Marc Sütterlin

Transketolase‐like 1 expression correlates with subtypes of ovarian cancer and the presence of distant metastases

Tumorbiology of ovarian cancer remains unclear. However, it is known that ovarian tumors, especially carcinomas, show elevated expression of glucose membrane transporters for facilitated glucose uptake. It can be assumed that increased glucose uptake leads to higher glucose metabolism. The energy resources of fully malignant transformed carcinomas are mainly supplied by aerobic glycolysis, for which several pathways are known. A key role in aerobic glycolysis is described for the transketolase enzymes. Recently, a novel transketolase-like enzyme called transketolase-like 1 (TKTL1) has been described that links aerobic glycolysis to the synthesis of fatty acids via production of acetyl-CoA. In order to investigate the role of TKTL1 for the progression of ovarian carcinomas, we examined paraffin sections of normal ovarian tissues, ovarian borderline tumors, and mucinous or serous papillary ovarian adenocarcinomas with respect to their expression of TKTL1. We identified a significantly elevated expression of TKTL1 in serous papillary ovarian adenocarcinomas, which correlates with poor prognostic parameters in the examined study group. Therefore, it can be assumed that TKTL1 plays a crucial role in ovarian cancer metabolism and that its expression predicts poor prognosis. Further investigations should be performed in order to evaluate whether this new enzyme is important for ovarian cancer tumorbiology and to analyze the potential role of TKTL1 as new target for specific antitumoral therapy

Plasma endothelin and big endothelin levels in women with severe preeclampsia or HELLP-syndrome.

Abstract.Objective: To compare maternal and umbilical venous big endothelin (big ET) and endothelin-1 (ET-1) levels of pregnancies complicated by severe preeclampsia (PE) or HELLP-syndrome to those of a well-matched normotensive pregnant control group. Methods: We measured plasma levels of ET-1 and big ET in 16 patients with severe PE and 14 patients with HELLP-syndrome by commercially available RIAs and compared them with those of well-matched normotensive pregnant controls. Additionally, the umbilical venous ET-1 and big ET levels were determined in 10 corresponding newborns. Results: The plasma concentrations of ET-1 and big ET were significantly higher in patients with severe PE and especially in women with HELLP-syndrome when compared with controls. The molar ratios of big ET to ET-1 were significantly lower in the two study groups. The levels of ET-1 and big ET were higher in umbilical venous plasma than in maternal plasma, but there were no significant differences in the umbilical venous concentrations between normotensive and by severe PE or HELLP-syndrome complicated pregnancies. Conclusions: These findings suggest that ET-1 may be considered as a marker of endothelial injury in by severe preeclampsia or HELLP-syndrome complicated pregnancies. The increase of the ET-1 plasma levels may be due, at least in part, to changes in the conversion of big ET to ET-1 by the endothelin-converting enzyme.

Doppler ultrasonographic evidence of intrapartum brain-sparing effect in fetuses with low oxygen saturation according to pulse oximetry☆☆☆

OBJECTIVE This study was undertaken to verify by means of Doppler ultrasonography and simultaneous fetal pulse oximetry the redistribution of fetal blood flow in favor of the brain during intrapartum hypoxemia. STUDY DESIGN During labor 11 term fetuses with abnormal heart rate patterns and arterial oxygen saturation <30% and 14 control term fetuses with normal oxygen saturation were simultaneously monitored by pulse oximetry and Doppler ultrasonography. The results were compared with the Student t test. RESULTS The blood flow velocity in the middle cerebral artery was significantly higher in the presence of reduced oxygen saturation, implying lower pulsatility and resistance indices (P <.001). The reduction of blood flow in the umbilical artery was not significant (P =.61). CONCLUSION Simultaneous intrapartum pulse oximetry and Doppler ultrasonography proved that reduced arterial oxygen saturation (<30%) is associated with profound changes in fetal hemodynamics and could be tolerated for only a limited period, which should be the subject of further studies.

Transvaginal volumetry of first trimester gestational sac: a comparison of conventional with three-dimensional ultrasound.

Abstract The aim of this study was to determine whether three-dimensional (3D) ultrasound is superior to two-dimensional (2D) ultrasound in evaluating first trimester gestational sac volume (GSV). 130 mainly low risk pregnancies between 5 and 12 weeks gestation were prospectively investigated. The 2D volumetry of GSV was performed using the ellipsoid formula; the 3D volumetry was carried out in all three planes using the contour mode and the volume from the measured circumferences and the distances between them were computed by a software. The data were analysed by variance and regression. The mean GSV increased from 1.5 ± 2 ml with 5 weeks to 127 ± 27 ml with 12 weeks (3D, longitudinal plane). The standard deviation of measured GSV increased with gestational age (GA) and GSV, and was more evident using 2D than 3D volumetry. GSV of pregnancies with similar GA differed considerably and viable pregnancies followed by miscarriage did not show different GSV. We conclude, that 3D volumetry of first trimester GSV is superior to 2D volumetry in its estimation, but seems to be without a prognostic significance for gestational outcome.

Cytogenetic and Y chromosome microdeletion screening of a random group of infertile males.

OBJECTIVE To assess whether to perform routine cytogenetic and Y chromosome microdeletion screening on all infertile male patients. DESIGN A cytogenetic and Y microdeletion study of a random group of infertile men. SETTING University department. PATIENT(S) In total, 40 patients had azoospermia (21 nonidiopathic), 27 had severe oligozoospermia/oligoasthenozoospermia (<or=5 x 10(6)/mL) (5 nonidiopathic), 20 had oligozoospermia/oligoasthenozoospermia (5-20 x 10(6)/mL) (6 nonidiopathic), and 16 had asthenozoospermia (5 nonidiopathic). Many were candidates for intracytoplasmic sperm injection (ICSI). INTERVENTION(S) Collection of blood samples from all patients and buccal cells from one patient. MAIN OUTCOME MEASURE(S) Karyotype analysis, polymerase chain reaction (PCR) screening for Y chromosome microdeletions, and fluorescence in situ hybridization of abnormal chromosomes. RESULT(S) Ten (9.7%) subjects, including one nonidiopathic patient, were found to have an abnormal karyotype. Two idiopathic azoospermic patients were missing large portions of Y chromosome euchromatin, confirmed by PCR analysis and an additional idiopathic azoospermic patient had a Y chromosome microdeletion. CONCLUSION(S) Routine cytogenetic analysis of all infertile male patients is required but it may be advisable to limit routine Y chromosome microdeletion screening to patients with severe male factor infertility (<or=5 x 10(6)/mL).

Combination of misoprostol and mechanical dilation for induction of labour: a randomized controlled trial.

OBJECTIVE To evaluate a combination of oral misoprostol (OM) and mechanical dilation of the cervix to improve efficacy in inducing labour. STUDY DESIGN This prospective, randomized study included 122 term pregnancies with an indication for induced labour. Each woman was randomly assigned to one of two groups. In the study group, a combination of OM and mechanical dilation with a double-balloon catheter for cervical ripening was used. In the control group, only OM was administered. The primary outcome measure was the rate of failure to induce labour, defined as no vaginal delivery within 48h. RESULTS In the study group, the rate of failure to induce labour was significantly lower in comparison with the control group (9.3% vs. 21.2%; P=0.007). The median times for inducing labour were 15.3h in the study group and 20.8h in the control group (P=0.158). There were no significant differences between the two groups with regard to other outcome parameters. As there were no failures of induced labour among women with premature rupture of membranes, the study results were also evaluated after excluding these cases. Among those women without rupture of membranes, the median times for induction were 15.8h in the study group and 32.6h in the control group (P=0.024). The rates of failure to induce labour were 10.8% vs. 28.2% (P=0.002). CONCLUSION A combination of OM and a double-balloon catheter improves the efficacy of labour induction in term pregnancies, particularly in women without premature rupture of the membranes.

Placenta percreta with subsequent uterine rupture at 15 weeks of gestation after two previous cesarean sections.

A 25‐year‐old gravida 3 para 2 woman was referred to our hospital at 15 weeks’ gestation with an acute abdomen and free fluid in the peritoneal cavity. On admission she was somnolent. She had a history of two cesarean sections. Fetal cardiac activity was detectable by ultrasound preoperatively. Intraoperatively, a lower uterine‐segment rupture was identified in the area of the presumed prior uterine incision. The great blood loss with consecutive coagulopathy required an emergency hysterectomy and multiple blood transfusions. The placenta was located on the lower anterior uterine wall. Intervening decidual cells between placenta and maternal scar tissue were absent in the area of the prior uterine incision. Placental villous tissue deeply invaded and perforated the scar tissue. Histological examination revealed a placenta percreta. Placenta percreta with subsequent uterine rupture is a rare but dramatic complication after previous cesarean section. This should be kept in mind as the rate of elective cesarean sections is rising continuously. Our patient recovered completely.

Plasma renin activity and aldosterone serum concentration are decreased in severe preeclampsia but not in the HELLP‐syndrome

BACKGROUND To investigate plasma renin activity and aldosterone serum concentrations in severe preeclampsia (PE) or HELLP-syndrome. METHODS We measured plasma renin activity and serum concentrations of aldosterone, progesterone, estradiol and estriol in 16 patients with PE and 14 patients with HELLP-syndrome and in well-matched normotensive pregnant controls. Additionally, the umbilical venous levels of aldosterone and plasma renin activity were determined in ten corresponding newborns. RESULTS Serum aldosterone levels as well as plasma renin activity were significantly lower in patients with PE but not in women with HELLP-syndrome when compared to controls. We did not find any relationship either between aldosterone serum concentration or plasma renin activity and progesterone, estradiol or estriol levels in PE or in the HELLP-syndrome. Umbilical venous renin activity and aldosterone levels were higher than in maternal blood, but there were no significant differences in the umbilical venous levels between normotensive pregnancies and pregnancies complicated by either severe PE or HELLP-syndrome. CONCLUSION It is concluded that in patients with PE well-known changes in the renin-angiotensin-aldosterone system cannot be found in patients with HELLP- syndrome. This finding is not related to alterations in sex steroid levels.

Myasthenia Gravis in Pregnancy: A Case Report

Objective. To present a case of maternal myasthenia gravis in pregnancy and give a systematic review of the literature. Case. We report the case of a 38-year-old parturient with a life-threatening complication of immune-mediated myasthenia gravis shortly after an elective cesarean section on patients request under spinal anesthesia at 35 + 3 weeks of gestation. The newborn was transferred to the pediatric unit for surveillance and did not show any signs of muscular weakness in the course of time. The mother developed a respiratory insufficiency on the second day postpartum. The myasthenic crisis led to a progressive dyspnoea within minutes, which exacerbated in a secondary generalized seizure with cardiac-circulatory arrest. After successful cardiopulmonary resuscitation, the patient was transferred to intensive care. The interdisciplinary therapeutic approach included ventilatory assistance via endotracheal intubation, parenteral pyridostigmine, azathioprine, and steroids. By interdisciplinary measures, a stable state was regained. Conclusion. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management.

Accelerated Partial Breast Irradiation in Clinical Practice.

Accelerated partial breast irradiation (APBI) has been under clinical investigation for more than 15 years. There are several technical approaches that are clinically established, e.g. brachytherapy, intraoperative radiotherapy (IORT), or external-beam radiotherapy. The understanding of the underlying biology, optimal technical procedures, patient selection criteria, and imaging changes during follow-up has increased enormously. After completion of several phase III trials using brachytherapy or IORT, APBI is currently increasingly used either in phase IV studies, registries, or in selected patients outside of clinical studies. Consensus statements about suitable patients are available from several international and national societies like ASTRO, ESTRO, and DEGRO. One may expect that 15-25% of patients undergoing breast-conserving surgery may qualify for APBI, i.e. patients with small invasive ductal breast cancer without clinical lymph node involvement.