[Tubal pregnancy after tubal sterilization by bipolar electrocoagulation]. / Tubargravidität nach Tubensterilisation durch bipolare Elektrokoagulation.

Sterilization belongs to the safest contraceptive methods. The most popular sterilization procedure is by coagulation of the fallopian tube. The failure rate is mainly attributed to ectopic pregnancies which can lead to the risk of life.

[Integration of plastic surgery-esthetic aspects in surgical therapy of breast carcinoma]. / Integration plastisch-ästhetischer Aspekte in die operative Therapie des Mammakarzinoms.

Within the last 20 years there was an important change in the operative treatment of breast cancer. New considerations on the tumor biology resulted to the conviction, that the operative radicality does not affect the overall survival rate. This was in addition the birth hour of the breast conserving surgery and of the efforts of reconstructive procedures of the female breast. Muscle flap procedures got more and more importance in clinical practice. This paper gives an overview on our concept of breast conserving therapy and primary reconstruction in case of carcinoma of the breast, which is based on oncoplastic aspects. With consideration this model we are enabled to improve the cosmetic results even in cases with larger tumors.

[Hormone replacement therapy (HRT) in peri- and postmenopause. Is it also allowed after treatment of breast carcinoma?]. / Hormone Replacement Therapy (HRT) in der Peri- und Postmenopause. Ist sie auch nach Behandlung eines Mammakarzinoms erlaubt?

Hormone Replacement Therapy (HRT) is an approved strategy of health care. Its characteristic features and benefits for women in the perimenopausal and postmenopausal state are represented. HRT is justifiable and necessary for prophylaxis and therapy of estrogen deficiency. The risk of breast cancer is not or only little increased. HRT can even take place after the therapy of breast cancer, if the consequences of the ovarian hormone deficiency can be diminished only by this method. Then the advantages preponderate over the theoretically possible risks. The mortality of women ist rather reduced by HRT.

[Appendicitis in pregnancy]. / Appendizitis in graviditate.

The incidence of appendicitis is about 1:1000-1:1500 pregnancies. Therefore, it seems to be in pregnancy as frequent as in the general population. The common signs and symptoms of appendicitis are in pregnancy less reliable than in nonpregnant women. An important role to diagnose appendicitis in suspicious cases has the ultrasonography, first of all the "graded compression ultrasound". Appendicitis increases the rate of spontaneous abortions, preterm delivery, small for gestation babies, and neonatal mortality in the first 7 days of life. After appendectomy the rate for preterm deliveries is increased for seven days. After the 7th postoperative day the pregnancy usually continuous to term. There is no increase of malformations because of appendectomy. At the end of pregnancy appendicitis is frequently complicated by phlegmoneous and perforated forms of illness with and without peritonitis. Before 20th w.o.p. laparoscopy is a recommendable method to diagnose and treat appendicitis. After 20th week of pregnancy laparotomy should be preferred. Cesarean section is not recognized part of treatment for appendectomy and only to be performed for obstetric reasons. Tocolysis should be prevented because of risk of pulmonary injury.

[Weight discordance of the second twin: effect on perinatal morbidity and mortality. An 8-year analysis of 213 twin deliveries]. / Gewichtsdiskordanz des zweiten Zwillings: Einfluss auf perinatale Morbidität und Mortalität. Eine 8-Jahres-Analyse von 213 Zwillingsgeburten.

In this retrospective eight-years-study we examine factors to be considered responsible for higher perinatal mortality in twins, especially in twins with discordant body weight. As a main risk factor for this we find vaginal delivery, i.e. from a non-vertex position. Other additional reasons for the higher perinatal mortality of twins are prematurity (less than 34 weeks of gestation) and birthweight lower than 1500 grams. Early hospitalisation has a positive influence on that risk. The perinatal mortality in the second twin (6.7%) is twice as high as in the first twin. The highest perinatal mortality (17.6%), however, is in twins with discordant growth whereas the second twin had a higher birthweight at delivery (15% more than the first twin). In twins with discordant body weight cesarean section gives advantage to the second twin versus vaginal delivery from breech presentation.

[Reaction of the anterior eye segment to preventive Credé treatment]. / Die Reaktion des vorderen Augenabschnittes auf die Credé-Prophylaxe.

A controversily carried discussion concerning the prophylaxis according to Credé is in process. Reviewer decline the Credé-prophylaxis. The high rate of side effects (Argentum conjunctivitis) interdicts with applications of Argentum nitricum. In a blind study we examined the reaction of the ophthalmic front-region in the first 5 days after delivery in 40 neonates with and without Credé-prophylaxis with Argentum nitricum. We found no significant differences in the frequency of pathological chances in the palpebra, conjunctiva bulbi et tarsi and cornea between the two groups. In the group of children, who had not been given Credé-prophylaxis there was the same frequency of palpebral edema and conjunctival hyperemia. Until there is no general screening for gonorrhea in the late pregnancy and because of lack of a better method as the prophylaxis according to Credé we can recommend the Credé-prophylaxis with argentum nitricum as an undangerous and save method for preventing gonoblennorrhea of neonates.

[Blood pressure values in normal pregnancy]. / Blutdruckverhalten in der normalen Schwangerschaft.

In two studies independent from each other we examined the behaviour of arterial blood pressure in normal pregnancy. Study 1 was performed in exactly defined external conditions, study 2 in normal antenatal clinic. Especially in study 1 a distinct reduction of blood pressure could be proved. Towards the end of pregnancy there is a raise of blood pressure. Blood pressure is dependent on the position of the body. Havdarized examination conditions have to be claimed with respect to reproducibility and comparability of the values.

[The new terminology and classification of hypertensive diseases in pregnancy]. / Die neue Terminologie und Klassifikation hypertensiver Erkrankungen in der Schwangerschaft.

For hypertensive disorders of pregnancy there are not only a lot of terms and trials for classification--but also the definition of hypertension as the leading sign is unclear. This explains the confusion around this meaning-full problem. The International Society for the Study of hypertension in Pregnancy (ISSHP) submitted proposals for a new terminology and classification of hypertensive disorders in pregnancy. The members of the ISSHP's German Section and the German Study group for Hypertension in Pregnancy/Gestosis simplified this new ISSHP-proposal and adapted it to the peculiarities of German language. This new concept is presented and recommended for use in medical practice.

[Incidence of hypertension in pregnancy in relation to the definition of hypertension]. / Häufigkeit der Schwangerschaftshypertonie in Abhängigkeit von der Hypertoniedefinition.

According to a proposal of the International Society for the Study of Hypertension in Pregnancy (ISSHP) the definition of hypertension is based on a diastolic blood pressure of 90 mmHg or more. Systolic and mean arterial blood pressure (e.g. MAP II) are not be taken into account. Out of a clear defined district the totality of n = 2259 pregnant women has been strictly supervised till to delivery and afterwards. The frequency of hypertension according to the old ACOG-definition was calculated to be 15.9% (n = 360). According to the newer ISSHP-definition it was 12.7% (n = 287). To detect severe and hazardous cases the newer ISSHP-definition seems to be better than the older definition of ACOG. Therefore, the acceptance of the ISSHP-proposal is recommended.

[The clinical value of plasma fibronectin in pregnancy]. / Die klinische Wertigkeit des Plasmafibronektins in der Schwangerschaft.

We have measured plasmatic fibronectin in 23 normotensive pregnant women during pregnancy (overall 161 values). On the average 6 samples from every woman have been taken. Plasmatic fibronectin rose continuously from 313 +/- 76 mg/l in the first trimester to 416 +/- 194 mg/l in the third trimester. Normal pregnant women (n = 173, 358 +/- 140 mg/l) were compared with pregnant patients with preeclampsia (n = 37), woman with chronic hypertension in pregnancy (n = 25) and normotensive pregnant patients with intrauterine growth retardation (IUGR, n = 5). In the group with chronic hypertension (466 +/- 119 mg/l) there was no significant difference to the normal group, but we found a significant (p < 0.01) different value of fibronectin (748 +/- 195 mg/l) in the group of patients with preeclampsia. A tendency to higher fibronectin values was also noticed in the group with IUGR (739 +/- 212 mg/l). Because of the low number of patients this difference was not statistically significant. We conclude, that plasmatic fibronectin is an important, but not absolutely specific screening parameter for estimation of the endothelial injury in hypertensive disorders of pregnancy. We believe, that fibronectin is one the best parameters to forecast a preeclampsia.

[The circadian rhythm of the colloid osmotic pressure of the blood]. / Die zirkadiane Rhythmik des kolloidosmotischen Druckes des Blutes.

In 29 normotensive nonpregnant women, the circadian rhythm of the colloid-osmotic (oncotic) pressure (COP) was estimated. On average the COP was 25.3 mmHg (3.34 kPa). Around this value (= 100%) the daily oscillation was 13.5% with an interindividual variation of between 28.1 and 4.3%. A stable sinusoidal daily rhythm occurred with the lowest values in the night and the highest values in the afternoon. Changes in arterial blood pressure and of the permeability of capillaries depending on the time of day are discussed as the main reason for this circadian rhythm. For COP estimations in clinical routine proofs should be taken at about 8.00 a.m. since these values correspond most closely to the daily average.

[Occlusion of a vesicovaginal fistula with Latzko-repair]. / Verschluss von Blasen-Scheidenfisteln durch Latzko-Plastik.

UNLABELLED: The Latzko procedure is a well-known method for the closure of small vesico-vaginal fistulas occurring in the vaginal dome after hysterectomy. This method is favoured by gynaecologists. In three Departments of gynaecology, a total of 104 patients were treated. 76% had been referred from other hospitals. 56.7% resulted from gynaecological operations. In 69.2% was a benign and in 28.8% a malignant disease. In only 2 cases, the primary disease remained unknown. RESULTS: In 97 of 104 (= 93.3%) cases, the procedure according to Latzko succeeded at the first attempt. 5 of 7 recurrences were resolved by the second attempt with the same operative technique according to Latzko, signifying a secondary success rate of 98%. There were only 2 notable complications: the one, where a postoperative bladder haemorrhage attributed to anticoagulants, and the second with a bladder stone noticed 11 years after the Latzko procedure. This technique can be performed in 95% of all vesico-vaginal fistulas occurring. The fundamental advantages of its use are: short duration of the procedure, high cure rate and few complications.

[Urinary fistula after radical hysterectomy with lymph node excision]. / Harnfisteln nach radikaler Hysterektomie mit Lymphonodektomie.

In 908 radical hysterectomies including dissection of pelvic lymph nodes, 13 (= 1.43%) urogenital fistulas were seen. They occurred postoperatively between the 7th and 15th day. In 12 cases it was a uretero-vaginal and once a vesico-vaginal fistula. The operation report of 7 cases with uretero-vaginal fistula reveals difficulties in separating the ureter in its prevesical part proceeding from tumour spread, endometriosis, scar or bleeding. Since 1985 a percutaneous nephrostomy has been performed (5 cases). 4 fistulas were cured spontaneously, one of them had a percutaneous nephrostomy. In all cases, urography was normal. In 7 cases, ureterocystoneostomy had to be performed. This was done once with fixation of the psoas muscle and 6 times according to Boari. All patients were cured without any complications and with an undisturbed drainage assessed 1 year later by urography. 1 patient, who refused any follow-up, died subsequently. The only vesico-vaginal fistula has been closed by Latzko's procedure. In recent years the problems concerning urogenital fistulas resulting from surgery of cervical cancer have receded. However, if patients adopt an offensive attitude against surgical therapy of stage T2b, the rate of incidence of this complication can be expected to increase.

[Decrease in premature birth rate through consequent application of diagnostic and therapeutic standards in pregnancy monitoring]. / Senkung der Frühgeburtenrate durch konsequente Anwendung von Diagnostik- und Therapiestandards in der Schwangerenbetreuung.

All pregnant women living in the district of Suhl have been observed in our prenatal outpatient department. All gave birth in our department for obstetrics and gynaecology. This observation is made on the base of a standard. From 1981-1987 there were 5,657 pregnant women with singleton pregnancies. In this time the rate of premature birth was on an average of 4.7%. But, over the time there was a slope from 7.3 to 2.8%. Consecutively there was a decrease of 50% in perinatal mortality. The successful standards for observation of pregnant women used in our department have been discussed.

[The colloid osmotic pressure of blood. Physiology, measuring technique and pre-analytic factors of influence]. / Der kolloidosmotische Druck des Blutes. Physiologie, Messtechnik und präanalytische Einflussfaktoren.

Since the fundamental work of Starling the central of colloid osmotic pressure for maintaining volume homoeostasis and for transcapillary fluid exchange has been well known. To treat an intravasal volume deficit colloidal plasma substitution solutions are able to secure a sufficient colloid osmotic pressure. The last one can be measured by oncometry. Therefore an individual therapy is possible. This review describes the physiologic function, measurement techniques and important influencing parameters and disturbing factors which may be taken into consideration when colloid osmotic pressure is determined.

[Micturition and incidence of postoperative urinary tract infections in surgical gynecology]. / Miktionsverhalten und die Inzidenz postoperativer Harnweginfektionen in der operativen Gynäkologie.

In a retrospective analysis postoperative courses of 879 patients (1987-1989) have been analysed with respect to micturition behaviour and incidence of postoperative urinary tract infections. 58.5 per cent urinary tracts infections could be registered following uro-gynecology operations and 48.9 per cent after radical hysterectomies according to Wertheim-Held. The lowest rate of 15.9 per cent we found after simple interventions at the adnexas. Within the uro-gynecological operations vaginal plastic procedures had a higher rate (66.4 per cent) than colposuspensions with 41.5 per cent. Because of the different extent of the bladder preparation there were distinct differences with regard to first spontaneous micturition and lack of residual urine.

[Course and outcome of pregnancy in adolescents]. / Schwangerschaftsausgang und Schwangerschaftsverlauf bei Adoleszentinnen.

All pregnant women living in the district of Suhl were observed and delivered in our Department for Obstetrics and Gynaecology, County Hospital of Suhl. In a retrospective study, the course and outcome of 732 pregnancies in adolescents (less than or equal to 19 years) were analysed. In all women bearing to maturity, the course of delivery and the neonatal outcome were studied. All results were compared with those of an equal-sized group of women of 20-24 years of age. Out of the 732 adolescent pregnancies, nearly 62% gave birth; in 30% an artificial abortion was undertaken. In a subgroup of 179 adolescents aged less than 18 years, the rate of artificial abortion was 61.5%. Only 34% gave birth to a child. The course of pregnancy in adolescents was not more complicated as it was in older patients (comparison group). The rate of premature delivery was not increased and premature rupture of membranes was even rarer. During birth, there were no increased risks, the duration of birth being identical in both groups. In adolescents, there were a few more spontaneous deliveries. Body weights and neonatal conditions were the same as in the comparable group. Consequently, pregnancy in adolescents is not accompanied by increased risks for mother or child.

[Pelvimetry using computerized tomography. I. Theoretical and methodical fundamentals]. / Pelvimetrie mittels Computertomographie. Teil I: Theoretische und methodische Grundlagen.

The first part of our article deals with the basic aspects of using computed tomography in obstetrical pelvimetry. A macerated osseous female pelvis was used to measure the true conjugate, the transverse plane of the pelvic inlet, the interspinous line and the distance between the ischial tuberosities. The same pelvis was then examined computed tomographically. A lateral and a posterior-anterior scan, and a single scan through the iliac spines were performed. The results of the direct measurement agreed highly with the values achieved computed tomographically if the phantom was positioned exactly on the mid-line of the examination-table, if not, the true conjugate was elongated. Measurements of the superficial and the intravaginal radiation dose in patients demonstrated a significantly lower risk in computed tomography than in conventional x-ray methods. We recommend computed tomography in obstetrics as a safe, accurate and reliable method.

[Bacteriuria screening in gynecologic practice: what is the value of mid-stream urine?]. / Bakteriurie-Screening in der gynäkologischen Praxis: Welchen Stellenwert hat der Mittelstrahlurin?

In 55 healthy women corresponding urine proofs were taken by suprapubic punction and by mid stream technique from the same content of the urinary bladder. For detection or exclusion of bacteriuria both collection-methods are of equal value. In 96% of the cases the microbiological results were corresponding. The leucocyte-count is of no value to detect indirectly a bacteriuria as well in punction- and in mid stream urine. A pathologic count is just as little pathognomonic for infection as a normal count excludes a bacteriuria. Therefore the counting of leucocytes should be given up to the favour of a better microbiological observation in gynecological outpatient departments.