[Primary hyperparathyroidism in the 3d pregnancy trimester]. / Primärer Hyperparathyreoidismus im dritten Schwangerschaftstrimenon.

HISTORY AND FINDINGS: A 24-year-old pregnant woman had to be hospitalized in the 33rd week of pregnancy because of premature contractions and clinical signs of pyelonephritis. She had a history of nephrolithiasis. Laboratory tests showed a total calcium of 3.6 mmol/l, hypophosphataemia of 0.59 mmol/l and an increased parathormone level of 420 ng/l. Ultrasonography demonstrated a large parathyroid adenoma, confirming the diagnosis of primary hyperparathyroidism. COURSE AND TREATMENT: Despite several recommendations of conservative treatment in the literature it was decided to perform a parathyroidectomy, which was done without complication during the 35th week of pregnancy. A healthy, mature boy was born at the beginning ot the 41st week: at no time did he show any signs of hypoparathyroidism. CONCLUSIONS: Surgical treatment of hyperparathyroidism is a reasonable and possible choice even in the 3rd trimester, because it allows regeneration of the fetal parathyroid. However, this decision must be individualized, in relation to the period of pregnancy and any progression of the disease.

[Primary hyperparathyroidism and pregnancy. Aspects of neonatal morbidity]. / Primärer Hyperparathyreoidismus und Schwangerschaft. Aspekte der Neugeborenen-Morbidität.

Primary hyperparathyroidism has to be accused to cause serious morbidity during pregnancy not only on the maternal, but also on the fetal side: the fetus is threatened by prematurity, dystrophy and an increased risk of stillbirth. Postpartually hypocalcaemia and tetany may be observed as the result of neonatal hypoparathyroidism caused by maternal and thus also fetal hypercalcaemia. We report the case of a 32-year-old pregnant woman suffering from a severe form of primary hyperparathyroidism caused by an adenoma of the parathyroidea. The tumor was removed in the 34. week of pregnancy. Six weeks later the patient delivered a healthy boy (birth weight 3450 g). A survey is given of the therapeutical procedures that should be arranged individually by interdisciplinary consulting depending on the degree of maternal disease and on the gestational age.

[Status of fractionated abrasion and vaginal endocervical cytology in diagnosis of endometrial cancer]. / Stellenwert der fraktionierten Abrasio und der Portio-, Endozervikalzytologie in der Diagnostik des Endometriumkarzinoms.

The predictive value of cervical cytology and uterine curettage in 150 endometrial carcinoma was investigated. Cytology proved negative in 56% of all carcinomas and in 42.2% of those in stage 2 or 3. Uterine curettage was found to have a false-negative rate of 6%, endocervical curettage of 5.3%. By contrast, we found a high false-positive rate of 70.8% for endocervical curettage. 13.2% of the 129 endometrial carcinoma stage 1 had a false-positive endocervical fraction. No residual disease was found in 4.7% of all 150 hysterectomy specimens. Negative cervical cytology seems to be a reasonably good predictor of actual cervical involvement, if a positive endocervical curettage is to be interpreted.