[Duration of desire for a child, contraceptive behavior and rate of previous infertility treatment. An epidemiologic study of 750 consecutive patients in labor at the Oldenburg Gynecologic Clinic using a structured interview]. / Kinderwunschdauer, kontrazeptives Verhalten und Rate vorausgegangener Infertilitätsbehandlungen. Eine epidemiologische Untersuchung bei 750 konsekutiv erfassten Wöchnerinnen der Oldenburger Frauenklinik durch strukturiertes Interview.

In order to gain current information, on how long a healthy couple desiring a child has to wait until conception, on previous contraceptive behaviour and prior infertility treatment, 750 women were interviewed within 7 days after delivery between January and November, 1989, using a standardised questionnaire. This sample represents one third of all patients, who delivered a child in an Oldenburg hospital during the time period covered. 544 women had desired a pregnancy, an additional 206 women had not directly planned a pregnancy, and 73 of these had taken no precautions against conception, since they were willing to accept a pregnancy if it should occur. 133 women called their pregnancy an "accident", which in 87 couples occurred despite some kind of contraceptive procedure. The absolute number of contraceptive failures was highest for timed intercourse (n = 38) and users of oral contraceptives (n = 32). Couples without a history of infertility treatment had to wait for an average period of 3.4 months before a conception occurred (95% confidence limits: 3.1-3.8 months). The mean age of the women in this group was 28.1 +/- 0.2 years, whereas on an average their male partners were 30.9 +/- 0.2 years of age. The likelihood to achieve pregnancy within the first 4 months of trying, varied between 13 and 15% per month. After 6 months of waiting, the pregnancy rate per cycle was reduced to 6%, whereas, after one year, the likelihood for conception was only 1%. Half of all couples desiring a pregnancy achieved this within 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Adjuvant chemotherapy in primary radically operated ovarian cancer]. / Adjuvante Chemotherapie beim primär radikal operierten Ovarialkarzinom.

There are no conclusive studies on the value of adjuvant chemotherapy in radical resected ovarian carcinoma. General reflections including parameters, toxicity and formation of a secondary tumor suggest forgoing adjuvant therapy of stages Ia to IIa. The survival rate of all other stages is below 50%. A therapy would seem necessary. Only general recommendations can be made due to lack of conclusive trials.

[Gynecological and endocrinological studies of thalidomide-damaged girls]. / Gynäkologisch-endokrinologische Untersuchungen bei thalidomidgeschädigten Mädchen.

Gynaecological examinations were done for the first time in 32 girls, between age 13 and age 18 damaged by thalidomide. 11 of the girls had primary amenorrhoea at the time of examination. 9 of these cases showed genital malformations. 7 cases showed aplasia of the uterus. A rudimentary uterus and a hypo-plastic uterus were found in one patient each. In 8 girls these changes were combined with abnormalities of the vagina, 3 cases had vaginal aplasia. 4 cases had a blind vaginal sac. 1 case had a urogenital sinus. Two patients had primary amenorrhoea without genital malformations. In the girls who had started menstrual periods none of the 21 cases showed genital malformations. Supplementary endocrinological investigations were done to answer the question whether functional disturbances were caused by thalidomide in addition to organic changes. The development of puberty can be diagnosed from secondary sexual markers. Our patients had almost all advanced puberty with more mammary development than pubic development. The menarche between age 11 and age 16 showed no deviation from the normal in our patients. 11 girls had regular cycles. The hormonal vaginal cytology in 28 patients showed no sign of deficient estrogen. Neuro-endocrine maturation is responsible for the development of puberty. The basal secretions of FSH and LH increase. The dynamic functional test with LHRH shows the LH reserve of the pituitary which rises in a typical pattern. 14 patients had a LHRH test and nine of these showed a mature LH reserve corresponding to the index R2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Case report on the administration of diuretics during pregnancy]. / Kasuistik zum Problem der Diuretikaeinnahme in de Gravidität.

Diuretics potentiate existing hypovolaemia and hämoconcentration in patients suffering from toxemia of pregnancy. This effect also applies to the fetus. A case is presented of an intrauterine spontaneous thrombosis in the inferior vena cava and its tributaries in a fetus with resulting perinatal death during long-term diuretic therapy because of edema in the mother in the third trimester. Basing on this example, the present state of assessment and necessity of treatment of the symptom "edema" in late pregnancy is discussed, with the conclusion that administration of diuretics, if it becomes necessary in a life-threatening state of the pregnant mother (pulmonary edema or oliguria in pre-eclampsia or eclampsia) is indicated only with monitoring of the hematocrit and central venous pressure.

[Neurofibromatosis involving urinary bladder and vesico vaginal septum (author's transl)]. / Neurofibromatose mit Befall der Blase und des Septum vesico vaginale.

A case of generalized neurofibromatosis with involvement of urinary bladder and septum vesico vaginal is reported in connection with a short review of literature.

Sexual differentiation of the hypothalamus in gonadal agenesis and testicular feminization.

Cyclical hypothalamic function was investigated in three patients with an XY karyotype and female external genitalia; in one of them we diagnosed gonadal agenesis, and in the other two testicular feminization. We studied the effect of estradiol and progesterone on gonadotropin release. The patient with gonadal agenesis had cyclical hypothalamic function, but this cyclical function was suppressed in the patients with testicular feminization in whom no LH secretion could be provoked by steroid stimulation. These observations support the concept that hypothalamic sexual differentiation is due to testosterone (which is locally converted to estradiol in the hypothalamus).

[The influence of highly purified hCG on the immunocompetence of human lymphocytes and DNA repair system]. / Untersuchungen über en Einfluss von hochgereinigtem Choriongonadotropin auf die Immunkompetenz menschlicher Lymphozyten und das DNS-Reparatursystem.

PHA-stimulation of human T-lymphocytes, a parameter of cellular immunocompetence, can be suppressed by highly purified human chorionic gonadotropin (hCG) in a dose-dependent manner. This was shown spectrophotometrically and by the mitosis index. Our results are in agreement with H3-thymidine incorporation studies. We further investigated the DNA repair system in UV-light- and hCG-explsed lymphocytes. It could be shown that DNA repair-replication is disturbed by hCG. Such repair disturbances may cause reduced H3-thymidine incorporation in PHA-stimulated and hCG-treated lymphocytes. It is probably on this molecular level that hCG influences the immunocompetence of human lymphocytes.

[Pregnancy and delivery combined with hereditory angioneurotic edema (author's transl)]. / Schwangerschaft und Entbindung beim hereditären angioneurotischen Odem.

Two deliveries in a patient combined with hereditory angioneurotic edema are reported. Although even the smallest trauma can lead to life threatening edema the tendency to edema is reduced during pregnancy. Neither in the vagina nor the vulva the deliveries caused edema. The episiotomy did not cause a concomitant edema of the vulva, despite the predilection of the external genital organs for edema. It is possible that a correlation between the gonadotrophin level and the tendency to edema exists in hereditory angioneurotic edema.

[Familial endocrine adenomatosis (author's transl)]. / Zum Problem der familiären Adenomatose.

The combination of pituitary and thyroid gland adenomatosis is reported in four family members of two generations. This finding of dominant inheritance is discussed with special reference to multiple familial adenomatosis, also known as Wermer's syndrome. The endocrine status including dynamic function tests is presented. It is our intention to point out that in cases of monoglandular adenomatosis clinical attention should be directed not only to anterior pituitary and thyroid gland but also to their possible incidence with tumours of the parathyroid gland and the islet cell organ.

[Gonadoblastoma and overgrowing dysgerminoma in Turner mosaicism [45, XO/46, Xi (Xq)] (author's transl)]. / Gonadoblastom mit überwucherndem Dysgerminom bei Turner-Mosaik [45, XO/46, Xi (Xq)]

It is well established that the Y-chromosome is associated with germ cell tumor development. There is a considerable tumour risk in XY- and XY/XO-gonadal dysgenesis. In the absence of Y-chromosome germ cell tumours are extremely rare. The history of a patient with 45 XO/46 Xi (Xq)-karyotype is presented, who had a gonadoblastoma with overgrowing dysgerminoma. According to basal body temperature recordings, this patient ovulated up to the age of 22 years. After this cyclical ovarian function was exhausted; histologically no primordial follicles could be detected. Gonadotropin as well as prolactin binding sites in the tumours could not be demonstrated, suggesting hormone independency and complete malignant transformation of the tumor. In general the clinician should be aware of a possible germ cell tumour development in the absence of a Y-chromosome. However as far as the clinical management of patients with dysgenetic gonads is concerned, prophylactic gonadectomy is only indicated in the presence of a Y-chromosome.

Gonadotrophin release during chronic administration of D-ser (TBU)6 LH-RH-EA in functional amenorrhoea.

Six women with long-standing functional amenorrhoea were treated with 5 microgram of D-Ser (TBU)6 LH-RH-EA twice daily for 14 days. The functional states of the gonadostats, as assessed by a 25 microgram LH-RH test dose, varied widely before the treatment was started whereas at the end of it they were uniformly low. In all patients D-Ser (TBU)6 LH-RH-EA induced gonadotrophin release, the peak values occuring between day 1 and 3 of therapy. Despite further injections mean gonadotrophin levels declined rapidly therafter and remained in the basal range for the rest of the study. Release of oestradiol was very uncharacteristic. No consistent ovarian response pattern was observed during the analogue administration. It is obvious that chronic stimulation with D-Ser (TBU)6 LH-RH-EA leads to a decreased responsiveness of the pituitary gland.

[Tumour regression in pituitary adenoma by bromocriptin (author's transl)]. / Regression eines Hypophysenadenoms unter Bromocriptin.

A 35 year old patient with longstanding amenorrhea-galactorrhea due to a pituitary macroadenoma has been observed for a period of more than 2 years. During this time tumour expansion was radiologically evident. A full term pregnancy was responsible for most of the tumour growth. Following postpartum period Bromocriptin treatment led to considerable regression of the adenoma. Recalcification of sella structures and an involuted sella volume was radiologically evident. With reference to the experimental investigations of Lloyd (1975) and following the suggestions of L'Hermite (1977) and Vaidya (1977) this tumour regression is interpreted as being due to the antimitotic effect of Bromocriptin via inhibition of c-AMP and DNA.

[Clinical endocrine investigations in patients with pituitary adenoma (author's transl)]. / Klinisch-endokrinologische Untersuchungen bei Patientinnen mit einem Hypophysenadenom.

LH-RH tests of hypothalamo-pituitary gonadotropinfunction were performed in 26 patients with pituitary adenomata before and after prolactin suppression and/or surgical treatment. Various degrees of galactorrhea together with menstrual disorders were the key symptoms in all patients. There was a significant association of elevated prolactin levels with impaired LH-responses. Seven patients have undergone transspenoidal dissection of the pituitary adenoma and in five of them the pituitary LH-response reverted to normal (R2) after surgery. Nine of 15 amenorrhoic patients had a recurrence of menstrual cyclicity, partly biphasic within 3 months and a normalized LH-response after Bromocriptin therapy. 19 of our patients were desirous of pregnancy. Five pregnancies were confirmed within 4 months of treatment.