[Diagnostic reliability of vaginal ultrasound in ectopic pregnancy]

The therapeutic approach to ectopic pregnancy (EP) has changed over the last decade. A prerequisite for a differentiated management is an early diagnosis of EP. This can be achieved by transvaginal sonography (TVS). The purpose of this study was to evaluate the accuracy of TVS in the diagnosis of EP. 184 patients with clinically suspected ectopic pregnancy were examined by TVS. In 103 cases suspicion of EP was confirmed, in 81 cases it was ruled out. All cases were evaluated by laparoscopy, D&C, serial HCG determinations or sonographic follow-up in case of an intrauterine pregnancy. Sensitivity of TVS in the diagnosis of EP was 96%, specificity 88%, the positive predictive value was 89%, the negative predictive value was 95%. Four cases with a false negative result at TVS were very early in pregnancy and were subjected to laparoscopy because of persistent high HCG values without demonstration of an intrauterine pregnancy. Five cases of sonographically confirmed ectopic pregnancies were missed by the first laparoscopy. These cases required intervention because of clinical symptoms and had low levels of HCG. TVS has a high diagnostic accuracy in the diagnosis of ectopic pregnancy.

[Diabetic retinopathy and nephropathy--complications in pregnancy and labor]

The purpose of this retrospective study was to determine the risk factors for the morbidity of the mothers and their fetus in patients with diabetic retinopathy and/or nephropathy with an open family planning. We compared the course of pregnancies, complications as well as the maternal and neonatal morbidity in 76 patients with diabetic retinopathy or nephropathy (White R F) with 85 patients without severe microangiopathy (White C D). We found a correlation between retinopathy progression and hyperglycaemia during the first trimester (p < 0.05). There was an increase in the deterioration of visual acuity up to blindness due to the progression of this microangiopathy in cases of proliferative retinopathy. There was a significant increase of the mean diastolic blood pressure (mdp) and preeclamptic symptoms occurred in 71% of the cases with severe microangiopathy (p < 0.05). Deterioration of the diabetic nephropathy with excessive proteinuria (> 10 g/d) and unmanageable hypertension or a progression of the retinopathy led to an earlier delivery in 80% of the patients (p < 0.05). A high rate of preterm deliveries (39%) and a frequent occurrence of intrauterine growth retardation's (9%) characterised the fetal outcome. The following examinations for a patient with an open family planning, if diabetes is diagnosed during childhood or the course of the disease is between 10 and 15 years, should be done: Ophthalmological evaluation, control of the renal function, contraceptive advice and an improvement of the metabolic situation. In case of a diabetic nephropathy in combination with hypertonus the patients shoud be warned against pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevention of neonatal risk by general screening for diabetes in pregnancy, intensive diagnosis and subsequent therapy]

Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.

Sequential administration of recombinant human granulocyte-macrophage colony-stimulating factor and human erythropoietin for treatment of myelodysplastic syndromes

Treatment of myelodysplastic syndromes (MDS) with recombinant human erythropoietin (Epo) is successful in only 10% to 25% of patients. We performed a pilot study in 10 anaemic patients with MDS to examine whether sequentially applied recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) and Epo improves haemoglobin levels and/or reduces red blood cell transfusion requirements. Morphological diagnoses of patients were refractory anaemia (RA) in 3 cases, RA with ring sideroblasts in 3 cases and RA with excess blasts in 4 cases. GM-CSF was given subcutaneously at a dose of 150 micrograms/m2/d during the initial 10 days. From day 11, Epo was administered by subcutaneous injections for 8 weeks at a dose of 100 U/kg/d and subsequently at an escalated dose of 200 U/kg/d in 3 patients. Changes in reticulocyte counts, haemoglobin levels, RBC support and ferrokinetic parameters were compared with pretreatment values. Two out of 8 evaluable patients showed a rise in haemoglobin levels at week 8 and 10, respectively, and lost their transfusion dependency for a period of 13 and 27 weeks. In 1 patient, haemoglobin level increased only after dose escalation of Epo (200 U/kg/d). Leukocyte counts remained uneffected by treatment with Epo, while 1 patient showed a 4-fold increase in platelet numbers. Toxicity was mild. Two patients died of pneumonia and global heart failure, respectively, unrelated to growth factor therapy. Based on this pilot study, we conclude that sequential treatment with GM-CSF and Epo does not increase erythroid responses in anaemic patients with MDS. Because of the delayed increase in haemoglobin in both responders, we surmise that the beneficial effects were induced by Epo alone.

[A pioneer in surgical gynecology. On the 55th anniversary of the death of Paul Ferdinand Strassmann (23 October 1866 to 15 August 1938)]

This year (1993) we want to commemorate the 55th anniversary of the death of the Berlin gynecologist Prof. Paul Ferdinand Strassmann. In the first half of the 20th century, Strassmann was one of the leading specialists of plastic surgery of the female genital tract. Famous gynecologists and surgeons, e.g. the Mayo brothers, visited the Strassmann clinic in the Schumannstrasse with the aim of learn new surgical techniques. The present paper aims to outline particularly the life of Paul F. Strassmann but also his importance in the creation of modern gynecological surgery.

Kinetics of 14(R,S)-fluorine-18-fluoro-6-thia-heptadecanoic acid in normal human hearts at rest, during exercise and after dipyridamole injection

The myocardial uptake kinetics of 14(R,S)-[18F]fluoro-6-thia-heptadecanoic acid (FTHA) were evaluated in humans with PET. The relationship between human myocardial FTHA uptake kinetics and the rate-pressure product (RPP) as an index of myocardial oxygen consumption was investigated in seven normal subjects under fasting conditions.

METHODS

Seven studies were performed at rest and under submaximal continuous supine bicycle exercise with elevated RPP. An additional five studies were performed after dipyridamole injection to increase myocardial blood flow independent of the myocardial energy requirement.

RESULTS

In all studies, rapid tracer uptake was found within 2-3 min after injection, which remained nearly constant during the 30-min study. Patlak plots of myocardial FTHA kinetics showed a linear increase, indicating metabolic trapping. The mean uptake rate constant, Ki, obtained from Patlak plot analysis was 0.11 +/- 0.02 ml/g/min at rest and increased significantly to 0.26 +/- 0.06 ml/g/min during exercise. The dipyridamole study yielded a comparatively small elevation with a mean Ki of 0.15 +/- 0.02 ml/g/min, which was not significant in the analysis of variance and the Duncan range test. There was a significant correlation between Ki and RPP, with r = 0.85 (p < 0.01).

CONCLUSION

Analysis of FTHA uptake kinetics with PET may be useful for noninvasive assessment of myocardial utilization of exogenous long-chain fatty acids in general and of beta oxidation in the fasting state.

[The protocol book I. An important contribution to the history of the German Cancer Society (1900-1907)]

On initiative of E. von Leyden the committee for cancer research, the origin of the present German Cancer Society was founded in Berlin in 1900. In 1991 in the Charité the original minute book of the committee of the years 1900 to 1907 was found. This historical document gives interesting insight into the beginnings of the German combat against cancer, themes treated, organisational questions and particulars of persons.

[Improvement in nuclear medicine diagnosis of kidney function using 99m technetium mercaptoacetyltriglycine (MAG3)]

Renal scintigraphy and clearance measurement are indispensable in nephro-urologic disorders. A continuous series of 103 sequential scintigraphies and clearance measurements were performed with the new technetium-labelled agent MAG3 (Gamma-kamera, Phillips Tomo Diagnost) and 131I-orthohippuric acid (OIH) using the Oberhausen method (Nucleopan, Siemens). The time-activity curves obtained with the two radionuclides agreed exactly. Reaching a tubular excretion rate of nearly 90%, the clearance of MAG3 differed by no more than 6% from the OIH clearance in 95% of the cases. The factor between clearances of the two radionuclides was determined by means of a commercially available software according to the Oberhausen method and amounted to 0.59 +/- 0.09. The favorable physical properties and high activity of MAG3 permit exact examination of tubular function and better assessment of renal morphology than hippuran-labelled radionuclides. The low radiation dose combined with a better spatial resolution, especially, the constant availability in a nuclear medicine department should give the preference to MAG3.

[Are there regional differences in Tc uptake?]

The 99mTcO4-uptake (TcTU) was measured in 363 clinically and by laboratory findings euthyroid patients without history of hyper- or hypothyroidism, no evidence of iodine contamination and with a Delta-TSH less than 2.5 IU under a longterm suppressive thyroxine therapy. The medians of TcTU in the different regional groups from the Federal Republic of Germany (mail zip code 2000-8000) were not statistically different from each other, indicating that under suppression with thyroxine the effect of the iodine supply on TcTU is nearly negligible, and that, using the same method, results from different nuclear medicine departments should not differ significantly from each other.

Gibt es regionale Unterschiede im Tc-Uptake?

The 99mTcO4-uptake (TcTU) was measured in 363 clinically and by laboratory findings euthyroid patients without history of hyper- or hypothyroidism, no evidence of iodine contamination and with a Delta-TSH <2,5 IU under a longterm suppressive thyroxine therapy. The medians of TcTU in the different regional groups from the Federal Republic of Germany (mail zip code 2000-8000) were not statistically different from each other, indicating that under suppression with thyroxine the effect of the iodine supply on TcTU is nearly negligible, and that, using the same method, results from different nuclear medicine departments should not differ significantly from each other.

Heterogeneous expression of glutamine synthetase mRNA in rat liver parenchyma revealed by in situ hybridization and Northern blot analysis of RNA from periportal and perivenous hepatocytes

Using radiolabeled specific cDNA glutamine synthetase mRNA could be detected by in situ hybridization exclusively within those few perivenous hepatocytes which stained immunocytochemically for glutamine synthetase. This localization of glutamine synthetase mRNA was recently reported by Moorman et al. [(1988) J. Histochem. Cytochem. 36, 751-755]. Biotinylated cDNA was not suitable for mRNA detection because of a very high background staining under the conditions of in situ hybridization. Dot blot and Northern blot analysis of RNA isolated from periportal and perivenous subfractions of hepatocytes also demonstrated the exclusive perivenous localization of two hybridizable glutamine synthetase mRNAs of length 2.8 and 1.6 kilobases. These results indicate that the unique heterogeneity of glutamine synthetase in rat liver parenchyma is controlled at the pretranslational level.

Gene cluster for streptomycin biosynthesis in Streptomyces griseus: nucleotide sequence of three genes and analysis of transcriptional activity

Three streptomycin (SM) production genes from Streptomyces griseus clustered around aphD, the major resistance gene, have been sequenced: strB, coding for an aminocyclitol amidinotransferase, ORF5 (strR), a putative regulatory gene, and ORF1 (strD), possibly coding for a hexose nucleotidylating enzyme. Three promoters and at least five, partially overlapping, transcripts have been identified by S1 mapping and Northern blot experiments. aphD, the resistance gene, is transcribed from two promoters. One of them, located inside the strR gene, seems to be constitutive and the other is switched on later in the growth phase. The late transcripts cover the resistance gene (aphD) and a regulatory gene (strR) which controls the expression of strB.

Gene cluster for streptomycin biosynthesis in Streptomyces griseus: analysis of a central region including the major resistance gene

A central segment of a cluster of biosynthetic genes for the antibiotic streptomycin cloned from Streptomyces griseus was analysed for open reading frames, as well as for transcriptional and translational activity. The nucleotide sequence revealed two significant open reading frames, ORF1 and APH(6), orientated in opposite directions and with a spacer of 885 bp between the start codons. The first, ORF1, had a coding capacity of 38 kDa. One open reading frame, APH(6), was identified as the major resistance gene coding for streptomycin 6-phosphotransferase, a protein of 307 amino acid residues and 33 kDa. Sequence determination of the first 14 N-terminal amino acid residues of the purified APH(6) enzyme protein was in agreement with the proposed primary structure. The possible identity of the presumed gene product of ORF1 with an in vitro translated protein (apparent molecular weight 41 kDa) is discussed. Comparison of the two APH(6) genes from S. griseus and the hydroxystreptomycin-producing S. glaucescens (cf. Vögtli and Hütter 1987) revealed 75% nucleotide sequence homology in the coding region and 74% conservation of the polypeptide sequence. Two protein domains which are highly conserved in other antibiotic and protein phosphotransferases were detected.

Advantages of potassium cardioplegia and perfusion hypothermia in left ventricular hypertrophy

An attempt was made to determine the effect of hypothermic potassium cardioplegia (35 mEq of potassium chloride) on the hypertrophic ventricle. Puppies with induced left ventricular hypertrophy were divided into four groups and studied after one hour on global ischemia. Myocardial adenosine triphosphate (ATP) was best preserved in the hypothermically perfused groups and correlated well with measurements of coronary sinus creatine phosphokinase (CPK). In Groups 1 and 2 (anoxic arrest at 37 degrees C and KC1 perfusion at 37 degrees C), CPK at 30 minutes of reperfusion was 1,031 and 198 IU, respectively, compared to 35 IU in Group 3 (KC1 perfusion at 4 degrees C) and 44 IU in Group 4 (Ringer's lactate at 4 degrees C). Myocardial injury was milder in Groups 3 and 4 regardless of whether potassium chloride was added. It is apparent that hypothermic perfusion of a hypertrophic ventricle was the major factor in myocardial preservation, as determined by myocardial ATP and coronary sinus CPK.