Hämatologische und biochemische Serienuntersuchungen bei Patientinnen mit EPH-Gestosis,unter besonderer Berücksichtigung der Vorliegens eines Hellp-Syndroms

Ohne Zusammenfassung     

Postmenopausal virilization due to ovarian hyperthecosis

A case of a 66-year-old obese women with type 11 diabetes mellitus and a 4 year history of virilism is presented. After removal of the ovaries the raised testosterone levels returned to normal and signs of virilism gradually receded. The histological finding of nodular hyperthecosis of the ovaries is discussed in relation to hyperinsulinaemia.     

Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men

Background:

Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV).

Methods:

The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application.

Results:

Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; _pη² = 0.499), SDNN (p < 0.001; _pη² = 576), RMSSD (p = 0.015; _pη² = 194), NN50% (p = 0.008; _pη² = 0.224), and LF% (p = 0.014; _pη² = 0.196), and moderate effects with respect HF% (p = 0.099; _pη² = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response.

Conclusions:

Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.     

Methods of prenatal determination of fetal maturity based on differentiation of the fetal skin during the last weeks of pregnancy

During the process of 'maturation' of the fetal skin, detachment of the layer of vernix caseosa takes place from the fetal epidermis into the amniotic fluid, in the course of the last weeks of pregnancy. This results in: (a) a change of the cytological image of the amniotic fluid followed by a considerable increase in the proportion of the keratinized epidermic cells, (b) a simultaneous increase in the turbidity of the amniotic fluid and (c) a parallel increase in the quantity of sediment which remains after centrifugation of the amniotic fluid. The data presented in this paper, measured in 87 samples of amniotic fluid from normal, eutrophic, uncomplicated pregnancies, indicate the difference between the values of the various parameters before and after the main detachment of the vernix caseosa. Since the fetal skin is the organ reflecting most accurately the general status of the fetal maturity at the end of pregnancy, we consider that an overall examination of findings from the amniotic fluid indicating the condition of the fetal skin supplies us with reliable results for making a prenatal prediction of the maturity status of the fetus.     

Postparacentesis bilateral massive vulvar edema in a patient with severe ovarian hyperstimulation syndrome

OBJECTIVE: To report a case of bilateral massive vulvar edema following lower abdominal paracentesis in a patient with ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University teaching hospital. PATIENT(S): A 32-year-old woman with primary infertility. Intervention(S): The patient underwent ovarian stimulation with leuprolide acetate, highly purified FSH, and hCG. Because of the development of severe ovarian hyperstimulation syndrome, bilateral paracentesis through the lower abdominal quadrants was performed. MAIN OUTCOME MEASURE(S): Treatment of ovarian hyperstimulation syndrome. RESULT(S): Development of bilateral massive vulvar edema 24 hours after lower abdominal paracentesis. CONCLUSION: This case report suggests that lower abdominal paracentesis could be the cause of vulvar edema development in ovarian hyperstimulation syndrome, probably due to a fistulous tract created between the peritoneal cavity and the subcutaneous tissues.     

Ovarian remnant syndrome: a case report and review of the literature

The ovarian remnant syndrome in an unusual complication of bilateral oophorectomy, usually presenting with pelvic mass and pain. A case of the syndrome is described in a 35-year-old woman with a history of abdominal hysterectomy and bilateral oophorectomy. We suggest that ovarian remnant syndrome should be considered in the differential diagnosis of chronic pelvic pain after recorded oophorectomy.     

Ovary and ovulation: Application of image analysis cytometry in fofficular fluid cells obtained from in-vitro fertilization cycles: relationships to patient's age, oocyte maturity, fertilizability and in-vitro fertilization outcome

In an in-vitro fertilization (LVF)/embryo transfer pro grammegranulosa cells obtained from 59 individual preovulatory follicleswere analysed using multiparameter image analysis cytometry,in an attempt to determine whether their morphometric and DNA-cytometricparameters could prove useful in assessing follicle and oncytematurity and in predicting fertilizabifity and outcome of theseIVF cycles. Almost all morphometric and DNA- cytometric parameterswere not correlated with either the patient's age or oocytematurity, and did not predict oocyte fertilization or occurrenceof a clinical pregnancy. The only possible relevant parameterwhich, despite its inverse correlation to total luteinizinghormone administration, also proved to be inversely correlatedto pregnancy outcome (in the seven cases in which a pregnancyoccurred), was the percentage of granulosa cell nuclei withincreased DNA content (>5c). Finally, if granulosa cellsdo not reveal euploid polyploidization in spontaneous or inducedovulatory cycles, the detected cells with increased DNA contentshould be interpreted as aneuploid, i.e. with chromosomal aberrations,and so their presence could also be discussed in connectionwith the hypothetical risk of prospective neoplastic transformationof the tissue.     

p53 codon 72 polymorphism and risk of intra-epithelial and invasive cervical neoplasia in Greek women.

In 1998, Storey and co-workers suggested that individuals homozygous for arginine (Arg) at codon 72 of the p53 gene are about seven times more susceptible to human papillomavirus (HPV)-related carcinogenesis than heterozygotes. Since then, several studies from Northern Europe, Japan and the USA have failed to demonstrate a similar correlation. By contrast, a study in Brazil as well as one recent study in Italian and Swedish populations showed strong positive associations. We examined the frequency of p53 codon 72 polymorphism in samples from both invasive and intra-epithelial cervical neoplasias (CIN), and compared them with samples from healthy controls. All 88 samples came from women with a Greek ethnic background. Tissue specimens were collected from archival material with histologically diagnosed low-grade CIN (LGCIN), high-grade CIN (HGCIN) or cervical cancer (CxCa). As a control, we used cellular material newly collected by cytobrush from the cervices of 30 healthy women with normal cytological and colposcopical examinations. p53 Arg homozygosity (Arg/Arg) alone was associated with four-, six- or eight-fold increased risks for LGCIN, HGCIN or invasive cancer, respectively. The frequency of the p53Arg/Arg genotype and of the proline (Pro) allele showed significant linear trends according to the degree of severity of the lesion (P = 0.0007 and P = 0.0009, respectively). Exclusion of the ten HPV16/18-negative cases did not substantially alter the Arg/Arg frequency among the groups nor the significant linear trend. Our results confirm the initial findings of Storey and co-workers, as well as the data of the Brazilian and the recent European study, but do not accord with those of the other aforementioned studies. Variations in ethnic background, laboratory performance, verification of the HPV status, definition of controls, and sample size are the most plausible explanations for this controversy. In all our samples, the distribution of the p53 alleles fits the Hardy-Weinberg equilibrium and the 0.48 frequency of the Pro allele in our controls accords well with the percentages previously reported for different ethnic groups as characteristic of the assumed north-south cline. Some authors assert that the discrepancy in the results could not be attributed to differences in the methods; however, the Brazilian study emphasized the effect of inter-laboratory variation in detecting the association between p53 polymorphism and cervical cancer. Regarding the control group, our samples were only from women with a cytologically and colposcopically benign cervical epithelium. We think that simply choosing 'normal volunteers' for collecting control DNA blood samples without knowing the status of their cervical epithelium is indeed a possible source of bias. Finally, it is very unlikely that loss of heterozygosity at the p53 locus could be a factor interfering with the allelotype distribution. Our present small study results, which suggest a biologically relevant association, provide strong evidence that homozygous arginine at codon 72 of p53 may confer a higher susceptibility to HPV-associated intra-epithelial and invasive cervical neoplasia.