GYNAECOLOGIE Consecutive EC patients = 70 years were included prospectively in eight Dutch centres. EC specimens were analysed for MSI, IHC of four MMR proteins, MMR gene methylation status and BRAF-mutations. tumours were classified as; 1) likely to be caused by LS, 2) sporadic MSI-H, or 3) microsatellite stable (MSS). Tumour specimens of 179 patients (median age 61 years, IQR 57-66) were analysed. In our study 92% of included patients were over 50 years of age. Eleven EC patients were found likely to have LS (6%; 95% CI 3-11%), including 1 patient suspected of an MLH1, 2 of an MSH2, 6 of an MSH6 and 2 of a PMS2 gene defect. Germline mutation analyses revealed 7 MMR gene germline mutations. Ten patients likely to have LS (92%) were older than 50 years. In addition, 31 sporadic MSI-H tumours with MLH1 promoter hypermethylation (17%; 95% CI 13-24%) were identified. Molecular screening for LS in patients with EC diagnosed = 70 years, leads to identification of a profile likely to have LS in 6% of cases. New screening guidelines for LS are needed, including recommendations for EC patients older than 50 years of age. Fluid shift out of the fetal circulation during intrauterine red cell transfusion. Kamping MA, Pasman SA, Bil-van den Brink CP, Oepkes D, Adama van Scheltema PN, Vandenbussche FP. Ultrasound Obstet Gynecol. 2012 Nov 5. doi: 10.1002/uog.12338. [Epub ahead of print] PMID: 23124821. OBJECTIVES: Intrauterine transfusion presents a considerable burden on the fetal circulation by increasing volume and pressure. Already during transfusion, a fluid shift out of the fetal circulation occurs. Aim of the study was to quantify the intraprocedural fluid shift, and the effect of procedural and fetal characteristics on this fluid shift. METHODS: In 95 alloimmunized pregnancies, we calculated fluid shift at first intrauterine transfusions, by determining initial and final blood volumes. We evaluated the association of the fluid shift with speed and volume of transfusion, severity of anemia and presence of hydrops. RESULTS: Of the included fetuses, 11 were mildly hydropic and 4 were severely hydropic. A mean fluid shift of 36% of transfused volume was found. Fluid shift related positively to transfused volume (p<0.00). The percentage fluid shift of transfused volume was inversely related to speed of transfusion (ml/kg/min) (p<0.041) and not related to severity of anemia (p=0.55) or hydrops (p=0.66). At low gestational age, fetuses had been unintentionally burdened with relative high volume and speed of transfusion. CONCLUSION: Around one third of transfused volume is lost from the intravascular compartment already during intrauterine transfusion. A large variation, partly explained by volume and speed of transfusion, was observed. Neither severity of anemia or hydrops played a clear-cut role, thus other factors may explain the variation in fluid shift. The probability that hematocrit will still increase after transfusion, due to a continuing fluid shift, should be considered in transfusion policy. Advice is given on gestational age adjusted speed of transfusion. Sequential urodynamic assessment before and after laparoscopic sacrocolpopexy. Kummeling MT, Rietbergen JB, Withagen MI, Mannaerts GHH, Van der Weiden RMF. Acta Obstet Gynecol Scand 2012; Nov 16. doi: 1111-aogs. 12045. PMID: 23157606. 28 WETENSCHAPPELIJK jaarverslag 2012 Pagina 27
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SFG Jaarverslag 2012 Lees publicatie 130Home