Stefanie Bussen

Thyroid antibodies and their relation to antithrombin antibodies, anticardiolipin antibodies and lupus anticoagulant in women with recurrent spontaneous abortions (antithyroid, anticardiolipin and antithrombin autoantibodies and lupus anticoagulant in habitual aborters).

OBJECTIVE This study was undertaken to evaluate the incidence of thyroid autoantibodies in women with a history of recurrent spontaneous abortions (RSA) and to investigate their relationship to non-organ specific autoantibodies. STUDY DESIGN 28 euthyroid non-pregnant habitual aborters were analysed for thyreoglobulin (TG), thyroid peroxidase antibodies (TPO), and autoantibodies to thromboplastin, cardiolipin and lupus anticoagulant. 28 multigravidae without previous abortions or endocrine dysfunctions served as controls. RESULTS 11 of 28 women with recurrent spontaneous miscarriage (39%), but only 2 of 28 controls (7%) (Chi square test: p < 0.01) demonstrated positive titres of TG, TPO, or both antibodies, 12 patients were positive for antithrombin antibodies and 3 for anticardiolipin. Only one women was lupus anticoagulant positive. No significant correlation between thyroid antibody positivity and positivity for antiphospholipids (Fishers exact test: p = 0.441), anticardiolipin (p = 0.664) or lupus coagulant (p = 0.607) was found. CONCLUSIONS The incidence of thyroid antibodies in euthyroid women with recurrent pregnancy loss appears to be significantly increased compared with controls of reproductive age without previous abortions. No correlation between the presence of thyroid autoantibodies and non-organ specific autoantibodies could be established.

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.

Maternal sepsis and intrauterine fetal death resulting from Candida tropicalis chorioamnionitis in a woman with a retained intrauterine contraceptive device

Since the first report of fetal candidiasis in 1958 57 cases including this case have been reported in the English language literature. As in the above reported case 20 of these were associated with an IUD in situ. A very low incidence of maternal febrile morbidity (4%) indicating hematogenous spread was noted in this collective. The first reference to C. tropicalis as an intrauterine pathogen was by Whyte et al. in 1982 who isolated C. tropicalis from a placenta of a pregnancy complicated by intrauterine Candida infection. Nichols and coworkers in 1995 presented the first case of C. tropicalis chorioamnionitis at 25 weeks of gestation diagnosed antenatally with confirmed congenital infection. In concordance with our findings autopsy revealed fetal ascites infiltration of alveoli and terminal airways by granulocytes and a marked acute chorioamnionitis. In both the aforementioned publications there was no evidence for systemic maternal infection; neither were the pregnancies complicated by a retained IUD. Our report confirms that an intraamniotic infection with C. tropicalis in an asymptomatic pregnant women can lead to hematogenous dissemination manifesting in a severe maternal infection requiring intensive care treatment. (excerpt)

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.

Relationship of bacteriological characteristics to semen indices and its influence on fertilization and pregnancy rates after IVF

Background. To determine if routine semen culture is useful in asymptomatic couples joining an in‐vitro fertilization (IVF/ET) program.

Semen parameters in patients with unilateral testicular cancer compared to patients with other malignancies

AimThe aim of our study was to evaluate pretreatment semen quality in patients with unilateral testicular cancer in comparison to semen parameters of patients suffering from other malignancies.MethodsSemen analysis according to WHO recommendations were performed in 16 patients suffering from unilateral testicular cancer (group 1) and in 21 patients who were diagnosed to have other malignant tumors (group 2: non-Hodgkins lymphoma: n=7, Hodgkins disease: n=6, leukemia: n=3, osteosarcoma: n=2, rectal cancer: n=2, thyroid carcinoma: n=1) prior to anti-cancer treatment.ResultsNormozoospermia was observed in none of the testicular cancer patients but in five of the other patients (p=0.047). Sperm concentration was significantly decreased in the patients of group 1 compared to those of group 2 (18.7±22.3×106/ml versus 35.6±31.3×106/ml, p=0.03). The percentage of rapid progressive motile spermatozoa was significantly less in testicular cancer patients than in patients suffering from other malignancies (WHO group a: 1.1±2.0% versus 4.7±5.6%, p=0.02). Normal morphological findings of spermatozoa were found in a smaller percentage in group 1 (16.2±6.0% versus 26.1±18.0%, p=0.03).ConclusionsOur investigations revealed that especially testicular cancer has an adverse influence on sperm quality. Hence, we advise careful and sufficient cryopreservation of semen in those patients taking the negative impact of cytotoxic treatments on semen parameters into account.

Incidence of Obesity in Female Patients with Fecal Incontinence

Background: The aim of this study was to evaluate the correlation between body mass index (BMI) and the incidence of fecal incontinence in female patients. Patients and Method: In this study, data of 98 female patients presenting with fecal incontinence and of 98 healthy control subjects were retrospectively analyzed. Results: In 34% of the study patients and 50% of the controls, body mass indices were within the normal range (BMI 18.5–24.9 kg/m2) (Mann-Whitney U test: p > 0.05). 29% of the study patients and 32% of the control group were overweight (BMI 25.0–29.9 kg/m2) (U test: p > 0.05). 26% of the study group and 9% of the control collective were identified as obese according to the WHO classification I (U test: p = 0.033). 5% of the patients and 6% of the controls were diagnosed as obese according to the WHO classification II (U test: p > 0.05), and 2% of the patients and 1% of the controls fulfilled the definition for obesity based on the WHO classification III (U test: p > 0.05). Conclusion: Since the percentage of females suffering from obesity is significantly higher in patients presenting with fecal incontinence when compared to healthy controls, weight loss should be pointed out strongly in a conservative treatment of fecal incontinence.

Interval of 9 h between birth of twins at term: case report and review of the literature

Abstract We report the case of a primipara who delivered healthy twins vaginally at term with a time interval between twins of 9 h and 19 min. Neonatal outcome and further development were normal in both twins.