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Introduction: Unprotected power morcellation can lead to a spread of previously undiagnosed malignancy. We present a new containment bag with two closable trocar insertion sites to reduce this risk. This pilot study was designed to assess the feasibility of this device under everyday conditions., Material and Methods: The containment bag was used in ten laparoscopic supracervical hysterectomies. We evaluated time requirement for bag insertion into the abdominal cavity and in-bag morcellation. A 2000 ml polyurethane morcellation bag was used for all interventions. All surgeries were carried out in a three-trocar setting., Results: We carried out ten supracervical hysterectomies. No intraoperative complications and no bag ruptures occurred. The meantime requirement to insert the bag and prepare the specimen for morcellation was 10.5 min (range, 7-19 min). The mean specimen weight was 191.9 g (range, 32-710 g). Mean morcellation time was 10.5 min (range, 3-28 min), mean weight of remaining tissue and fluid in the bag after morcellation was 12.1 g (range, 7-19 g)., Conclusions: The presented data demonstrate that the endobag can be successfully applied in the clinical routine. Further studies are required to evaluate additional characteristics, such as individual learning curve and time requirements.

With the objective of evaluating the functional maturation age and developmental disturbances we have previously introduced the fetal autonomic brain age score (fABAS) using 30 min fetal magnetocardiographic recordings (fMCG, Jena). The score is based on heart rate pattern indices that are related to universal principles of developmental biology. The present work aims at the validation of the fABAS methodology on 5 min recordings from an independent database (fMCG, Bochum).We found high agreement of fABAS obtained from Jena normal fetuses (5 min subsets, n =  364) and Bochum recordings (n =  322, normal fetuses). fABAS of 48 recordings from fetuses with intra-uterine growth restriction (IUGR, Bochum) was reduced in most of the cases, a result consistent with IUGR fetuses from Jena previously reported. fABAS calculated from 5 min snapshots only partly covers the accuracy when compared to fABAS from 30 min recordings. More precise diagnosis requires longer recordings.fABAS obtained from fMCG recordings is a strong candidate for standardized assessment of functional maturation age and developmental disturbances. Even 5 min recordings seem to be valuable for screening for maturation problems.

Background and Objectives: Laparoscopic surgery is associated with reduced morbidity, and postoperative pain is reduced. The aim of this study was to assess postoperative pain intensity, analgesic requirements, and the influence of cofactors after laparoscopic sacral colpopexy., Methods: The study assessed 287 patients treated with laparoscopic sacropexy for genital prolapse with a Pelvic Organ Prolapse Quantification grade>1. Patients were asked to evaluate their pain postoperatively using a 4-point verbal pain rating scale. In addition, medical records were analyzed regarding the requirement for analgesic medication., Results: Patients distinguished between abdominal pain and shoulder pain after laparoscopy. Abdominal pain reached maximum severity on day 1 and showed a good response to nonsteroidal antiphlogistics, whereas shoulder pain was rarely found (6.27%). Of the patients, 38% required no pain treatment or required 1 dose at most. The need for pain medication reached its climax on day 1 and decreased during the 5 following days. Non-opioid analgesics provided a sufficient therapeutic effect., Conclusion: Laparoscopic sacropexy is associated with a moderate degree of postoperative pain. Non-opioid analgesics should be preferred as first-line therapy. The typical shoulder-tip pain showed only a low prevalence in our study group. From our point of view, the low rate of shoulder-tip pain corresponded with the low intra-abdominal carbon dioxide pressure.

Introduction: The partogram is a central record in everyday practice for midwifes and obstetricians. For legal enquiries it is one of the most important documents, however, so far there is no standardised partogram in use in Germany. This study explores the current requirements and develops a standardised partogram., Material and Methods: In Germany 95 hospitals with a focus on tertiary referral centres were randomly selected to be questioned. Obstetricians and midwifes were asked to answer a questionnaire, which was based on a current literature search and expert interviews., Results: 49 obstetricians (51.6%) and 24 midwives (25.3%) returned the questionnaires. 80% of those regularly cooperate with the other specialty with a partogram. 75% are using a standardised partogram, 8% an empty page and 6% computerised obstetric records. Most responders are using parameters which are defined in the current guidelines of the German Society of Obstetrics and Gynaecology. Variations were especially pronounced in the scoring system of the cardiotocogram and on legal issues. Room for improvement of the current documentation was documented in half of the cases., Discussion: There is a need for optimising the current birth documentation. With the results of the questionnaire a standardised model for a partogram was developed., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study examines signal availability in fetal electrocardiogram (FECG) beat-to-beat acquisition and the accuracy of fetal heart rate variability (HRV) analysis in the clinical setting using a commercially available FECG monitor. Signal availability was examined in 130 FECG recordings of 0.3-17.5 h duration collected in 63 fetuses (25th-42nd week of gestation) under uncontrolled conditions. Identification of R-peaks demonstrated a signal loss of 30% ± 24% with 3.6 ± 1.7 signal gaps per minute. Median duration of the gaps within a recording was 1.8 ± 0.2 s. Per hour of recording, 1.8 ± 2.1 episodes of 5 min of uninterrupted data were found. Signal availability improved with gestational age and was poorer in women with high body-mass index. Fetal HRV between weeks 36-42 was examined on the basis of 5 min RR-interval episodes obtained under controlled quiet conditions in 55 FECG compared to 46 high quality fetal magnetocardiograms. There were no differences in RR-interval duration, its standard deviation and low frequency power. However, various measures of short-term HRV were significantly higher in the FECG data: root mean square of successive differences (10.0 ± 1.8 versus 6.6 ± 3.0 ms, p < 0.001, high frequency spectral power (24 ± 12 versus 13 ± 13 ms(2), p < 0.001) and approximate entropy (0.86 ± 0.16 versus 0.73 ± 0.24, p = 0.007). We conclude that, in spite of considerable signal loss, FECG recordings can accurately estimate heart rate and its overall variance. However, measures that quantify short-term beat-to-beat HRV will be compromised due to possible recurring inappropriate detection of single R-peaks.

Aim. There is no consensus about the normal fetal heart rate. Current international guidelines recommend for the normal fetal heart rate (FHR) baseline different ranges of 110 to 150 beats per minute (bpm) or 110 to 160 bpm. We started with a precise definition of "normality" and performed a retrospective computerized analysis of electronically recorded FHR tracings. Methods. We analyzed all recorded cardiotocography tracings of singleton pregnancies in three German medical centers from 2000 to 2007 and identified 78,852 tracings of sufficient quality. For each tracing, the baseline FHR was extracted by eliminating accelerations/decelerations and averaging based on the "delayed moving windows" algorithm. After analyzing 40% of the dataset as "training set" from one hospital generating a hypothetical normal baseline range, evaluation of external validity on the other 60% of the data was performed using data from later years in the same hospital and externally using data from the two other hospitals. Results. Based on the training data set, the "best" FHR range was 115 or 120 to 160 bpm. Validation in all three data sets identified 120 to 160 bpm as the correct symmetric "normal range". FHR decreases slightly during gestation. Conclusions. Normal ranges for FHR are 120 to 160 bpm. Many international guidelines define ranges of 110 to 160 bpm which seem to be safe in daily practice. However, further studies should confirm that such asymmetric alarm limits are safe, with a particular focus on the lower bound, and should give insights about how to show and further improve the usefulness of the widely used practice of CTG monitoring.

Objective: The objective of this study was to assess the fetal heart rate (FHR) signal quality of non-invasive abdominal fetal electrocardiogram (fECG) in comparison to the Doppler ultrasound cardiotocogram (CTG) during the first and second stage of labour., Study Design: This was a prospective observational study of non-invasive fECG using five abdominally sited electrodes against the traditional Doppler ultrasound CTG probe on 144 patients. Data were analysed for signal quality before and after outlier removal., Results: Abdominal fECG signal quality was significantly better during the first stage of labour in comparison to Doppler CTG (median fECG reliability of 95.7 % vs. median 87.3 % for Doppler, p < 0.001), whereas during second stage of labour, equivalence was demonstrated (p > 0.05). For the first and second stage of labour, fECG showed 106/135 (78.5 %) and 46/98 (46.9 %) women having fetal signal loss below 20 %, respectively. Similarly, Doppler ultrasound demonstrated 104/135 (77.0 %) and 51/98 (52.0 %) women having fetal signal loss below 20 % during first and second stage of labour, respectively., Conclusion: The non-invasive abdominal fECG presents an improved FHR signal quality during the first stage of labour and an equivalent signal quality during the second stage.

Introduction: No validated questionnaire that evaluates vaginal symptoms is currently available in the German language. Here, we report the translation and validation process of the German ICIQ-VS., Subjects: Pilot study: 10 patients without any specific disease. MAIN STUDY: 58 Patients (cases) suffering from genital descensus higher than grade 1 pelvic organ prolapse quantification (POPQ) and 51 patients (controls) without vaginal affections., Methods: To establish a cultural-adaptive equivalent in German, recommendations from Guillemin et al. [J Clin Epidemiol 1993;46:1417-1432] were carefully followed. Participants of the main study were asked to fill in the questionnaire at three time points [baseline (T1), 7 days later (T2) and 1 year later (T3)]. Reliability, validity and sensitivity to change were evaluated., Results: In our pilot study, all questionnaire items were correctly interpreted and answered. In the main study, no changes from the original format were observed after translation and cultural adaptation. For the cases, internal consistency was acceptable (Cronbach's alpha 0.72-0.79) and test-retest reliability was moderate to near-perfect for single items (weighted kappa 0.67-0.94). Sensitivity to change and content validity were excellent. Construct validity revealed statistically significant differences between groups., Conclusion: The ICIQ-VS has successfully been translated and validated into the German language., (Copyright (c) 2010 S. Karger AG, Basel.)

In this first prospective, randomized, single-blind, placebo-controlled study, 28 infertile patients with severe oligoasthenozoospermia received acupuncture according to the principles of traditional Chinese medicine (TCM) and 29 infertile patients received placebo acupuncture. A significantly higher percentage of motile sperm (World Health Organization categories A-C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture.

The phylloid tumor (PT, formerly called cystosarcoma phylloides) is a rare neoplasia of the female breast. Usually the PT is treated with breast-conserving surgery. In spite of progress in early diagnosis, PTs recur frequently--independently of tumor's degree of malignancy. Especially in cases of malignant PT, complete resection with tumor-free margins is seen as the only predictive marker for tumor recurrence or metastases. Benign PT is also often resected with wide tumor-free margins. Because of the tumor's occasionally enormous dimensions, this therapy concept makes breast-conserving surgery almost impossible. A simple enucleation of benign PT is an option to facilitate the preservation of breast tissue and a cosmetically satisfactory breast reconstruction. In the case of particularly large benign PT, enucleation even without wide margins prevents tumor recurrence.

Objective: To identify sensitivity and specificity of computerised cardiotocography (CTG) analysis for fetal acidosis during delivery., Design: Retrospective observational study., Setting: Tertiary referral labour ward, Technical University München (TUM) and University Witten/Herdecke (UWH)., Population: All deliveries, which had at least one fetal scalp pH measurement and electronically saved CTG traces, between 2000 and 2002 (TUM) and between 2004 and 2005 (UWH)., Method: Correlation analysis of fetal scalp pH values and computerised International Federation of Obstetrics and Gynecology (FIGO) classification using 'CTG Online' program of digitally saved CTG traces., Main Outcome Measures: Fetal scalp pH values, FIGO parameter (baseline, variability, acceleration and deceleration) using computerised analysis., Results: Both collectives showed a high sensitivity (95.0%) for computerised FIGO classification 'suspect' and 'pathological', together with a low specificity (21.8%) for fetal acidosis. The most sensitive single FIGO parameter was deceleration. Very low sensitivity (<50%) was shown for the parameters variability and acceleration., Conclusions: Computerised CTG analysis is highly sensitive for fetal acidosis and can be used as an objective adjunctive criterion during delivery. Further CTG data are needed to adjust and optimise each FIGO parameter and increase sensitivity and specificity.

Addition of the inflammatory cytokine interleukin (IL)-6 to the culture medium of human cord blood haematopoietic stem and progenitor cells (HSPCs) has been shown to lead to an altered stromal cell-derived factor-1alpha-dependent migratory phenotype. This study investigated whether this effect was attributed to a differential engagement of protein kinase C (PKC) isotypes. The migratory activity of both Flt3-ligand and Flt3-ligand/IL-6 cultured cord blood HSPCs was PKC-alpha dependent on day 1, but PKC-alpha independent after 5 d of cultivation. PKC-alpha expression was not down-regulated in cells cultured for 5 d indicating a switch of signalling molecules directing cell migration.

We present a case of supraventricular tachycardia affecting one fetus in a twin pregnancy. Before and after treatment with flecainide and cardioversion, we examined conduction times and heart rate variability (HRV) in both twins on the basis of magnetocardiography. Cardiac conduction times increased in both fetuses but HRV showed opposing effects with a number of HRV measures. This case demonstrates that magnetocardiography not only enables identification of fetal arrhythmia, but also permits the investigation of the effects of antiarrhythmic treatment on the conductive system as well as on interaction with the autonomic nervous system.

Intrauterine intestinal volvulus is a difficult diagnosis to make, but has life-threatening implications for the fetus. We present a case of vulvulus without malrotation in a single fetus revealed in the 32nd gestation week in a 44-year-old woman. The presenting complaint of this patient was reduced fetal movements. Ultrasound examination showed a normal result except for a dilated stomach. Doppler ultrasound results were within the normal range. Computed cardiotocography (CTG) showed pathological results for acceleration and suspect values for variability. Short-term variability (STV) was at 2.80 ms. Due to the pathological computed CTG results a Caesarian section was carried out. The newborn received prompt postnatal surgical treatment and continues to be in good overall condition.

To date, cancer is still the second most prevalent cause of death after cardiovascular diseases in the industrialized word, whereby the primary cause of cancer is not attributed to primary tumor formation, but rather to the growth of metastases at distant organ sites. For several years it was considered that the well-known phenomenon of organ-specific spreading of tumor cells is mostly a mechanical process either directed passively due to size constraints (mechanical trapping theory) or due to a fertile environment provided by the organ in which tumor cells can proliferate (seed and soil hypothesis). Both mechanisms strongly depend on the adhesive properties of tumor cells either to endothelial cells and/or cancer cells, which are facilitated by a variety of cell adhesion molecules including carbohydrates and integrins. Within the past years it became evident that the organ-specific metastatic spreading of tumor cells does not only rely on heterotypic and homotypic adhesive interactions, but also on the interplay of chemokines and their appropriate receptors. Moreover, the identification of cancer stem cells in various tumor tissues has opened new questions. Cancer stem cells possess self-renewal, differentiation, and tumor-initiating capacities. Thus these cells are ideal candidates to be the seed of a secondary tumor. In the present review we will give a brief overview about the complex process of organ-specific metastasis formation depending on the interplay of adhesion molecules, chemokines, and the putative role of cancer stem cells in metastasis formation.

Background: Magnetocardiography and M-mode fetal echocardiography are non-invasive techniques capable of identifying fetal arrhythmias. The STAN-fetal scalp electrode system can record the fetal echocardiogram in labor., Case: A patient was admitted to hospital with preterm contractions and cervical insufficiency at 28 weeks of gestation. After treatment with a beta-sympathomimetic drug (Partusisten) one fetus developed supraventricular tachycardia. After terminating the Partusisten medication, there was no effect on the fetal arrhythmia and flecainide therapy was initiated. Maintenance dosages controlled the condition thereafter. Cardiac time intervals of a fetus in labor can be presented, which did not change significantly throughout the first stage of labor., Conclusion: Flecainide is an effective therapy for supraventricular tachycardias in a twin pregnancy. Analyzing the cardiac time intervals during pregnancy can improve perinatal outcome., (Copyright 2008 S. Karger AG, Basel.)

Background: Heart rate variability (HRV) is becoming increasingly important in the analysis of prepartal cardiotocography (CTG). Dawes and Redmann have developed a computer algorithm which can calculate short-term variability on the basis of CTG data. In dealing with artefacts, CTG monitors average heart rate values over several beats which makes the use of standard measures of HRV such as the root mean square of successive differences (RMSSD) inappropriate. Fetal magnetocardiography (FMCG) enables the registration of signals similar to the electrocardiogram and this permits the precise determination of heart beat duration and, in consequence, of measures of fetal HRV., Methods: In this study we applied both methods--CTG and FMCG--sequentially and simultaneously in healthy pregnancies. Fetal short-term HRV was estimated on the basis of RMSSD values for both methods., Results: The RMSSD values of the FMCG data were generally higher and showed a wider dynamic range than those of the CTG. The direct comparison of the simultaneously acquired data demonstrated that the data processing of the CTG signal leads to a suppression of essential aspects of short-term HRV., Conclusion: FMCG permits a substantially more differentiated examination of fetal HRV and offers new possibilities in the analysis of fetal cardiac activity.

Monocytes originate from precursors made in the bone and remain in the circulation for nearly 24 h. Much effort has been done to identify the molecules regulating transendothelial migration of monocytes during inflammatory conditions. In contrast, considerably less is known about the process of constitutive monocyte emigration although nearly 340 million monocytes leave the circulation each day in healthy individuals. Previous studies indicated that chemokines were up-regulated in monocytes cocultured with endothelial cells that induce the retraction of the latter cell type, thereby increasing vascular permeability. Thus, we hypothesized that the utilities required for efficient constitutive monocyte extravasation are generated by monocytes themselves because of adhesion to naïve endothelial cells. To test this hypothesis, cDNA microarray analysis was performed to determine the changes in the gene expression pattern of primary monocytes that have been attached to endothelial cells compared with monocytes that were held in suspension, and we were able to identify three major groups of genes. The first group includes genes such as matrix metalloproteinase 1, monocyte chemoattractant protein 1, and tissue transglutaminase 2, which are likely required for monocyte extravasation. The second group consists of genes that are expressed in phagocytes such as caveolin-1 and CD74. Finally, the third group comprises genes that are expressed in cells of endothelial tissue and cartilage including E-selectin, fibronectin-1, matrix Gla protein, and aggrecanase-2. In summary, we conclude that adhesion of peripheral blood monocytes to naïve endothelial cells has two effects: mandatory extravasation-specific genes are regulated, and the differentiation program of monocytes is initiated.

Prenatal growth deficiencies as well as gender have been associated with cardiovascular disease in later life. It is also known that the duration of fetal cardiac time intervals (CTI) are dependent on fetal development. The aim of this work was to examine the relationship between fetal CTI in healthy and intrauterine growth retardation (IUGR) fetuses, taking gender into account. A total of 269 magnetocardiograms (MCG) were obtained in 47 healthy and 27 IUGR pregnancies. In each signal-averaged MCG, durations of CTI were determined. Age- and heart rate-corrected values were compared between normal and IUGR fetuses separately with respect to gender. Overall, there was an association between atrial and ventricular conduction times and estimated fetal body weight. In female fetuses, IUGR was associated with shorter P WAVE, PQ segment, PR interval, and QRS complex and longer STT and QT intervals. For males, this was so only for P wave, QRS complex, and STT interval. The shortening of conduction times in IUGR may be explained by reduced cardiac muscle mass associated with lower body weight. On the other hand, the gender-specific differences, particularly in the IUGR fetuses may be due to hormonal factors.

Objective: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI)., Design: Randomized, prospective, controlled clinical study., Setting: University IVF center., Patient(s): Two hundred twenty-five infertile patients undergoing IVF/ICSI., Intervention(s): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture., Main Outcome Measure(s): Clinical and ongoing pregnancy rates., Result(s): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%)., Conclusion(s): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

The non-stress test is the most commonly used method in prepartal surveillance. Due to the high intra- and interobserver variability involved in subjective evaluation, the computer-assisted analysis is gaining in importance. Some studies have shown that low foetal STV may be associated with higher rates of acidosis and intrauterine mortality. Other factors influencing STV are largely not known. Low STV has been found as an effect of cortisone. In this case report, we illustrate the relevance of haemodilation therapy in the context of essential hypertension in the 27 (th) week of gestation and its effect on SVT. The treatment led to a prolongation of pregnancy to the 32 (nd) week. At the start of treatment STV increased to 4.5 ms and dropped back below this value concurrently with centralisation as documented by Doppler sonography. STV correlated clearly with the foetal condition. However, STV is dependent on numerous factors which should be investigated in further studies in order to determine appropriate reference values.

We hypothesized that inclusion of p21(WAF1), an indicator of biological function, into the p53 assay might improve the clinical value of p53 in breast cancer diagnosis. In primary breast carcinomas (n = 146) and healthy/benign controls (n = 40), the p53 protein was quantified by luminescence immunoassay. The p21 protein was simultaneously measured by quantitative ELISA in a representative subgroup of breast cancers (n = 52) and controls (n = 17). In controls, p53 but not p21 was detectable. In almost all cancer tissues, p53 and p21 expression could be quantified. There was no correlation between the concentrations of both proteins. However, if p53 exceeded a threshold of 1.0 ng/mg protein, p21 expression was significantly reduced compared with samples with p53 below threshold. p21 was normally distributed in the low-p53 subpopulation, but not in the high-p53 group. The histologic parameter 'grade III' was more often found (p = 0.002) in tumors with p53 >1.0 ng/mg protein than in those with p53 below the threshold. Histological criteria of high tumor malignancy were found more often in cases with high p53 but low p21. Consequently, in clinical routine, a quantitative double assay of p53 and p21(WAF1) might help to discriminate breast cancers with preserved or impaired/lost p53 function., (Copyright (c) 2006 S. Karger AG, Basel.)

Surgical stress and anaesthetics are able to suppress the immune system. This may accelerate the growth and metastasis of residual cancer cells. As Viscum album L. extracts (VA-E) are known to exert both effects, immunomodulating and apoptosis-inducing properties, a Good-Clinical-Practice-guided, prospective bi-centric phase II study was conducted to measure the influence of a perioperative intravenous application of a VA-E on granulocyte function. In 98 patients with breast cancer, it was shown that a single intravenous application of the standardized VA-E "Iscador M special" in a final concentration of 1 mg/individual prior to surgery prevented the surgery-associated inhibition of the oxidative burst. As no VA-E-related side-effects were observed, this distinct route of application may be a rationale to restrict immunosuppression by surgical stress and anaesthesia.

Extravasation has been described as a rate-limiting step in the process of hematogeneous metastasis formation. Thereby, transendothelial migration of tumor cells consists of a complex series of events involving multiple cell-cell and cell-matrix interactions. 3D-extravasation assays are valuable tools for the identification of genes, which are the key players at switchboards of the intracellular signaling pathways. In consequence, the combination of 3D-modeling and whole genome expression analysis lead to unravel molecular parameters which descripe distinct clinical phenotypes of cancer and therefore, work as prognosticators, predictors of therapy and new therapy targets.

Objective: To determine the effect of intra-operative monitoring of bladder neck elevation on cure rate and post-operative complications in patients undergoing colposuspension., Design: Prospective, observational study., Setting: Urogynaecology units, university hospitals., Population: Ninety women operated on for genuine stress urinary incontinence., Methods: The topography of the bladder neck and proximal urethra was assessed with pre-, intra- and post-operative introital ultrasound. These measurements were repeated during follow up for up to 48 months after surgery. Burch colposuspension of the bladder neck was performed under intra-operative introital ultrasound control, with reference to the patients' individual pre-operative ultrasound, to achieve a vertical height correction of 1-10 mm., Main Outcome Measures: Mid-term surgical outcome and post-operative complications., Results: Ninety patients underwent colposuspension and 50 (56%) completed 48 months of follow up; 85 women (94%) were objectively continent at 12-month follow up and 42 of 50 (82%) at 48-month follow up. Surgical elevation of the bladder neck resulted in a median intra-operative elevation of 9 mm (7 mm at 48 months). All post-operative measurements demonstrated a significant decrease in linear dorsocaudal movement of the bladder neck during straining (P < 0.001). Funnelling and hypermobility were still decreased 48 months after incontinence surgery (P < 0.001). Voiding difficulty and urgency were uncommon and associated with evidence of funnelling and hypermobility., Conclusion: Intra-operative introital ultrasound standardises Burch colposuspension and thus might help to avoid overelevation and associated post-operative complications such as voiding difficulties and de novo urge incontinence without compromising the success of the operation.

Ever since the first report on fetal magnetocardiography by Kariniemi in 1974 numerous studies have examined cardiac activity in healthy fetuses using this technique. Recently there has been an increase in reports on the identification of fetal pathological states, in particular in the diagnosis of fetal arrhythmias, using magnetocardiography. Other possible applications of this non-invasive method include the assessment of intrauterine growth retardation and fetal stress. In a patient with gestational hypertension and asymmetric growth retardation without pathological ultrasound findings, fetal magnetocardiography showed a reduced beat-to-beat heart rate variability indicating signs of fetal stress. On the day following the magnetocardiographic recording, fetal Doppler ultrasonography findings indicated an incipient brain sparing effect. The fetal growth retardation was reflected in the duration of the fetal cardiac time intervals. We conclude that fetal magnetocardiography non-invasively enables the timely identification of pathological fetal conditions.

The abilities of tumor cells to extravasate from the blood vessel system and to migrate through the connective tissue are prerequisites in metastasis formation. Both processes are chiefly mediated by integrins, which mediate both cell-cell and cell-matrix interactions. We investigated the role of integrin subunits in the adhesion, extravasation and migration of the highly invasive human bladder carcinoma cell line T24. Here we show that inhibition of the beta(1)-integrin subunit using the specific beta(1)-integrin blocking antibody 4B4 significantly reduces the adhesion to HUVEC and transmigratory activity of T24 cells. The blockade of the beta(1)-integrin subunit also resulted in a significantly reduced locomotory activity of T24 cells. A detailed cell migration analysis on a single cell level revealed that blockade of the beta(1)-integrin subunit leads to an altered migration pattern of single cells but does not influence migration per se. Migration parameters such as time active, velocity and distance migrated were significantly reduced as compared to untreated control cells. Our observations strongly suggest a central role for the beta(1)-integrin subunit in forming the cell-cell and cell-matrix bonds necessary for adhesion, extravasation and migration.

Evidence is mounting that hematopoietic stem cells (HSCs) play a critical role in bone marrow regeneration and tissue renewal, for which migration is an obvious prerequisite. Computer-aided analysis and a three-dimensional collagen matrix assay enabled us to analyze single-cell migratory characteristics of stromal cell-derived factor-1 alpha (SDF-1 alpha)-stimulated cord blood-derived HSCs. We defined and resolved specific migratory parameters in spontaneous and SDF-1 alpha-induced migration of these cells. The addition of interleukin 6 to the culture medium led to differential SDF-1 alpha-stimulated migratory response, which comprised a recruitment of nonmoving cells and an increase in speed and frequency of pauses but a decrease in pause duration. We were thus able to decipher the exact parameters that result in an increase in the migration of HSCs and demonstrate that extensive analysis of single-cell behavior is elementary in the study of stem cell migration.

Objective: The aim of this study was to examine changes in the heart rate variability based on the frequency power spectrum of healthy fetuses during the second and third trimester of pregnancy., Methods: We analyzed 222 fetal magnetocardiograms recorded in 49 healthy singleton pregnancies between the 16th and 42nd week. Discrete Fourier transformation was performed on the time-based step function of the RR-intervals. Changes of spectral density in the frequency spectrum in various bands between 0.003 to 1 Hz, including low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: 0.15-0.40 Hz) bands, were examined as a function of gestational age., Results: Spectral density between 0.003 to 1.0 Hz increased with gestational age with large changes, in particular, at lower frequencies. At approximately the 32nd week, the rate of increase in power slowed substantially. Prior to this time, the rates of change in power were different for the bands 0.003 to 0.40 Hz, 0.40 to 0.60 Hz and 0.60 to 1.0 Hz. LF and HF showed similar development, with HF increasing slightly more rapidly., Conclusion: We conclude that characteristic spectral bands that increase in spectral density at different rates during the second and third trimester may be identified. They most likely reflect developmental changes and behavioral states during pregnancy., (Copyright 2003 John Wiley & Sons, Ltd.)

Haemorrhage from ruptured uterine vessels is a rare but life-threatening complication during pregnancy. The high rate of mortality associated with this condition is correlated to the rapidity of haematoma formation. The dynamics of this event become particularly evident at the time of birth when the uterus requires one-fifth of the cardiac output. This high rate of flow emphasizes the possible fatal consequences of delayed therapeutical intervention. Information available on the aetiology and pathogenesis of such events is poor, especially if an involvement of cervical vessels or extraperitoneal (incomplete) rupture of the uterus can be excluded. Diagnosis and therapy are based on the classical clinical symptoms of acute abdominal pain-and-shock symptomatology. We report on a 31-year old patient after spontaneous delivery and initially uneventful puerperium. She had to be laparotomised on the third day post partum because of pain and haemoglobin deficiency. We found a large retroperitoneal (supralevatorial) haematoma caused by ruptured lateral branches of the left arteria uterina. The uterus was preserved after haematoma removal and revision and suture of the bleeding vessels. The case reported on shows that peripartal rupture of arterial uterine vessels may turn out to be clinically relevant only after a relatively long time (> 72 hours). Only four comparable cases have been reported in the literature, the course being different from that in all the other cases. In all the documented cases arterial uterine haemorrhages resulted in short-term acute aggravation of the symptomatology with severe abdominal pain, haemodynamic collapse and simultaneous haemoglobin deficit. The case under report in the present paper was at first clinically occult and eventually developed a pathology that had not been described before. Its specific significance lies in illustrating the need for re-evaluating such initially hidden cases while paying special attention to ruptured uterine vessels.

Reactivations of herpes simplex virus (HSV) either symptomatically (recrudescence) or without symptoms (recurrence) are well documented. As an asymptomatic reactivation may contribute to transmitting HSV to potential acceptors the frequency of reactivations should be evaluated. In order to evaluate the frequency of HSV-2 reactivation 173 genital swabs of a group of women chosen at random were analyzed by nested PCR. 34 (19.6%) showed clinical evidence of a herpes infection, 77 (44.5%) had no symptoms at all and 62 (35.8%) had other symptoms. In 26 (15%) HSV-DNA was detected. 11 (38.4%) could be characterized as asymptomatic reactivations. Typing of the HSV-positive swabs resulted in 11 HSV-2 and 10 HSV-1 strains. Additionally 18 HSV-positive swabs of the oral cavity resulted in 15 (83.2%) HSV-1 and 3 (16.4%) HSV-2 strains. The results of typing indicate a change of HSV-1 and HSV-2 epidemiology., (Copyright 2002 S. Karger AG, Basel)

Under normal conditions, p53 protein is thought to maintain genomic stability. We measured this parameter in healthy tissues from female breast and genital tract using a quantitative, highly sensitive luminometric assay. An organ-specific pattern of p53 expression became evident: breast parenchyma (n = 40, median p53: 0.0346 ng/mg protein) and ovarian tissue (n = 12, 0.063 ng/mg) demonstrated markedly higher p53 levels than endometrium (n = 24, 0.0065 ng/mg), myometrium (n = 31, 0.005 ng/mg) or uterine cervix tissue (n = 25, 0. 002 ng/mg). Malignant tumors derived from these organs maintained the pattern of p53 expression with ovarian cancers (n = 14, median: 0.84 ng/mg) exceeding all other tissue types examined. Generally, p53 concentrations in malignant tumors, but also in uterine myomas were significantly higher than those in healthy controls. Breast cancer tissues, subgrouped according to prognostic parameters, demonstrated the highest p53 concentrations in samples with atypical histology, grading II-III, negative steroid receptors, and in cases of positive axillary lymph nodes. The frequency of elevated p53 concentrations in cancer cytosols, based on organ-specific normal concentrations, varied between 62% in breast cancers and 100% in cervical carcinomas. Uterine myomas showed 6% of elevated values. Grade II-III breast carcinomas overexpressed p53 more often than those with grading I (p < 0.05). In all carcinomas, the frequencies of overexpressed p53 protein markedly exceeded the frequencies of mutated p53 gene mutations reported in the literature. In conclusion, our data indicate that the extent of p53 expression and overexpression is organ dependent. When data of other studies on primary breast cancers are included, elevated levels of p53 protein in malignant tumors to some extent may indicate p53 gene mutations and worse prognosis if they exceed a higher threshold., (Copyright 2000 S. Karger AG, Basel)

Aim of this study was the examination of fetal heart rate variability and complexity measures during pregnancy using fetal magnetocardiography. We registered 80 fetal magnetocardiograms in 19 healthy fetuses between the 16th and 41st week of gestation. On the basis of beat to beat intervals, mean RR interval (mRR), its standard deviation (SD), root mean square of successive differences (RMSSD), as well as complexity variables such as dimension (ApD1), entropy (ApEn), Lyapunov exponent (ApML) and trajectory divergence rate (p) were calculated for each recording. Dependency of these variables on gestational age was evaluated with correlation analysis. All variables changed consistently over time. RMSSD showed the strongest dependency on gestational age, followed closely by ApEn, SD and p. ApD1 and mRR showed only weak dependency. We conclude that magnetocardiography is well suited to register fetal cardiac activity with sufficient accuracy to permit detailed analysis of various heart rate variables during the second and third trimester of pregnancy. The observed increases in heart rate variability and complexity of fetuses most likely reflect differing but overlapping aspects of fetal development. They may be linked to the maturation of the autonomic nervous system and could aid in the timely identification of pathological conditions.

Objective: We evaluated fetal Erythropoietin (EPO) in a clinical obstetrical environment, aiming to collect more information upon its role in diagnosis of fetal stress. As it is known that EPO cannot pass the placental barrier, we restricted to measure the concentration in the umbilical artery (UA) immediately after delivery., Patients and Methods: EPO was correlated to relevant obstetrical parameters. We looked for each parameter that was tested for differences in fetal sex. For this purpose, the statistics were performed by means of the Behrens-Fisher-Test (meaning a special application of the Student-T-Test). This device is an algorithm developed to compare regressions. For significance, a confidence level of less 5% was accepted. For the rest, we only used descriptive devices., Results: We found weak but positive correlation to gestational age for both sexes. No correlation was calculated for the duration of parturition or the birth weight. Highly significant differences were found for respiratory values of blood gases, taken from the UA when differentiated for fetal sex: males showed a strong and negative correlation for pO2 (r(m)= -0.45); the female EPO-level was not influenced by decreasing O2-level (r(w)= +0.06, p > 0.01). Similar results could be found for pCO2. (r(m)= +0.36; r(w)= -0.07; p < 0.01. Not significant, but comparable differences for the EPO-level in fetal blood were found for pH and base deficit., Conclusions: If we accept that the EPO-level in fetal blood rises with relevant oxygen deficiency, then females seems to be better protected against damage from distress. This observation is congruent with the clinical experience from the authors who have the subjective impression that female sex is advantageous in harmful deliveries.

Fungal vaginal infections/colonisations can be divided into a symptomatic vaginal candidiasis and an asymptomatic vaginal Candida-carriage. The latter seems to be a predisposing factor for the development of a symptomatic vaginal candidiasis. The fungal organism isolated most frequently is Candida albicans, followed by Candida glabrata, which was previously also known as Torulopsis glabrata. To a lower extend, other Candida species such as Candida tropicalis and Candida krusei can be prevalent in the vulvovaginal region. Predisposing factors for vaginal candidiasis are gravidity, diabetes mellitus or a therapy with immunosuppressive agents. Also gestagenes showed to be a pre-disposing factor for vaginal candidiasis. Divergent results concerning the predisposition to vaginal candidiasis or colonisation due to oral contraception have so far been reported. Therefore we performed a study with two healthy collectives of female volunteers (n = 2 x 60) which were different concerning the taking of oral contraceptives. Overall, in 17% of the subjects (20/120) yeast could be cultured out of the vaginal secretions. There was no evidence for a higher rate of Candida-colonisation in subjects taking oral contraceptives. Further, there was no evidence for a relationship between the length of the taking of oral contraceptives and the rate of vaginal yeast-carriage. Also the type of oral contraceptive (combination or sequential contraceptive) had no influence on the frequency of Candida-carriage. Candida albicans was the most prevalent yeast (16/20), followed by Candida glabrata (4/20).

Magnetocardiography provides a new, alternative method for fetal surveillance. This method allows the registration of changes in the magnetic field produced by the fetal cardiac system. In comparison to fetal ECG, the fetal magnetocardiogram (fMCG) is not affected by intermediate tissue, in particular by the insulating effect of the vernix caseosa. Furthermore fMCG's with a good signal noise ratio can be obtained in the second trimester. A multichannel biomagnetometer allows the non-invasive measurement of the magnetic signals produced by the fetus. Examples of dta and evaluation techniques are given. Signal processing software allows the identification of all fetal beats in a data set, permitting the calculation of an averaged beat and the evaluation of signal morphology and cardiac time intervals. Furthermore it is possible to produce a beat to beat time series with high temporal resolution, making the evaluation of heart rate variability with measures from the time, frequency, and phase domain accessible. Particularly the latter are of interest in investigating changes in temporal complexity of the fetal cardiac system. Magnetocardiography thus holds the promise of improved antenatal surveillance as of the second trimester.

This article is concerned with the increase of alkaline phosphatase of a 32-year old primipara, five to six times higher than the upper basal values, during the last trimenon of pregnancy. The physiological increase of serum total alkaline phosphatase levels during pregnancy were two to three times higher than the basal values (4, 11). Hepatopathies, osteopathies, endocrinological disorders, infections as well as other medical causes were excluded by anamnesis due to close-meshed laboratory chemical and clinical controls relating to differential diagnosis. Thus, only pregnancy could be considered as a trigger mechanism. Differentiating the alkaline phosphatase by laboratory chemical means in the course of this pregnancy, an isolated increase of the alkaline phosphatase placenta isoenzyme (PLAP) was seen. Besides premature labour pains, which led to the admission of the patient to the maternity ward, around a calculated 32nd week of pregnancy, a discreet foetal growth retardation was recognised, which continued to increase constantly up to a minus discrepancy of three weeks. The delivery of a dystrophic girl took place at the beginning of the 37th week of pregnancy. Post partum alkaline phosphatase levels normalised to basal values. The correlation: the increase in PLAP and intra-uterine foetal growth-retardation was evident in the case presented and was also discussed in connection with previous observations by other authors of similar studies.

26 days past an obstetric catheter epidural anesthesia a subdural haematoma right fronto-temporal was diagnosed and relieved by operation in a primipara of 19 years of age. Already several days after the delivery the patient was suffering recurrent headaches, at first misinterpreted as post-spinal headaches. Weeks later a cranial computer tomography lead to the right diagnosis. Although the occurrence of a subdural haematoma after catheter epidural anesthesia is extremely rare, untypical headaches following spinal, epidural or caudal procedures, should call your attention towards this complication. Because of the pressing mechanisms during childbearing, delivering mothers run the risk of a subdural haematoma.

In the period between October 1990 and July 1992 58 newborn were ultrasonographically examined because of intrauterine breech presentation and therefore higher pressure on the fetal hips. These children were compared with other 66 children who had neither risk factors nor family disposition. We noted significant differences in the distribution of hip dislocation types (by Graf) between both groups. There was a normal distribution among the control group. Children in breech presentation, whether twin or single pregnancy, showed the following: (1) shift of the fine distribution to type Ia, (2) increase of type IIa, classified as pathological not before the 3rd month of life (type IIb, persistence of delay of ossification), (3) two hip dislocations type IIg, (4) one hip dislocation type IIIa. We recommend to perform ultrasound screening after delivery in all children who have had an intrauterine breech presentation, so that treatment can be started as soon as possible.

From March 1988 to September 1990, 1844 patients (pregnant women) were sonographically examined following a pregnancy monitoring programme and for further diagnostic clarification of unclear sonographic patterns. The ultrasound examinations were carried out with a 3.5 Mhz convex transducer, and by pregnancies before the 16th week with a 5 Mhz vaginal transducer (Toshiba SSA 250 a), respectively. In 13 cases (0.7%), foetal chorioidal plexus cysts were found; in 6 of them they occurred unilaterally and in the other 7 bilaterally. In general, most of the cases were diagnosed between the 13th and 22nd weeks of pregnancy. All unilateral cysts appeared transitorily, were of small size and receded by the 24th week of pregnancy. From the 7 patients with bilateral plexus cysts, 4 foetuses showed no signs of anatomical abnormalities. In the other 3 foetuses, it was possible, to recognise further anatomical abnormalities, when performing ultrasound i.e. 2 of them proved to be a trisomy 18 and the third case a trisomy 21.