[ENZIAN-score, a classification of deep infiltrating endometriosis]. / ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose.

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

A 47,XXY female with unusual genitalia.

A 47,XXY karyotype was found in a 6-year-old girl. The patient had female external genitalia, clitoromegaly, remnants of the ductus mesonephricus, uterus, and gonads in the labia majora which were determined to be testes by histology. Cytogenetic and DNA analyses suggest that the Y chromosome had a normal structure and that both X chromosomes were of maternal origin. The unusual clinical findings in the patient are discussed.

[Dysgerminomas. Clinical aspects, therapy and prognosis with reference to the cooperative therapy study MAIKEI 83/86 for non-testicular germ cell tumors of the Society of Pediatric Oncology]. / Dysgerminome. Klinik, Therapie und Prognose unter Berücksichtigung der kooperativen Therapiestudie MAKEI 83/86 für nichttestikuläre Keimzelltumoren der Gesellschaft für Pädiatrische Onkologie (GPO).

In comparison to other malignant germ cell tumors, dysgerminomas of the ovary show a high sensitivity to radiotherapy. According to histology and biological behaviour, dysgerminomas of the ovary are similar to testicular seminomas, which seem to be very sensitive to chemotherapy. Therefore, in the protocol for non-testicular germ cell tumors of the German Society of Pediatric Oncology (GPO) a treatment for dysgerminomas is established, in which the indication for primary tumor resection and a supplementary radiotherapy, or, in selected cases, primary chemotherapy and delayed tumor resection after the spreading, has been graded. After a median follow-up of 26 months, 17 of 18 patients were alive and disease-free, from which 3 patients with tumor progression after initial ovariectomy are in the second remission phase following relapse therapy. One patient died of tumor progression despite combined chemotherapy and irradiation. With a stratified therapy regime, fertility could be preserved with high probability in 13 of 17 patients.

[Indications and the process of vaginoscopy in children]. / Indikation und Durchführung der Vaginoskopie im Kindesalter.

The optimal recognition of gynecological diseases in childhood and adolescence requires gynecological examination with empathy and subtility. Just like the elder woman the young girl can demand that we take care of her gynecological problems in order to avert upcomming dangers. Concordant to adult's gynecological diseases we find the same problems in children and adolescents. That's why the examination cannot be different in newborns, girls and adolescents. The complete gynecological examination requires vaginoscopy or examination by means of speculum. It's necessary beyond the inspection of the vulva and rectal digital explorations of minor pelvis. Indications for vaginocolposcopy: 1. Bleeding; 2. Relapsing genital infections; 3. Foreign bodies; 4. Tumors; 5. Traumas: after accidents and sexual crimcs; 6. Abnormalities: intersexuality, malformations; 7. Premature or delayed development; 8. Gyneco-surgical diseases; 9. Gyneco-urological diseases; 10. Tentative diagnosis. The vaginoscopes are adapted to the developing infant genital organs. We don't need narcosis resp. premedications. It's incorrect that sonography--as less invasive performance--could substitute vaginoscopy. Sonography is a means of completing children gynecological examination. Furthermore vaginoscopy substitutes the irradiation of the gonads by genitography. We can't understand the lack of vaginoscopy in infant gynecological examination with respect to it's pre- and disadvantages. The anatomical adaptability of the hymen supports our opinion.

Severe clostridium infection following perforation of the uterus in a patient with an ectopic pregnancy.

Twenty-eight hours after CO2 insufflation and curettage in a 26 year old, haemolysis, jaundice and anuria developed. As an ectopic pregnancy was also suspected, a diagnostic laparoscopy was done and was followed by a hysterectomy and left salpingo-oophorectomy before Clostridium perfringens was grown on culture. The survival of the patient despite clostridial infection is probably due to immediate surgical treatment and intensive post-operative care.

[On the dispersion capacity of an intra-vaginal contraceptive ovule. Results of an in-vivo study in sexually not stimulated women (author's transl)]. / Zur Frage des Dispersions-vermögens eines intravaginalen kontrazeptiven Ovulum. Ergebnisse eines In-vivo-Versuches bei sexuell nicht stimulierten Frauen.

In 62 sexually mature women in the out-patient department the intra-vaginal contraceptive ovule was inserted by the physician into the posterior vaginal vault and removed 15 minutes later and then weighed. The mean loss of weight was about 24%. Except in one case the ovule remained intact in all other cases the foam development was confined to the upper third of the vagina. With a probability of error of P = 0.12 it can be assumed that the dispersed amount from the ovule is less in older patients than in younger patients. There was no difference in the dispersed amount during in the first and the second half of the menstrual cycle. Further in-vivo investigations on intra-vaginal contraceptive ovules appear to be required.

PIP: In 62 sexually mature women in the outpatient department, an intravaginal contraceptive ovule was inserted by the physician into the posterior vaginal vault and removed 15 minutes later and then weighed. The mean loss of weight was about 24%. Except in 1 case, the ovule remained intact; in all other cases the foam development was confined to the upper 1/3 of the vagina. With a probability of error of P=0.12, it can be assumed that the dispersed amount from the ovule is less in older patients than in younger patients. There was no difference in the dispersed amount between the first and second 1/2 of the menstrual cycle. Further in vivo investigations on intravaginal contraceptive ovules is necessary. (author's)

A study of impression moulds of the genital tract of female fetuses.

Contrary to current opinion, the fetal vagina is not a solid plate. Already at the 14th week of gestation, the urethra, vagina, uterus, and Fallopian tubes have a lumen which can be identified by means of the intravaginal injection of rapidly setting silicon liquid. However, after the 26th week of gestation the injected substance fills the vagina but does not enter the cervical canal. This is probably due to functional plugging of the endocervical canal by the secretory activity of its epithelium. Silicon plastic moulds of the vaginal vault consistently show a circular groove separating the middle from thupper third of the vagina. This groove could be the line of fusion between the mesodermal Mullerian ducts and the urogenital sinus.

[Vaginoscopic investigation of the cervical ectopy in the neonate (author's transl)]. / Die Ektopie in der Neugeborenenperiode. Eine vaginoskopische Studie.

The percentage of the physiologic ectopy of the endocervical epithelium onto the portio vaginalis of the cervix in the neonate was unknown. Vaginoscopy of 124 new born females in our Obstetric unit showed that the ectopy of the cervix is not found in 36% but in almost all cases (90%). Colposcopy and cytology excluded pathology of the portio. The cervical ectopy retracts in the physiologic involution process of the neonate. Vaginoscopy of the newborn was technically quite feasible and in some cases medically necessary.

[The balloon vaginoscopy (author's transl)]. / Vaginoskopie mit dem Ballonvaginoskop. Gleichzeitig ein Beitrag zur Extraktion von Fremdkörpern aus der kindlichen Scheide.

The regular Huffman vaginoscope is fitted with an endotracheal sleeve to obtain a balloon vaginoscope. The balloon vaginoscope makes inspection of the cervix in children much easier, and facilitates the removal of foreign bodies from the vagina of children. Vaginoscopy can be learned easier with the balloon vaginoscope.

[An atraumatic instrument for the removal of the lost string intra-uterine device (author's transl)]. / Ein atraumatisches Instrument zur Auffindung und Entfernung eines im Uterus "verlorenen" Intrauterinpessars.

A less common complication of intra-uterine device contraception is the lost string. Since the intra-uterine devices are more used the problem of the search for lost string intra-uterine devices has increased. An intra-uterine device forceps with a diameter of 2.5 mm. is presented. The instrument can easily be used in office practice. Removal of the device under general anaesthesia after dilation of the cervix with a large instrument can best be avoided.

PIP: A forceps 2.5 mm in diameter is described and recommended for the search and retrieval of lost strings in IUD wearers. Because of its small size and flexibility, it can be used in office practice, obviating general anesthesia and the use of large cervical dilators.

[Polyps of the uterine cervix during the hormonal resting phase in childhood (author's transl)]. / Polypen der Cervix uteri in der kindlichen hormonalen ruheperiode

The occurrance of polyps of the uterine cervix during childhood is described which is exceedingly rare according to the literature. A pediatric gynaecological outpatient department was established two years ago and among about 600 children examined by viginoscopy, nine children with polyps of the cervix were detected. All nine girls had similar symptoms and signs. There was vaginal bleeding with malodorous discharge which could also be characteristic of a malignant tumor. The vaginal introitus was rather larger with an almost absent hymen. It is important to recognize the conditions early and to treat it. The vaginal discharge was treated. The polyp was removed and the base of the polyp was coagulated to avoid a recurrence. It can be expected that polyps of the uterine cervix in childhood will be found more often as the interest in pediatric gynaecology increases.