Heinz S. Scholz

Accuracy of frozen section examination of pelvic lymph nodes in patients with FIGO stage IB1 to IIB cervical cancer

OBJECTIVE We evaluated the accuracy of intraoperative frozen section histology of pelvic lymph nodes in patients with FIGO stage IB1 to IIB cervical cancer. METHODS A total of 96 patients with cervical cancer FIGO stage IB1 to IIB had surgery including systematic pelvic or pelvic and paraaortic lymphadenectomy and intraoperative frozen section examination of pelvic lymph nodes at our department between January 1997 and October 2001. The results of frozen section were compared with those of final histology. RESULTS A total of 1044 pelvic lymph nodes underwent intraoperative frozen section examination and node metastases were found in 29 patients (30%). Final histopathology yielded a total of 5042 lymph nodes and identified an additional seven patients with node metastases for a false negative rate of 19%. The specificity and the positive predictive value of frozen section examination were 100%; the negative predictive value was 90% (60/67). CONCLUSION The diagnostic accuracy of frozen section analysis of pelvic lymph nodes should be considered when intraoperative decisions are based on its results.

Low fetal oxygen saturation at birth and acidosis.

Objective To measure umbilical cord blood oxygen saturation, to calculate preductal oxygen saturation at birth, and to assess its predictive value for acidosis. Methods Umbilical cord blood samples of 1537 live-born singleton neonates were analyzed. Oxygen saturation was measured by spectrophotometry; pH and base excess were measured by a pH and blood gas analyzer. Preductal oxygen saturation was calculated with an empirical equation. Acidosis was defined as 2 standard deviations (SDs) below the mean of umbilical artery (UA) pH or base excess (7.09 and −10.50 mmol/L, respectively). The predictive value for acidosis of UA and umbilical vein (UV) oxygen saturation and calculated preductal oxygen saturation was determined with receiver operating characteristic curves. Results The mean values (±SD) of UV, UA, and calculated preductal oxygen saturation were 52 ± 18%, 26 ± 17%, and 31 ± 16%, respectively. Forty-seven neonates had UA pH less than 7.09 and 60 had UA base excess less than −10.50 mmol/L. The UV, UA, and calculated preductal oxygen saturation showed considerably weaker relations to UA base excess (multiple r2 = .056, .003, and .017, respectively; P < .001) than to UA pH (multiple r2 = .112, .126, and .148, respectively; P < .001). Receiver operating characteristic areas under the curve were higher when predicting low pH compared with low base excess (for UV, UA, and calculated preductal oxygen saturation: 0.716 versus 0.699, 0.747 versus 0.586, and 0.765 versus 0.628, respectively). The difference was significant for UA oxygen saturation (P < .05). All tests showed high sensitivity and negative predictive values, but low specificity and positive predictive values. Conclusion Low fetal oxygen saturation measured at birth seemed to be associated with low fetal pH and base excess values, but its predictive value for acidosis in an unselected population was limited, particularly if acidosis was metabolic.

Cord blood oxygen saturation in vigorous infants at birth: what is normal?

Objective To define the normal ranges of umbilical cord blood oxygen saturation (SaO2) and acid‐base status at birth and to evaluate the effect of gestational age on cord blood values in vigorous newborn infants following spontaneous vaginal birth from a vertex position.

Course of Maternal Serum Magnesium Levels in Low-Risk Gestations and in Preterm Labor and Delivery

Objectives: To describe the course of total and ionized magnesium and total calcium levels in maternal serum during low-risk pregnancies and to compare women who developed preterm labor and delivery with those who delivered at term. Methods: 209 women with low-risk pregnancies were enrolled in a prospective trial before the 18th week of gestation. No woman received oral magnesium supplementation. The ionized and total magnesium and total calcium levels in maternal serum were measured every 4–6 weeks. The data were grouped into 3 gestational periods (≤18, 19–27 and ≥28 weeks of gestation) for overall comparison and analyzed with the general linear model for repeated measurements and ANOVA. p values of < 0.05 were considered statistically significant. Results: 145 gestations were available for analysis. 27 women were hospitalized for preterm labor and in 16 of these preterm delivery occurred. Ionized and total magnesium and calcium levels were significantly lower after the 18th week of gestation than before. The cation levels in women with preterm labor and delivery did not differ from those with term delivery. Conclusion: Ionized and total magnesium and calcium levels decrease with increasing gestational age. Preterm labor and delivery do not seem to be related to changes in serum cation levels.

Does the Hemoglobin Concentration in Fetal Blood Interfere with the Accuracy of Fetal Reflection Pulse Oximetry

Objective: Our goal was to investigate the influence of the fetal hemoglobin (Hb) concentration on the accuracy of reflection pulse oximetry. Methods: 179 fetuses were monitored by a reflection pulse oximetry system (RPOX MK2). Pulse oximetry measurements (SO2POX) were compared with the oxygen saturation and pH of umbilical artery and vein (UA-, UV-SaO2) immediately after delivery. Correlation and linear regression analyses were performed. Because it is unknown whether low or high Hb concentrations might interfere with the SO2POX measurements, the influence of the Hb level on the correlations was evaluated by weighting the linear regression in both ways; by Hb concentrations as weighting factor and as an inverse weighting factor (1/Hb). Results: There was a significant correlation between SO2POX and UV-SaO2 (for the last 10 min of delivery, r = 0.45, p < 0.0005) but not with pH or UA-SaO2. Linear regression analysis between SO2POX and UV-SaO2 showed a multiple R of 0.45. Hb concentration in fetal blood ranged from 9.2 to 20.5 mg/dl. The weighted regression indicated a multiple RHb of 0.49, which did not differ by the inverse weighting (multiple Rinverse Hb: 0.49). Conclusions: Pulse oximetry measurements seem to reflect oxygen saturation in fetal blood, however further improvement is necessary. The Hb concentration in fetal blood does not interfere with the accuracy of fetal pulse oximetry and need not be taken into consideration in calibration curves.

Platzbauch nach Misgav-Ladach-SektioEin Fallbericht

Einführung: Wir beschreiben den Fall einer Patientin, bei der eine Nahtinsuffizienz an der Rektusfaszie nach Misgav-Ladach-Sektio zur Manifestation eines Platzbauches führte. Fallbeschreibung: In der Schwangerschaftswoche 36 + 5 wurde bei einer 33-jährigen Nullipara eine primäre Schnittentbindung aus fetaler Indikation durchgeführt. Nach primär unauffälligem postoperativem Verlauf fand sich, als Folge einer Nahtinsuffizienz, am siebenten Tag das grosse Netz im mittleren Bereich der Laparotomie im Sinne eines Platzbauches prolabiert. Schlussfolgerung: Auch wenn aus einem Einzelfall keine generellen Empfehlungen abzuleiten sind, werden weitere Berichte über Komplikationen dieser Technik zeigen, ob sie so sicher ist wie bisher angenommen.

Tarsusmetastase als Primärmanifestation eines Endometriumkarzinoms: Ein Fallbericht mit Langzeitüberleben

Introduction: Isolated distant metastasis at the time of diagnosis of endometrial cancer is rare. We report on a patient with long-term survival after presenting with a solitary tarsal metastasis of an endometrial cancer. Case Report: A 61-year-old patient presented with pain and swelling of the left foot. Radiography and bone scintigraphy showed a cystic lesion of the left calcaneus and talus. Open biopsy showed endometrial adenocarcinoma. Transvaginal ultrasonography was suspicious and curettage confirmed endometrial carcinoma. All other studies were normal. Abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and amputation of the lower left leg were performed. Histology of the uterus and the metastasis in the tarsus showed a well differentiated endometrioid adenocarcinoma. Postoperatively, the patient received six courses of platinum-based chemotherapy and medroxyprogesterone acetate orally for 5 years. The patient is alive and free of disease 96 months after the primary diagnosis of the tarsal metastasis. Conclusion: Radical surgery and adjuvant chemotherapy with a curative intent appear warranted in patients with a solitary bone metastasis of endometrial adenocarcinoma.

Contents Vol. 14, 1999

313 14th International Congress ‘The Fetus as a Patient’ New York City, N.Y., USA, April 22–24, 1999 285 Erratum 321 Drs. Haackert Prize 1999 Awarded to Prof. Juri Wladimiroff, The Netherlands Brezinka, Ch. (Innsbruck) 323 Prenatal Orogastric Gene Delivery Results in Transduction of the Small Bowel in the Fetal Rabbit Wu, Y.; Liu, J.; Woo, S.; Finegold, M.J.; Brandt, M.L. (Houston, Tex.) 328 Hemangioma of the Umbilical Cord: Stenotic Change of the Umbilical Vessels Kamitomo, M.; Sueyoshi, K.; Matsukita, S.; Matsuda, Y.; Hatae, M. (Kagoshima); Ikenoue, T. (Miyazaki) 332 Course of Maternal Serum Magnesium Levels in Low-Risk Gestations and in Preterm Labor and Delivery Arikan, G.M.; Panzitt, T.; Gücer, F.; Scholz, H.S.; Reinisch, S.; Haas, J.; Weiss, P.A.M. (Graz) 337 Failure of Amniotic Septostomy in the Management of 3 Subsequent Cases of Severe Previable Twin-Twin Transfusion Syndrome Pistorius, L.R. (Johannesburg/Pretoria); Howarth, G.R. (Pretoria) 341 Serum Enzyme Activities in Premature Infants with Bronchopulmonary Dysplasia Zanardo, V. (Padua); Rizzo, L. (Livorno); Trevisanuto, D.; Simbi, K.A.; Golin, R.; Magarotto, M.; Marzari, F. (Padua) 345 Significance of Echogenic Foci in the Left Ventricle of the Fetal Heart in a Low-Risk Population Jaffe, R. (New York, N.Y.); Cherot, E.; Allen, T.; Glantz, J.Ch. (Rochester, N.Y.) 348 Are Bilateral Fetal Lung Masses Double Trouble? Lipshutz, G.S.; Lopoo, J.B.; Jennings, R.W.; Farrell, J.; Harrison, M.R.; Albanese, C.T. (San Francisco, Calif.) 351 Amniotic Band Syndrome in Triplet Pregnancy Suzuki, S.; Yoneyama, Y.; Sawa, R.; Sinagawa, T.; Hayashi, T.; Araki, T. (Tokyo) 354 Continuous Observation of Nitric Oxide Production in the Fetal Rat Brain during Uteroplacental Ischemia Asakura, H.; Nakai, A.; Yokota, A.; Sekiguchi, A.; Koshino, T.; Araki, T. (Tokyo) 360 Multifetal Pregnancy Reduction and Selective Termination: The Canadian Experience von Dadelszen, P.; Johnson, J.-A.M. (Toronto); Farquharson, D.F.; Wilson, R.D. (Vancouver); Seaward, P.G.R. (Toronto) 365 Cerebellar Hypoplasia: Could It Be a Sonographic Finding of Abnormal Fetal Karyotype in Early Pregnancy? Rosati, P.; Guariglia, L. (Rome) 368 Initiating Extradural Analgesia during Labour: Comparison of Three Different Bupivacaine Concentrations Used as the Loading Dose Harms, C.; Siegemund, M.; Marsch, S.C.U.; Surbek, D.V.; Hösli, I.; Schneider, M.C. (Basel) 375 Abstracts 7th Journées Parisiennes Obstétrico-Pédiatriques, February 5, 1999 378 Erratum 379 Author Index Vol. 14, 1999 381 Subject Index Vol. 14, 1999 No. 5 No. 6