Chorea gravidarum is a rare maternal complication during pregnancy. Like the better known chorea minor it shows extrapyramidal symptoms with involuntary movements, lack of coordination, slurred speech and psychic disorders. The neurological state is normal except for a loss of muscle tone. The symptoms most commonly begin in the first trimester of pregnancy and usually resolve spontaneously after 2-3 months. The maternal mortality lies below 1%. In the case of subjectively disturbing symptoms anticonvulsive and sedative therapy with benzodiazepine or neuroleptics may be indicated. Etiological factors including rheumatic fever, chorea minor, hormonal, psychic and autoimmune disorders are discussed. Elective termination of the pregnancy is not indicated. The presented case report shows a chorea-like situation beginning in the ninth week of pregnancy.
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 28.3% a hypothalamic pituitary disorder must be diagnosed, in 5.1% a hypergonadotropic profile was observed. Uterine amenorrhea was seen in 0.6%, a hyperprolactinemia in 6.1%. The hyperandrogenemia with an incidence of 42.1% is remarkable and should be included in the WHO-classification.
The aim of the study was, to evaluate the possible curative effect of punch biopsy on low grade cervical intraepithelial dysplasia (CIN I) as indicated by the literature. After a three-month interval, 115 women with PAP-smears indicating CIN I were subsequently controlled by cytologic cervical smears. Additional colposcopically directed punch biopsies were taken in 26 patients at the first examination. The remission rate was similar in patients with or without punch biopsy (54% to 49%), as well as the progression rate (8% to 7%). In addition we performed in-situ hybridisation in all biopsy specimens for the detection of human papillomavirus (HPV)-DNA. On comparing the progression and remission rate of women with HPV-positive and HPV-negative dysplastic tissue, we found no difference between these two groups. Punch biopsy does not seem to have a therapeutic effect either in HPV positive or HPV negative CIN I.
70 women were evaluated clinically and urodynamically both before and, on average 16 (12-48) months after undergoing endoscopic suspension of the bladder neck, following Stamey, for genuine stress urinary incontinence. The average age of the patients at surgery was 52 (35-85) years; the average parity was 3 (0-10). Preoperative and postoperative lateral colpocystograms were performed on 48 patients. 40 patients had marked descent of the pelvic organs; 30 patients had previously undergone vaginal hysterectomy and anterior colporrhaphia. Overall, 70% of the patients were postoperatively clinically and urodynamically continent at follow-up; however, only 44% of the patients with a preoperative urethra closure pressure (UCP) less than 20 cm H2O were continent. The functional urethral length was unchanged but the point of maximum closure pressure was shifted to the proximal third of the urethra. The UCP at rest decreased significantly (p = 0.0277). Radiologically, the bladder neck was elevated further and the angle beta decreased more in the patients continent after surgery, than in those who remained incontinent. These data suggest that the Stamey operation is effective in selected patients with stress incontinence, but not in patients with a low UCP at rest.
The aim of screening for infectious diseases in pregnancy is to identify subjects who are at risk of a specific infection, which lends itself to effective intervention. The value of routine screening is determined by the validity of the test and the prevalence of the disorder in the population. During pregnancy, serological screening for rubella, syphilis, toxoplasmosis, HIV, hepatitis B and bacteriological screening for asymptomatic bacteriuria and gonorrhea is recommended. The search for additional infections is reserved for patients presenting special risk factors or clinical symptoms.
Invasive cervical cancer can be treated by surgery, radiotherapy, and cytostatic chemotherapy. For decades, surgery alone or in combination with radiotherapy has been the treatment of choice. Radiotherapy only was reserved for patients with advanced disease. Antineoplastic agents, especially combinations including cisplatin, achieved good results in patients with advanced disease of after other therapeutic modalities had been exhausted. This led us to use postoperative chemotherapy for high-risk patients with positive pelvic or parametrial nodes or vascular invasion. Radiotherapy had not improved the survival of such patients. A combination of bleomycin, vincristine, mitomycin-C and cisplatin and later a combination of carboplatin and bleomycin was used. The results were compared to those of patients with radical abdominal surgery only (N = 118) or with surgery and postoperative radiotherapy (N = 108). The 32 patients who underwent surgery and chemotherapy had statistically higher incidence of all risk factors. Nonetheless, after 4-year follow-up they had less recurrences and deaths than the other patients.
683 women were assessed in the present study. All study participants were subjected to an overall clinical examination before and after a 4-month regimen of a low-dose norgestimate-containing combination oral contraceptive (Cileste); in addition, their subjective well-being was investigated by an appropriate questionnaire. 63.3% of the study participants rated drug tolerance as 'very good' and 23.0% rated it as 'good' at evaluation in the 4th cycle. Between the first and second evaluation, we observed a significant improvement of the depressive mood and of skin and hair problems. Women with skin and hair problems often suffer from 'severe dysmenorrhea'. This difference was statistically significant only at the first evaluation (i.e. before the combined norgestimate regimen) and was not observed in the 4th cycle (i.e. during the Cileste regimen), while the incidence of menstrual disturbances was generally found to decrease.
The development of a portable electronic gestation calculator enables the obstetrician for the first time to recall all relevant data for his daily routine work from an electronic memory. This is useful not only for the calculation of the duration of pregnancies or the determination of delivery data, but also includes all relevant information from ultrasound biometry of the fetus. This paper presents the experience with this new electronic device, 'Babycomp', and comments on its design, technical features, functions and performance. The device has been thoroughly tested especially with respect to its suitability for practical purposes. Compared with the widely used disk for pregnancy calculations, the 'Babycomp' has a wide range of advantages for all users working in the field of obstetrics and reproductive medicine.
The first part addresses general principles such as foreign body reaction, strength of sutured tissues, direction of the incision, knot technique and common suture materials. It is recommended to use fine-gauge sutures, as required by tissue strength. The continuous closure of a midline vertical incision is faster than an interrupted one or a transverse incision. In the second part, different closure techniques are discussed: closure of a vertical incision of the skin, uterine closure, episiotomy and repair of the anal sphincter.
