In general, the diagnosis of pregnancy-related anemia relies on the estimation of the hemoglobin level. The findings of this study suggest that the additional estimation of serum ferritin – a reliable index of the iron stores – can improve the diagnosis of anemia. Hematological data of 150 pregnant women were retrospectively related to the courses of pregnancy, in particular to the incidence of premature labor contractions. 70% of the pregnant women included in the investigation had a serum ferritin value below 20 µg/l and thus iron deficiency. If the hemoglobin value alone had been estimated, 50.6 % of the women with iron deficiency (serum ferritin < 20 µg/l) would not have been detected among those pregnant women with a hemoglobin value of more than 11 g/dl. These findings are also of particular relevance as a significant correlation has been found between the incidence of premature labor contractions and the serum ferritin level: only 11 % of the pregnant women investigated whose serum ferritin values exceeded 20 µg/l had premature labor contractions, whereas premature labor was recorded in 48 % of the pregnant women with serum ferritin values below 10 µg/l.
The results of this study suggest that the additional determination of serum ferritin in pregnancy is necessary for a more reliable classification of iron deficiency. In 300 pregnant women the hematological values (Hb, MCH and serum ferritin) were determined toward the end of gestation. In 36 per cent of the women both Hb values greater than 11 g/dl and MCH values less than 28 pg fail to give evidence of an existing iron deficiency, indicated by serum ferritin values below 20 micrograms/l. The determination of serum ferritin is of particular relevance as a significant correlation was ascertained between low serum ferritin levels and the incidence of preterm labor: 52.3% of the women with serum ferritin levels below 10 micrograms/l and only 9.5% of the women with serum ferritin levels above 20 micrograms/l went into preterm labor. A convincing explanation for this has not yet been found.
A kinetic test (Phadebas®) was used to determine the isoamylase activity in 50 serum specimens and 159 samples of amniotic fluid. A highly significant difference between the isoamylase patterns of serum and amniotic fluid was ascertained which strongly supports the view that amylase activity in amniotic fluid is not of maternal origin. During the whole course of gestation the activity of pancreatic isoamylase was constantly low whereas there was an increase of nonpancreatic activity (S-type amylase) from 44 ± 10 U/l in the 18th week of gestation to 445 ± 170 U/l in week 39/40. A comparison between the dispersion of the ascertained values and the lecithin-sphingomyelin (L/S) ratio showed a clear overlapping. There was a correlation coefficient of r = 0.645 for 115 amniotic fluid specimens examined in our investigation. The findings show that the estimation of nonpancreatic isoamylase (S-type amylase) activity in amniotic fluid is a valuable indirect parameter for determining fetal maturity and fetal lung maturity. The easy and quick determination method will provide even those hospitals with an index of fetal maturity which are presently not in a position to estimate the L/S ratio, thus being of great assistance in the field of premature deliveries.
The causes of tooth and gum disorders during pregnancy and possible prevention measures are discussed. The evaluation of a nation-wide survey comprising 700 pregnant women reflects the women's respective scope of knowledge in respect of mouth and tooth hygiene, 357 of the 700 women included in the investigation had no dental treatment in the course of their pregnancy. 57.7% showed incidence of gingivitis during gestation. 70.9% were not instructed regarding mouth and tooth hygiene in the respective period and 81.7% did not receive any written material on this topic. 41.3% of the respondents did not seek information on matters of mouth and tooth hygiene and 44.3% stated that they felt that their knowledge in these matters was sufficient. When questioned about the causes of the bad state of their teeth, 28.4% stated an actual cause (insufficient tooth hygiene, excessive sugar consumption). 262 (37.4%) suffered from morning sickness, 45% of these women (n = 118) stating that they subsequently brushed their teeth. 45.6% used their toothbrush for a period of six months and 67.9% had no knowledge of fluoride treatment. These findings high-light the need for more information for the prevention of tooth decay and more information on mouth and tooth hygiene during pregnancy. It is suggested to supplement pregnancy guidelines by including two visits to the dentist as an integral part of antenatal checkups.
In 55 patients with medullary carcinoma of the breast follow-up data over an average period of 68.1 +/- 35.3 months were recorded. The histological slides of all tumors were retrospectively classified according to the same criteria. The parameters registered were: tumor-size, histological grading, receptor status, necrosis of tumor tissue, cellularity of the stroma, status of axillary nodes, reactive changes of axillary nodes and tumor invasion of lymphatic vessels. The importance of each parameter registered for disease-free survival and overall survival was calculated statistically using the log-rank-test. Of all parameters, only the nodal status of the axilla proved prognostically significant. Metastases of axillary nodes were demonstrable in only 31% of all MC. The incidence of nodal involvement proved to be less than in non medullary breast cancers. In 15 (27.3%) of the patients, progression of the tumor occurred. All women with distant metastases i.e. 12 (21.8%) died of the disease, whereas patients with only local recurrence of breast cancer are still alive. 72.7% of the patients showed relapse-free survival. Other parameters of proven prognostic value in breast cancers like receptor status and histological grading were of no relevance to the survival in MC. Prediction of prognosis depends on the correct classification of the tumor subgroup according to strict microscopical and macroscopical criteria.
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