[Doppler flow studies (duplex sonography). Differential diagnostic assessment of intrauterine growth retardation and uncertain gestational age].

In 116 patients referred to Heidelberg University Gynecological Clinic because of a discrepancy between calculated and biologically determined gestational age, the suitability of the Doppler Flow examination method (duplex method) for resolving this question was studied. The signals from the fetal descending aorta, the umbilical artery, and from maternal placental vessels were used. An A/B ratio of over 7 in the fetal aorta, an A/B ratio of over 4 in the umbilical artery, and detection of an early diastolic incisure in the so-called arcuate arteries were considered pathologic.

[Carnitine in therapy of placental insufficiency--initial experiences].

Carnitine (3-hydroxy and 4-trimethylaminobutyrate) present in all living cells, plays an important role in the oxidation of fatty acids. It is known that high dose carnitine activates surfactant synthesis. Given to women with imminent premature delivery, its benefit on the post natal period is proved.

[Preoperative diagnosis, pathologic anatomy and clinical significance of mucoceles of the appendix from the gynecologic viewpoint].

Owing to their proximity to the true pelvis and their topography, mucoceles of the appendix frequently cause clinical symptoms which call a gynecologic condition to mind. Sonographically, the structures of mucoceles are often similar to those of ovarian tumors. Within 12 months four patients with mucoceles underwent surgery at Heidelberg University Gynecological Clinic following diagnosis of a gynecologic disease (two tentative diagnoses of ovarian carcinoma, one of advanced ovarian carcinoma, one chance finding during Wertheim's operation).

[Carnitine levels in pregnancy].

Carnitine (trimethylamino-hydroxy butyric acid) is present in all living cells. It is necessary for the transport of fatty acids into mitochondria and for other metabolic functions of the cell. Studies in various animal species have demonstrated a transfer of carnitine from the mother to the fetus during pregnancy.

[Influence of pindolol on maternal cardiovascular parameters and contractility of the puerperal uterus].

In the present study the influence of beta-receptor blockers on uterine activity was examined. In the postpartum period of 16 enrollees blood pressure, heart frequency, contraction frequency, basal tone, contraction intensity as well as the Montevideo Units were recorded at intervals of 10 minutes during and after infusion of 0.8 resp.

[Treatment of tubal pregnancy by local and systemic administration of prostaglandin. Initial experiences].

The present study reports on the treatment of 6 tubal pregnancies established by laparoscopy intratubal PGF2 alpha injection accompanied PGE2 applied systemically. The method was successful in all cases avoiding the usual surgical procedure. Concerning the side effects one patient exhibited higher postoperative temperature, whilst another showed hypertony and tachycardia immediately after PGF2 alpha injection which lasted a few minutes.

[Comparison of urodynamic findings before and after loop operations for recurrent incontinence].

30 patients with a recurrent stress incontinence were undergoing a dura-sling operation. The mean period of incontinence complaints up to the second surgery was 2.6 years.

[The older primipara: labor induction and rigidity of the soft tissues].

Textbooks and literature reports frequently view the primipara of advanced age as a group being at increased risk of prolonged labor, dystocia, injuries to the birth canal and fetal distress. Particularly, a rigid cervix and reduced elasticity of the soft tissues of the birth canal are claimed responsible for these risks. Clinically, this view causes a higher frequency of operative deliveries in this group of primipara.

[Joint pain in pre- and postmenopausal arthropathia climacterica].

The menopausal syndrome consists of a variety of psychic and physical signs of different intensity. At our outpatient department for climacteric complaints and osteoporosis prevention (1. Dept.

[Possibilities of therapy by ear acupuncture in female sterility].

Following differentiated endocrinologic-gynecologic diagnosis auricular acupuncture was used in 15 women with oligoamenorrhea and 12 women with luteal body insufficiency who had come for hormone consultation because of sterility. In both groups the subsequent incidence of pregnancy was comparable to that achieved by drug therapy. The greatest successes were in cases of amenorrhea with positive gestagen test and normal basal hormones or hyperandrogenemia, while there was less improvement in cases with negative gestagen test, anorexia and luteal insufficiency.

[Diagnosis of occult fallopian tube cancers by intraoperative peritoneal cytology].

Clinical and ultrasonographic examination are the usual methods of diagnosis for carcinomas of the fallopian tubes and ovarian carcinomas. It is only in rare cases that the diagnosis is based on the cytology of the cervical smear. The use of cytology--more exactly, the cytological examination of secretion in Douglas' space in cases of vaginal hysterectomies--for the detection of ovarian and tubal carcinomas that cannot be diagnosed by clinical and paraclinical procedures, is a rather unusual and rarely described method.

[Avoidance of homologous blood transfusions in gynecology and obstetrics].

Public concern about the safety of transfusion was aroused by the discovery that the acquired immuno deficiency syndrome (AIDS) can be transmitted by blood transfusion. Patients who require transfusion are now apprehensive to the point of seeking alternatives or even refusing to receive blood. "Autologous transfusion" of the patients own blood can completely eliminate the risk of disease of transmission.

[The medroxyprogesterone acetate serum level following various medroxyprogesterone acetate dose schedules in gynecologic oncology].

Medroxyprogesterone acetate (MPA) is used as an adjuvant hormonal medication in patients with different kinds of carcinomas. Since adequate serum levels are thought to be essential we determined the individual, postoperative MPA levels in 36 patients with endometrial carcinoma over a period of 12 weeks. The patients received either an oral dose of 3 X 100 mg MPA or a weekly changing scheme with 2 X 10 mg Tamoxifen and 3 X 100 mg MPA.

[Effect of a parenteral ozone-oxygen mixture on the concentration of immunoglobulins (IgA, IgG, IgM), of vitamin A and lysozyme activity in patients with cervical cancer].

In the literature you can find several therapeutic possibilities in the treatment of carcinoma by additive ozone therapy. We investigated the consequences of ozone therapy for the immunological status, lysozyme and vitamin A. 21 women with progressive cervical cancer (Stage III, IV) got besides the conventional irradiation therapy also an additive ozone therapy.

[Incidence of hyperandrogenemia].

Within two years 341 amenorrheic patients treated in our endocrinological outpatient department were listed up retrospectively in WHO-classification groups. In 30 patients a primary amenorrhea and in 311 patients a secondary amenorrhea could be registered. In 28.

[Progestagens in contraception].

The different spectrum of biological actions of the various synthetic progestogens is compared on the basis of their chemical structure, pharmacokinetics and interaction with the multiple receptors. In detail, the mechanism of action of the progesterone derivatives (medroxyprogesterone acetate, chlormadinone acetate and cyproterone acetate), the norethisterone-related (norethisterone, ethynodiol diacetate, lynestrenol and norethynodrel) and the norgestrel-related progestogens (levonorgestrel, desogestrel, gestodene and norgestimate), and a possible influence of some metabolites upon the biological profile are discussed. With regard to the progestogenic activity, the time-course of the serum concentrations of the steroids after the application (pharmacokinetics) which is dependent upon absorption, metabolization in the gastro-intestinal tract and liver (first-pass effect), distribution and storage in fat and other tissues, binding to serum proteins, inactivation, and conjugation, is of particular importance.

[Estrogens in contraception].

Ehtinylestradiol (EE) and Mestranol (ME) are oral highly effective estrogens. They inhibit pituitary FSH and LH and thus cause inhibition of ovulation. This effect is synergistically increased by progestogens.

[Significance of the examination position in urodynamic assessment of female urinary incontinence].

The present paper describes a test center which permits urodynamics tests with the patient in various positions, such as lithotomy position (A), supine position with outstretched legs (B) and, by continuously raising the patient, upright position (C). The results of a comparative investigation show the influence of these different examination positions on urodynamic parameters, in particular the functional length of the urethra and maximum urethra closing pressure at rest. Urodynamic tests on 40 patients with urinary incontinence showed that there is a significant increase in the functional length of the urethra when the patient is in lithotomy position (A) as compared to lying with outstretched legs (B), and that it is once again significantly reduced when the patient is raised to upright position.

[Surgical gynecologic interventions in 1 to 15-year-old girls].

1200 girls, aged between newborn to fifteen years, came to our outpatient department of children and adolescent gynecology, during the last seven years. 86 children (7%) had to be hospitalized. In the 86 young patients 111 operations were necessary; 36 operations had to be performed at the vulva, 33 at or through vagina and 42 intraabdominal.

[Computer-assisted documentation and recording of findings of obstetrical ultrasound findings].

Since 1976 on our department obstetrical reports are generated and stored by computer. This kind of documentation has been also introduced for obstetrical ultrasound investigations. One year ago the part of our database for storing and recording the results of obstetrical ultrasound examinations was changed according to new purposes.

[Stimulation of prolactin secretion by vasoactive intestinal peptide].

Dopamine has already been recognized as an inhibiting factor of prolactin. On the other hand, the stimulators of prolactin are still judged diversely at the moment. In addition to hypothalamic TRH, serotonine as well as endogenous opiates and VIP are under discussion.