Associated malformations in congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a severe neonatal anomaly. The aim of this study was to evaluate the frequency and types of malformations associated with CDH. The outcome was compared with that in newborns with CDH alone. The study included 362 fetuses and newborns at a single national center for CDH. Associated malformations and chromosomal aberrations were noted prenatally and postnatally. The neonatal outcome was assessed relative to the use of extracorporeal membrane oxygenation (ECMO) and the mortality rate. At least one associated malformation was diagnosed in 143 cases (39.5%). Altogether, 272 associated malformations were found. Only 50 (18.4%) anomalies were diagnosed antenatally. In 62 (17.1%) cases, 102 major malformations were found along with CDH, with a prenatal detection rate of 35.3%. The associated malformations were very heterogeneous, but cardiovascular malformations were the most common. Newborns with major anomalies, chromosomal aberrations, or syndromes additional to CDH had a significantly lower survival rate than newborns with an isolated CDH. Associated malformations did not affect the rate of ECMO treatment. Associated malformations in CDH are frequent and heterogeneous, and diligent and experienced antenatal and postnatal care is important.

Comparison of different sonographic methods to determine fetal abdominal circumference.

PURPOSE: In modern obstetric management, accurate estimation of fetal weight is an important prognostic parameter of neonatal morbidity and mortality, and a valuable tool for determining further treatment. Fetal abdominal measurements, mostly abdominal circumference (AC), are not only included in the majority of commonly used weight equations, but also have the greatest impact on weight estimation. This therefore underlines the importance of accurate determination of the AC. The aim of our study was to evaluate which method for AC calculation is the most accurate one and thereby gives the best results for fetal weight estimation. MATERIALS AND METHODS: This prospective study included 239 term pregnancies. Inclusion criteria were a singleton pregnancy and ultrasound examination with complete fetal biometric parameters within 3 days of delivery, and absence of structural or chromosomal malformations. For calculation of the sonographic AC, three different methods were used. As a reference method, AC of the infant was determined immediately after birth. The accuracy of fetal weight estimation was determined for all of these methods of AC measurement using a commonly used weight equation. Differences were compared by using percentage error (PE), absolute percentage error (APE), limits of agreement (LOA) and cumulative distribution. RESULTS: The ellipse region-of-interest (ROI) method showed the best results of all sonographic methods. For estimating fetal weight, it had the lowest median APE of the sonographic methods and the lowest SD of the PE, as well as the narrowest LOA. Regarding the cumulative distribution, ellipse ROI technique included the most cases at all discrepancy levels (5, 10, 15, and 20%). CONCLUSION: Accurate measurement of fetal AC is important for good fetal weight estimation. The differences between the three techniques were small; however, there was a significant advantage when using the ellipse ROI method.

Umbilical cord blood donation during caesarean section does not lead to increased maternal blood loss.

BACKGROUND: Umbilical cord blood haematopoietic stem cell donation (UCBD) has increased in recent years. While performing UCBD during caesarean section, suturing the uterotomy is delayed for a few minutes. The aim of our study was to analyse if this causes an increase in maternal blood loss. PATIENTS AND METHODS: In this retrospective study, we compared pre- and postpartal haemoglobin levels of 100 patients who delivered by caesarean, either with UCBD (study group) or without UCBD (control group). P-values < or = 0.05 were regarded as significant. RESULTS: The main clinical characteristics did not show any significant differences between the two groups. There was no significant difference of decrease in haemoglobin between the study group and the control group (p=0.747). CONCLUSION: UCBD during caesarean section does not lead to increased maternal blood loss. Objections to the safety of UCBD regarding increased maternal blood loss during caesarean section can be dispelled.

Serum levels of interleukin-6 in patients with primary head and neck squamous cell carcinoma.

Interleukin (IL)-6 plays a central role as a differentiation and growth factor of tumor cells. IL-6 has been identified in a wide variety of malignancies, including head and neck squamous cell carcinomas (HNSCC). The aim of this study was to investigate the association between the serum levels of IL-6 in HNSCC patients and the biological characteristics of the tumor as well as the clinicopathological status of the patients. The circulating level of IL-6 in sera from patients with various HNSCC (n = 90) as well as from healthy normal controls (n = 39) was investigated. Serum IL-6 concentrations were determined as serum immunoreactivity using a quantitative sandwich enzyme immunoassay technique. For statistical analysis, the Kruskal-Wallis test was performed. The majority of the patients with HNSCC were found to have high serum IL-6 concentrations. The IL-6 levels in the sera of patients with cancer ranged from below the detection limit to 312.8 pg/ml (mean, 19.5 pg/ml). In contrast, the IL-6 serum levels in 39 healthy individuals ranged from below the detection limit to 52.2 pg/ml (mean, 6.0 pg/ml), with the concentration being significantly higher in HNSCC patients (p < 0.001). Furthermore, the correlation of the IL-6 serum concentration with tumor stage was significant (p = 0.04). Accordingly, there was a significant difference of IL-6 serum concentration of tumors with positive and negative lymph nodes (p = 0.045), with concentration being significantly higher in lymph node-positive tumors. Our data on elevated IL-6 serum levels in the majority of HNSCC cancer patients and its correlation with tumor stage and lymph node status suggest that serum IL-6 reflects the proliferative activity of the tumor in patients with head and neck cancer. IL-6 serum determinations might serve as a biological marker and help to identify advanced head and neck tumors.