Oliver Preyer

Concentration of vascular endothelial growth factor (VEGF) in the serum of patients with suspected ovarian cancer.

As a promoter of angiogenesis, vascular endothelial growth factor (VEGF) is believed to play a pivotal role in tumour growth and metastasis. The aim of this study was to determine the value of preoperative serum VEGF levels in the early diagnosis of ovarian cancer and in the differential diagnosis of adnexal masses. We examined preoperative serum VEGF levels in healthy women (n = 131), patients with benign ovarian cysts (n = 81) and in ovarian cancer patients (n = 44) by using an ELISA (R&D Systems, Minneapolis, MN, USA). A logistic regression model was carried out to determine the influence of VEGF and CA 125 on the probability of malignancy. VEGF revealed a significant influence on the odds of presenting with malignancy vs healthy women (P = 0.001). At 363.7 pg ml(-1), VEGF achieved a sensitivity of 54% and a specificity of 77%. With respect to the differentiation between benign cysts and ovarian cancer, CA 125 (P < 0.0001) but not VEGF (P = 0.229) predicts the presence of malignancy in a multivariate model. In conclusion, VEGF does not appear to be a useful tool in the early diagnosis of ovarian cancer or for indicating the absence or presence of malignancy in patients with an adnexal mass.

Maternal Serum Leptin Concentrations Do Not Correlate With Cord Blood Leptin Concentrations in Normal Pregnancy

Objective: To determine whether there is a difference in maternal leptin concentration and cord blood concentration, consistent with the hypothesis of a noncommunicating, two-compartement model of fetoplacental leptin regulation. Methods: Blood samples were collected from 139 women, identified as having an uncomplicated pregnancy, from an antecubital vein at delivery. Cord blood samples were taken from the umbilical vein. Leptin was measured by radioimmunoassay, and its relationship to fetal and maternal anthropometrics was assessed by Spearman correlation. Differences in maternal and cord blood leptin levels between male and female infants were tested twith the Mann-Whitney U test. Maternal and cord blood leptin were compared by the Wilcoxon signed rank test. The outcome measures were maternal and cord blood leptin at delivery, fetal birth weight, length, weight/length ratio, and ponderal index, maternal prepregnancy body mass index, pregnancy weight gain, relative weight gain, and body mass index at delivery. Results: No correlations were found between maternal and cord blood leptin concentrations. Fetal leptin level correlated with birth weight (ρ = 0.665; p < .0001), length (ρ = 0.490; P < .0001), ponderal index (ρ = 0.260; P = .002), and weight/length ratio (ρ = 0.625; P < .0001). Median leptin concentrations were higher in female (9.3 ng/mL, range 1.5-34.4 ng/mL) than in male (8.2 ng/mL, range 1.6-38.3 ng/mL) neonates, but this difference was statistically not significant. Logistic regression analysis showed a significant influence on umbilical venous leptin concentration for birth weight (P < .0001) but not for gender. Maternal leptin concentrations were significantly higher than cord leptin concentrations (P < .0005 for the male and female neonates and the entire group). Conclusion: There was no correlation between maternal and cord leptin, whiich supports the hypothesis of a noncommunicating, two-compartment model of fetoplacental leptin regulation.

Decreased maternal serum leptin in pregnancies complicated by preeclampsia

OBJECTIVE: To determine whether circulating levels of leptin differed between women with preeclampsia and women who had an uncomplicated pregnancy. METHODS: Maternal and umbilical venous plasma leptin concentrations obtained at delivery were compared in 36 pairs of women with either preeclampsia or normal pregnancy, matched 1:1 for prepregnancy body mass index and fetal gestational age at delivery. RESULTS: Prepregnancy body mass index was 21.1 ± 2.1 kg/m2 in either study group (range 17.6-25.3 kg/m2 and 17.7-25.3 kg/m2 in the normal and preeclamptic group, respectively). Mean fetal gestational age at delivery was 40.1 ± 1.3 weeks and 40.1 ± 1.2 weeks in the normal and preeclamptic group, respectively. Median leptin concentrations were significantly lower (p < .0001) in women with preeclampsia (8.3 ng/mL, range 3.5-20.0 ng/mL) than in normal pregnant women (20.2 ng/mL, range 6.0-63.7 ng/mL). Median umbilical venous leptin was not significantly different between groups (preeclampsia 11.8 ng/mL, range 2.0-37.2 ng/mL; normal 7.6 ng/mL, range 1.6-24.3 ng/mL; P =.377). Umbilical venous leptin levels correlated positively with birth weight in both groups (preeclampsia p = 0.501, P = .002; normal p = 0.517, P = .001), whereas no correlations were found between maternal and fetal hormone concentrations. Maternal leptin concentrations did not correlate with birth weight. CONCLUSION: Our data suggest that the correlation between umbilical venous leptin concentration and birth weight is independent of the presence of preeclampsia. Given the inconsistency in literature concerning circulating leptin levels in preeclampsia, further studies should investigate the regulatory systems of leptin in preeclampsia.

Serum leptin concentration in cord blood: relationship to birth weight and gender in pregnancies complicated by pre-eclampsia.

The aim of the study was to investigate cord blood leptin concentrations and their relationship to birth weight and gender in term pregnancies complicated by pre-eclampsia. Cord blood samples were obtained from 52 women, identified as having pre-eclampsia, and their newborns (31 males and 21 females) immediately after birth. Specimens were analyzed using a human leptin125 I radioimmunoassay. The relationship between leptin and anthropometrics was assessed by Spearman correlation. Differences in cord blood leptin levels between male and female infants were tested with the Mann- Whitney U test. The correlation between leptin and gender was computed using the productmoment-biseral correlation analysis for continuous and dichotomous variables. The multiple logistic regression analysis examined influences of sex, birth length, birth weight, birth weight/birth length ratio, ponderal index and maternal leptin as covariates on the fetal cord leptin level. Fetal leptin correlated positively with birth weight, length and weight/length ratio, in the total group and in the male subgroup and additionally with ponderal index in the female subgroup. Cord blood leptin concentrations in female newborns were significantly higher than in male newborns (p = 0.015), and concentrations correlated with gender (r =-0.315; p = 0.023). Multiple logistic regression analysis revealed four potential independent factors influencing fetal cord leptin: gender, birth weight, birth weight/birth length ratio and maternal leptin. In conclusion, cord leptin concentrations in pregnancies complicated by pre-eclampsia correlate positively with birth weight and gender. Leptin concentrations in female newborns are higher compared to male newborns.

Percutaneous tibial nerve stimulation versus tolterodine for overactive bladder in women: a randomised controlled trial

OBJECTIVE We performed a randomised controlled trial of percutaneous tibial nerve stimulation (PTNS) versus tolterodine for treating treatment naïve women with overactive bladder (OAB). STUDY DESIGN 36 patients with symptoms of OAB were randomised to 3 months of treatment with weekly PTNS or tolterodine (2mg bid p.o.). The primary outcome measure was the difference of micturitions per 24h. The secondary outcome measure was the impact on quality of life (QoL) measured with a visual analogue scale (VAS) between baseline and after 3 months of therapy. RESULTS Micturition frequencies did not decline significantly (p=0.13) over time and there were no significant treatment differences (p=0.96). QoL was significantly dependent from its level at baseline (p=0.002) and showed improvement over time compared to baseline measurements but no significant differences between both treatment groups (p=0.07). Incontinence episodes per 24h depended significantly on the level at baseline (p=0.0001) and declined significantly (p=0.03) during 3 months of therapy in both therapy groups. However no significant treatment differences on the reduction of incontinence episodes in 24h could be shown between both therapy groups (p=0.89). PTNS had fewer side effects than tolterodine (p=0.04). CONCLUSION PTNS and tolterodine were both effective in reducing incontinence episodes and improving QoL in patients with OAB but not micturition frequencies. PTNS had fewer side effects.

Breech presentation : a retrospective analysis of 12-years' experience at a single center

ZusammenfassungFRAGESTELLUNG: Welchen Einfluss hat die Art der Entbindung bei Beckenendlage auf den postpartalen Zustand des Neugeborenen. METHODIK: 1345 Termingeburten eines 12-jährigen Zeitraumes wurden nach einer Entbindung aus Beckenendlage retrospektiv untersucht. Es konnte die kindliche Morbidität und die perinatale Mortalität in den einzelnen Entbindungsgruppen verglichen werden. ERGEBNISSE: Es wurden 1345 Neugeborene am Termin entbunden. In 1041 (77,4%) Fällen wurde eine vaginale Geburt angestrebt, die bei 808 (60,1%) Frauen durchgeführt werden konnte. 233 (17,3%) Patientinnen mussten durch einen sekundären Kaiserschnitt entbunden werden. Bei 304 (22,6%) Patientinnen wurde eine elektive Sectio durchgeführt. In der Gruppe der vaginalen Geburten zeigten sich keine signifikanten Unterschiede in der Rate niedriger APGAR Werte in der 5. Lebensminute oder von Nabelschnur pH Werten ≤ 7 verglichen mit einer primären Sectio. Es zeigte sich eine höhere kindliche Transferierungsrate nach einer vaginalen Entbindung als nach einer primären Sectio (55,0% vs. 20,0%). Als geburtshilfliche Traumata konnten 8 schwere Plexusparesen beobachtet werden, die sich ausschließlich nach einer vaginalen Entwicklung zeigten. Dieser Unterschied ist statistisch signifikant (p = 0.0025). Perinatal verstarben zwei Kinder ohne angeborene Missbildungen nach einem vaginalen Entbindungsversuch. In der Gruppe der geplanten Schnittentbindungen verstarb kein reifes Kind. SCHLUSSFOLGERUNG: Die höhere Transferierungsrate und eine signifikante Häufung geburtsbedingter Traumata in der vaginalen Entbindungsgruppe unterstreichen die Vorteile eines geplanten Kaiserschnittes bei Entbindungen aus einer Beckenendlage.SummaryOBJECTIVE: To investigate neonatal outcome after breech presentation in term pregnancies. STUDY DESIGN: Data from 1345 term breech deliveries over a 12-year study period were retrospectively reviewed. Neonatal morbidity and mortality were compared by route of delivery. RESULTS: We investigated 1345 term breech deliveries. A total of 1041 patients (77.4%) attempted a vaginal delivery; of these, 808 (60.1%) were delivered vaginally and 233 patients (17.3%) who failed at vaginal birth underwent cesarean section. The other 304 women (22.6%) were delivered by a planned cesarean section. No statistical differences were found in the incidence of low 5-minute Apgar scores and arterial cord blood pH values ≤ 7. Admission to neonatal units was higher after vaginal delivery than after elective cesarean section (55.0% vs. 20.0%). The difference between vaginal delivery and cesarean section in the rate of severe plexus injuries was statistically significant (P = 0.0025). Two neonatal deaths occurred at term after a trial of labor. No perinatal death of a term breech infant occurred in the cesarean section group. CONCLUSION: The increased risk of birth trauma and admission to a neonatal intensive care unit after vaginal delivery emphasizes the advantages of a planned cesarean section for a breech presentation.

Umbilical venous leptin concentration and gender in newborns.

OBJECTIVE: To investigate the relationship between umbilical venous leptin concentration and gender in 20 pairs of newborns matched 1:1 for birth weight and gestational age at sampling. MATERIALS: Blood samples were obtained from 40 women at delivery, identified as having an uncomplicated pregnancy. Umbilical venous blood samples were obtainedfrom their newborns (20 females and 20females) at birth. Specimens were analyzed using a human leptin 125-I radioimmunoassay. RESULTS: Fetal leptin correlated positively with birth weight (r s= 0.541; P < .001). Umbilical venous leptin concentrations in female newborns (median: 10.7 ng/mL, range: 3.5-34.4 ng/mL) were significantly higher (P = .028) than in male newborns (median: 7.7 ng/mL, range: 2.0-19.3 ng/mL). There was no significant correlation between maternal and fetal leptin concentrations. Multiple logistic regression analysis revealed birth weight and gender to be independent factors influencing fetal cord leptin. CONCLUSION: Our results suggest that in the fetus, as in children and adults, gender and weight are the major determinants of circulating leptin levels.

High resolution magnetic resonance imaging of urethral anatomy in continent nulliparous pregnant women

INTRODUCTION To quantify the distribution of morphologic appearances of urethral anatomy and measure variables of urethral sphincter anatomy in continent, nulliparous, pregnant women by high resolution magnetic resonance imaging (MRI). MATERIALS AND METHODS We studied fifteen women during their first pregnancy. We defined and quantified bladder neck and urethral morphology on axial and sagittal MR images from healthy, continent women. RESULTS The mean (±standard deviation) total transverse urethral diameter, anterior-posterior diameter, unilateral striated sphincter muscle thickness, and striated sphincter length were 15±2 mm (range: 12-19 mm), 15±2 mm (range: 11-20 mm), 2±1 mm (range: 1-4 mm), and 13±3 mm (range: 9-18 mm) respectively. The mean (±standard deviation) total urethral length on sagittal scans was 22±3 mm (range: 17.6-26.4 mm). DISCUSSION Advances in MR technique combined with anatomical and histological findings will provide an insight to understand how changes in urethral anatomy might affect the continence mechanisms in pregnant and non-pregnant, continent or incontinent individuals.

Impact of Maternal Anthropometry and Smoking on Neonatal Birth Weight

The purpose of this study was to determine the effect of maternal pre-pregnancy body mass index (BMI) and maternal smoking habits on neonatal birth weight. We reviewed 10,240 normal singleton term pregnancies between 1985 and 1995 at the University Department of Obstetrics and Gynecology, Vienna. Birth weights of infants of overweight smokers were greater than those of smokers in general and similar to birth weights of nonsmokers, but smoking did have a fetal growth-retarding effect in overweight smoking mothers. Infants of underweight mothers who increased their daily cigarette consumption during pregnancy had significantly lowest birth weight. Our results suggest that the negative effects of smoking during pregnancy cannot be mitigated by a higher pre-pregnancy BMI and/or an improved weight gain during pregnancy. Especially the infants of underweight mothers benefit from their mothers’ decision to cease smoking.

Chromosomal Translocation t(10;11)(q26;q13) in a Woman with Combined Pituitary Hormone Deficiency

We describe the case of a girl with combined pituitary hormone deficiency (CPHD) carrying a balanced chromosomal translocation t(10;11)(q26;q13) with paternal transmission. Her father, with no apparent physical abnormalities, had the karyotype: 46, XY, t(10;11)(q26;q13). CPHD denotes impaired production of growth hormone (GH) and one or more of the other five anterior pituitary-derived hormones. Pit-1 gene and Prop-1 gene mutations and deletions have been reported being responsible for CPHD. Although our patient had a t(10;11) (q26q13) paternal chromosomal translocation, the phenotype was similar to that found in humans with different Pit-1 or Prop-1 gene alterations. Interestingly, the patient’s father had the same translocation without phenotypic effects. In conclusion, we describe panhypopituitarism in a woman with a paternally transmitted translation, which appears to be phenotypically expressed only in females.