoperative pulmonary status, antibiotic coverage, recognition of dextrocardia, necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis. Anticholinergic and antitussive medications are relatively contraindicated, as are nasal tubes. In the present case an intubation anaesthesia with thiopental, nitrous oxide, enflurane and succinylcholine was carried out; cefoxitin was administered for antibiotic treatment, and the patient made an uneventful recovery.

[Hereditary prolonged QT interval (Romano Ward syndrome) in obstetric management]. / Hereditär verlängertes QT-Intervall (Romano Ward Syndrom) im geburtshilflichen Management.

In the Romano-Ward syndrome, an inherited form of abnormally prolonged QT duration is a matter for concern. The frequency-corrected QTc value in the ECG amounts to more than 0.44 s. Persons suffering from Romano-Ward syndrome are vitally endangered by attacks of arrhythmia, syncope and cardiac arrest which are triggered or aggravated by stress or certain drugs. In obstetrical anaesthesia, attention should be paid to the foetus, which, due to the genetic dominance, will have a 50% probability of suffering from the disorder. A 28-year-old para I was admitted with cervical dilation on her predetermined date of delivery. Romano-Ward syndrome had been diagnosed 10 years earlier. The patient had been free of complaints and had received no treatment. Due to cephalopelvic disproportion and the cardiac syndrome, a primary Caesarean section was performed. The QTc values were pathologically prolonged (0.47 s; 0.48-0.63 s) during the pre- and intraoperative period. Haemodynamic irregularities did not occur in the perioperative period. The newborn was vital (3.830 g; 50 cm; Apgar scores 10/10/10; umbilical cord pH 7.29). Directly postpartum isolated supraventricular extra systoles occurred, and the QTc duration increased to 0.51 s.

[Hereditary prolonged QT interval (Romano-Ward syndrome) in a female patient with non-elective cesarean section]. / Hereditär verlängertes QT-intervall (Romano-Ward-Syndrom) bei einer Patientin mit nicht-elektiver Sectio caesarea.

In the Romano-Ward syndrome, an inherited form of abnormally prolonged QT duration is the matter of concern. The frequency-corrected QTc value in the ECG amounts to more than 0.44 s (upper mean value: 0.44 s). Persons suffering from Romano-Ward syndrome are vitally endangered by attacks of arrhythmia, syncope, and cardiac arrest that are triggered or aggravated by stress or certain drugs. In obstetrical anesthesia, attention should be paid to the fetus, which, due to the genetic dominance, will have a 50% probability of having the disorder. A 28-year-old para I was admitted with cervical dilation on her predetermined date of delivery. Romano-Ward syndrome had been diagnosed 10 years earlier; the patient had been free of complaints and had received no treatment. Due to cephalopelvic disproportion and the cardiac syndrome, a primary cesarean section was performed. Following premedication and provision of a beta-blocker, defibrillator, and drugs for resuscitation, intubation anesthesia with methohexital, nitrous oxide, enflurane, and succinylcholine was carried out. The QTc values were pathologically prolonged (0.47 s; 0.48-063 s) during the pre- and intraoperative period. Hemodynamic irregularities did not occur in the perioperative period. The newborn was vital (3,830 g, 50 cm; Apgar scores 10/10/10; umbilical cord pH 7.29). Directly postpartum isolated supraventricular extrasystoles occurred, and the QTc duration increased to 0.51 s. Simultaneous registration of the ECG and phonocardiogram showed premature occurrence of the second cardiac sound, which is typical of Romano-Ward syndrome.