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The clinical significance of the sonographic finding "periportal hyperechogenicity", which is characterized by hard periportal echoes, is largely undetermined. This phenomenon has been reported in a large number of disorders, as well as in healthy persons.A prospective study of 1853 patients revealed this finding in 12 cases. These 12 patients were followed up after two to four months.Only four cases were seen to still have diffuse periportal accentuation in the follow-up, while five patients showed a partially and three a completely normal liver. The laboratory values of these 12 patients were largely normal at the time of diagnosis and follow-up. Periportal accentuation was not correlated with any hepatological disorders. Examination using two different ultrasound devices revealed no major differences.Overall, these findings confirm the earlier assumption that this sonographic picture designated as periportal hyperechogenicity or accentuation is not diagnostic of any hepatological disorder, nor is it even a sign of disease, because most patients with this phenomenon can be termed hepatologically "healthy".

Mother-father relationship during pregnancy and its influence on obstetric complications, such as premature contractions, has been little investigated, but seems to be far more important than has been acknowledged so far. From a psychoanalytic and psychodynamic perspective three case studies are used to illustrate the ongoing dynamics. First the fetus is identified with an object of the past and/or the present. To ward off threatening object representations the pregnant woman needs a third person, the father. If he is unavailable for her she is in danger of rejecting the child. Results are discussed also in relation to the medical support system.

In a psychosomatic study we interviewed 33 women who had undergone tubal anastomosis or IvF after tubal ligation. As a control group we chose a randomised sample of 45 women after elective tubal ligation. We used a semi-structured interview and the Giessen-test as psychometric instruments. According to the leading indication for reanastomosis, we allocated women to one of 2 groups: 21 patients had found a new partner (R-partner), 12 mentioned experiences of loss (R-loss). The groups were well comparable in respect of sociodemographic items, but showed relevant differences in psychological variables, like motivation for and time for deliberation to sterilisation or age difference between partners. Women of the R-partner group were highly satisfied with tubal reanastomosis as compared to R-loss subjects. Satisfaction with the procedure was basically independent of an actual pregnancy. Women experienced the two methods in different, rather specific ways. Cluster analysis of the Giessen-test result confirmed group allocation. We conclude that experiences of loss as a leading reason for tubal reanastomosis are unfavourable prognostic factors. IvF has an unfavourable prognosis in women with the intention to restore the mutilated body image. Preoperative counselling by a psychotherapeutically trained counsellor seems mandatory.

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.

The integration of psychological counselling programmes into the treatment procedures of breast cancer has to overcome specific methodological and contextual difficulties. We present a counselling strategy for breast cancer patients which aims at a reduction of short-term sequelae of the crisis of cancer diagnosis and stress of therapy. Its main features, summarized as follows are based on the relevant literature and the results of a pilot study in our department. Counselling is offered and made available to all patients, since both self- and professional referral lead to a selection bias. Psychological counselling is considered as integral part of the entire diagnostic and therapeutic process. The psychologist acts as a continuous supportive partner at all relevant treatment stages, and is introduced to the patient at the outset of the therapy and is always available as familiar contact person for discussion of all problems. Intensity and structure of counselling closely follow the different stages of somatic treatment. Technically, elements of crisis intervention and Progressive Muscular Relaxation (PME, according to Jacobson) are applied. Aspects of patient/doctor relationship and interdisciplinary cooperation between physicians and psychologists are discussed.

The emotional state of the gravida shortly before childbirth has a predictive value for her comportment during parturition. We evaluated, whether the concept of defensive coping with fear (repression vs. sensitization) contributed to a better identification of patients at risk. Both repression and sensitization are inadequate attempts of warding off fear, the difference being the interpretation of the triggering situation. We interviewed 101 primiparous women during routine pregnancy check-ups between the 34th and 40th week of pregnancy. The following instruments were applied: demographic data, repression-sensitization scale, scales concerning birth preparation and fear of birth, Spielberger's STAI-X and the Giessen scale of psychosomatic complaints. Three days post partum a scale concerning the experience of birth and the STAI-X were completed. Sensitizers had a tendency to admit fears more openly in the STAI-X and to experience birth as threatening. They complained about more psychosomatic symptoms than the repressor group in the Giessen scale. Non defensive-copers were found in-between. Sensitizers showed highest levels of fear of birth. No differences between repressors, non-defensive copers and sensitizers could be found concerning demographic data like birth complications (spontaneous delivery vs. cesarean section/forceps delivery). Neither did the groups show differences concerning the attendance of birth preparation courses.

Ten primiparous mothers were randomly selected from two groups of women who had spent different amounts of time with their newborn infants. The speech behavior of the mothers in the two groups was compared while they were addressing their 2-year-old children in an informal play situation. Speech patterns of the mothers revealed that those who had been given extra contact with their infants during the neonatal period used significantly more questions, adjectives, words per proposition, and fewer comands and content words than did the control mothers. These observations suggest that the linguistic behavior of the young child may be shaped by hospital-care practices for mother and her infant.

Quite a number of young parents want to consciously experience and take active part in the very first days after childbirth. We interviewed prospectively 95 women as to their attitude towards rooming-in, breast-feeding and child care and how they had been able to carry out their intentions. Special consideration was given to those personal and institutional factors that might promote or reduce their feeling of satisfaction with the rooming-in experience. 89 couples made use of the rooming-in offer. 78 of them found the offered times "just right". Women wanting to go back to work used rooming-in significantly more often than housewives. 92% of the persons interviewed regretted not being allowed to change diapers or to bathe the baby. Those women who even before parturition had been wanting to bathe their infants and change diapers, returned their baby to the nurses significantly less often. Thus, both institutional and interactional problems contribute towards the successful management of the postnatal period. Women whose partners attended rooming-in, and those who retrospectively agreed with their decision of how to give birth, were significantly more satisfied with their overall experience.

Fear of childbirth was described on the basis of an analysis of fear-inducing situations spontaneously written by 40 pregnant women, and on the basis of the analysis of questionaires concerning anxieties before parturition and answered by 80 additional gravidae, at 12 weeks before and some days before the expected date of delivery. The following factors of anxiety before parturition were found: fear of injury of the mother or of the newborn, fear of efforts in labour, and their concomitant traumas and symptoms, fear of complications during delivery, fear of feeling to be helpless, fear to lose control of coping with labour, and fear of the unknown. The focus of the anxieties varied during the course of pregnancy. 12 weeks before term the main contribution to fear was given by the anxiety of injury, whereas some days before delivery anxiety of efforts in labour and their concomitant symptoms dominated. An offer of different courses of preparations for childbirth in our department should help the pregnant women to cope with her anxieties before parturition or fear of childbirth.

In a retrospective survey we interviewed 53 patients with respect to side effects of adjuvant therapy for breast cancer. All of them had undergone modified mastectomy and were randomly assigned to either chemotherapy, irradiation or a combination of both. Standardized questionnaires concerning the side effects and semi-structured, focusing counseling talks were the methods used in questioning the patients. Patients named significantly more side effects of severe and extreme intensity with chemotherapy, and especially in the group given combination therapy, where chemo- and radiotherapy could be directly compared by the patient. The experience was particularly threatening when several side effects occurred simultaneously. Different psychological aspects and visualisation of systemic and local side effects are discussed with respect to the patient's ability to cope with adjuvant therapy. Consequences for routine care are: continuous explanatory talks about side effects throughout the whole process, muscle relaxation and interdisciplinary cooperation.

Immediately after delivery 80 women were asked about her impression of cardiotocography (CTG) during labor. 97% of the primigravidae (PGR) and 83% of the plurigravidae (PLG) believed, that every delivery should be observated by CTG. Only 3% of the PRG an 14% of PLG found it necessary only in complicated delivery. Unnecessary was the fetal heart rate observation found in 3% of the PLG, but not in one case of PRG. Very important for the psychological situation of women under birth is the information about the use of CTG. Our results show the great agreement of the patients about this perinatal observation method.

Due to the rising number of couples who experience childbirth together, a rising number of men is faced with the problem of feeling as an "intruder" to the delivery room, which traditionally was reserved to women. Therefore, many "Lamaze-Groups" tried to better prepare couples for the birth situation. Since it is often difficult to carry out the commonly practiced 8-hour course, we decided to offer a "short preparation course for couples" and to evaluate, whether this program could convey strategies to cope with the emotional problems of childbirth and how this might manifest itself in individual experience. At two evenings, during two hours each, we referred and discussed the following topics: normal parturition and puerperium, rooming-in, breast-feeding and the psychological situation during this period; relaxation and labor-control exercises were practised together and all relevant rooms of the hospital were visited. In order to evaluate the efficacy of this short preparation, the following data were collected from 26 prepared and 27 unprepared couples: Couples were asked to answer the STAI X-1 state anxiety questionnaire according to Spielberger. Relevant medical data were collected from the patients records. During puerperium, a semi-standardised interview concerning the childbirth experience was carried out. Prepared (EG, n = 26) and unprepared (CG, n = 27) couples did not differ in socio-economic or marital status, parity or acceptance of pregnancy. Age was significantly higher in the TG for men as well as for women. In Spielberger's anxiety questionnaire prepared couples have lower values throughout most items, thus generally may said to be less anxious.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes and expectations of future parents towards the birth experience have changed thoroughly in the past years. In a prospective trial with 95 women we evaluated whether prepartal intentions for a common birth experience were actually carried out and what changes occurred during the past 5 years. 95 women with uncomplicated pregnancies filled in a questionnaire in the 38th week of pregnancy and several days after birth. Behavioural intentions and their realisation correlated well. The changes of attitude became evident comparing our results with those of a survey made 5 years ago in the same hospital. Depending on the social status of the couples, an increase in the participation of fathers of up to 30% was noted. 92% of the couples of social stratum B experienced childbirth together. Participation in any kind of birth preparation was comparably low and seems improvable. Women of lower social status, in particular, should be supported instead of discouraged to attend birth preparation courses.

81 women were tested in early pregnancy with a personality questionnaire (FPI), a bodily symptoms checklist and a structured questionnaire with respect to various psychosocial events. Women with and without Emesis in early pregnancy differ significantly according to the following characteristics: Quality and quantity of past and present bodily symptoms, psychosomatic affect-resonance, calmness, occupational attitudes, description of family-relationship and expectancy to vomit. Results are interpreted that vomiting in early pregnancy seems to be a psychosomatic reaction, based on a extenuated perception of reality, in combination with difficulties "leaving home" as well an expectancy to vomit in pregnancy.

Eighty-one pregnant women in early pregnancy were examined with psychological tests: Semantic Differential about the perception of bearing a child and an adjusted FishbeinAjzen (1975) questionnaire according to perceptional and attitudinal styles related to the perceived consequences of the pregnancy. Women with Emesis Gravidarum in this population differ significantly from women without vomiting in early pregnancy in the following areas: 1. Pregnancy and its consequent life-changes are seen more positively. 2. Additional analysis shows that at the same time more frightening events are expected (in the sense, that positively evaluated events will not come true or negatively evaluated events will come true). 3. Inconsistent attitudes were observed frequently. The above mentioned characteristics allow the interpretation, that events are perceived more unrealistically in women with Emesis Gravidarum. We can conclude that coping with these life-events is more difficult for them. One possibility to express these existing conflicts is the somatic symptom of vomiting.

The main sources of conflict in pregnancy and labour are depicted in the introduction. Then the psychohygienic possibilities of preparation for childbirth are pointed out and discussed in the light of a program for preparation for childbirth by the author, oriented on behavioural, learning-theoretical and group-psychological principles. All interventions of this program are designed to consider continually the cognitive and emotional capacity of information processing of each group-member. This is realised by problemsolving-training and self-control strategies, administered to actual tasks and problems. By this means important ego-functions are strengthened, which counteract emotions of helplessness and depression. These assumptions are supported by the results of an empirical investigation of this program.

Methods of prenatal diagnosis have changed the time when, and the circumstances in which parents find out that their child has a malformation. The different phases of counseling of a couple who had experienced recurring fetal cystic hygroma in two consecutive pregnancies are described. In several consultations the authors tried to respond to the specific psychologic reactions to the diagnosis of fetal malformation and to deal with them. Typical sequelae such as shock, grief, and the formation of subjective theories are discussed, as well as the time needed for counseling and interaction with clinic staff. Guidelines for client-centered, interdisciplinary and preventive counseling are proposed.

Psychological effects of an ultrasound exam in early pregnancy were assessed on 59 women (33 primiparae, 26 multiparae). The subjects were between their 12 to 18th week of pregnancy and did not have a prior ultrasound exam in the present pregnancy. Ultrasound was performed under high feedback conditions explaining the image on the screen thoroughly. After the exam patients rated the method and the emotions accompanying it on polarity profiles. Ultrasound as a method was evaluated highly positive with only very few deviant opinions. The emotions raised by it did vary considerably, however, despite the basically positive attitude. Of the 59 women interviewed, 53 and 52, resp., agreed with the statement, that they could gain a clearer image of the baby and of their own body.