Evidence of the impact of maternal nutritional status on pregnancy outcome is increasing. However, reference values for vitamin and homocysteine concentrations in maternal blood during normal pregnancy are scarce, and are lacking for the preconceptional period and early pregnancy. Thus, in a longitudinal study we evaluated vitamin and homocysteine concentrations in 102 nulliparous women with an uneventful singleton pregnancy and normal outcome not using supplements. The physiological changes in vitamin and homocysteine concentrations in blood were determined from the preconceptional period throughout pregnancy until 6 weeks post-partum. The vitamins evaluated comprised retinol, thiamin, riboflavin, pyridoxal 5Hphosphate, folate in serum and erythrocytes, vitamin B 12 and a-tocopherol. The plasma homocysteine concentration was also measured, considering the essential roles of folate, vitamin B 6 and vitamin B 12 in homocysteine metabolism. The concentrations of retinol, thiamin, pyridoxal 5H -phosphate serum folate and vitamin B 12 decreased during pregnancy. In contrast, the concentrations of riboflavin, a-tocopherol, and folate in erythrocytes increased or showed only minor changes. Homocysteine concentrations also remained approximately constant during pregnancy. These observations emphasize the importance of preconceptional and post-partum concentrations of vitamins in the evaluation of pregnancy-induced changes. These data have provided valuable reference values for vitamins and homocysteine before, during and after pregnancy in order to contribute to better diagnosis of maternal deficiencies and to study further the relationship between maternal vitamin status and adverse course and outcome of pregnancy.

Objective: To validate the six-item short form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) for usage in screening outcomes in a Dutch population receiving preconception counseling. Methods: Men and women completed the 20-item full form of the STAI before (n = 310) and after preconception counseling (n = 147). Prorated scores of the six-item form were compared to the full form using Pearson’s correlation coefficients and paired t tests. Results: Cronbach’s α for the Dutch translation of the short-form of the STAI-state was 0.83. The short form highly correlates with the full form (r = 0.95). The short form was able to discriminate between different levels of anxiety and was sensitive to change. Conclusion: The Dutch translation of the short form of the STAI-state has good reliability and validity and was found to be useful as a quick tool to evaluate the effectiveness of screening programs on anxiety levels. We believe our results will be applicable to other populations, although this needs to be confirmed in other studies.

Endosonography (ES) was used for the preoperative TNM (1987) staging of tumors in 43 patients with pancreatic cancer and 24 patients with ampullary carcinomas. These results were correlated with the histologic findings of resected specimens. Early-stage tumors could be distinguished from advanced stages of cancer with ES. Detailed images of ductular and parenchymal abnormalities allowed distinction between pancreatic and ampullary carcinomas based on anatomic location. The overall accuracy of ES in the assessment of tumor classification in pancreatic and ampullary carcinoma was 92% and 88%, respectively. In diagnosing regional lymph nodes in pancreatic and ampullary tumors the accuracy of ES was 74% and 54%, respectively. For diagnosing metastatic lymph nodes in pancreatic and ampullary carcinoma the accuracy of ES was 91% and 80%, respectively. The prevalence of lymph node metastases in T1 pancreatic cancers and T1 ampullary carcinomas was 40% and 0%, respectively. Discrimination between inflammation and metastases was difficult with ES. ES was not accurate in assessing distant metastases because of the limited penetration depth of ultrasound.

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