[End-to-end anastomosis in the primary repair of anal sphincter laceration occurring during delivery]. / Suffizienz der End-zu-Endanastomose bei primärer Versorgung eines geburtstraumatischen Analsphinkterrisses.

PURPOSE: To assess the quality of end-to-end anastomosis in the primary repair of anal sphincter laceration occurring during delivery. METHODS: Forty-nine women with third degree perineal laceration (PL III) and 42 controls were included in a 3-year postpartal follow-up study. RESULTS: Ultrasound showed end-to-end anastomosis to be inadequate in 22 (48.1 %) women. Thirty-one (63.2 %) women developed grade I-III anal incontinence. DISCUSSION: There was no correlation between ultrasound findings and the presence of anal incontinence. The unsatisfactory sonomorphometric outcome after 6 weeks results from inadequate repair with retraction of the sphincter ends. Defects newly demonstrated after 36 months indicate dedifferentiating atrophy with damage to peripheral motor nerves.

Are cumulus cells necessary for the spontaneous maturation of germinal vesicle-stage oocytes to metaphase II.

PURPOSE: In this study we investigated the need of the support from cumulus cells for germinal-vesicle (GV) oocytes collected from stimulated ovaries to complete their maturation to metaphase II (MII). METHODS: We compared the maturation rate of GV oocytes after coculture with cumulus cells (study group) with their spontaneous maturation in culture medium alone (control group). RESULTS: Sixty-four and nine-tenths percent of the GV oocytes matured to metaphase II in the coculture group, and of these, 43.5% gave normal 2pn zygotes following intracytoplasmic sperm injection (ICSI), while 73.8% of the GV oocytes spontaneously matured to the MII stage and 30% of these reached the zygote stage after ICSI. CONCLUSIONS: It is probable that a follicular factor is responsible for this arrested maturation in the human and that maturation occurs spontaneously when the oocytes are separated from their follicular fluid environment after collection.

Intracytoplasmic sperm injection (ICSI) with testicular sperm extraction (TESE) in non-obstructive azoospermia--two case reports.

Intracytoplasmic sperm injection (ICSI) with microsurgical epididymal sperm extraction (MESA) or testicular sperm extraction (TESE) can be offered to azoospermic men. We report our initial experience of two cases with ICSI-TESE in non-obstructive azoospermia. Both couples had a successful ICSI with embryo transfer. An ongoing triplet pregnancy at 21 weeks is observed.

Ultraviolet light hardening in polymorphous light eruption--a controlled study comparing different emission spectra.

Polymorphous light eruption (PLE) is a common disorder characterized by a delayed, abnormal response to ultraviolet (UV) radiation, with a varied morphology of itching efflorescences on sun-exposed areas of the skin. Thirty-one PLE subjects were treated with either UVA (340-400 nm) or UVA and UVB (300-400 nm) phototherapy during spring 1987 (10 exposures to UV light). They were randomly allocated to these 2 groups. For subjects of the UVA group, the applied dose corresponded to their individual minimal tanning dose; for subjects of the UVA and UVB group it corresponded to approximately 3/4 of their individual minimal erythema dose. The sun protection effect was studied by a high dose of UVA (80-160 J/cm2; 340-440 nm) after the treatment period, by analysing the histidine content of the stratum corneum and the urocanic acid photoisomerization, and by evaluating the subjects' diaries. The patients were asked to expose their skin to sunlight at least 3 times after UV hardening in the following 2-10 weeks. The results of both the UVA provocation and of the natural sun exposure confirmed the success of UV hardening without the occurrence of severe side effects. The content of histidine and of its metabolite urocanic acid in stratum corneum was significantly increased during the treatment. These data are interpreted to be biochemical markers for improved sun protection.

[Ocular side effects of added sympathomimetics in local anesthetics]. / Nebenwirkungen am Auge von Sympathomimetikazusätzen in Lokalanästhetika.

In facial dermatosurgery, the addition of sympathomimetics to local anesthetics produces a desirable topical effect as they provide an almost bloodless operation field due to temporary vasoconstriction. In an 87-year-old woman, who had lost her left sight owing to a meningoma, we removed a basal-cell carcinoma from the right side of her nose. The local anesthetic applied contained noradrenaline at a concentration of 1:50,000. After the operation, the patient complained of a headache and a transitory loss of sight. We suppose that noradrenaline reached the arteria centralis retinae via arterial periorbital anastomoses, thus causing a vasoconstriction of this artery. As far as dermatosurgery of the middle and upper face is concerned, patients with severe vision disorders should be considered as a risk group; in local anesthesia of those patients an addition of sympathomimetics should be avoided.

[Characteristics of polymorphous light dermatosis--results of a prospective survey and study of 302 affected patients]. / Charakteristika der polymorphen Lichtdermatose--Ergebnisse einer prospektiven Befragung und Untersuchung 302 Betroffener.

In a prospective study on 302 patients (females = 87%), we registered the historical and clinical data of polymorphous light eruption (PLE) and compared our results to similar studies from Finland, Sweden, and the USA. The mean age of onset of the disease was 24.0 years; the average duration time was 10.1 years. We found the following clinical and historical characteristics of PLE: skin types I and II - 49%; positive family history - 29%; latent period between sun exposure and the first skin eruptions - in 39% less than 2 hours, in 5% 3 days and more. Mostly we observed paular eruptions and strong pruritus, and usually the typical body areas were involved (i.e. décolleté, upper and lower arm, thigh, back of the hand, and face). In 64% of the patients who avoided exposure to the sun, the PLE did not continue but less than a week. Our findings may supply a useful tool regarding the diagnosis of ambiguous photodermatoses.

[Pitfalls in occupational dermatology: airborne contact eczema caused by plants]. / Fallstricke in der Berufsdermatologie: Das aerogene Kontaktekzem auf Pflanzen.

Two case reports are presented involving the occurrence of airborne contact dermatitis in a farmer and a gardener. In both cases, direct contact dermatitis or photoallergic dermatitis was suspected at first. Possible allergens for occupational airborne contact dermatitis in agriculture are discussed.

[Transient vision loss caused by scandicaine with added arterenol in the excision of basalioma of the side of the nose]. / Passagere Visusminderung durch Scandicain mit Arterenol-Zusatz bei Basaliom-Exzision am Nasenflügel.

In facial dermatosurgery, the addition of sympathomimetics to local anaesthetics produces a desirable topical effect by creating an almost bloodless operation field due to transitory vasoconstriction. In an 87-year-old woman suffering from a meningioma that had caused blindness of the left eye, a basal-cell carcinoma was removed from the right side of the nose. The local anaesthetic contained noradrenaline at a concentration of 1:50,000. After the operation, the patient complained of headache and a transient loss of vision. We suggest that noradrenaline caused vasoconstriction of the arteria centralis retinae via arterial periorbital anastomoses. Patients with severe vision disorders should be considered a risk group, in whom sympathomimetics should not be added to local anaesthetics used in skin surgery of the middle and upper face.