Search

The relative advantages and disadvantages of the transabdominal versus the transvaginal approach to hysterectomy were evaluated and the two procedures were compared for differences in hospitalization, patient age, bowel activity and operating time on the basis of a material of 94 hysterectomized patients. Intestinal complications such as subileus were noted only in subjects who were treated by abdominal hysterectomy. This corresponded with the significant decrease in potassium in abdominally operated patients on the second post-surgical day. Transvaginal hysterectomy was found to be superior in terms of all of these parameters. Complications associated with the two procedures were also compared. Of eight potential complications, seven were found to be confined to laparotomy, while only one occurred after transvaginal hysterectomy which was, however, invariably combined with colporrhaphy. The conclusion from the above should, therefore, be not to select patients indiscriminately for either the transvaginal or the transabdominal approach, but rather to use both routes of access as best fits the circumstances.

Previous perinatal trials using Doppler ultrasound have demonstrated a favorable correlation between abnormal blood flow spectra and feto-maternal problems. 33 patients with manifest placental unsufficiency were subject to daily transcutaneous nerve stimulation in a 2-week therapeutic course. 23 patients of the control group were treated by bed rest over 2 weeks. The patient group with transcutaneous nerve stimulation (TNS) showed significant improvement of the investigated blood flow parameters (A/B ratio) of the umbilical artery and fetal aorta (p less than 0.01). In the placebo group there were no significant alterations of blood flow parameters. The clinical findings (improved flow parameters and perinatal outcome) are not expected to yield any significant improvement when placental insufficiency is treated with bed rest alone.

We examined 11 patients suffering from advanced cervical carcinomas, who were treated primarily with radiation. The blood flow through the uterus was established by measuring the Doppler pulse flow through the arteria uterina before and after radiotherapy. In a reference group of 25 women, free from cervical carcinomas, we established a median PI of the arteria uterina of 3.52 (+/- 1.10) with values between 1.64 and 5.06. In contrast, the group of 11 patients suffering from inoperable cervical carcinomas, were found to have a PI of 1.80 (+/- 1.40), with values between 0.41 and 4.41 (Wilcoxon Test: p = 0.001). After completion of the radiotherapy, 7 of the 11 patients showed no measurable pulsations of the arteria uterina, 3 patients had only systolic blood flow and only one patient had the same unchangingly high rate of blood flow as registered before radiotherapy. The significantly reduced flow of blood through the tumour tissue after radiotherapy, indicates a very limited response to chemotherapy. Therefore, chemotherapy should be administered before radiotherapy.

In a prospective study of sonographic and radiographic methodologies we compared morphologic bladder data in 30 patients before and after stress incontinence surgery. 18 women were subject to colposuspension according to Burch due to recurrent stress incontinence, 12 women underwent anterior colporrhaphy. Visualisation of bladder, urethra and beta-angle was adequate with both methods. The good visualisation of the anatomical and functional situation of the vesico-urethral area is a major benefit of introital sonography.

Pulsed Doppler Flow Measurements in patients suffering from collum cancer using a coloured pulsed Doppler technique measurements of blood flow of the uterine artery were performed in a group of 35 patients suffering from an inoperable collum cancer (stage II and III according FIGO) and compared with a collective of 30 healthy women with normal anamnesis. The mean pulsatility index (PI) was significantly lower in the sick group (stage II 1.6 +/- 1.17, stage III 0.76 +/- 0.21) than in the healthy group (PI = 3.18 +/- 0.99) (p less than 0.01). In 14 subjects of the last group there was no significant difference in PI between the left and right uterine artery (left: PI 2.81 +/- 0.83), right: PI 2.78 +/- 0.76).

This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.

This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.

Significant differences occurred on various scales by comparing 30 pregnant women who suffered from dysfunction of placenta chosen at random. Comparison was made by means t-tests and cross tables in GT, FPI, SSG sociological and medical data. Additionally a controlled experiment was performed. Dominating parts on a body level are the masochistic and the rigid one, both high charged structures. They seem to be more frequent than schizoid, oral and psychopathic parts. Looking to psychosomatics of dysfunction of placenta aggressive wishes against the child could be found.

Using a pulsed Doppler technique measurements of blood flow of the arcuate artery, umbilical artery and foetal aorta were performed in the third trimenon in a group of 163 patients with risk pregnancies and compared with the weights of the newborn. In normal values of blood flow of the arcuate artery (n = 144) less than 10% of the weights of the newborn were below the tenth percentile. In pathological values (n = 19) about 42% newborn werde below the tenth percentile. In normal values of blood flow of the umbilical artery (n = 158) about 10% of the newborn were below the tenth percentile. In pathological values (n = 5) all newborn were below the tenth percentile. In normal values of blood flow of the foetal aorta (n = 139) about 12% of the newborn were below the tenth percentile. In pathological values (n = 4) all newborn were below the tenth percentile. Of the group with "normal" blood flow data a sub-group was formed with flow values between the first and second standard deviation. These were labelled "suspicious" and had shown a significant correlation with the birth weights of the newborn. Based on these experiences a schema was prepared comprising the blood flow measurements and cardiotocography, from which recommended clinical procedures were derived.

In a prospective study covering 175 gravidae it was investigated whether the risk of a "small" placenta could be detected by determining HPL or serum estriol once during the first 18 weeks of pregnancy. The results show that neither the HPL value nor the serum estriol value correlate with the weight of the placenta or the child. Therefore, the problem of early detection of a "small" placenta cannot be resolved with these hormone parameters.

Twenty-five patients, having either unilateral ovarian tumors of unknown etiology or suspected of having ovarian cancer recurrence were investigated by the method of immunoscintigraphy to rule out primary and/or metastatic tumor sites. Four-hundred micrograms of the tumor-associated monoclonal mouse antibody HMFG-2, raised against human milk fat globulin membranes and labeled with 123I, were used for each patient to display the tumor sites by external scintigraphy. The dose ranged between 0.5 and 2.2 mCi, the specific activity between 1.25 and 5.5 mCi per mg of antibody. Nineteen of the patients underwent operations a few days after immunoscintigraphy. The remaining six patients were investigated by transmission computed tomography (TCT) to establish the presence or absence of tumor of the imaging. In 22 of the 25 cases the scintigraphic results correlated with the situation found at the subsequent operation, or by TCT, respectively, as well as with the histological diagnosis of the tumor type. Overall, there were just two false-negative and one false-positive scan report, the latter due to faulty reading of the scintigrams. Sixteen out of 18 tumor sites in 25 patients could be revealed by immunoscintigraphy, the smallest one being 1.5 cm in diam. In four of the patients immunoscintigraphy was the only noninvasive investigation method that could reveal the malignant tumor sites prior to the operation.

Highly selective vagotomy was performed in 361 patients over the past 10 years. The mortality was 0.3% in uncomplicated, and 1.6% in complicated duodenal ulcer. With a mean follow-up period of 52 months the recurrence rate was 7.4%. The known advantages of this operation, namely low mortality and low postoperative morbidity (dumping 0.8%, diarrhoea 0.8%, unintentional weight loss 0%, food intolerance 1.9% and epigastric fullness after meals 1.9%), were confirmed in our patients. The overall clinical result was excellent or good (Visick I or II) in 87% of patients. Clinical failures were most often caused by recurrent ulceration. Highly selective vagotomy is still the operation of choice in uncomplicated duodenal ulcer. It can also be recommended in selected cases of complicated ulcer disease.

The foetal outcome was examined in 24 pregnant females with EPH gestosis and a placental weight below the 20th percentile. The results show a high perinatal mortality in such cases. 11 newborns with a mean birth weight of 1092 g and a mean gestational age of 33.8 weeks died perinatally versus 13 newborns with a mean birth weight of 1705 g and a mean gestational age of 35.6 weeks, who survived. Perinatal mortality was equally high in cases with primary Caesarean section as in cases with spontaneous labour. Perinatological research should, therefore, focus on the development of techniques for estimating placental weight. Patients with a small placenta and EPH gestosis could then be monitored exactly and be delivered at the optimal moment.

Sixteen patients suffering from breast cancer were investigated by the method of immunolymphoscintigraphy (ILS) to evaluate the axillary lymph node status. Two monoclonal tumour associated antibodies (HMFG-1 and HMFG-2) that are known to react strongly with a wide range of epithelial malignomas were used as tumour seeking agents in our recent study. All patients were operated a few days after the scanning procedure including a radical axillary lymph node dissection. Therefore the scan reports could be correlated in each case with the histology of the surgically removed probes. While HMFG-1 failed to show correct results, HMFG-2 gave accurate results in 9 of 13 cases of questionable lymph node involvement. Among the 4 false results, one turned out to be false positive and three false negative. If better antibodies or their fragments, respectively, are used, we are convinced this noninvasive approach will greatly improve preoperative diagnosis of lymphatic involvement in breast cancer patients.