[Transvaginal diagnosis of adnexal diseases].
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Adnexal Diseases↗
Biomedical subjects
R Osmers
Publications and source records attributed to R Osmers.
Localisation of extracellular matrix components in the embryonic human notochord and axial mesenchyme.
The unsegmented axial mesenchyme is the first anlage of the embryonic vertebral column in amniotes. Its development and differentiation are influenced by the notochord. The appearance of extracellular matrix (ECM) components which may regulate the developmental processes in the human embryonic axial mesenchyme and the notochord was studied in 5 human embryos between Carnegie stages 12 and 14 (4th and early 5th gestational wk) by using Alcian blue histochemistry and immunohistochemistry with antibodies against types I and II collagens, the proteoglycans aggrecan, biglycan and decorin, the glycoproteins fibronectin, laminin and tenascin and the growth factor TGF-beta. The results demonstrate that the notochordal sheath contains high amounts of sulphated glycosaminoglycans, hyaluronic acid and the glycoproteins fibronectin, laminin and tenascin during all developmental stages examined. Additionally type II collagen and the small proteoglycan decorin were found. Type I collagen and the small proteoglycan biglycan could be detected in notochordal cells. The number of TGF-beta-immunoreactive notochordal cells increased between stages 12 and 14. The ECM of the axial mesenchyme is rich in sulphated glycosaminoglycans, hyaluronic acid, fibronectin and tenascin. Strong immunoreactions for collagen type I were found only during the early stage 12. The absence of aggrecan and keratan sulphate indicates that large aggregating proteoglycan complexes are missing. Epithelial-mesenchymal interactions which may be influenced by TGF-beta and the ECM components demonstrated are discussed.
Alcian Blue↗
[Changes in cervical fibronectin levels during pregnancy, labor and in the postpartum period].
The authors analysed the fibronectin content of the uterine cervix during pregnancy and delivery. The aim of their investigation was furnishing data to the biochemical changes during cervical maturation. The ripening of the uterine cervix during pregnancy is a result of complicated interactions between different macromolecules, where the fibronectin plays a key role. The quantitative determination of the extracellular matrix fibronectin is impossible because its extraction from tissues recently is not solved. Taking this fact in consideration the authors choose a semiquantitative method, being reliable indicator of changes in fibronectin content of uterine cervix. They took small pieces of materials from portio vaginalis uteri of 139 women being in postmenopause and premenopause, in different stages of pregnancy and parturition concerning directly after delivery. The slides were incubated, with rabbit-anti-human fibronectin-FITC. The evaluation of fluorescence happened with an Axiophot (Zeiss) microscope. Authors stated that the fibronectin content in the cervical extracellular matrix and in the cellular membrane of fibroblasts increases during the 1st trimester pregnancy. This increase can be shown in the 3rd trimester as well and it drops significantly during delivery. They could not found any relationship between the leucocyte invasion observed during delivery and the changes of cervical fibronectin content. These observations call our attention to the importance of fibronectin in cervical ripening respectively dilatation and the need of further examinations.
Cervix Uteri↗
[Sialidase activity in cervical connective tissue during cervix maturation and dilatation during labor].
The authors obtained small pieces of materials from portio vaginalis uteri of 122 women being in postmenopause and premenopause, in different stages of pregnancy and parturition concerning directly after delivery. Different biochemical investigations of these 30-200 mgs specimens were performed to study the physiological background of its ripening process. They examined the changes in activity of sialidase which cleaves terminal sialic acids. The authors performed these investigations with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. The evaluation of the lectin linkage happened with fluorescence microscope. They evaluated the whole fluorescence of extracellular matrix but separately of different extracellular matrix elements as well. From their investigations was stated that the number of WGA and LPA binding sites of the uterine cervix increases predominantly in the 1st trimester pregnancy compared to the non-pregnant state. As compared to the 1st trimester they described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA and WGA binding sites in the extracellular matrix were observed during parturition. These results coincide with the authors' previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play a recently yet not cleared role in the ripening of the human uterine cervix during pregnancy and in dilatation at the time of parturition.
Adult↗
Discrepant karyotypes after second- and third-trimester combined placentacentesis/amniocentesis.
Cytogenetic data are presented from a total of 1306 consecutive pregnancies with successful diagnosis obtained from both chorionic villi after short-time culture (CVS-SC) and amniotic fluid cell cultures (AC); samples had been taken simultaneously at combined placentacentesis (placental biopsy) and amniocentesis during the second (92.8 per cent) and third (7.2 per cent) trimesters. Concordant results were obtained in 1218 pregnancies with a normal karyotype and in 62 pregnancies with an aberrant fetal karyotype. Discrepant, i.e. false-positive and false-negative, results were found in 26 cases (2 per cent). From these data the accuracy of CVS-SC, defined as the proportion of all correct diagnoses, is calculated to be 98 per cent. Three non-mosaic and 14 mosaic false-positive results obtained after CVS-SC could not be confirmed by AC. Related to 1235 true normal fetal karyotypes, the specificity of CVS-SC, i.e. the proportion of normal karyotypes correctly diagnosed, amounts to 98.6 per cent. In nine pregnancies, an aberrant fetal karyotype detected after AC was missed by CVS-SC. The sensitivity of CVS-SC, i.e. the proportion of abnormal fetuses correctly diagnosed (62 out of 71), amounts to 87.3 per cent in our study group.
Amniocentesis↗
Transvaginal sonography in patients with pathological cervical exfoliative cytology or histologically verified cervical carcinoma.
OBJECTIVE: The aim of the study was to evaluate whether detection of cervical carcinoma or cervical dysplasia is possible with the use of transvaginal sonography (TVS). METHODS: TVS was performed in 215 patients with pathological cervical cytology (PAP III-V), suspicious clinical findings or histologically verified carcinoma of the cervix. RESULTS: Cone biopsy in 54 patients with suspicious cytology and normal cervical features revealed 26 cases of cervical intraepithelial neoplasia (CIN) 0-II and 19 cases of carcinoma in situ. Sonography failed to detect cervical carcinoma in only nine cases (stages Ia, Ib and IIa). False-positive results of TVS were associated in no cases with CIN 0. In 161 cases with suspicious cervical lesions, 133 invasive cancers and 23 carcinomas in situ were detected. The most striking cytological finding was that 92% of patients with PAP III/IIID and abnormal sonographic signs, and 7% with normal sonographic results and suspicious PAP, had cancer of the cervix uteri. CONCLUSION: We conclude that TVS could be usefully applied to the routine pretreatment evaluation of patients with cervical carcinoma.
Adult↗
Serum collagenase levels during pregnancy and parturition.
Recent studies have described the origin of the collagenase responsible for the degradation and loss of collagen during cervical ripening and dilatation to be polymorphonuclear leukocytes. In the present study the clinical feature of cervical dilatation was correlated to the serum levels of human granulocyte collagenase. The serum collagenase level was measured in 19 premenopausal women and in 181 pregnant women. In 15 of these pregnant women serum samples were obtained from the onset of labour to the active phase of labour at four different times. The collagenase concentrations remained low up to the 35th week of gestation (19.4 ng/ml) in comparison with the beginning of pregnancy. From the 35th week of gestation on we found a slight increase in collagenase in maternal serum. The maximum peak was reached during parturition at a cervical dilatation of 6-8 cm (71.2 ng/ml). The serum levels returned to non-pregnant values the first day following delivery. The results show that collagenases are critically involved in parturition.
Collagenases↗
[When may, should, must the ovary by removed--with which technique?].
The growing demand for minimally invasive operative processes and the unmistakable progress in pelviscopy, have led to an extension of the indications for minimally invasive surgery. At the same time, the operative treatment of ovarian cysts is the third most frequently performed pelviscopic operation. The indication for ovarectomy depends, above all, on anamnestic factors, the clinical findings and the results of pre-operative vaginal sonography. In the event of inadequate hormone secretion by the ovaries, the indication for organ removal should be generously applied. Vaginal sonography is not capable of proving or excluding the existence of a malignancy with 100% certainty. The average rate of ovarian carcinomas is 2.6% in case of smooth-walled, unicamerate cysts. Pelviscopy is also unable to differentiate reliably between benign and malignant ovarian tumours. With the aid of pelviscopic operative processes, a cystic ovarian tumour cannot be extirpated in toto with the necessary certainty. In spite of the conflicting results in the literature, an iatrogenic rupture of an early ovarian carcinoma can be expected to result in worsening the prognosis. The Department of Obstet. Gynecol. University of Göttingen, adopted the following procedure: 1. A (mini-) laparotomy with immediate section for microscopic examination is always performed on sonographically suspect ovarian tumours. 2. On smooth-walled unicamerate ovarian tumours > or = 3 cm which persist or fail to respond to treatment with oral contraceptives, (mini-) laparotomy is performed with complete extirpation of the cystic ovarian tumour and immediate section for microscopic examination; a conceivable alternative is, if possible, total pelviscopic extirpation of the ovarian cyst with immediate section for microscopic examination.(ABSTRACT TRUNCATED AT 250 WORDS)
Diagnosis, Differential↗
Visualization of blood flow in small ovarian tumor vessels by transvaginal color Doppler sonography after echo enhancement with injection of Levovist.
The echo-enhancing effect of an ultrasound contrast medium (Levovist) in color Doppler sonography of small vessels in ovarian tumors was studied in a group of 30 women. The vascularity of adnexal masses with a suspicion of primary carcinoma in 3 and benign lesions in 27 cases was investigated before and after injection of 300 mg/ml of Levovist. In 17 cases color flow mapping showed increased vascularity either in the cystic wall or in solid structures within the tumor. In all patients we observed enhancement of Doppler signal intensity. Our results show that Levovist facilitates waveform analysis in very small vessels with poor velocity patterns.
Adnexal Diseases↗
[Characteristics and adequate clinical management of "ovarian cysts"].
Early diagnosis resp. prophylaxis of ovarian cancer is possible by removal of all postmenopausal cysts (adnexae plus cystic pathology) of more than 3 cm diameter and of premenopausal cysts showing persistence or progression after 6-8 weeks of sonographic control after the primary examination. The presented retrospective study revealed 2.5% malignancy in premenopausal cysts and 19.5% in the postmenopause. The removal of intact cysts is mandatory. Different technical methods are discussed. In the presented study there were no false negative findings, the rate of unnecessary operations was 5.6%.
Adult↗
[Mortality of premature infants 1980-1990: analysis of data from the Göttingen perinatal center].
We analyzed retrospectively (1980-1990) the causes of death and by using a logistic regression model the perinatal and neonatal risk factors influencing the mortality in preterm infants < 34 weeks of gestation (n = 1132). When comparing the interval from 1980-1986 to 1987-1990 we observed a decreasing mortality in infants < or = 1000 g from 57% to 19% as well as in the preterm infants > 1000 g from 8.3% to 3.0% (p < 0.001). The causes of death changed considerably. During 1980-1986 fifty-two (8.2%) out of the 632 preterm infants and during 1987-1990 only seven (1.3%) out of the 600 preterm infants died in the course of a severe respiratory distress syndrome or intracranial hemorrhages. From 1980 to 1986 21% (n = 10) and from 1987 to 1990 77% (n = 10) of the neonatal deaths in preterm infants > 1000 g were attributed to lethal malformations. In those infants without lethal malformations (n = 1109) we performed a logistic regression analysis. 87 (7.8%) of these neonates died. The risk of dying was significantly higher in infants born before 1987, in male newborns and in infants suffered from a severe respiratory distress syndrome III-IV or septicemia (p < 0.0001). An increasing gestational age of one week resulted in a lowered risk of mortality (odds ratio 0.59, p < 0.0001). Adjusted for these basic variables the mortality risk was also significantly higher for birth weights < or = 1000 g, low Apgar scores, peripartal acidosis, hypothermia and intracranial hemorrhages. An intrauterine growth retardation < 10. percentile resulted in a lower mortality risk.
Birth Weight↗
Changes in binding capacity of sialic acid-specific lectins in the connective tissue of the uterine cervix during its physiological maturation.
The authors obtained small pieces of materials from portio vaginalis uteri of women being in postmenopause and premenopause, in different stages of pregnancy and parturition respectively after delivery. Biochemical investigations of these specimens were performed to study the background of physiological ripening of the uterine cervix. They examined the changes in activity of sialidase which cleaves terminal sialic acids. Investigations were performed with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. These lectins bind specifically to the sialic acids. The evaluation of the lectin linkage was carried out with fluorescence microscope. Separately was evaluated the fluorescence of different extracellular matrix elements concerning the whole fluorescence of connective tissue as well. It was stated that the number of WGA- and LPA-binding sites of the uterine cervix compared to the non-pregnant state increases predominantly in the 1st trimester pregnancy. In relation to the 1st trimester we described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA- and WGA-binding sites we observed during parturition in the extracellular matrix. These results coincide with the author's previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play certain role in human uterine cervix during the gestational process. Their role at the time of pregnancy and delivery however remains to be cleared.
Cervix Uteri↗
Lectin-binding patterns in the embryonic human paraxial mesenchyme.
The paraxial mesenchyme in seven human embryos aged between Carnegie stages 12 and 17 was studied by lectin histochemistry with the lectins AIA, Con A, GSA II, LFA, LTA, PNA, RCA I, SBA, SNA, WGA. The paraxial mesenchyme was found to be segmented into sclerotomes by intersegmental vessels and from late stage 12 by intrasclerotomal clefts dividing each sclerotome into a cranial and caudal half. The lectins Con A, GSA II, LFA, LTA, SBA and SNA did not react at all in the paraxial mesenchyme. Staining for AIA, PNA, RCA I and WGA was found in the developing sclerotomes. However, no differences in the staining pattern between the two sclerotomal halves could be seen. It was striking that in contrast to the chick embryo no differences in binding for PNA between the cranial and caudal sclerotomal parts was observed. These findings reveal that PNA-binding sites do not play the same functional role in segmented axonal outgrowth and neural crest immigration into cranial sclerotomal halves in the human embryo, as found in chick embryonic development. Beginning with the stage 16-embryo, the already condensed caudal sclerotomal halves express Con A-, RCA- and PNA-binding sites. The staining for PNA in particular marked the differentiation of chondrogenous structures developing in this half. From the late stage 12 or stage 13, the walls of intersegmental and other vessels showed binding sites for AIA, PNA, RCA I, SNA and WGA.
Embryonic and Fetal Development↗
Prenatal diagnosis of congenital nephrosis of the Finnish type (CNF) in the second trimester.
Congenital nephrosis of the Finnish type is an hereditary, autosomal recessive disease which leads to death in early infancy. This is a case report concerning an affected fetus with legal interruption in the 24th week of gestation on the basis of certain sonographic changes in the fetal kidneys and changes in the protein profile in amniotic fluid, which were consistent with nephrotic damage of the kidneys. Light and electron microscopy showed evidence of CNF, i.e. increase of mesangial matrix and cells in glomeruli, dilated tubular segments, and effaced and plumb foot-processes of the glomerular epithelial cells. Antenatal diagnosis of CNF therefore seems feasible in the second trimester of gestation by means of AFP determinations in maternal serum and amniotic fluid as well as by using sonographic criteria and determination of proteins in amniotic fluid.
Amniotic Fluid↗
Biochemical changes in human cervical connective tissue after intracervical application of prostaglandin E2.
Cervical biopsies were taken during the first trimester from primigravidae and plurigravidae at different time points after intracervical application of prostaglandin E2-gel. Collagenase activity was determined by a highly specific technique using native, triple helical collagen as substrate. Elastase-alpha 1-proteinase-inhibitor complex (elastase) was measured by a commercially available assay, and glycosaminoglycan (GAG) analyses were performed as described by Greiling et al. (5, 6). The maximum activity of collagenase was found 2 hours after PGE2 application in plurigravidae and 4 hours after application in primigravidae. Elastase activity rose nearly 7-fold to maximum values 4 hours after PGE2 application. The total GAG concentrations and the dermatan sulfate concentrations increased by approximately 10%, while the hyaluronic acid concentrations were found to be elevated significantly by nearly 50% in the PGE2-primed cervices. We conclude that a time-dependent enzymatic collagen degradation by collagenases and other proteinases and an increase in hyaluronic acid concentrations are the significant biochemical events underlying PG-induced cervical ripening.
Abortion, Induced↗
Glycosaminoglycans in cervical connective tissue during pregnancy and parturition.
OBJECTIVE: To investigate the content and distribution patterns of glycosaminoglycans in the human cervix during pregnancy and parturition. METHODS: We obtained a total of 87 specimens from nonpregnant and pregnant women. Biopsies (weight 50-200 mg) were taken from the posterior lip of the cervix. Hyaluronic acid, dermatan sulfate, chondroitin sulfates, and heparan sulfate were separated on a Dowex 1 x 2 column and identified. RESULTS: The total amount of glycosaminoglycans increased during pregnancy from 2800 to 5000 nmol/g dry weight. The highest values were observed at the onset of labor (7100 nmol/g dry weight), followed by a sharp decrease during parturition. The clinical features of cervical ripening and dilatation were also associated with remarkable changes in glycosaminoglycan patterns. CONCLUSION: Besides collagenolysis during pregnancy, the glycosaminoglycans are also important regulators of cervical function. The different clinical features of the human cervix are characterized not only by variation in the total glycosaminoglycan content but also by changes in the proportions of the different glycosaminoglycans.
Cervix Uteri↗
Transvaginal sonography in endometrial cancer.
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Editorial↗
Genetic amniocentesis in twin pregnancies: results of a multicenter study of 529 cases.
To evaluate the risk of abortion after genetic amniocentesis in twin pregnancies, a retrospective study of 15 centers was performed. The spontaneous abortion rate up to 20 completed weeks of gestation was 2.3%; the abortion rate up to 28 completed weeks, as defined by WHO, was 3.7%. The abortion rate could not be correlated either with the number of needle insertions or with the type of marker dye used. There was also no correlation between the abortion rate and the gestational age at which amniocentesis was performed. A significant association was shown between congenital intestinal obstructions and the application of methylene blue intra-amniotically as a marker dye. Considering the increased natural loss rate in multiple gestations, amniocentesis in twin pregnancies seems to be a safe and reliable technique.
Journal Article↗