Carney complex--an unexpected finding during puerperium.

Carney complex is an extremely rare, autosomal dominant, multi-system disorder characterized by multiple neoplasias and lentiginosis. The genetic defect responsible for this complex has been localized to the short arm of chromosome 2 (2p16). The most prevalent clinical manifestations in patients with Carney complex are spotty skin pigmentation, skin and cardiac myxomas, Cushing's syndrome and acromegaly. Here we report the case of a 31-year-old woman with a spontaneous pregnancy. At 32 weeks of gestation, she was admitted to our Department of Obstetrics with hypertension and severe back pain. In addition, she had unusual pigmentation and typical cushingoid features. One day after admission, the pregnancy was terminated by emergency cesarian section because of preeclampsia and pathological CTG. During the postoperative period the severe back pain persisted, and radiographic evaluation revealed a collapse of L(2)/L(3) with severe osteopenia. A CT scan showed a mass in the right suprarenal area. Histopathological examination revealed a primary pigmented nodular adrenocortical disease. After biochemical confirmation of the diagnosis of Cushing's syndrome, it was recognized that the patient met the diagnostic criteria for Carney complex.

[The "gentle caesarean section" - an alternative to the classical way of sectio. A prospective comparison between the classical technique and the method of Misgav Ladach]. / "Die sanfte Sectio" - Eine Alternative zur klassischen Sectiotechnik - Prospektiver Vergleich der klassischen Technik mit der Misgav-Ladach-Methode -

OBJECTIVE: A new technical variant of caesarean section was described a few years ago, which is characterised by blunt surgical preparation and simplified seam technique. A prospective investigation compared the differences in the surgery and postoperative process as well as the rate of complications between this Misgav Ladach method and the conventional technique of Sectio. The individual postoperative well-being of the women was recorded by visual analog scales. - PATIENTS AND METHODS: Women, whom realize the including criterias (first caesarean section, >/= 32. week of pregnancy, one baby), were examined in this study over one year: 105 patients operated with the Misgav Ladach method and 67 conventionally operated patients. The patients were randomized in a function of the first letter of the surname (A-K: Misgav-Ladach method; L-Z: classical technique). - RESULTS: The surgical time from the cut to the seam was significantly shorter (29.8 vs. 49.3 min; p < 0,001) in the Misgav Ladach group. There were no differences between the two methods in the rate of postoperative complications. The febrile morbidity was equivalent in both groups (7.6 % vs. 9 %), likewise the frequency of postoperative hematomas (3.8 % vs. 3 %). The postoperative period with consumption of analgetics was significantly longer in the group of conventionally operated patients (1.9 d vs. 2.4 d; p < 0.01). The postoperative presentness was estimated significantly better (p < 0,.01) by the patients of the Misgav ladach group - probably caused by the significantly earlier mobilization (p < 0.05). - CONCLUSION: The surgical technique described by Misgav and Ladach allows a safe execution of the caesarean section and represents an alternative to the conventional method. The duration of operation (cut-seam-time) was significantly shorter. The technique of less traumatising of tissue caused a significantly earlier mobilisation and a significantly shorter requirement of analgetics. The women estimated her postoperative physical condition as better.

[Life situation of parents of twins and triplets: a qualitative study]. / Lebenssituation von Zwillings- und Drillingseltern: eine qualitative Studie.

BACKGROUND: Starting in the middle of the 1980s, an increasing incidence of multiple pregnancies in Germany has been reported, with assisted reproduction mainly contributing to this increase. In the management of multiple pregnancies, the main focus is on optimising the obstetric care. The difficult socio-economic and psychosocial situation of parents of multiples, however, is often underestimated. METHODS: The present study examines the life situation of parents of twins and triplets using focus groups as a qualitative research method. Nineteen mothers and fathers of twins and triplets were interviewed in four focus groups. Main topics were the parental reaction to the diagnosis of multiple pregnancy, the first time at home with the multiples, special situations and wishes and ideas for a better care during multiple pregnancy. RESULTS: The diagnosis of multiple pregnancy was made at early gestational age, with the parental reactions being described between "happiness" and "shock". With this diagnosis, however, the future parents feel alone. Caring for the babies is leading to the limits of parent's ability to take stress. Marital problems and social isolation are discussed controversially. Exceptional situations such as illness of the mother require fast and un-bureaucratic solutions. CONCLUSIONS: The interviews suggest that special problems of multiple parenthood such as social isolation, marital and psychic problems are not necessarily related to higher order multiples or handicapped children. It appears to be essential to offer a more individual care for women expecting multiples, whereas the main resource for improving care is in providing contact and information possibilities.

A study of fetal macrosomia.

We describe the maternal characteristics in pregnancy with fetal macrosomia, fetal and maternal complications related to macrosomia, and the risk of impaired glucose tolerance. The study is based on a comparison of maternal and neonatal data in 956 cases of fetal macrosomia (birthweight > or =4000 g) in non-diabetic pregnancy with data in a control group of 6407 mothers with non-macrosomic infants (birthweight 3000-3999 g). The main factors investigated were maternal age, weight, parity, gestosis rate, maternal and fetal birth injuries, maternal oral glucose tolerance test results and umbilical blood insulin levels. Macrosomic infants occurred in 9.1% of all deliveries. Mothers delivering macrosomic infants were significantly older, of higher parity and of greater weight than mothers of the control group. Fetal macrosomia was associated with a higher frequency of gestosis, operative deliveries, birth injuries and postpartum haemorrhages. 26.2% of the mothers had abnormal of oGTT results. The macrosomic infants were more often male and had a significantly higher risk of shoulder dystocia and birth injuries. No essential differences could be observed in the Apgar-scores and umbilical artery pH values. 34% of macrosomic infants had higher insulin levels in umbilical blood.

[Müllerian adenosarcoma of the uterus. A case report]. / Müllersches Adenosarkom des Uterus. Eine Kasuistik.

A case of Müllerian adenosarcoma of the uterus is described. The patient, an 81-year old female, was treated in hospital for vaginal bleeding in 1993. She was diagnosed as having a tumour of the uterus. The patient underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy. We found a polypoid intrauterine tumour which had led to a swelling of the cavum and cervical canal. Histologically a Müllerian adenosarcoma was diagnosed. The tumour consisted of a benign glandular component and an mesenchymal component in the form of a low differentiated pleomorphic rhabdomyosarcoma.

[Prenatal growth of children of epileptic mothers]. / Untersuchungen zum pränatalen Wachsum von Kindern anfallskranker Mütter.

In this study 67 children of 59 females with epilepsy and on anticonvulsants were investigated. Children of epileptic women on medication with Primidon are of lower weight and have smaller heads than children from epileptic mothers without medication and children from parents without epilepsy.

[Cystine aminopeptidase and oxytocin in the plasma of pregnant patients with premature labor]. / Cystin-Aminopeptidase und Oxytocin im Plasma Schwangerer mit vorzeitiger Wehentätigkeit.

L-cystine aminopeptidase (CAP) activity in plasma was determined by spectrophotometry in 243 normal pregnant women in week 20-40 and 68 pregnant women with premature pains in week 28-37 of pregnancy. For significantly diminished CAP activity, pains and the subsequent premature birth correlated with infantile dystrophy, while in case of normal CAP activity the number of premature births was significantly less and newborns had eutrophic birth weights. In addition, radioimmunological measurements of oxytocin concentration in plasma were performed in ten pregnant women each of these groups. In women with premature pains, the oxytocin concentration was significantly higher than in normals. The present findings suggest that fetal oxytocin release might be the trigger signal for pains, thus causing premature birth. This signal might be chronically induced by a stress situation which manifests itself in hypotrophy of the newborns.

[Epilepsy and pregnancy--results of interdisciplinary cooperation]. / Epilepsie und Schwangerschaft--Ergebnisse interdisziplinärer Zusammenarbeit.

A total of 19 female epileptics were jointly counselled, cared for and delivered during 21 pregnancies. Special aspects that must be taken into account during pregnancy in epileptics are described. Due to changes in the pharmacokinetics of anti-epileptic drugs, plasma level checks must be performed every four weeks during early pregnancy. The possible teratogenic effects of anticonvulsants and other factors tending to increase the malformation rate are discussed. An explanation is given for the use of prophylactic folic acid and vitamin k treatment in connection with anti-epileptic therapy. Breast feeding has not only proved advantageous from the nutritional standpoint but also helps withdraw the new-born, who is habituated to anticonvulsants, from the drugs without negative symptoms. The benefits of counselling prior to pregnancy and general questions relating to women who are prone to seizures while they are of child-bearing age is discussed.

[Care and delivery of epileptic pregnant patients]. / Betreuung und Entbindung anfallskranker Schwangerer.

The collective care of women having epileptical fits by gynecologists and neurologists is reported in this paper. Questions of the course of pregnancy as well as the management of delivery are dealt with the help of the collective observation material. The condition of the newborns is described, too. It is especially referred to the fact that the anticonvulsive treatment during the pregnancy has to be maintained, if possible a monotherapy should be used and the plasma level of drugs should be controlled, particularly in the first time of pregnancy. Induction of labor at term has been approved besides of intensive prenatal care with facilities of control by modern equipment. Accumulation of fits during pregnancy or complications by hemorrhage in the newborns were not to be seen. All children with only two exceptions were normally nursed. This regime was not harmful.

The antenatal use of ambroxol (bromhexine metabolite VIII) to prevent hyaline membrane disease: a controlled double-blind study.

A prospective double-blind clinical trial was carried out to determine whether ambroxol (bromhexine metabolite VIII) treatment (1000 mg/day for a period of 5 days) reduces the risk of hyaline membrane disease (HMD) in potentially premature infants. Amniocentesis was performed before the first and 24 h after the last application of ambroxol or placebo to assess the development of the total phospholipid phosphorus content, the L/S ratio, the P/S ratio, and the properties of the surface tension of the amniotic fluid after ambroxol or placebo. There were 246 infants born to 224 mothers. Of the 116 infants with less than or equal to 36 completed weeks' gestation, 56 were in the ambroxol and 60 in the placebo group. No differences between groups occurred in risk factors for HMD (diabetes, asphyxia, male sex, cesarean section). Statistically significant differences in favor of the infants in the ambroxol group were found in the HMD incidence: 23.2% in the ambroxol group compared with 41.7% in the placebo group (p less than 0.05). There was no reduction of the HMD incidence in the less than or equal to 32-week gestational age category in the ambroxol group compared with the placebo group inspite of the fact that all the examined parameters for determining lung maturity reflected a stimulatory effect of ambroxol compared with the results of the placebo group, particularly before the 33rd week of gestation. Prolonged rupture of the membranes played no protective role against HMD.

[Undifferentiated cell leukosis in pregnancy]. / Unreifzellige Leukose in der Schwangerschaft.

The appearance of an undifferentiated cell leucosis during pregnancy is relatively rare. However, it is increasingly more frequently to be reckoned with this fact, since the rate of leucosis is increasing. On account of the extraordinary situation in the individual case may be difficult diagnostic and above all therapeutic decisions which are discussed with the help of the represented case.

[Worsening prospects for urban England?]. / Schlechtere Aussichten fur das stadtische England?

PIP: The author reviews trends in urban population development and migration in England during the period 1961-71 and then analyzes statistics for the years 1971-78. The trend toward urban flight is discussed, and arguments for and against the preservation of urban areas are noted. Social factors affecting reproductive behavior that need to be considered in developing a model of future population development are discussed. A typology of economic prospects for regions and cities in the United Kingdom is presented, and implications for regional planning are considered^ieng

[Combination of cerclage and drug tocolysis in threatened premature labor]. / Kombination von Zerklage und medikamentöser Tokolyse bei drohender Frühgeburt

The paper reports on the combination of cervix cerclage and tocolysis for treating imminent abortus and premature delivery. Up to now 59 patients have undergone treatment by this method. 37 children were delivered in good health at the approximate date of birth as estimated and survived. The number of survivals out of 15 prematures is 10, bringing the total number of survivals for these children whose life is in peril up to 47 (79,6%). The combined treatment of imminent abortus and premature delivery represents a reasonable alternative to other proven methods.

[Psychometric studies on female patients during sterility counseling]. / Psychometrische Untersuchungen an Patientinnen einer Sterilitätssprechstunde

The application of the VNPI-test, i.e. neurosis screening, to 46 female patients attending consultations on sterility, is reported. For patients having normal genital organs, the test results indicated a neurotic personality at rate three times higher (52%) than for patients found to have pathological genitals (17%). This result is understood to confirm the opinion which, in addition to somatic causes, also accepts a psychogenic etiology of sterility. Therefore, the importance of early psychological investigation is pointed out, which should not start as late as once all somatic efforts have failed.