Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride.

The efficacy of betanecholchloride in the postoperative treatment of bladder dysfunction is controversial. We therefore performed a comparative study on the effect of this therapy for the prophylaxis of detrusor hypotonia after Wertheim-Meigs operation. Forty patients with cervical cancer FIGO stage Ib/IIa were divided into two study groups. The control group (24 patients) only received betanecholchloride if the residual urine persisted above 50 ml after the 10th postoperative day. The study group (16 patients) received 50 mg betanecholchloride three times a day from the 3rd postoperative day onward. In this group postoperative catheter treatment, and consequently hospital stay, were significantly shorter (9.6 versus 13.3 days and 15.5 versus 18.6 days). The residual urinary volume normalized faster (8.0 versus 13.0 days) and the rate of cystitis was lower (18.8 versus 25%). According to our study, a prophylactic application of the parasympathomimetic drug betanecholchloride diminishes postoperative complications associated with bladder dysfunction after Wertheim-Meigs operation.

[The course of pregnancy and fetal outcome in diabetic patients with anamnestic fetal death]. / Schwangerschaftsverlauf und Fetal-outcome bei Diabetikerinnen mit anamnestischer Totgeburt.

Of 116 pregnant patients with diabetes mellitus type 1 or gestational diabetes, 12 (10.3%) had previously suffered stillbirth, while in four (3.4%) cases spontaneous abortion after the 6th month had occurred. In these 16 cases, we examined the mean daily blood glucose concentration, glycosylated hemoglobin (HbA1c), fructosamine as well as glucose and albumin elimination via urine. These control data on carbohydrate metabolism were correlated with the intensity of gestational monitoring in relation to course of pregnancy and neonatal morbidity and/or mortality. In addition, we retrospectively analyzed the cause of prior intrauterine death. In six of eight cases evaluable, we could hereby demonstrate disturbed carbohydrate metabolism. Pregnant women with diabetes mellitus type 1 were hospitalized twice as often (on average four times) as patients with gestational diabetes (2.1 admissions on average). While five of seven type 1 diabetics were primarily admitted prior to the 20th week of gestation, the majority of gestational diabetics (7/9) were first examined by qualified medical personnel trained in the care of gestational diabetes after the 28th week of gestation. Two of nine were first diagnosed post partum. 13 of 14 patients with prepartally known diabetes demonstrated mean blood glucose values under 110 mg/dl. While one of the two patients with postpartally diagnosed diabetes suffered stillbirth once again, the other had to be delivered by emergency C-section because of fetal distress (pH art. 7.08). Our results show that adequate monitoring of carbohydrate metabolism and proper care of diabetic pregnant women can lower obstetrical/neonatal risks to more acceptable levels, especially in those patients who have had stillbirth in their prior medical history.

[Determination of postpartum fructosamine for assessment of gestational diabetes--a suitable method?]. / Postpartale Fruktosamin-Bestimmung zur Erfassung des Risikofaktors Gestationsdiabetes--eine geeignete Methode?

Postpartal screening of undetected gestational diabetes has proven to be difficult. Rapid decrease in diabetogenic hormones and normalisation of the former delayed insulin-response make it difficult to detect disturbed glucose tolerance in the puerperium. Therefore, glycolysated serum proteins offer the opportunity for retrospective diagnosis. They allow an evaluation of the patient's carbohydrate metabolism, retrospectively over several weeks. In this context, we were most interested in the significance of fructosamine. In a prospective study covering 12 months, 123 patients with several risk factors for gestational diabetes underwent a 100 g glucose tolerance test in the puerperium. Furthermore, we measured fructosamine and glycolysated hemoglobin. A carbohydrate intolerance could be detected by the oral glucose tolerance test in 22.7%. In 12.2% of the cases, glycolysated hemoglobin was found to be higher than 5.5%. Fructosamine levels were normal for all patients, with a mean value of 1.84 mmol/l. Even though fructosamine concentration was significantly higher (p < 0.05) in patients with a pathologic glucose tolerance, our study showed the oral glucose tolerance test to be better to detect unknown gestational diabetes than measurement of serum fructosamine.

[The value of tumor markers CA 15-3 and CEA in breast cancer]. / Zur Wertigkeit der Tumormarker CA 15-3 und CEA beim Mammakarzinom.

Tumor marker serum levels of 580 patients in different stages of breast cancer were examined in a retrospective analysis. Patients with nonmetastatic breast cancer showed a preoperatively elevated CA 15-3 in 16% and an elevation of CEA in 12%. In case of local recurrence in 24% CA 15-3- and in 9% CEA-levels were positive. The sensitivity of both markers increased in stage of distant metastasis (58%/48%). CA 15-3 was significantly more sensitive than CEA in case of visceral metastatic spread (56%/34%).

Fenoterol depot and fenoterol in premature uterine contractions--a multicentric double-blind comparative study.

In a double-blind randomized study, the effect of a single dose of a fenoterol preparation with delayed release of active substance (designated as fenoterol depot) was compared with a fenoterol product with undelayed release of active substance (designated as fenoterol) in two groups respectively comprising 66 and 65 female patients with premature uterine contractions. The fenoterol depot was administered p.o. in a single total dose of 21 mg at the beginning of an investigation period of 360 minutes and the fenoterol was administered p.o. within 235 minutes in three identical consecutive doses resulting in a total dose of 22.5 mg. The increased uterine activity present at the beginning was markedly lowered by an initial intravenous infusion of Partusisten. After administration of the two oral preparations, the uterine contractions remained at the low level achieved. The fenoterol depot was slightly superior to fenoterol with regard to the reduction of the duration of contractions: the difference in the inhibition of the duration of the contraction between the two preparations was a maximum of 25.7% in favor of fenoterol depot. The frequency of uterine contraction was substantially reduced by both preparations, but to a greater extent by the depot form. The tocolytic efficacy and the tolerance were rated as "good" in 70% and 75% respectively with fenoterol depot and in 69% and in 71% respectively in the case of fenoterol. The maternal pulse rate remained at the level reached at the end of Partusisten infusion with the two preparation, and the blood pressure fluctuated slightly within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

There is evidence that amniotic fluid arginine vasopressin is a marker for foetal stress in rhesus erythroblastosis.

In response to different stress stimuli the foetal neurohypophysis releases arginine vasopressin (AVP). Part of the AVP is cleared from circulation by urinary excretion into the amniotic fluid (AF). Increased AF AVP levels may therefore indicate foetal stress, all the more because AF AVP solely is of foetal origin. We therefore studied AF AVP levels in 13 patients with rhesus erythroblastosis from 22 to 34 weeks of gestation. Twenty-eight patients from 14 to 34 weeks of gestation served as controls. The AVP levels were measured by RIA. Spectral absorption curves were performed and delta/E values determined at 450 nm. Mean AF AVP levels in controls were 2.39 pg/ml and were not normally distributed. There was no significant change in AF AVP levels with different gestational age. If in rhesus erythroblastosis patients the delta/E value was low (n = 7; x = 0.048 +/- 0.007 SE), the AF AVP values were not increased. If the delta/E values were within zone III (n = 6; x = 0.22 +/- 0.035 SE), indicating severe haemolysis, the AF AVP levels were significantly elevated (4.7 pg/ml +/- 0.51 SE; P = 0.001). Linear regression analysis showed a significant correlation between delta/E and AF AVP values (P = 0.05; y = 1.94 +/- 10.88 x). We conclude that there is evidence for the role of AF AVP as a marker for foetal stress in rhesus erythroblastosis.

[Is amniotic fluid prolactin an osmoregulatory hormone of clinical importance?]. / Fruchtwasser-Prolaktin, ein osmoregulatorisches Hormon mit klinischer Bedeutung?

The present paper reports on the amniotic fluid prolactin concentrations in 61 pregnancies with undisturbed amniotic fluid volume from the 17th to the 41st week of pregnancy. The amniotic fluid prolactin concentrations reach a peak in the 19th week of pregnancy with a slight decrease to the 21st week. After a plateau from the 23rd to the 31st week of pregnancy, prolactin concentrations decrease to very low levels in late gestation. In pregnancies with disturbed amniotic fluid volume the prolactin concentrations are pathologically changed in comparison with "normal" pregnancies. The authors conclude that the amniotic fluid prolactin concentrations have a characteristic profile depending on the stage of pregnancy. From the pathologic prolactin concentrations in patients with hydramnios and otherwise pathologic pregnancies it may be concluded that prolactin is a clinically relevant osmoregulatory hormone for humans too.

[Prenatal diagnosis and therapy of fetal hemolytic disease with Rh incompatibility]. / Pränatale Diagnostik und Therapie des Morbus haemolyticus fetalis bei Rhesus-Inkompatibilität.

Between 1966 to 1984 a total of 636 intrauterine foetal transfusions were performed at the Hamburg University Hospital on 280 foetuses suffering from severe erythroblastosis. 54.6% of these foetuses survived. Ascitic fluid was found in 29,6% of the foetuses at the beginning of therapy. The survival rate improved to 22%.

[Prenatal diagnosis and therapy of hemolytic disease of the newborn]. / Pränatale Diagnose und Therapie des Morbus Haemolyticus Neonatorum.

From 1966 to 1983 a total of 586 intra-uterine fetal transfusions on 268 fetuses suffering from severe Rh-erythroblastosis were performed at the Hamburg university hospital. 149 (56%) fetuses survived. 29% of 268 fetuses exhibited ascitic fluid at the beginning of therapy. The survival rate improved to 63% in the last five years. The diagnostic and therapeutic procedures are explained in detail. The amniotic fluid analysis has been improved. In addition to Rh-antibodies, it is important to detect other blood group antibodies such as anti-Jk(a) and anti-Fy(a), that can diminish the survival rate of the donor erythrocytes in the fetus.

[Nonpuerperal mastitis--a disease with increasing clinical relevance?]. / Mastitis non-puerperalis--eine Erkrankung mit zunehmender klinischer Relevanz?

During the last few years, a relative increase in the number of patients with non-puerperal mastitis was recorded. From 1980 to 1983, 51 patients were treated who were suffering from an abacterially or bacterially complicated nonpuerperal inflammation of the breast tissue. The present paper reports on patients' history, clinical symptoms, and the development of this form of mastitis during different methods of treatment. The importance of pre-existing lesions of the breast tissue and of hormonal data for the pathogenesis is discussed. The authors conclude that the administration of prolactin inhibiting drugs is an effective therapy. This treatment results in lower rates of abscesses. Long-term therapy with bromocryptine can prevent recurrence of this disease.

[Effect of the menstrual cycle on spontaneous and mitogenous lymphocyte transformation]. / Einfluss des Menstrualzyklus auf die spontane und mitogene Lymphozytentransformation.

The spontaneous and the mitogenous lymphocyte transformation by phyt-hemaglutinine P of the peripheral T-cells of healthy women during the menstrual cycle and after the menopause was measured by the 3H thymidine incorporation into DNA. Whereas the transformation of lymphocytes has a uniform pattern after the menopause, the spontaneous transformation in women with menstrual cycles is diminished during the secretory phase of the cycle and periovulatory reduced stimulation by phyt-hemaglutinine P is observed. The formation of spontaneous rosettes was not different.

[Cellular immunity in breast cancer patients]. / Untersuchungen zur zellulären Immunität bei Mammakarzinompatientinnen.

84 breast cancer patients were examined prior to surgery regarding cellular immunity. 47 patients were free from secondary tumors, 37 already had axillary lymph node metastases, but no other secondary growth. 37 healthy women formed a control group. With reference to the total leukocyte count and to the percentage of T cells in the total lymphocyte count, there was no difference between the control group and the cancer patients. The latter, however, showed a significantly increased lymphocyte count compared with that of the control group. Despite an increase in the number of lymphocytes in cancer patients, there was a significant decrease in their ability to be stimulated by concanavalin A. In breast cancer patients with regional metastases the ability to be stimulated by phytohemagglutinin was decreased, too.

Occurrence of cyclopia, myelomeningocele, deafness, and abducens paralysis in siblings.

As holoprosencephaly without chromosome defect may be associated with other CNS-related anomalies such as mental retardation, mental illness, facial paralysis, endocrine disorders, deafness, spina bifida, and myelomeningocele, we present a family in which one girl had a myelomeningocele, a brother had orbital hypotelorism, facial and cerebral asymmetries, cerebral palsy, abducens paralysis, and inner ear deafness. A 3rd pregnancy was terminated at 16 weeks; the fetus had cyclopia. A common cause is discussed in these cases and in those families in which holoprosencephaly and additional malformations occur among different generations.

Congenital malformation syndromes and elevation of amniotic fluid alpha-fetoprotein.

Fetal malformations may introduce complications of maternal pregnancy. A polyhydramnios represents one such complication during pregnancy. We want to report five abnormal pregnancies which were marked by acute polyhydramnios and/or premature labor due to an amniotic band syndrome associated with cerebral herniation in two cases, malignant oral teratoma in one case, bilateral cystic hygromas associated with generalized fetal hydrops in one case, and multiple internal malformations in one case alpha-fetoprotein (AFP) values between the 25th and 34th week of gestation were elevated 3.5 to 44 times the normal median value. Since all fetuses showed severe malformations incompatible with life our observations indicate the necessity to determine AFP in cases of acute polyhydramnios independent of the week of gestation. Conversely, elevated AFP levels in amniotic fluid obtained during prenatal diagnosis in the 16th week of gestation may also suggest rare fetal malformations outlined above.

Studies on the methodology and evaluation of the lymphocyte transformation microtest.

Optimum experimental conditions for the lymphocyte transformation microtest in healthy persons are described. The dependence of PHA stimulation on duration of culture, additions of serum and PHA concentration is investigated. A function of normal distribution pattern can be set up by determining the lymphocyte stimulability with four different PHA concentrations in the optimal stimulation range. With this function, the area under the curve, steepness, position and height of the maximum can be calculated. These parameters should serve for better interpretation of cellular immunity.