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The discovery of leptin, the product of the obese (ob)-gene, has broadened the horizons of research on energy balance. This hormone, produced and secreted by adipose tissue and some placental cells, finds its way to the hypothalamus, where it binds to the leptin receptors and signals satiety through the neuroendocrine axis. The fact that adipose tissue is not merely a storage depot, but also an important endocrine tissue, has revived the interest in the "lipostatic" theory of body fat regulation and has initiated many research efforts in the field of obesity, anorexia nervosa, bulimia, reproduction and haematology.

Epidermal growth factor (EGF) in urine was measured at 4-week intervals in 83 women referred for suspected intrauterine growth retardation (IUGR); 138 women with normal singleton pregnancies and newborns of normal weight served as controls. Of the 83 women, 30 delivered babies with weight below the 10th percentile after week 37. During pregnancy these women had shown significantly lower EGF levels than women who delivered normal-weight babies. However, due to the wide distribution of individual EGF data, no clear clinical cut-off point between normal and IUGR values could be established.

The value of the TAG-72 (CA 72-4) serum marker in primary diagnosis was investigated in 110 patients with histologically diagnosed ovarian cancer. A reference group consisted of 103 patients with benign pelvic masses. Compared to the well-established CA-125, TAG-72 showed a low sensitivity of 42% in the detection of ovarian cancer. By contrast, when the cut-off level for TAG-72 was set at 6 U/ml, it showed a very high specificity of 99%. When the measurement of TAG-72 was combined to that of CA-125, improvements in both the specificity (as compared to a single CA-125 determination) and the sensitivity (as compared to a single TAG-72 assay) were observed. In such a combined assay, our results suggest that the best predictive value (positive and negative) was obtained if CA-125 is assigned a relatively high cut-off value (65 U/ml) in conjunction with a low cut-off level (3.2 U/ml or 4 U/ml) for TAG-72. In the present study, at threshold values of 65 U/ml respectively, a sensitivity of 86%, a specificity of 83% and a positive and negative predictive value of 85% were obtained. In mucinous carcinomas of the ovary, however, the additional TAG-72 determination did not lead to a better predictive power than did CA-125 measurement alone.

We report on two similar cases of young women with irregular menstrual bleeding. Curettage and biopsy revealed an adenofibroma of the uterus in case 1 (31 yrs) and an uterine adenosarcoma in case 2 (30 yrs). Hysterectomy was subsequently performed in both patients: histological examination of the hysterectomy specimen showed no remnants of the tumour in case 1. There was adenosarcoma tissue in the uterine cavity of case 2 but no myometrial infiltration. The difficulties of differential diagnosis of uterine soft tissue tumours in young women are discussed and the literature is reviewed.

Laparoscopic injection has become an important tool in tubal pregnancy. Intratubal injection of 5 mg of prostaglandin F2 alpha (PG F2 alpha) was successful at a serum human chorionic gonadotropin (hCG) level of more than 2500 mlU/ml. Intrauterine pregnancy occurred 112 days after laparoscopic treatment, during earlier removal of the contralateral tube.

At the ob/gy department of the Innsbruck University routine, genetic amniocentesis has been offered from the 13/14 week of gestation since 1991. In 1991 44.5% of all amniocenteses were performed as early amniocentesis, it rose in 1992 to 61.5%, the rest being performed in the 16th week of gestation. In a total of 346 genetic amniocenteses, 8 pathological karyotypes were obtained (six trisomies, one 47 XXY, one marker chromosome), six from samples obtained at early amniocentesis and two obtained at the 16th week. Three weeks following the procedure, a spontaneous abortion rate of 0.87% occurred. Cultivation took 1-2 days longer with samples from early amniocentesis than with samples collected at the 16th week. In two cases the cultures failed and a repeat procedure had to be performed at the 16th week. With early amniocentesis performed at week 13/14 results are known of gestation. The long period of anxiety, which many women see as a serious disadvantage of amniocentesis is thus significantly reduced.

The influence of histamine, a biogenic amine known for many years, on the contractility of uterine specimens, was investigated. A highly significant (p > 0,0001) increase of uterine activity after the application of histamine 10(-6) M was observed, caused by a similar increase of frequency, duration and amplitude of the contractions.

The influence of serotonine, a vasoactive neurotransmitter, on the spontaneous motility of uterine strips was investigated. A highly significant (p less than 0.001) increase of uterine activity was observed when serotonine 10(-6) M was added to the perfusing medium.

After birth of an infant with a birthweight of 4000 g or more maternal glucose tolerance should be examined. We measured blood glucose values after a 100 g oral glucose challenge and compared them with serum fructosamine values of the same subjects. 40 women who had given birth to an infant with macrosomia (group I) were matched with 40 women who had delivered babies with normal birthweight (group II). Impaired glucose tolerance was found in 6 women (15%) of group I, and in one woman (2.5%) of group II. Fructosamine values were within the normal range in each of the seven women (1.74 + 0.2 mmol/l vs 1.73 + 0.2 mmol/l). Thus, fructosamine determination is not sensitive enough to detect impaired glucose tolerance in asymptomatic women post partum. It is not feasible to replace the oral glucose tolerance test in screening for gestational diabetes mellitus.

In the case of a 21-year old woman, who complained of chronic pelvic pain and where cystic structures in the adnexal region had been diagnosed ultrasonically and by laparoscopy, a tumour made up of many small cysts was discovered in the pouch of Douglas next to a typical endometrial cyst. Both the endometrial cyst and the cystic tumour were excised by laparotomy. Histology established the tumour as a multicystic peritoneal mesothelioma. Postoperative recurrence was noticed by ultrasound less than one year later. Laparotomy revealed a 5 cm serous cyst of the right ovary and again countless liquid-filled grape-like small cysts in the pouch of Douglas. Histology revealed a multicystic peritoneal mesothelioma identical to the previously excised tumour. Multicystic peritoneal mesothelioma is a rare soft tissue tumour noted for its frequent recurrences. Most authors agree, that it belongs to the morphological spectrum of reactive mesothelial proliferative lesions and not the neoplastic spectrum. It appears mostly in women, often concomitant with endometriosis and pelvic inflammatory disease and frequently in women, who had previous surgical interventions in the abdominal region.

Because of the risk of ventilatory depression, agonistic and partially agonistic/antagonistic opiates are well suited for providing pain relief in obstetrics. We compared two groups of 20 women each with pregnancy on term who received equipotent doses of nalbuphin (0.1 mg/kg) and pethidin (0.8 mg/kg) intramuscularly. We found a significantly longer (6h) and better analgesic effect in the nalbuphin group but also a significantly more pronounced sedation. Other side effects were fewer in this last-named group. There were no differences in the behaviour of the babies between both groups. We consider that because of the "ceiling effect" of ventilatory depression, nalbuphin may allow better analgesia without the risk of ventilatory depression of both mother and newborn.

Three cases of a vanishing twin are reported. We observed twin pregnancies in three women, who had their ultrasound examination before the 10th week of pregnancy. Positive heartbeat was registered in both embryos. When a further sonographic examination took place at the 11th week, intrauterine death of one of the embryos was observed. All three pregnancies continued as singleton pregnancies to uneventful term deliveries. When the placentae and chorionic membranes were examined after delivery, small nodular pigmented areas were observed. Histological examination showed the remains of the embryo, who had vanished in the first trimester of pregnancy.

When serious cerebral malformations of the fetal cerebrum are diagnosed, the pregnancy is in most cases so far advanced, that termination would be difficult medically, controversial ethically and--depending on legislation--impossible legally. Most cerebral malformations associated with hydrocephalus appear late in the 2nd and early in the 3rd trimester. Routine pregnancy ultrasound scan of the fetal brain is difficult due to the dynamic changes in cerebral anatomy during normal pregnancy and due to the artefacts produced by intra-cranial reverberations. The concept that there is a "right time" for in utero diagnosis of fetal hydrocephalus is reviewed. Unequivocal early diagnosis is only possible in cases of anencephaly. 15 cases of severe cerebral malformations that were seen during prenatal ultrasound at Innsbruck University Hospital are presented "Nonaggressive Obstetric Management" as a novel and structured approach to such cases is discussed.

3 cases of severe discordant malformations diagnosed by ultrasound (anencephaly, myelomeningocele, prune belly-syndrome) in multiple pregnancies have been described. Operations have been given up consciously.

A hospital outbreak of Acinetobacter Calcoaceticus in a ward with patients with intravenous tokolysis is reported. Within 2 months 9 pregnant women who had tokolysis for premature labour developed septic fever that only subsisted after the administration of tokolysis was stopped. In 7 cases blood culture was positive for Acinetobacter Calcoaceticus. This endemic outbreak was responsible for premature deliveries in four cases, leading top post partum death of two infants. Source identification was inconclusive, no further outbreaks have occurred since the reported endemic occurrence. Dangers of nosocomial infections in patients with intravenous tokolysis are discussed.

The lead content of the milk of 28 breast feeding mothers from various regions in Tyrol was examined using flameless atomic absorption spectrometry. These examinations showed that the milk of women living in places with heavier traffic had a seven-fold higher lead level as compared with the data in women from regions with little traffic. This difference was statistically significant. We also determined the lead level of specimens of drinking water from 7 towns in Tyrol. The mean level was half the value found in maternal milk from women living in low-traffic regions.

It is reported on an abnormally prolonged action of vecuronium in a female patient with known neurofibromatosis (Morbus von Recklinghausen). In this female patient an increased sensitivity to vecuronium (0.06 mg/kg) was observed during anaesthesia for Caesarean section. A 100% block lasted 50 minutes and the neuromuscular recovery from 75% block to 25% block amounted to 25 minutes. This prolonged neuromuscular block can also be due to overdosing, relative hypovolaemia during arterial hypertension and the previous application of suxamethonium.

Radioactivity in human breast milk was determined in 32 women in February and March 1987 by means of a Germanium detector. At this time radioactivity increased again by feeding the hay to the cattle harvested in the weeks following the disaster of Chernobyl. 8 (25%) of the values were above 0.3 nCi/l for babies milk recommended by the local authorities.

A fist-sized tumour was seen in a Caesarean section scar of a 28-year old pregnant Turkish woman who had been operated on three years previously. The tumour was excised during Caesarean section and diagnosed as desmoid tumour. Etiology and pathogenesis of these rare soft tissue tumours are discussed and the literature reviewed.

Radioactivity was determined in the milk from 39 patients and in amniotic fluid, urine and placentas from 17 patients shortly after the Chernobyl disaster by means of a beta and gamma-scintillation counter. Elevated radioactivity (7.6 nCi/l beta activity and 7.4 nCi/l gamma activity) was found only in one sample of breast milk.

Migrant workers from Turkey and their families make up 1% of the population of the Tyrol province in the west of Austria. They are the largest group of aliens. 152 Turkish women who were seen at our obstetrics department were investigated. Records of 121 women who had given birth to infants in the years 1984-86 were compared. 31 pregnant women were interviewed in their native language. More than 80% of all women studied went for routine check-ups four times or more during pregnancy. A number of conditions that would otherwise remain undetected are being diagnosed at routine pregnancy checks: tuberculosis, diabetes, genetic disease. Although patient compliance is good in this group, communication problems often put a successful outcome of the pregnancy at risk. Many women, who have been living in Austria for many years, are still unable to speak and understand German. Unqualified interpreters (husbands, children, relatives, hospital cleaning staff that is composed largely of Turks) often create problems by making up things the doctor would like to hear. The rate of cesarean sections is 11% in this group. Perinatal infant mortality rate is much higher than in the native Austrian population. The strict hygienic rules of Islam, the support and nurture supplied by the tightly-knit family structure of Turkish emigrants and a basically confident and trusting attitude towards doctors and nurses, if these can make themselves understood, should be recognised as positive factors and should be used to reduce perinatal risks in pregnant Turkish women.

This study investigates the degree of effectiveness of post partum rubella vaccination, measured as percentage of true seroconversions. The vaccine used was RA 27/3. In the years 1983/84 the seronegative rate was 7% of the total number of births. The 270 seronegative women who had given birth during these two years had all been vaccinated post partum. 128 of them were controlled, and a seroconversion rate of 91.4% was obtained.