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Purpose: To evaluate the incidence of hematomas after cesarean section with and without formation of a bladder flap, since non-formation reduces blood loss. Material and Methods: At the university hospital of Vienna 64 women undergoing cesarean delivery were randomly included into the study. In the study group (n = 31) cesarean section was performed with a Pfannenstiel and a low transverse uterine incision about 1 cm above the vesicouterine peritoneal fold, and without prior dissection and formation of a bladder flap. In the control group (n=33) a common formation of a bladder flap was performed. All women underwent transabdominal and transvaginal ultrasound on the 5th day after delivery. Hematomas were defined as a inhomogeneous area ≥2 cm in diameter in relation to the uterine incision. Results: No significant differences concerning sonographically diagnosed hematomas were found between the two groups (23% vs. 30%, p=0.27). Operating time, bloodloss, and microhematuria were decreased in favor of the study group. No woman demonstrated postoperative fever. Conclusion: Hematomas are common sonographic findings after cesarean section. Analogue to the reduced bloodloss a trend towards a lower incidence of hematomas was found after omission of the bladder flap. This fact was not of clinical importance in the study, but indicates less trauma.

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We present the case of a 26-year-old patient with an anterior sacral meningocele which had been discovered during gynaecologic surgery because of a cystic pelvic mass. Subsequently, the patient underwent two pregnancies. The management of a pregnancy complicated by a coexisting anterior sacral meningocele presents a challenging problem for the obstetrician. Because of the high maternal mortality due to rupture of the meningocele under labor, primary cesarean delivery is indicated as soon as fetal lung maturity is established and was performed in our patient in both pregnancies in the 35 week, without complications for mother and children.

In a non-randomized cohort study, we compared continuous with interrupted sutures for the closure of the lower uterine segment at cesarean section. Eighty-two women, who underwent cesarean section at the Department of Obstetrics at the University Hospital of Vienna between January and May 2000, were included in the study. Thirty-eight patients had single-layer closure of the lower uterine segment and 43 patients had closure with interrupted sutures. There were significant differences in total operating-time (32 min vs 40 min, P=0.001) and in the pre- and postoperative maternal hemoglobin (DeltaHb 0.6 g/dl vs 1.1 g/dl, P

Angiogenesis is an essential component for tumor development regulated by both proangiogenic and antiangiogenic factors. Thrombospondin 1 (TSP 1) suppresses angiogenesis by inhibiting endothelial cell proliferation and inducing endothelial cell apoptosis. The aim of this study was to compare the expression of TSP 1 in cases with leiomyoma, uterine smooth muscle tumor of uncertain malignant potential (STUMP) and leiomyosarcoma (LMS). Furthermore, we evaluated the prognostic relevance of TSP 1 in uterine LMS.TSP 1 expression was investigated by immunohistochemistry from paraffin-embedded tissue in 26 patients with leiomyoma, in 24 patients with STUMP and in 21 patients with LMS. Standard immunohistochemical techniques were used to study the expression of TSP 1 in 5-mum-thick tumor sections. TSP 1 expression was correlated with survival using the Kaplan-Meier method and log-rank test for univariate analysis.TSP 1 was expressed in 77% of leiomyomas, in 13% of STUMP and in 24% of LMS. A statistically significant difference regarding the frequency of TSP 1 expression was observed between leiomyoma and LMS (P0.05) as well as between leiomyoma and STUMP (P0.05), but not between LMS and STUMP (P0.05). Furthermore, a statistically significant correlation between vascular space involvement and TSP 1 expression was observed in patients with uterine LMS, with patients without vascular space involvement having more frequently TSP 1 positive tumors (P = 0.04). No statistically significant correlation between TSP 1 and clinical stage, age and recurrence disease could be detected (P0.05).We found that TSP 1 was more frequently expressed in leiomyoma compared to STUMP and LMS. Additionally, the statistically significant negative correlation between vascular space involvement and TSP 1 expression in patients with uterine LMS shows that TSP 1 might work as a predictive factor in patients with LMS. Further clinical studies are necessary to prove our results and to clarify the role of TSP 1 in uterine smooth muscle tumors.

To investigate the incidence and the prognostic value of platelet count and serum haemoglobin (Hb) in patients with recurrent ovarian cancer prior to second-line chemotherapy.Clinical records were reviewed for 31 patients with recurrent ovarian cancer. Survival analysis was evaluated by univariate (Kaplan-Meier product limit method and log-rank test) analysis. We analysed the results for the overall survival. Anaemia and thrombocytosis were defined as a serum Hb level12 g/dl and as platelet count300,000/microL, respectively.Thrombocytosis and tumour anaemia were present in 55% and 42% of the patients, respectively. Tumour anaemia was of no prognostic value with respect to overall survival in our series. In patients with thrombocytosis, the median survival rate was reduced (p = 0.05).Our data suggest that a platelet count300,000/microL appears to be an adverse prognostic parameter in patients with recurrent ovarian cancer prior to a second-line chemotherapy.

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We present the case of a 26-year-old patient with an anterior sacral meningocele which had been discovered during gynaecologic surgery because of a cystic pelvic mass. Subsequently, the patient underwent two pregnancies. The management of a pregnancy complicated by a coexisting anterior sacral meningocele presents a challenging problem for the obstetrician. Because of the high maternal mortality due to rupture of the meningocele under labor, primary cesarean delivery is indicated as soon as fetal lung maturity is established and was performed in our patient in both pregnancies in the 35 week, without complications for mother and children.

To evaluate the predictive value of preoperatively determined squamous cell carcinoma antigen (SCC-Ag) serum levels for the risk of inguinofemoral lymph node metastasis.In this retrospective trial, preoperative serum levels of SCC-Ag in 29 patients with invasive squamous cell vulvar cancer (pT1 + 2) were evaluated and compared with nodal status.Twenty patients had negative inguinofemoral nodes, whereas in nine an inguinofemoral lymph node metastasis could be observed. The median SCC-Ag in women with negative nodes was 1.3 micrograms/L (0.2-11.5) and with positive nodes, 2.7 micrograms/L (0.4-9.1) (P = .35).Measurement of the serum level of SCC-Ag cannot be used for preoperative evaluation of the risk of lymph node metastasis in patients with clinically localized tumors since there is a significant overlap between both cohorts.

The aim of this case-controlled study was to determine whether non-closure of the peritoneum is detrimental in vaginal hysterectomy. 233 patients who underwent total vaginal hysterectomy (TVH) or laparoscopically assisted vaginal hysterectomy (LAVH) at the University of Vienna/Austria were analyzed. Cohorts of patients were formed according to their peritonealization status (open, n=117, vs closed peritoneum, n=116) and further stratified according to the type of surgical procedure: simple TVH ( n=115), TVH with concurrent vaginal repair and/or urinary incontinence surgery ( n=91) and LAVH ( n=27). No significant differences could be observed in analyzed surgical outcome (operation time, blood loss and analgesia). Complications (fever, infection, hemorrhage or revision) were similar whether the peritoneum was closed or not. After simple TVH, resumption of bowel function took place earlier in patients with open peritoneum than in those where it had been sutured (1.9 vs 2.4 days, P=0.001). No readmission for prolapse of the vaginal vault was recorded. Non-closure of the peritoneum at vaginal hysterectomy appears to be safe. Omission of peritoneal closure reduces the potential risk of injury and has a beneficial effect on bowel function.