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In the course of a prospective study 43 women underwent axillary immunolymphoscintigraphy (ILS) shortly before a planned operation for suspected carcinoma of the breast. The aim was to test the feasibility of this procedure for the noninvasive staging of lymph-nodes. Three antibodies were used: HMFG-1 (3 patients), HMFG-2 (13) and 3C6F9 (27). The diagnosis was confirmed in 35 patients. They underwent radical mastectomy with removal of the lymph-nodes. There were marked differences in the usefulness of HMFG-2 and 3C6F9 for ILS in these circumstances. There were too few patients to evaluate HMFG-1. Sensitivity and specificity of the test were 0.57 and 0.83, respectively, for HMFG-1 and 0.83 and 0.93 for 3C6F9.

Sowohl bei der Entstehung als auch bei der Therapie der weiblichen Harninkontinenz spielen die Anatomie und die Funktion des Beckenbodens eine wichtige Rolle. Das Ziel dieser Fallkontrollstudie war es, festzustellen wie der Kenntnisstand geriatrischer Frauen mit Harninkontinenzsymptomen bezuglich ihres Beckenbodens, ist und wieweit sie imstande sind die Beckenbodenmuskulatur willkurlich willkurlich und reflektorisch zu kontrahieren. 377 geriatrische Frauen mit Harninkontinenzsymptomen wurden im Rahmen eines Harninkontinenz-Basis-Assessments untersucht. Die Fahigkeit zur Kontraktion der Beckenbodenmuskulatur wurde mittels einer digitalen vaginalen Palpation gepruft. Das Ausmas der festgestellten Muskelkraft wurde eingeteilt mit der sechsteiligen Oxford Grading Scale nach Laycock 1994. 65,5% der Patientinnen wussten nicht, was der Beckenboden ist und waren zu keiner Beckenbodenmuskelkontraktion fahig (Grad 0 bis 1 nach Laycock), 22% hatten eine vage Ahnung von der Lage ihres Beckenbodens—konnten aber nur eine insuffiziente Muskelkontraktion erreichen (Grad 2 nach Laycock). Nur bei 12,5% der Patientinnen konnte eine sichere, masige bis starke Muskelkontraktion festgestellt werden (Grad 3 bis 4 nach Laycock). Eine Untergruppe bestehend aus 83 Patientinnen hatte in der Vergangenheit bereits Bekkenbodenubungen durchgefuhrt, 80 davon mit konventionellen Unterweisungen, 3 mit digitaler vaginaler Kontrolle. In dieser Untergruppe konnten 54,2% der Patientinnen den Beckenboden nicht (Grad 0 bis 1 nach Laycock), 25,3% nur insuffizient (Grad 2 nach Laycock) kontrahieren. 20,5% waren zu einer sicheren Beckenbodenkontraktion fahig (Grad 3 bis 4 nach Laycock). Die 3 Patientinnen, deren Beckenbodenubungen mittels einer digitalen vaginalen Palpation kontrolliert worden waren, befanden sich in dieser Gruppe und erreichten eine Beckenbodenmuskelkraft Grad 4 nach Laycock. Ein groser Prozentsatz geriatrischer Patientinnen mit Harninkontinenzsymptomen hat keine oder eine eingeschrankte Kenntnis uber die Lage und die Funktion des Beckenbodens. Der Einsatz konventioneller Beckenbodenubungen ohne zielgerichtete Kontrolle scheint bei geriatrischen Patientinnen die Fahigkeit zu einer Beckenbodenmuskelkontraktion als Schutz vor einem unfreiwilligen Harnverlust nicht zu verbessern.

A rupture of a splenic artery aneurysm in the postpartal period is a rare but dramatic event with a high rate of maternal mortality. We report on a 29-year-old woman who, after a normal ambulant delivery in our department, experienced an attack of pain in the left epigastrium 7 hours later at home and fell into a state of hemodynamic shock. Owing to a targeted diagnostic work-up and immediate surgical intervention, the patient survived this incident with no damage. According to the international published literature, the mortality rate for this condition is 50%. In developed countries a rupture of a splenic artery aneurysm during pregnancy or the postpartal period is a very significant cause of maternal morbidity and mortality. Based on a review of the published literature, the causes, diagnosis, clinical work-up and treatment of these ruptures are addressed in the Discussion section. For the purpose of differential diagnosis, every obstetrician and emergency medicine specialist should be familiar with this relatively rare condition. Immediate diagnosis and prompt establishment of the indication for laparotomy are essential in order to ensure that the mother and the child survive the incident.

Purpose: The aim of this prospective randomized study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) versus transobturator vaginal tape (TOT) for the surgical therapy of female stress urinary incontinence (SUI). Material and Methods: Clinical and urodynamic examinations were carried out in 110 women suffering from stress urinary incontinence. Mean age was 51 years (range, 37-75). Patients with overactive bladder symptoms, pelvic prolapse and previous surgery for stress urinary incontinence were excluded from the study. The women were randomized into two groups, TVT (n = 52) and TOT (n = 53). The tapes were positioned without tension under the junction between the mid and distal urethra. The women received spinal and general anesthesia according to patient preference. 105 women were re-examined 12-17 months after these procedures. Results: Patient characteristics and urodynamic evaluations were similar in the two groups. The cure rate at follow-up was 86% for the TVT procedure and 84% for the TOT procedure. In both groups urethral pressure profiles demonstrated a significant improvement in Dep.Q (p < 0.05). We observed no prolonged pain or sling rejection. Operation time was significantly shorter in the TOT group (15 min vs 26). No bladder injuries and no vascular (hematoma or bleeding) complications occurred in the TOT group versus 13% (n=7) in the TVT group. In 5 cases (12%-TVT) and 6 cases (10%-TOT) we observed new onset detrusor instability. Conclusion: The TOT procedure appears to be as effective as TVT for the surgical treatment of female stress urinary incontinence at 15 months follow-up. TOT avoids damage to the urethra and bladder and, therefore, makes cystoscopy unnecessary. Overall, the TOT seems to be a good alternative to the TVT.

Purpose: Patients with stress urinary incontinence at low urethral closure pressure, defined as maximum closure pressure equal or lower than 20 cm H 2 O, are at a higher risk for failure of surgical intervention. The aim of the study was to evaluate the objective healing and the changes of the urethral closure pressure of such women with severe urinary stress incontinence at hypotone urethra undergoing tension-free vaginal tape procedure. Material and Methods: Out of 150 patients who underwent TVT procedure between May 1999 and August 2000 because of urinary stress incontinence we found 29 of them with hypotone urethra. 25 of these were followed up in this study. Condition for enclosure was a positive stress test (leakage of urine like a jet at filled bladder with 300 ml while coughing as well in lying as in standing position) and a maximum urethral closure pressure lower or equal to 20cm H 2 O 4-6 weeks before surgery while performing urodynamic examination. 7 (4-12) months after surgery urodynamics and stress test were repeated. Healing was defined as negative stress test and regular maximum urethral pressure (higher than 20 cm H 2 O) at the time of control. Results: 19 (76%) patients had a negative stress test and a regular urethral pressure. At 4 (16%) women we found a negative stress test and still a hypotone urethra although maximum urethral pressure had risen but not up to 20 cm H 2 O. One (4%) patient still had a positive stress test with regular urethral closure pressure and one (4%) patient had a positive stress test as well as a hypotone urethra. Over all 23 (92%) patients had a negative stress test and were healed of urinary stress incontinence in all day situation. Conclusion: Our dates confirm TVT as a minimal invasive procedure to cure urinary stress incontinence in women with low pressure of the urethra.

Fatty acid methyl esters are well established as an alternative fuel called “biodiesel.” For economic reasons, used frying oil is an interesting alternative feedstock for biodiesel production. The chemical changes that occur during heating of rapeseed oil, especially the formation of polymers, were investigated. Heated rapeseed oil samples were transesterified with methanol and analyzed by size-exclusion chromatography. During heating, the amount of polymers in the starting oil increased up to 15 wt%, but only up to 5 wt% in the transesterified samples. So during transesterification, dimeric and trimeric triglycerides in the starting oil were mainly converted into monomeric and dimeric fatty acid methyl esters. The amount of polymeric fatty acid methyl esters had a negative influence on fuel characteristics. After 6 h of heating, the amount of Conradson carbon residue and after 16 h the viscosity exceeded that of the existing specifications for biodiesel. Therefore, the amount of polymers in waste oil is a good indicator for the suitability for biodiesel production.

Fragestellung: Ziel der therapeutischen Bestrebungen in der Urogynakologie ist das Beheben einer Harninkontinenz. Welche Vorteile bietet die Verwendung des Endo-Stitch-Nahtinstrumen

In a prospective clinical study we investigated 115 patients prior to vaginal surgical interventions to determine the antimicrobial efficacy of six different procedures for vaginal antisepsis. To sample the microorganisms we used a cotton swab moistened with a neutralising fluid. Immediately after the time of action of the antiseptic procedures (3 minutes), providone-iodine solution, applied undiluted or diluted 1:10, yielded the strongest median reduction of the vaginal flora (log RF 3.60 and 2.68, respectively). Of three detergents with antiseptic efficacy, octenidine 0.1% was the most efficient formula (log RF 2.32). After 30 minutes the log reduction factors (log RF) of almost all procedures (log RF 2.79-3.25) were in a fairly close range, excepting chlorohexidine 0.05% (log RF 2.07). Overall, the antiseptic detergents showed a marked residual effect, which was less pronounced, if at all, with providone-iodine solutions. A germ-reducing effect of povidone-iodine vaginal suppositories, applied 2 to 3 hrs prior to surgery, was not confirmed, while additional findings indicated that providone-iodine solution applied with the help of a vaginal douche yields a similarly strong germ reduction as the application by means of a ball swabs.

In a retrospective study the survival rates of 161 patients with stage Ib cervical cancer after radical operation (Latzko, Wertheim-Meigs) including complete or incomplete pelvine lymphadenectomy were compared. To increase radicality of lymphadenectomy, preoperative targeting of pelvic lymph nodes was done in all the patients using 99mTc-Sb2S3 radiocolloid. Intraoperatively, a gamma-camera being integral part of an operating table allowed delineation and scintigraphy-guided resection of pelvic lymph nodes. Dependent on the evidence of remaining pelvine foci of radioactivity at the end of the operation, lymphadenectomy was assessed as complete or incomplete. Mean observation time of completely lymphadenectomised patients (n = 117,72.67%) were 80 months (5-169 months) and 42 months (1-149 months) of the incompletely lymphadenectomised patients (n = 44,27.33%). In 28 (23.93%) completely lymphadenectomised patients against only 5 (11.36%) patients with incomplete lymphadenectomy, lymph node metastases were proved histologically. Five year-survival rate of completely lymphadenectomised patients was 85.47% and 88.64% of incompletely lymphadenectomised patients (not significant, Mantel-Test). Also, selective comparison of lymph node-positive patients did not suggest a divergent trend indicated by 13 (46.43%) deaths of completely and 3 (60.0%) deaths of the incompletely lymphadenectomised patients after an observation of five years. The technique of scintigraphy-guided pelvic lymphadenectomy using 99mTc-Sb2S3 radiocolloid cannot be expected to improve prognosis of patients with cervical cancer stage Ib.

Detrusor instability is the second most common cause of femal urinary incontinence. Oxybutynin chloride anticholinergic action with direct muscle-relaxant properties. 39 women with persistent-urgeincontinence participated in a pilot study of intravesical oxybutynin application. Patients received either 20 mg oxybutynin or placebo as 40 ml sterile sodium chloride solution administered intravesically over a period of 10 days. Urodynamic assessment as well as micturition protocols were performed before and after treatment. The intravesical oxybutynin-application was significantly better than the placebo application concerning reduction of pollakisuria and nycturia. Oxybutynin also increased bladder capacity more than in the placebo-treated group (p < 0.01) and provided an improvement of bladder compliance (p < 0.05). No local or systemic side effects were observed which would have immediately terminated the oxybutynin treatment.

Local intravaginal application of oestriol is part of the therapeutical programme of sensory urge-incontinence. The effectiveness of a new method--intravesical administration of 1 mg oestriol versus a placebo--has been proved in a prospective randomised study. 21 patients each were treated over a period of three weeks with oestriol or with the placebo-substance intravesically. The effectiveness of the administered therapy was checked with clinical and urodynamic parameters. The intravesical administration of 1 mg oestriol proved to be efficient and free of side effects in respect of the parameters such as imperative micturition, bladder capacity, of the maximum urethral closure pressure as well as the number of micturitions per diem. The intravesical administration of oestriol may be considered as additional method of therapy for treatment of sensory urge-incontinence.

This prospective randomised study involved 52 female patients suffering from recurrent stress urinary incontinence, objectively confirmed by means of clinical incontinence tests and urodynamic examinations. They alternatively underwent colposuspension according to Burch or suburethral sling procedure surgery. Urodynamic and sonographic examinations were carried out before and 2.5 years (i.e. within a range of 2-3) after surgery according to Burch or suburethral sling procedure. There was no significant difference between the two methods with respect to subjective and objective rate of cure, which amounted to 85% of the cases involving colposuspension and 88% of cases involving the suburethral sling procedure. Both methods resulted in a significant improvement of the depression quotient and a significant elevation of the internal urethral meatus (p < 0.05). Apart from an aggravation of urge symptoms in both groups, the patients with surgery according to Burch tended towards enterocele and rectocele in the medium range, whereas urination disorders had to be accepted in the patients operated on according to the sling procedure in the long term.

411 women who had dysplasia, selected from an ambulatory group as well as 240 women from a random control group were examined, by using cervical smears, which were initially diagnosed as human papilloma viruses-DNA (HPV-DNA) of the type 6/11, or 16/18, or 31/33/35. This was achieved by the in-situ nucleic acid hybridisation technique. The results of the HPV-DNA typing were tabulated with the cytological diagnosis (Munich Papanicolaou (Pap.) group-classification). The control group corresponding to Pap.Gr. I, and was HPV-DNA positive in 6 (2.5%) of the 240 cases. The group of 180 patients with a Pap.Gr. II showed a HPV-DNA positive result for 75 cases (41.7%); 57 of 99 cases (57.6%) occurred in Pap.Gr. IIID; 42 of 54 cases 77.8% (L) were found in Pap.Gr. IV (a/b), and 72 of 78 cases (92.3%) appeared in Pap.Gr. V. The HPV-DNA mixed infections became evident as the cellular dysplasia increased. The results of the HPV-DNA positive diagnosis clearly indicate a close correlation with the Pap.Gr.-classification. The HPV-DNA type 16/18 was most frequent in cervical carcinomas (Pap.Gr. V). The cyto-histological control of the 57 HPV-DNA positive cases of the untreated Pap.Gr. IIID showed a regression in 31.6% of the 18 cases after a period of 3 to 6 months (post HPV-DNA typing). These were histologically normal. In 33 cases (57.9%), there was a persisting Pap.Gr. IIID (CIN I/II) and in 6 cases (10.5%) a progredient correlation in Pap.Gr. IV a/b. The Pap. group IV (a/b) was histologically a CIN grade III.

A collective of 31 women with recurrent stress urinary incontinence was subject to Burch colposuspension. The average time interval between the primary treatment (anterior colporrhaphy) and surgical colposuspension was 5.5 years. All patients underwent clinical, urodynamic and sonographic assessment of incontinence prior to and after surgery. The follow-up examination was performed at an average of 14.5 months after colposuspension according to the method reported by Burch. In 87% of patients, continence was achieved. 90% of patients were able to void without any formation of residual urine in the bladder. In the attempt to optimise the diagnostic and therapeutic procedures pertaining to female incontinence, introitus sonography and urodynamic assessment have proved to be valid adjuvant tools.

In postmenopausal patients, stress and urge incontinence often occur as a consequence of oestrogen deficiency. We performed a comparative study in a prospectively randomised and placebo controlled group of women with urge incontinence to investigate different dosages of intravaginally applied oestriol. Clinical and urodynamic parameters were also compared. 15 women (Group I) received 1 mg oestriol applied daily intravaginally over 3 weeks; 15 women (Group II) received a daily dosage of 3 mg and 10 women received a placebo. A complete clinical and urodynamic evaluation was carried out twice at a 4-week interval. The women receiving a daily dose of 3 mg oestriol applied intravaginally demonstrated a significant improvement of the parameters strong desire to void, pollakisuria, and nycturia. No improvement was seen in patients with motoric urge incontinence.

In the treatment of urge incontinence, drug therapy predominates. In a prospective randomised study on treatment of females with motor urge incontinence, intravesically administered lidocaine-gel and oral emepronium bromide were compared using clinical and urodynamic parameters. From 30 patients, 15 women were treated for 3 weeks with repeated intravesical lidocaine gel instillations whilst the other 15 had a peroral emepronium bromide medication. The intravesical lidocaine gel installation proved more efficient compared with peroral emepronium bromide therapy with regard to the parameters of imperative micturition, occurrence of detrusor contractions as well as number of urinary frequencies per diem. Intravesical application of lidocaine-gel is particularly indicated in patients with increased sensitivity against parasympathicolytics and anticholinergics.

Besides the relatively frequent perioperative and postoperative dysfunctions of micturition, urogenital fistulae are the most frequent complication occurring after surgical gynaecologic interventions. Vesico-vaginal fistulae are the most common communication between efferent urinary passages and genital tract. From 1969 to 1986, 36 women developed a vesico-vaginal fistula after abdominal or vaginal surgery and were operated on again. Upon admission, all 36 patients were subject to surgical closure of the vesico-vaginal fistula according to the vaginal method of Chassar Moir. In 35 women (97.2%) continence was re-established by adequate closure.

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. Forty patients suffering from recurrent stress incontinence underwent a dura-sling operation, i.e. loop surgery. The mean period od incontinence complaints prior to secondary surgery was 2.6 years. Follow-up urodynamic parameters revealed a slight improvement in urethral closure pressure (UCP) as well as significant improvement in functional urethral length and depression quotient. Radiologic investigations before and after sling surgery demonstrated good morphological results (angle beta). One year after surgery, 85% of the women had both clinical and urodynamic continence. Medium-term micturition complaints, however, have to be accepted in some of the patients.

1. Fragestellung: Wir fuhrten ein Register zur Erfassung des perioperativen Verlaufs bei transobturatorischen Bandoperationen wegen Stressharninkontinenz. 2. Methodik: Fragebogen (1-seitig; 15 Items zur Patientin, Operation und postoperativem Verlauf). 3. Ergebnisse: Insgesamt wurden 2263 Operationen mit 8 verschiedenen Bandsystemen an 45 Zentren erfasst. Intraoperative Komplikationen wurden fur 115 (5,1%) Operationen angegeben. Diese inkludierten vermehrte Blutung (n=82; 3,6%) sowie Perforation der Vagina (n=10; 0,4%), Blase (n=7; 0,3%) oder Urethra (n=2). 48 (2,1%) Band-bedingte Reoperationen wurden gemeldet (25 Lockerungen oder Durchtrennungen wegen Entleerungsproblemen, 9 vaginale Erosionen, 6 Abszesse, 1 retropubisches Hamatom). 12 (0,5%) Patientinnen gaben postoperativ signifikante Schmerzen an. Es gab keine Verletzungen von Darm oder grosen Gefasen und keine Mortalitat. 4. Schlussfolgerung: Schwere Komplikationen mit transobturatorischen Bandern sind selten. Vaginale Erosionen, Abszesse und Schmerzen sind vielleicht haufiger bei transobturatorischen als bei retropubischen Bandern, aber dies konnte auch auf die Struktur der verschiedenen Bander und (nicht auf den Zugang) zuruckzufuhren sein.

By 40 women with stress incontinence II.-III. degrees we performed a preperitoneal pelviscopic colposuspension (Burch) modified by Gill with the "Nottingham Needle". An urodynamic and sonographic assessment before and 6-9 months after the pelviscopic operation were done. In 38 cases from the 40 women (95%) we saw a good result. The new modification of the pelviscopic colposuspension showed us a low intra- and postoperative morbidity and we consider it a big advantage for obese women.

Not only do anatomy and function of the pelvic floor play an important role as possible causes of female urinary incontinence, they are also crucial for its therapy. The aim of this case control study of female geriatric patients with symptoms of urinary incontinence was to determine the knowledge about their pelvic floor and to assess their ability to contract pelvic floor muscles voluntarily and reflexly.A total of 377 female geriatric patients with symptoms of urinary incontinence were investigated in a Basis Assessment for Urinary incontinence. The ability to contract their pelvic floor muscles was examined by a digital vaginal palpation. The extent of the registered muscle strength was graded by the Modified Oxford Grading Scale by Laycock (1994).Of the patients, 65.5% were not aware of their pelvic floor and were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock), 22% had an inaccurate knowledge and only performed an insufficient pelvic floor muscle contraction (Grade 2 by Laycock). Only 12.5% could contract their pelvic floor muscles properly (Grade 3 to 4 by Laycock). A subgroup of 83 patients had already absolved pelvic floor exercises in the past, 80 patients with conventional instructions, 3 patients with digital vaginal control. In this subgroup 54.2% of the patients were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock) 25.3% only performed an insufficient contraction (Grade 2 by Laycock), while 20% were able to perform a sufficient and powerful contraction (Grade 3 to 4 by Laycock). The three patients in the past controlled by a digital vaginal palpation were part of this group and managed a pelvic floor muscle strength Grade 4 by Laycock. A high percentage of female geriatric patients with symptoms of urinary incontinence have a lack of understanding regarding the position and function of their pelvic floor. These results suggest that conventional pelvic floor muscle exercises without specific control are not an appropriate method to improve geriatric patients' ability to contract their pelvic floor muscles and to prevent urine leakage.

The menopausal syndrome consists of a variety of psychic and physical signs of different intensity. At our outpatient department for problems in menopause and prevention of osteoporosis (1. Dept. of Gynaecol. and Obstetrics, Vienna) 1287 women who were consulting this department for the first time because of prevailing complaints or prophylactic reasons, were registered during the years 1988 and 1989. In the course of this work we paid particular attention to the symptom "eye complaint" as a sign of the beginning of the menopausal period. 98 out of 430 patients with eye complaints were examined ophthalmologically. Referring to our patient population we tried to analyse epidemiologically the frequency and the degree of severity of menopausal eye complaints as well as the therapeutical response to a hormone substitution therapy. To what extent an endocrinological explanation can be found and which facts lead us assume such a statement, we have tried to demonstrate in the discussion.

In 21 patients, suffering from amenorrhoeic hypergonadotropic ovarian insufficiency (age 27 +/- 3 years [FSH: 43 +/- 10, LH: 40 +/- 8]), the bone density was measured by single-photon densitometry (SPA), before starting a hormonal replacement therapy with oestrogen/progesterone. Every 5 months, the trend in bone density change was measured in all cases. The bone density before hormonal treatment was lower in the WHO III-group (1.36 +/- 0.21 g/cm; 1.09 +/- 0.26 g/cm2) than in the age-matched group (1.57 +/- 0.21 g/cm; 1.28 +/- 0.31 g/cm2). Bone density increased after hormonal therapy (p less than 0.05). These results point to the necessity of hormonal replacement therapy in cases of WHO III.

By 40 women with stress incontinence II.-III. degrees we performed a preperitoneal pelviscopic colposuspension (Burch) modified by Gill with the "Nottingham Needle". An urodynamic and sonographic assessment before and 6-9 months after the pelviscopic operation were done. In 38 cases from the 40 women (95%) we saw a good result. The new modification of the pelviscopic colposuspension showed us a low intra- and postoperative morbidity and we consider it a big advantage for obese women.

It is the therapeutical aim of urogynecology to correct urinary incontinence. Which advantages offers the use of the Endo-Stitch needle in Burch's pelviscopic colposuspension?When extending the field of pelviscopic surgery, in a prospective study we performed Burch's pelviscopic preperitoneal colposuspension using the disposable Endo-Stitch suture instrument in 12 patients with stress incontinence grades 2 or 3. Clinical and urodynamic evaluations were performed before and 8.5 months after the pelviscopic operation.Clinical and urodynamic follow-up examinations revealed continence in 10 (83%) out of 12 patients.Our preliminary experience suggests that the pelviscopic incontinence operation by means of the Endo-Stitch needle is a good alternative to abdominal colposuspension. Follow-up results of a large number of patients will have to prove advantages in contrast to conservative surgery.