Sonographic changes in the endometrium of climacteric women during hormonal treatment.

Vaginal sonography of the endometrium is a new method of monitoring the effects of progestogen replacement therapy during the post-menopausal period. The advantages of transvaginal ultrasonic diagnosis are that the uterus can be seen from the fornix vaginae (that is from close range) and that the examination can be carried out whether the bladder is full or not. The differences in the thickness and structure of the endometrium, and the boundary with the surrounding myometrium, enable most of the endometrial changes that occur during the post-menopausal period to be detected sonographically. In the first group of patients we investigated, endometrial carcinoma was detected in 2 out of 60 women suffering from post-menopausal metrorrhagia, the findings subsequently being confirmed histologically. It was observed that post-menopausal women who have regular bleeding during post-menopausal hormone therapy show signs of endometrial proliferation during oestrogen therapy and of secretion during progestogen therapy.

[Hexoprenalin as a tocolytic drug (author's transl)]. / Hexoprenalin als wehenhemmende Substanz.

Hexoprenalin, a betasympathomimetic drug, was tested with respect to tocolytic effect and cardiovascular side effects. The dosage varied according to the obstetrical situation and the resultant indication for tocolysis. "Long-term tocolysis" in the prophylaxis of premature labour was indicated when more or less rhythmical uterine contractions were present without any effect, as yet, on the cervix. The dosage was 0.075 microgram/min hexoprenalin intravenously as long-term infusion using a motor pump. In a collective of 20 patients in the last trimester of pregnancy the tocolytic effect was satisfactory, the mean rise in fetal heart rate being 2.43% and the mean rise in maternal heart rate 4.13%. Massive tocolysis to inhibit effective premature labour was indicated when rhythmical uterine contractions had already exerted an effect on the cervix. The dosage was 0.33 microgram/min hexoprenalin intravenously in form of a long-term infusion using a motor pump. In a collective of 20 patients in the last trimester of pregnancy the tocolytic effect was satisfactory, the mean rise in maternal heart rate being 33% and the mean rise in fetal heart rate 3%. Acute tocolysis to inhibit labour during parturition was indicated when ominous signs of fetal distress were present, or as premedication before surgical intervention. The dosage was 1.0 microgram/min hexoprenalin as an intravenous bolus over a period of 5 min. In a collective of 10 patients the tocolytic effect was adequate. Evaluation of the rise in maternal and fetal heart rate does not appear to be useful.

[Induction of labour (author's transl)]. / Weheninduktion.

Labour can be induced by different methods: there are conductive, indirect and direct approaches. Conductive techniques are reversible and, as a rule, successful only in women approaching term. Indirect techniques, i.e. low and high amniotomy, are irreversible; they should be carried out only for a precise indication and are associated with certain hazards. Direct techniques, i.e. administration of oxytocin and, recently, of prostaglandins, need an intravenous infusion. The dosage of the drug per minute differs according to the obstetrical situation and the aim of the approach. Calculated statistical data of the tonus, the intensity, the frequency and the uterine activity were summarized in order to evaluate the effect of induction of labour. The induction of labour is associated with hazards and risk to the fetus and/or the mother. Labour induction must be avoided in obstetrical situations which preclude a vaginal delivery. The necessity of labour induction occurs primarily under circumstances in which the further continuation of pregnancy is associated with increased hazards to the mother and/or the child.

[Hexoprenalin as a tocolytic drug (author's transl)]. / Hexoprenalin als wehenhemmende Substanz.

Hexoprenalin, a betasympathomimetic drug, was tested with respect to tocolytic effect and cardiovascular side effects. The dosage varied according to the obstetrical situation and the resultant indication for tocolysis. "Long-term tocolysis" in the prophylaxis of premature labour was indicated when more or less rhythmical uterine contractions were present without any effect, as yet, on the cervix. The dosage was 0.075 microgram/min hexoprenalin intravenously as long-term infusion using a motor pump. In a collective of 20 patients in the last trimester of pregnancy the tocolytic effect was satisfactory, the mean rise in fetal heart rate being 2.43% and the mean rise in maternal heart rate 4.13%. Massive tocolysis to inhibit effective premature labour was indicated when rhythmical uterine contractions had already exerted an effect on the cervix. The dosage was 0.33 microgram/min hexoprenalin intravenously in form of a long-term infusion using a motor pump. In a collective of 20 patients in the last trimester of pregnancy the tocolytic effect was satisfactory, the mean rise in maternal heart rate being 33% and the mean rise in fetal heart rate 3%.

[Administration of 15-(S)-15-methyl prostaglandins F2 alpha in intrauterine fetal death, missed abortion and hydatidiform mole (author's transl)]. / Erste Erfahrungen mit 15-(S)-15-Methyl-Prostaglandin F2 alpha bei intrauterinem Fruchttod, Missed abortion und Blasenmole.

10 patients with missed abortion, intrauterine fetal death or hydatifidiform mole were given 15-(S)-15-methyl prostaglandin F2 alpha intramuscularly for the induction of labour or, in 2 cases, to obtain softening of the cervix prior to curettage. The mean time interval between induction and abortion was 6 h 9 min, with a mean dosage of 890 mcg prostaglandin per patient. Vomiting or diarrhoea occurred in 7 patients. Apart from a drop in haemoglobin concentration in 1 patient and a temporary increase in white cell count in 6 patients, no other pathological laboratory findings were detected. We conclude from these results and the relevant literature that the intramuscular administration of 15-(S)-15-methyl prostaglandin is an effective and safe means of inducing labour in missed abortion, intrauterine fetal death and hydratidiform mole.

[Attempts at placental localization by means of plate thermography (author's transl)]. / Versuch einer Plazentalokalisation mittels Plattenthermographie

The value of plate thermography in the determination of placental localization was investigated in 120 cases, and compared with the results obtained by the ultrasonic B-Scan method. The duration of pregnancy in these cases ranged from 15 to 37 weeks. The results of plate thermography corresponded with ultrasonic localization in 94 cases (78.3%), but the placenta was incorrectly localized by plate thermography in 26 patients. The highest degree of correspondence was observed in the group of anterior wall placentae, the localisation of the placenta by plate thermography being correct in 52 out of 62 cases. The group of posterior wall placentae showed the lowest rate or correspondence, plate thermography giving the correct localization in only 32 out of 45 cases. Hence, plate thermography does not appear to be of sufficient accuracy for clinical use or scientific investigations. Furthermore, no accurate determination of placental surface area and placental thickness is possible with plate thermography. For all these reasons it may be concluded that this method is greatly inferior to the ultrasonic B-Scan method in respect to placental localization.

[Ultrasound measurements in early pregnancy (author's transl)]. / Utraschallmessungen in der Frühschwangerschaft

With the aid of the ultrasound scan technique the amniotic sac was measured on more than 700 occasions between the 8th and 20th week of gestation. In each examination the greatest transverse, anterior-posterior and longitudinal diameters were determined. The statistical mean and the double standard deviation were calculated from these data. The areas of the transverse diameter and of the longitudinal diameter show a distinct and continuous increase, whilst the area of the anterior-posterior diameter displays a small and uncharacteristic increase during pregnancy. The values of 12 patients were registered in the region of the transverse and of the longitudinal diameter. The clinical findings, as well as the ultrasonic values, had shown no abnormalities at that time. The data show a decrease in these diameters during the following examinations; the last measurement was carried out when the fetal heart beat was absent for the first time. The increase in size of the amniotic sac during pregnancy can be observed by means of these examinations. Repeated examinations enable the detection of disturbances in the developement of the pregnancy at an early stage.

[The influence of socio-economic factors on the results of a prematury-Dysmaturity prevention programme (author's transl)]. / Einfluss sozialer Faktoren auf die Ergebnisse eines gezielten Frühgeburtenpräventionsprogrammes

All high-risk gravidae with regard to prematurity and dysmaturity (PDP programme) were collected over a time-limited period. More than two thirds (n = 72) of these women were submitted to intensive care (PDP group); one third (n = 33) (control group) refused intensive care. Furthermore, socio-economic factors were taken into consideration in this study and appropriate classification into 4 groups was undertaken. Gravidae of a higher social class were more often willing to undergo intensive care than gravidae of a lower class. In the PDP group 75% of the gravidae were delivered after the end of the 36th gestational week and 51% of the gravidae in the control group. A similar relationship was found in regard to the birth weight of the newborn infants: in the PDP group 74.4% of the babies weighed over 2500 g at birth in contrast to the respective figure of 42.9% in the control group. However, this socio-economic study shows that the results of intensive care are much more successful in women from a lower social stata than in women from a higher social class.

[Changes in obstetric management over the past decade (author's transl)]. / Uber den Wandel der geburtshilflichen Aspekte im letzten Dezennium.

Over a observation period of 10 years (1969-1979) developments in perinatal control techniques, mostly started in the 1st Department of Obstetrics and Gynaecology, University of Vienna, at the beginning of that period, and their effect on the obstetric management are presented. In contrast to a trend of decreasing birth rate for the whole of Austria the annual numbers of deliveries in this hospital remained -after a temporary increase-unchanged. Subpartial cardiotocographic monitoring is presently applied in about 95% of all cases. The frequency of Caesarean sections has risen from below 4% to approximately 8% over the past years. Simultaneously, a shift was observed from vital to preventive fetal indications in Caesarean sections, with a parallel tendency to relatively fewer vaginal-operative deliveries. The uncorrected perinatal mortality rate has been lowered to 1.35%. This decrease is partly due to our efforts to select high-risk pregnancies in order to control them intensively. Thus, ultrasound examinations have been liberally put into practice, e.g. leading to an early diagnosis of multiple pregnancy. Use of tocolytic drugs, as well as surgical closure of the cervix together with intensive prenatal care of pregnant women with a high risk of prematurity have proved their worth as compared with control groups. Due to early and special interest in research and in monitoring of placental insufficiency, hormone determinations and measurements of placental perfusion by isotopes took a fixed place in monitoring of high-risk pregnancies early on during the observation period. Evaluation of fetal lung maturity by amniocentesis now enables us to make well-grounded decisions to stop tocolytic measures or to induce labour. In the latter field the local application of prostaglandins to the cervix by an adaptor has recently opened up new aspects. Attention has also been paid to the emotional aspect by new techniques of psychprophylactic preparation for childbirth and by a policy of rooming-in of mother and child.

[Serum oestriol: a parameter of the function of the feto-placental unit (author's transl)]. / Serumöstriol als Parameter der Funktion der fetoplazentaren Einheit.

The determination of serum oestriol is known to be a useful parameter of the function of the feto-placental unit. In order to derive the normal range on application of the radioimmunoassay technique, the serum oestriol level was determined in 242 gravidae during the second half of pregnancy. The pregnancies were all uncomplicated and ended with the delivery of a healthy baby at term. The statistical mean and 4 confidence intervals were calculated for each gestational week individually. During the second half of pregnancy there was a continuous gradual increase in serum oestriol; between the 34th and 38th gestational week there was a further steep increase, followed by a decrease from the 39th gestational week onwards. The usefulness of this method is illustrated on the basis of case reports of 10 high-risk pregnancies in which oestriol determination is compared with the clinical findings and HPL determination.

[The place of plate thermography in the diagnosis of breast cancer (author's transl)]. / Zur Leistungsfähigkeit der Flüssigkristallthermographie in der Mammadiagnostik

A report is presented of 319 unselected patients investigated by the method of plate thermography according to Tricoire, which is a comparatively new method in the diagnosis of breast cancer. 281 cases were additionally examined by mammography and those cases in whom malignancy was suspected underwent further cytological and histological investigation. The results of plate thermography and mammography are compared. The high degree of diagnostic accuracy achieved in the present series of cases by the use of plate thermography indicates that this procedure is not only a valable adjunct in the diagnosis of breast cancer but, moreover, seems to be recommendable as a screening method.

[40 years Austrian Society for the Study of Sterility and Fertility]. / 40 Jahre Osterreichische Gesellschaft zum Studium der Sterilität und Fertilität.

The Second World Congress of the International Fertility Association (IFA) in Naples in 1956 permitted only the participation of national fertility societies with interdisciplinary structures: gynecology, andrology and veterinary medicine. This short historical review shows the situation at the time of the foundation of the Austrian Society for the Study of Sterility and Fertility regarding the preparations as well as the members of the founding committee.

["Evidence-based medicine"--guidelines as a threat or necessity for physician and patient?]. / "Evidence-Based Medicine"--Leitlinien als Bedrohung oder Notwendigkeit für Arzt und Patient?

Guidelines derived from 'evidence-based medicine' are supposed to provide assistance and information in order to improve diagnosis and therapy of individual patients and build up confidence in medical decisions. Guidelines possess no direct legal power. The doctor's freedom of decision must be warranted. Inadequate guidelines may have serious consequences: curtailment of therapeutic freedom, hampering of medical progress, deterioration of the relationship between doctors and their patients, risk of legal implementation and emergence of a defensive medicine.

[Our university clinics need research--so does our specialty!]. / Unsere Universitätskliniken brauchen Forschung--unser Fach auch!

University research has to serve as a substrate for science and technology and should raise a qualified, critical but motivated younger generation of scientists. These need a basic research which is independent and not oriented towards any short-term goals. An open and easy collaboration without any interdependence is necessary between the university and industry. All this requires greater autonomy for the universities. in German-speaking countries, many people distrust progress. However, it is not a matter of 'progress at any price' but of a careful, pertinent analysis of the benefits and risks. Parsimony in science and research is dangerous and shortsighted. To invest in research means to invest in the future.

[How much preoperative information? - How can it be documented?]. / Präoperative Aufklärung: wie weit? - Dokumentation: wie ausführlich?

Preoperative information for patients and documentation of this information are becoming increasingly significant. Opinions diverge especially on how to document the information provided, the information protocol being only an ancillary element. The patient must be in a position to make an informed decision without suffering any prejudice. Information protocols relating to treatment, that is to the operation, aim at ensuring the quality of the treatment and at documenting the information provided. A scheme of the operation is an important element of this information. Twenty-one presurgical information protocols have been tested in a pilot phase and are still being evaluated by a patients' association. Information and documentation concepts need to be set up by professional societies before insurance companies and governmental offices start getting involved.

[Effect of high performance sports on female menstrual cycle exemplified by windsurfing]. / Der Einfluss von Leistungssport auf das weibliche Zyklusverhalten am Beispiel Windsurfen.

Questionnaires were sent to all female members (n = 60) of the Austrian Funboard Association (funboard = the most athletic windsurfing class). They included questions about the menstrual cycle, physical capacity, libido and performance dependent on the particular cycle phase. There was no significant libido or capacity peak, neither for the windsurfers nor for a normal collective (n = 100); on the other hand there was an evident low during menstruation. A mean length of the menstrual cycle of 26.5 +/- 2.8 days and a bleeding time of 4.4 +/- 1.2 days were found, while metrorrhaghia and dysmenorrhea were less frequent than in the normal collective. One reason for these findings could be that physical activity reduces dysmenorrhea.

[Latent cervical virus infection as a possible cause of early abortion]. / Latente zervikale Virusinfektion als mögliche Ursache des Frühaborts.

Cervical smears of 50 women who had an abortion were examined by dot-blot hybridization for human papillomavirus (HPV), herpes simplex virus (HSV) types 1 and 2, and cytomegalovirus (CMV) DNA. HPV DNA type 16 or 18 positivity was shown in 17.6% of the cases; in the aborted material, however, it amounted to 30.8%. IgM-positive titres were present in a few cases. In cervical smears of intact pregnancies, positivity for HPV DNA types 6 and 11 was detected in 9.5% and for the HSV DNA types 1 and 2 and CMV DNA in 48.0% of the cases. In this group of patients mostly positive IgM and IgG titers were present.

[Age and sex specific differences in bone density of 4,000-year-old individuals. Bone density measurement of early Bronze Age femurs from excavations in Unterhautzenthal, Lower Austria]. / Alters- und geschlechtsspezifische Unterschiede der Knochendichte von 4000 Jahre alten Individuen. Knochendichtemessung an frühbronzezeitlichen Femora von Ausgrabungen aus Unterhautzenthal, NO.

Bone density measurements of 14 individuals (early Bronze Age, 2200-1600 BC), analyzed by dual-energy absorptiometry, showed a distinct difference between women and men. In men, there was a high bone density (+17.9%-0.290 g/cm2 difference). In females, a constant decrease in bone density was found after the age of 20-25 years (from 1.2 g/cm2 at 20 years to 0.8 g/cm2 at 40 years of age). With caution, the results are comparable with those of the present time.