[Tumor of the mesosalpinx with unclear differentiation]. / Tumor der Mesosalpinx mit unklarer Differenzierung.

Female adnexal tumors of probable Wolffian origin (FATWO) are rare tumors, which are mostly localized in the broad ligament or the mesosalpinx. They show high intratumor and intertumor variability of histological patterns (e.g. solid, tubular, cribriform and cystic) with usually unremarkable cellular and nuclear morphology and a lower mitotic rate. In general, they behave in a benign fashion but there are rare cases with malignant transformation, so that careful examination and surveillance are necessary. Differential diagnoses include Sertoli-Leydig cell tumors, metastasized endometrioid carcinoma and the FATWO-like variant of the endometrioid carcinoma of the fallopian tubes. The FATWOs express pancytokeratin, CD10, vimentin, calretinin and inhibin A. Estrogen and progesterone receptors are expressed in a minority of cases, whereas epithelial membrane antigen (EMA) is not detectable.

The influence of diffuse pollution on groundwater content patterns for the groundwater bodies of Germany.

Commissioned by Germany's Working Group of the Federal States on Water Problems (LAWA) the authors developed a procedure to define natural groundwater conditions from groundwater monitoring data. The distribution pattern of a specific groundwater parameter observed by a number of groundwater monitoring stations within a petrographically comparable groundwater typology is reproduced by two statistical distribution functions, representing the "natural" and "influenced" component. The range of natural groundwater concentrations is characterized by confidence intervals of the distribution function of the natural component. The applicability of the approach was established for 17 hydrochemical different groundwater typologies occurring throughout Germany. Based on groundwater monitoring data from ca. 26,000 groundwater-monitoring stations, 40 different hydrochemical parameters were evaluated for each groundwater typology. For all investigated parameters the range of natural groundwater concentrations has been identified. According to the requirements of the EC Water Framework Directive (article 17) (WFD) this study is a basis for the German position to propose criteria for assessing a reference state for a "good groundwater chemical status".

A procedure to define natural groundwater conditions of groundwater bodies in Germany.

Commissioned by Germany's Working Group of the Federal States on Water Problems (LAWA) the authors developed a procedure to define natural groundwater conditions from groundwater monitoring data. The distribution pattern of a specific groundwater parameter observed by a number of groundwater monitoring stations within a petrographically comparable groundwater typology is reproduced by two statistical distribution functions, representing the "natural" and "influenced" components. The range of natural groundwater concentrations is characterized by confidence intervals of the distribution function of the natural component. The applicability of the approach was established for four hydrochemically different groundwater typologies occurring throughout Germany. Based on groundwater monitoring data from 7920 groundwater monitoring stations, 15 different hydrochemical parameters were evaluated for each groundwater typology. For all investigated parameters the range of natural groundwater concentrations has been identified. According to the requirements of the EC Water Framework Directive (article 17) (WFD) this study is a basis for the German position to propose criteria for assessing a reference state for a "good groundwater chemical status".

[Partial hydatidiform mole in a cytogenetically normal fetus]. / Partielle Blasenmole bei zytogenetisch unauffälligem Fetus.

The diagnosis of a partial hydatid mole presents a difficult situation for both physician and parents. On the one hand there may be a normal pregnancy whereas on the other hand the mother may be threatened by numerous complications caused by the hydatid mole if the pregnancy is continued. We report on a pregnancy in the 18th week during which a partial hydatid mole was discovered where we considered it justified to advise the parents, after a thorough consultation, to continue with the pregnancy. Ultrasound examination had excluded infaust malformations whereas cytogenetically there was no triploidy of the fetus. Moreover it was possible to closely monitor the course of pregnancy to discover any possible complications well in time. Under these conditions continuation of pregnancy until birth is possible in about 60% of the cases without enhanced risk to the mother, as is evident from the data in the literature. In the case under report, however, there was a life-threatening uterine haemorrhage with placenta previa in the 22nd week of pregnancy resulting in mandatory premature termination of pregnancy. Repeated treatment with cytostatics was subsequently required due to persistence of the mole, since even hysterectomy could not achieve complete remission of the disease.

[Cerebral Doppler ultrasound in fetal hydrocephalus]. / Zerebrale Dopplersonographie beim fetalen Hydrocephalus.

Within a six-year period (1988-1993), we diagnosed and treated 143 cases of fetal hydrocephalus. We investigated the relationship between the degree of dilatation of the cerebral ventricles, the thickness of the pallium, and blood flow velocities in cerebral arteries. The assumption that progressive dilatation of the fetal ventricles leads to increasing resistance of the cerebral blood flow and disrupted cerebral perfusion was confirmed. Applying the postnatal pediatric principle of indication for shunt implantation based on Doppler sonographic diagnosis, delivery was instituted immediately in cases with pathologically increased pulsatility indices (PI). In all cases, this indication and the need for immediate shunt implantation were confirmed by postnatal pediatric ultrasonography. Cerebral Doppler velocimetry enables timely identification of fetuses at risk for pressure- or ischemia-induced cerebral tissue damage. The timing of delivery and subsequent neurosurgical therapy can thus be optimized.

[Rapid karyotyping in the 2nd and 3rd trimester: results and experiences]. / Schnelle Karyotypisierung im II. und III. Trimenon: Ergebnisse und Erfahrungen.

Rapid karyotyping in the second and third trimester is an increasing field of collaboration between women's hospitals and human genetics. Techniques available for rapid karyotyping are: 1. Amniocentesis; to obtain amniotic fluid cells for culturing and subsequent chromosome harvesting using the pipette method or the "in situ" technique. The average time between preparation of the amniotic fluid and the verbal notification of the analysed karyotype is 4.65 days for the pipette method and 5.97 days for the "in situ" technique. The major advantages are that amniocentesis can be handled safely by many gynaecologist, and the amniotic fluid samples can be posted easily to cytogenetic units familiar with rapid karyotyping. The main disadvantage is that currently only a few laboratories are able to handle the pipette method or the "in situ" technique for rapid karyotyping. 2. Fetal blood sampling (cordocentesis); and subsequent chromosome analysis on cultivated fetal lymphocytes leading to results within 2 to 4 days. The main advantage of this procedure is the reliability of the results obtained. Fetal blood sampling, however, is restricted to specialists; this may involve scheduling delays. 3. Placental biopsy; with subsequent direct preparation and long term culturing. In comparison to both other techniques this procedure is faster if direct preparation is used. Results can be obtained even on the same day. The main disadvantage, however, is the problem with the reliability of the direct preparation results. They must be confirmed by time-consuming long-term culturing. Data are presented on the likelihood of abnormal ultrasound findings being caused by chromosomal aberrations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasound detection of suspected chromosome abnormalities in the 1st and 2nd trimester. Results of a prospective study]. / Sonographische Erkennung von Hinweiszeichen für eine Chromosomenanomalie im I. und II. Trimenon. Ergebnisse einer prospektiven Studie.

4053 pregnancies were studied prospectively during 4 years (July 1988 to June 1992) with regard to the sonographical recognition of indications of chromosomal anomalies from 9 to 24 weeks, irrespective of the mother's age. The morphology of the fetal organs, the phenotype, the proportions of the fetal body, biometrical data and disorders of the placenta and the amniotic fluid were scrutinised. For the prediction of a chromosomal anomaly, a high sensitivity of 86.3% and specificity of 99.8% were found; the prevalence was 1.8%. The thickening of the nuchal fold or a nuchal oedema was the most significant fetal stigma and a guiding symptom in Turner's syndrome and in trisomy 21 and 18. When suspicious facts were found during ultrasonography, karyotyping was proposed after detailed counselling, especially to mothers below the age of 35. The extended sonographical examination is considered a non-invasive tool to differentiate the statistical age related risk of a chromosomal anomaly in each individual case.

Six years' experience with rapid karyotyping in prenatal diagnosis: correlations between phenotype detected by ultrasound and fetal karyotype.

From September 1985 to March 1992, 804 amniotic fluid samples from 64 different diagnostic centres of the Federal Republic of Germany were sent to our laboratory exclusively for rapid karyotyping. The average time needed for notification of the analysed karyotype was 4.65 days when the 'pipette method' was used for chromosome harvesting and 5.97 days when the 'in situ' technique was used. The overall incidence of chromosome aberrations was 15.3 per cent. Data are presented about the likelihood of abnormal ultrasound findings being caused by chromosome aberrations. These findings include polyhydramnios, oligohydramnios, growth retardation, fetal effusions, neural tube defects, craniofacial defects, heart defects, gastroschisis and omphalocele, gastrointestinal tract defects, urinogenital defects, and limb defects. In future, such data need to contain larger numbers of cases for each week of gestation. This will improve the risk evaluation for each case with abnormal ultrasound findings, which should lead to better management during pregnancy, delivery, and postnatal care for those who require rapid karyotyping.

[Drug induced prevention of the acid aspiration syndrome in non-elective cesarean section]. / Die medikamentöse Prophylaxe des Säure-Aspirations-Syndroms bei nicht elektiver Sectio Caesarea.

Pulmonary aspiration of gastric content with a subsequent aspiration syndrome is a major cause of maternal mortality. Since regurgitation in patients undergoing general anaesthesia cannot reliably be excluded, a prophylaxis with specific drugs is recommendable. In a prospective investigation on patients undergoing nonelective Caesarean section, the H2-receptor antagonist famotidine (fam), the antacid sodium citrate (cit) and the dopamine antagonist metoclopramide (met) were evaluated with respect to volume and acidity of gastric juice. When indicated, a group of 255 patients received 20 mg famotidine i.v., with a randomised subgroup of 126 of these patients also receiving 10 mg metoclopramide i.v. A second group of 171 patients received 20 ml 0.3 M sodium citrate p.o., with a randomised subgroup of 75 of these patients receiving 10 mg metoclopramide i.v. in addition. After induction of anaesthesia the gastric content was evacuated via a gastric tube. Mean volume and pH of the gastric juice as well as the percentage of patients at risk for the development of an aspiration syndrome (juice volume > 0.4 ml/kg and pH < 2.5) were determined. Already in the first hour after drug administration a lower percentage of patients at risk could be observed compared to data from patients without prophylaxis published in recent studies (fam 18.2%, fam + met 12.0%, cit 1.9%, cit + met 2.2%). Treatment with sodium citrate was most effective because of a rapid increase in pH (cit vs. fam: p < 0.05, cit vs. fam + met: p < 0.1, cit + met vs. fam: p < 0.05, cit + met vs. fam+met: p < 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid karyotyping in prenatal diagnosis: a comparative study of the 'pipette method' and the 'in situ' technique for chromosome harvesting.

Rapid karyotyping in the second and third trimesters has important implications for the management of pregnancies at risk. From September 1985 to March 1992, 735 amniotic fluid samples sent to our laboratory for rapid karyotyping from 64 different diagnostic centres of the Federal Republic of Germany were included in a comparative study on harvesting for chromosome analysis using the 'pipette method' or the 'in situ' technique. The average time between preparation of the amniotic fluid and verbal notification of the analysed karyotype was 5.41 days. The 'pipette method' needed on average 4.65 days, and the 'in situ' technique 5.97 days. In comparison with other more invasive techniques available for rapid karyotyping such as cordocentesis and placental biopsy, amniocentesis and subsequent chromosome harvesting using the 'pipette method' and/or the 'in situ' technique proved very useful and efficient. The overall incidence of chromosome aberrations was 15.3 per cent. The high rate of structural chromosome aberrations and uncommon aneuploidies found in our investigation (12 per cent) indicates that for rapid karyotyping in the second and third trimesters, conventional cytogenetic techniques cannot be replaced by faster techniques based on fluorescent in situ hybridization on interphase cells in the near future.

[Screening for fetal heart defects in the four chamber view with evaluation of larger arteries: possibilities and limits]. / Screening auf fetale Herzfehler im Vierkammerblick mit Beurteilung der grossen Arterien: Möglichkeiten und Grenzen.

The four-chamber view and the visualization of the root of the left and right ventricular outflow tracts has been proposed as a screening method for the detection of congenital heart disease in the fetus. In order to study the diagnostical value of the method we investigated 1600 fetuses between the 17th and 40th gestational week without anamnestic risk for congenital heart disease with this screening method in a two years' period. We found 33 fetuses to have an abnormality either in the four-chamber view or in the ventricular outflow tracts. The sensitivity of the method in the detection of congenital heart disease was found to be 81%, the specificity 99% and the positive predictive value 88%. Women at high risk for congenital heart disease in the fetus should still undergo a more detailed echocardiographic examination to maximize the sensitivity in the detection of structural heart defects. Nevertheless, the described screening procedure is an effective and feasible method to detect fetuses with severe congenital heart disease, whose prognosis may be improved by the delivery in a perinatological center.

[Disseminated intravascular coagulation caused by prenatal hemorrhage into a congenital mesoblastic nephroma. Case report]. / Verbrauchskoagulopathie durch pränatale Einblutungen in ein kongenitales mesoblastisches Nephrom. Fallbericht.

We report the case of a premature female newborn of the 35th gestational week with a congenital mesoblastic nephroma. The tumor was prenatally diagnosed in the 32nd week of gestation. By close sonographic controls, rapid enlargement was verified towards the end of the 35th week of gestation. This was probably caused by hemorrhage into the tumor. Anemia and postnatal disseminated intravascular coagulation followed. Cesarean section was done, because the anemia was suspected by Doppler sonographic evaluation. Disseminated intravascular coagulation could not be sufficiently controlled by conservative means but only by surgical removal of the tumor. The tumor turned out to be a congenital mesoblastic nephroma by histologic evaluation. Despite postoperative anuria and catecholamine dependency, our patient eventually showed a very favourable outcome. Diagnosis, clinical behavior and therapy of this tumor with a generally good prognosis are described and discussed.

Doppler flow measurements and histomorphology of the placental bed in uteroplacental insufficiency.

For the first time histomorphological findings of the uteroplacental vessels were correlated with Doppler flow parameters of this vascular area in a combined study. The study group consisted of 58 women with a pregnancy-induced hypertension or an otherwise presumed uteroplacental perfusion impairment delivered by cesarean section. The control group included 50 healthy pregnancies, delivered by cesarean section due to presentation anomalies or failure to proceed. After removal of the placenta a placental bed biopsy containing the uteroplacental vessels of the decidual and inner myometrial layer was taken. The occurrence of accepted histological signs of low uteroplacental perfusion was compared to Doppler flow velocity wave forms in uteroplacental arteries. The accuracy of doppler-sonographic findings of uteroplacental circulatory impairment confirmed by the histomorphological results was high, even in cases not complicated by hypertension. The good accordance of Doppler flow parameters with morphological findings offers new perspectives for differentiated insights in pregnancy courses with and without signs of uteroplacental insufficiency.

[Prenatal diagnosis of cleft lip and palate by ultrasound. Limits of prenatal sonography]. / Pränatale Diagnostik der Lippen-Kiefer-Gaumen-Spalte. Möglichkeiten der Pränatal-Sonographie.

During the past ten years diagnostic ultrasound has dramatically changed obstetric approaches. Improvements in instrumentation have made it possible to identify an increasing number of fetal anatomical structures. Ultrasonography of the fetal face has become important for the detection of major syndromal malformations or chromosomal disorders. In cases with a family history of cleft lip and palate ultrasound can confirm or exclude the diagnosis. Associated anomalies have to be ruled out when cleft lip is present. Positive findings have different obstetrical implications.

[Life-threatening perinatal hemorrhage of a sacral teratoma]. / Lebensbedrohliche perinatale Blutung eines Steissbeinteratoms.

Great sacral teratomas are rare congenital tumors. The frequency in liveborns is about 1:40,000. Well known complications of sacral teratomas are malignant degeneration, infection and, in case of intraabdominal expansion, compression of the urogenital tract. We report a case of unusual fulminant perinatal bleeding out of a great sacral teratoma ruptured during birth.