Das Ovarian-remnant-Syndrom ist dadurch charakterisiert, dass nach beidseitiger Oophorektomie ovarielles Gewebe in der Bauchhöhle zurückbleibt, hormonelle Aktivität besitzt und histologisch nachgewiesen werden kann. Auch kleine Fragmente können zu großen Tumoren heranwachsen und eine deutliche Beschwerdesymptomatik erzeugen. In der Differenzialdiagnose chronischer Abdominalschmerzen sollte es unbedingt Berücksichtigung finden. Im Folgenden wird der Fall einer 37-jährigen Patientin diskutiert, bei der im Rahmen einer bilateralen laparoskopischen Oophorektomie Ovarialgewebe in der Bauchhöhle verloren ging. Im weiteren Verlauf kam es zu einer ektopen hormonaktiven Manifestation dieses Gewebes an Omentum majus und Blasenwand, verbunden mit starken Schmerzen. Nach Laparotomie und Entfernung dieses Ovarian remnant war die Patientin beschwerdefrei. Wir schließen daraus, dass verloren gegangenes Ovarialgewebe in jedem Fall schon bei dem Primäreingriff gesucht und entfernt werden sollte.

Ovarian remnant syndrome occurs after bilateral oophorectomy when functioning ovarian tissue is left behind. It usually presents with pelvic pain and a palpable mass. The incidence of ovarian remnant syndrome is unknown. However, the condition is probably more prevalent than is generally appreciated. We report on a 37-year-old patient with ectopic manifestation of lost ovarian tissue in the abdomen following bilateral laparoscopic oophorectomy. This ovarian remnant located between the bladder and the greater omentum showed hormone activity and caused severe abdominal pain. Following laparotomy and complete resection of the remnant the patient was without symptoms. We conclude that lost ovarian tissue should in all cases be searched for and completely removed during the primary operation.

BACKGROUND:Granulosa cell tumor of the ovary is an uncommon neoplasm. The majority of patients are diagnosed in early stages of disease and overall prognosis is favorable. The stage at time of diagnosis is the only prognostic factor that is unequivocally related to survival. Other prognostic factors have not been well defined and are discussed in the literature controversially.MATERIALS AND METHODS:In a multi-institutional retrospective study we analyzed all relevant clinical data of patients with histologically proven granulosa cell tumor of the ovary. We applied the Kaplan-Meier method in order to estimate overall survival rates and evaluate prognostic factors.RESULTS:The median follow-up was 75 months (range, 6-315 months). Overall survival was 87% and 76% after 5 and 10 years, respectively. Eighty percent of granulosa cell tumors were diagnosed stage I (FIGO). The survival rate after recurrence was 56.8% after 10 years. Mitotic rate (p=0.003), tumor stage (p<0.001) and residual tumor disease (p<0.001) were associated with a poor prognosis (p<0.001). Age and rupture of the tumor could not be confirmed to be of prognostic value.CONCLUSION:The results of our study showed that the mitotic index may be a valuable prognostic factor. Complete tumor resection should always be attempted, since residual tumor disease is associated with a poor prognosis. Prospective studies are needed in order to confirm our findings.

Granulosazelltumoren sind seltene Tumoren und machen einen Anteil von etwa 2 - 3 % aller Ovarialtumoren aus. Auch wenn sich der Granulosazelltumor sowohl tumorbiologisch als auch prognostisch von den epithelialen Tumoren abgrenzen lässt, orientiert sich die Therapie an den Empfehlungen zum Ovarialkarzinom.

Purpose: Granulosa cell tumors account for 2-3% of ovarian malignancies. Treatment recommendations are based loosely on those for ovarian carcinoma, although the two entitites differ considerably in tumor biology and prognosis.Methods: We reviewed 25 women (median age, 51 years; range, 26-75) who received chemotherapy after surgery for ovarian granulosa cell tumors. Eighteen patients received adjuvant chemotherapy as a component of primary treatment (9 FIGO stage I, 9 stage II-IV) and seven after recurrence. Nine chemotherapy regimens were used and 15 patients received platinum-based regimens.Results: The median follow-up was 98 months (range, 6-189). Although the number of patients was small, there was no significant difference in overall survival between patients who received platinum-based regimens and those who received chemotherapy without platinum. The average overall survival was 96.6 months (95% CI, 78-115). The average overall survival of women with stage II-IV disease or recurrence was 81.4 months (95% CI, 54-109).Conclusion: The rarity of ovarian granulsa cell tumors suggests a need for a central registry and prospective studies to compare chemotherapy regimens.

According to the classification of Osathanondh and Potter of cystic kidney diseases an antenatal differential diagnosis is presented, which is based on the anatomic pathologic, ultrasonographic and genetic findings. Since the ultrasound evaluation influences the obstetric and neonatal management, each second and third trimester sonography should consider the most common malformations in pediatric autopsies. The autosomal recessive polycystic kidney disease (ARPK), autosomal dominant polycystic kidney disease (ADPK), multicystic renal dysplasia, obstructive multicystic kidneys and cystic renal malformations found in other syndromes with genetic linkage are discussed in this review.

A severe and rare ischemic brain lesion in a preterm twin boy is reported. The boy was born after two weeks of anhydramnios and amnionic infection at 24 weeks of gestation. Following a difficult Caesarian section and prolonged umbilical cord compression he developed prenatal acidosis with an umbilical cord pH of 6.96. At the age of 7 h, heart rate variability narrowed due to severely disturbed brain stem function and the patient developed clinical signs of hypoxic-ischemic encephalopathy. Sonography demonstrated extensive symmetrical brain stem and basal ganglia lesions. After a prolonged comatose and apneic state, death occurred at the age of 25 days. Autopsy confirmed columnar bilateral cavitation of basal ganglia, diencephalon, brain stem and spinal gray matter, as well as focal calcifications in the palladium, thalamus, and brain stem. The findings highly resemble those observed after experimental or clinical cardiac arrest.

OBJECTIVE The objective of this study was to clarify the influence of p21 protein expression in ovarian cancer. p21 (WAF1 [wild-type p53 activated fragment 1]/CIP1) is a universal cyclin-dependent kinase inhibitor and can be induced as a downstream effector of the p53 tumor suppressor gene. METHODS The expression of p21 was evaluated by immunohistochemical analysis with the monoclonal antibody WAF1 (Oncogene Science) on 106 formalin-fixed, paraffin-embedded tissue samples of epithelial ovarian cancer. RESULTS p21 was expressed in 65 (61%) of all cases. p21 expression was associated with early stage in FIGO classification (FIGO I and II, P = 0.003) and no tumor residues after primary tumor resection (P = 0.018). Immunohistochemical staining results were judged as negative if no tumor nuclei were stained, as weak positive if 1-49% were stained, and as strong positive if over 50% of nuclei were stained. Clinical follow-up showed a better overall survival for cases with strong p21 expression (79 months) versus 40 months for weak expression and 30 months for no expression (P = 0.033). Previously determined p53 expression of this cohort was compared with p21 status. p53 overexpression was observed in 49 cases (48%) and showed no association with p21 expression. CONCLUSION No correlation was found between p21 and p53 expression. p21 expression is a significant prognostic marker for improved survival in ovarian cancer and is associated with early FIGO stage and zero tumor residues after primary tumor resection.

The demonstration of a recto‐vaginal fistula in a patient with Crohn's disease is described. The patient was examined by vaginal ultrasound using the contrast medium Echovist‐200 (SHU 454, Schering AG, Berlin). This agent had not been used before under these circumstances and proved to be successful.

A differentiation is made between patient information on findings and diagnosis, patient information on avoidance of known dangers, and patient information on the risks involved in a particular intervention that has been selected. If no information is given on the risks inherent in a patient's condition and how she must proceed in order to ensure that they do not come about, this is considered to be a treatment error, and in these circumstances the intervention is then legally seen as bodily harm. Information on the risks involved in an intervention must be given in good time, which generally means on the day before the operation. An exception is made to this rule for day surgery. The patient must be informed about treatment alternatives when the method selected is not the method of choice or when there is an alternative offering equivalent chances but risks of a different kind. Such information is given to the adult patient who is capable of legal transactions. In the case of miners or of patients who are not capable of legal transactions their legal representative is responsible for receiving the information [and making decisions]. In the case of unconscious patients everything depends on,,presumable consent to the operation". If a patient later cites lacks in the information supplied to her to support a claim for compensation in a situation where it would be unwise to refuse an operation, she must elaborate plausible grounds for being in conflict over the decision even following appropriate information.

Background. The purpose of this study was the correlation of fetal oxygen saturation values to various fetal heart rate patterns, as well as to oxygen saturation values obtained by fetal blood analysis. These objectives need to be evaluated from the perspective that two generations of fetal oxisensors have been used,Methods. Two different oxisensor systems (FS10: 660+890 nm and FS14: 735+890 nm) and a blinded pulse oximeter (type N400, Nellcor Puritan Bennett) were utilized to monitor 112 fetuses. All data, including oxygen saturation, fetal heart rate patterns, signal and contact quality were stored on a personal computer and evaluated after delivery.Results. The following median fetal oxygen saturation values were obtained: during reassuring fetal heart rate sequences 54% with the oxisensor FS10 and 48% with the newer FS14 oxisensor, during intervals of variable decelerations 43% with the FS10 oxisensor and 40% with the FS14 oxisensor. These differences between values obtained during normal and abnormal fetal heart rate patterns are significant. Due to non-reassuring fetal heart rate patterns 81 fetal blood analyses were performed. The values of pulse oximetry were 9% higher (6% for the FS14) than those of spectrophotometry. Correlation of both methods was r=0.66 (0.74 for the FS14).Conclusions. In combination with fetal heart rate monitoring, fetal pulse oximetry promises a better differentiation between low and high risk heart rate patterns. Oxygen saturation values from intermittent fetal blood sampling reassure the clinician concerning the accuracy of this new method of intrapartum fetal surveillance and underline the increased quality of the new generation of oxisensor using light of a wavelength of 735 and 890 nm.

In order to be able to visualize spatial pattern formation during low-temperature carrier transport processes in solid state physics, we demonstrate a new concept of a scanning-laser microscope that is integrated inside an encapsulated cryogenic sample stage. All the components of the microsc:ope, i.e., a laser diode, the deflection unit, and the focussing optics, are cooled to the temperature of the sample under investigation. Furthermore, unwanted excitation of the sample, like excitation due to background radiation, is suppressed. Our technical solution meets the challenging experimental claims of a perfect shielding and low-temperature applicability further enables the sample to be exposed to strong magnetic fields. First results on imaging current inhomogeneities in both a semi- and a superconductor experiment will be outlined.

The objective of this study was to evaluate the prognostic significance of DNA ploidy and S-phase fraction (SPF) in epithelial ovarian carcinomas analyzed by image cytometry. Frozen tissue of 103 epithelial ovarian carcinomas was analyzed for DNA ploidy and SPF with a Cell Analysis System Image Analyser (CAS 200, Becton-Dickinson) and correlations with clinical and histomorphologic factors and time to progression and overall survival were evaluated by univariate and multivariable analysis. Fifty-four percent of the ovarian carcinomas were found to be diploid, 38% aneuploid, and 8% tetraploid. The S-phase fraction was low (<5%) in 27%, intermediate (5-14.5%) in 47%, and high (>/=14.5%) in 26% of the patients. By univariate analysis overall survival and time to progression were significantly correlated with the S-phase fraction (P = 0.003 and P = 0.003), but not with DNA ploidy (P = 0. 31 and P = 0.51). A DNA index > 1.4 was correlated with poor outcome but the result did not achieve formal statistical significance (P = 0.08 and P = 0.12). A high SPF was a strong predictor of early recurrence, while a low SPF identified patients with a favorable long-term outcome. Other significant predictors of survival were FIGO stage, grade of differentiation, presence of distant metastasis, residual tumor, lymph node metastasis, and patient age. In multivariable statistical analysis only FIGO stage, histologic grade, and residual tumor after surgery were independent predictors of overall survival and time to progression.

In einer offenen Interventionsstudie wurde der mögliche prospektive Wert der fetalen Pulsoximetrie für die Erkennung von hypoxischen Gefährdungssituationen des Feten in 180 Einsätzen getestet. Die Sättigungswerte waren sub partu nicht verfügbar. Die Geburtsüberwachung erfolgte allein aufgrund von CTG und Fetalblutanalysen. Die Korrelation zwischen pulsoximetrisch und nach FBA hämoximetrisch gemessenen Sättigungswerten zeigt eine zufriedenstellende Präzision der Methode (r = 0,74). Die gute Korrelation zwischen pulsoximetrischer Sättigungswerte und dem PO2 belegt die Bedeutung der Pulsoximetrie zur Diagnostik der fetalen Oxygenierung und Hypoxie. Allerdings ist durch Kenntnis der Sättigungswerte keine direkte Einschätzung des pH möglich. Erst der Verlauf der Sättigungswerte bei guter Signalqualität und möglichst lückenloser Signalausbeute erlaubt eine Einschätzung des fetalen Azidoserisikos. Es konnte eine Sensitivität von 60%, eine Spezifität von 79%, ein positiv prädiktiver Wert von 27% und ein negativer prädiktiver Wert von 95% für das Auftreten eines kindlichen Depressionszustandes berechnet werden. Dabei wurde ein Median der Sättigungswerte unter 33% als Schwellenwert angenommen.

Postpartal determination of lactate and glucose in the umbilical cord whole blood of 139 successive deliveries utilizing biosensors (blood gas analysator 865, Ciba Corning) are presented. The median lactate value in the umbilical arterial blood is 4.45 mmol/l and in the venous blood 4.23 mmol/l. Following categorization into control and high-risk groups, the arterial mean values are 4.23 mmol/l and 6.39 mmol/l and the respective venous values are 3.95 mmol/l and 5.04 mmol/l. Using the U-test these differences between the control and high-risk groups are significant. The mean of the measured lactate correlates significantly with the mean of the calculated base excess (< 0.001). The mean glucose value in the umbilical arterial blood is 78 mg/dl and in the venous 93 mg/dl. Between high-risk and control group no significant difference is found.

Prenatal diagnosis of the Currarino triad by means of obstetrical ultrasonography is described. Three related cases are presented. A literature review regarding the therapeutic, ultrasound-guided approach are discussed. The Currarino triad is a genetically transmitted syndrome consisting of an anorectal malformation, a sacral boney defect and a presacral mass. Prenatal diagnosis aids the early recognition and surgical management of persistent spinal-rectal fistulas, thus potentially avoiding life-threatening bacterial meningitis.

Objective: To determine whether maternal or fetal morbidity is increased in association with fetal pulse oximetry monitoring using an atraumatic intrapartum transcervical fetal oxisensor.Methods: In a prospective cohort study from January 1993 to June 1996, 196 fetuses were monitored during the intrapartum period with a fetal oximetry sensor placed between the uterine wall and the presenting fetal part. The oxisensors were in position for a median duration of 134 minutes. A total of 101 monitored fetuses underwent intrapartum fetal scalp blood sampling because of nonreassuring heart rate tracings. For a control group, we selected all cases during the same period in which fetal blood sampling was performed in the intrapartum period (n = 949) without pulse oximetry monitoring. Data for maternal and fetal morbidity were evaluated and tested for significant differences by the Mann-Whitney LT test.Results: There was no significant difference in gestational age, birth weight, duration of labor, fetal outcome parameters, cesarean rate, operative vaginal deliveries, episiotomy rate, or perineal injuries between the study and control groups. Similarly, the percentages of neonatal intensive care unit admissions, neonatal resuscitations, and neonatal infections were not statistically different in the two groups. A rare complication in the group with pulse oximetry monitoring was a transient impression of the oxisensor probe on the fetal cheek. The rates of postpartum maternal infections, anemia, or secondary wound disruptions were identical in both groups.Conclusion: There was no increased fetal or maternal morbidity associated with the use of an atraumatic intrapartum fetal pulse oxisensor. (C) 1997 by The American College of Obstetricians and Gynecologists.

Acta Obstetricia et Gynecologica ScandinavicaVolume 75, Issue 7 p. 683-684 Uterine rupture after laparoscopic myomectomy Priv. Doz. Dr. Wolfgang Friedmann, Corresponding Author Priv. Doz. Dr. Wolfgang Friedmann Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanyAbteilung für Geburtsmedizin Virchow-Klinikum Medizinische Fakultät der Humboldt-Universität zu Berlin Augustenburger Platz 1, 13353, Berlin, GermanySearch for more papers by this authorR. F. Maier, R. F. Maier Department of Neonatology, Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorA. Luttkus, A. Luttkus Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorA. P. A. Schäfer, A. P. A. Schäfer Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorJ. W. Dudenhausen, J. W. Dudenhausen Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this author Priv. Doz. Dr. Wolfgang Friedmann, Corresponding Author Priv. Doz. Dr. Wolfgang Friedmann Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanyAbteilung für Geburtsmedizin Virchow-Klinikum Medizinische Fakultät der Humboldt-Universität zu Berlin Augustenburger Platz 1, 13353, Berlin, GermanySearch for more papers by this authorR. F. Maier, R. F. Maier Department of Neonatology, Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorA. Luttkus, A. Luttkus Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorA. P. A. Schäfer, A. P. A. Schäfer Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this authorJ. W. Dudenhausen, J. W. Dudenhausen Department of Obstetrics, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, GermanySearch for more papers by this author First published: July 1996 https://doi.org/10.3109/00016349609054700Citations: 71AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume75, Issue7July 1996Pages 683-684 RelatedInformation

Objectives: Does the knowledge of fetal oxygen saturation allow to avoid fetal scalp blood sampling and to predict a pH less than or equal to 7.25 of the fetal blood sample? Study Design: Out of a group of 135 fetuses we determined the median, the 10th, 5th and 3rd percentile of oxygen saturation values by a blinded fetal pulse oximeter. Due to abnormal FHR-patterns, 110 fetal scalp blood samples (FBA) were assessed by the technique introduced by Saling. The pH of these FBA's ranged from 7,16-7,48 (median 7,28). We chose a 20 minute period before the FBA and calculated the individual median and percentiles. According to the pH of less than or equal to 7,25 in FBA we calculated the chi-square test for significance. Results: The median of < 35% SpO(2) has a sensitivity of 23%, specificity of 77%, positive predictive value of 27% and a negative predictive value of 73%. Conclusion: Fetal oxygen saturation alone shows a high specificity and a low sensitivity for pH < 7,25. Zn addition to FHR monitoring, pulse oximetry.