Die Konfokale Laser Scanning Mikroskopie (CLSM) ermöglicht eine zerstörungsfreie Hartgewebshistologie (1,2). Dabei können chemische, mechanische oder physikalische Artefakte durch die Möglichkeit unbearbeitete, d.h. ungefärbte, angeschnittene und unentkalkte proben zu untersuchen vermieden werden. Neben der Mikroskopie frischer Proben besteht die Möglichkeit, in Technovit eingebettete Proben zu untersuchen. Fragestellung dieser Arbeit ist es, inwieweit mit der Technoviteinbettung verbundene Desinfektionsund Fixierungstechniken mit Alkohol und Natriumacid die mechanischen Eigenschaften und die Mikroarchitektur kortikalen Knochens im CLSM beeinflussen.

Introduction: Diatoms dominate phytoplankton blooms in the ocean and hence play a key role in aquatic ecosystems and the global carbon cycle. These silica-shelled algae mainly constitute the "biological carbon pump" that draws down carbon dioxide from the atmosphere and exports it to oceans sediments (Yamaguchi et al., 2002). Important parameters in ecosystem models are the primary production and biomass of phytoplanton. Here we show results on C/Si ratios and C, Si contents/cell of three ecologically relevant species using microscope-coupled FTIR-spectroscopy. Materials and Methods: FTIR-spectra were recorded from cells of T. weissflogii, C. meneghiniana and S. costatum cultivated in media containing 0.35 - 0.01 mM Si. Cells were washed and dried for 20 min at 40 °C on a ZnSe-crystal before measurement. The used FTIR- system and applied conditions can be found elsewhere (Stehfest et al., 2004). Reference values were measured using ICP-AES and MS. Results and Conclusions: FTIR-spectra comprised the vibrational characters of all cell constituents. Typical bands at 1075 and 800 cm -1 indicative of silicate were present in all spectra of the different diatoms. This region was used to create a chemometric model comparing Si concentration-dependent changes of spectral features with the reference values. The same was done for the carbon content/cell using two spectral region between 3000 - 1300 cm-1. Actually, silicon content/cell reached 2 - 40 pg whereas carbon content varied between 10 - 200 pg/cell. The obtained models showed high correlations and were tested by employing cross validations. Since the three species investigated could be combined in one model, species-independent analyses were carried out. We could also use microscope-coupled FTIR-spectroscopy for species specific analysis. We conclude that FTIR-spectroscopy is a suitable method for rapid investigation of the elemental composition of small cell groups or single cells of diatoms.

We report on prenatal diagnosis of gastroschisis at 20th gestational week. In addition to gastroschisis intraabdominal intestinal stenosis was detected. As a consequence cesarean section was planned close to term. Control examinations in the last trimester didn't confirm initial diagnosis so that the recommended mode of delivery was changed. However postpartum diagnosis again confirmed the early diagnosis of gastroschisis including spontaneous necrosis of dislocated intraamniotic intestinal parts. The course demonstrates that even at unambiguous prenatal diagnosis control examinations are recommended as dynamic changes may occur in the second and third trimester. Thus mode of delivery may have to be adapted close to term to reduce maternal risk.

During the last 8 years in our department, fetal ventriculomegaly was diagnosed by prenatal ultrasound in 105 cases. Ventriculomegaly was detected at 25 ± 6 weeks of gestation. In 96 of 105 cases follow-up examinations have been performed both during pregnancy and after delivery. In 47 cases termination of pregnancy, late spontaneous abortion or intrauterine death occurred. 49 cases resulted in live births. Of these, 28 children could be followed up to the age of 36 months, a few children even longer. Myelomeningocele was the most frequent cause of ventriculomegaly (17 cases = 61%). Insertion of ventricular shunt systems was performed in 26 children at a median of 21 days of life. Analysis of postnatal development was performed by the Kaufmann Assessment Battery for Children, or the Munich Functional Development Test. Correlation analysis was performed between parameters of prenatal findings and postnatal development. It could be shown that results of single prenatal ultrasound examinations did not correlate with postnatal development whereas progression of ventriculomegaly was negatively correlated with mental development.

Purpose of the Study: This study presents the results of phototherapy of neonatal jaundice performed in the perinatal unit of the Dept. of Obstetrics at the University of Freiburg. Patients and methods: The data of 289 consecutive hyperbilirubinaemic neonates were evaluated and correlated to birth weight, gestational age, sex, blood type, Rhesus constellation, Coombs titre, incidence of maternal antibodies, pH value, APGAR score and bilirubin serum concentration before and after therapy. Results: Infants with low birthweight and newborn with high calory intake during therapy showed a significantly decreased duration of therapy and a rapid decrease of bilirubin serum concentration. Only 19% of the jaundiced newborn had to be referred to the Paediatric Department for further treatment. Conclusion: By cooperation between obstetricians and neonatologists, therapy of the neonatal jaundice can be performed in obstetrical units. Separation of mother and child can thus be avoided. Only if in additional complications such as persistent hyperbilirubinemia or infections occur will it be necessary to refer the patient to the Paediatric Department.

Fragestellung: In der vorliegenden Studie werden die Ergebnisse der Phototherapie des Neugeborenenikterus in der geburtshilflichen Klinik dargestellt. Patienten und Methoden: Es wurden retrospektiv die Daten von 289 hyperbilirubinämischen Neugeborenen (>37. SSW) in bezug auf Geburtsgewicht, Gestationsalter, Geschlecht, Blutgruppe, Rhesusfaktor, Blutgruppenkonstellation, Ergebnis des direkten Coombs-Tests, Inzidenz mütterlicher Antikörper, Nabelschnur-Arterien-pH, Apgar-Werte und die Serumbilirubinkonzentration vor und nach Therapie ausgewertet. Ergebnisse: Kinder mit niedrigem Geburtsgewicht bzw. Neugeborene mit hoher Kalorienzufuhr während der Therapie zeigten eine signifikant niedrigere Gesamttherapiedauer und einen rascheren Abfall der Bilirubinserumkonzentration pro Stunde. Insgesamt mußten nur 19% der hyperbilirubinämischen Neugeborenen aus der geburtshilflichen Klinik in die Kinderklinik verlegt werden. Schlußfolgerung: Durch enge Kooperation zwischen Geburtshelfern und Neonatologen kann die Überwachung und ggf. Therapie des physiologischen Neugeborenenikterus in der geburtshilflichen Klinik erfolgen. Damit entfällt die räumliche Trennung zwischen Mutter und Kind.

Seit der Einführung der Dopplersonographie ist die nichtinvasive Überwachung des fetomaternalen Kreislaufes möglich [7, 8, 9]. Durch die qualitative Analyse der Flußgeschwindigkeitskurven mittels winkelunabhängiger Indizes werden Parame ter wie die kardiale Funktion, die Gefäßwand-Compliance und der periphere Widerstand indirekt erfaßt [22, 31]. Durch pathologisch veränderte Flußmuster sowohl in der Aorta fetalis wie auch in der A. umbilicalis (A. umb.) kann eine drohende fetale Gefährdung erfaßt werden [12, 14, 25].DerenddiastolischeFlußverlust(EDFV) und der Reverse flow sind als hochpathologische Veränderungen des Flußmusters in hohem Maße mit intrauteriner Asphyxie, intrauterinem Fruchttod (IUFT) und perinataler Mortalität assoziiert [2, 6, 11, 18, 20, 29, 34]. Über das geeignete geburtshilfliche Management bei EDFV bestehen noch Unsicherheiten bzw. Kontroversen. Während einerseits bei EDFV die vorzeitige Entbindung empfohlen wird [27, 35], stellen z.B. Weiß und Berle (1991) [34] bei EDFV die Indikation für eine stationäre Intensivüberwachung. Nachgewiesene gute Korrelationen zwischen Blutgasanalyse und Dopplerbefunden [4, 21 ] lassen eine bessere Beurteilung des fetalen Zustandes erwarten. Ziel dieser Arbeit ist, anhand der Analyse von 41 Fällen mit EDFV unsere Erfahrungen darzustellen.

Vorliegende Untersuchungen haben eine Verbesserung der nicht invasiven Diagnostik des Endometriumkarzinoms (E-Ka) durch die Transvaginalsonographie (TVS) gezeigt (1–3). Ziel dieser Untersuchung war, die Wertigkeit der TVS in der Erfassung benigner und maligner E-veränderungen zu bestimmen. Hierzu wurden sonograph. Kriterien analysiert und geprüft, ob eine Kombination dieser die Diagnostik des E-Ka verbessert.

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16 %) foetuses, discordant growth occurred in 7 (39 %) pregnancies. 41 (73 %) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

Hypotension in pregnancy represents an often underestimated danger for mother and fetus. Several investigators have described an increased incidence of miscarriages, premature delivery and small for date babies. In a first study 10 pregnant women with hypotension and severe orthostatic dysregulation were treated with norfenefrine hydrochloride (3 x 45 mg p. os/day). To investigate the effects of this therapy we monitored maternal blood pressure, subjective well being, CTG and furthermore fetal circulation by using pulsed doppler sonography. An average 4.2 days of treatment were required for complete alleviation of symptoms. Blood flow volume and resistance-index were determined for the fetal aorta descendens, and were found to be the same as in normal pregnancies. In addition no difference in fetal outcome was seen and there was no occurrence of premature contractions.

Mit der Doppler-Sonographie ist die nichtinvasive Überwachung des fetomaternalen Kreislaufes möglich (7 – 10). Über die Beurteilung der Flußmuster in der fetalen Aorta und in der A. umbilicalis kann eine drohende fetale Gefährdung erfaßt werden, wobei der enddiastolische Flußverlust (EDFV) und der Reverse-Flow als hochpathologische Veränderungen des Flußmusters in hohem Maße mit intrauteriner Asphyxie, intrauterinem Fruchttod und perinataler Mortalität assoziiert sind (2, 6, 12, 17, 19, 25, 27). Über das geeignete geburtshilfliche Management bei EDFV bestehen noch Unsicherheiten bzw. Kontroversen (23, 27, 28). Mit der Analyse von 41 Fällen mit EDFV wird unsere Erfahrung und unser geburtshilfliches Management dargestellt.

Hypotension in pregnancy represents an often underestimated danger for mother and fetus. Several investigators have described an increased incidence of miscarriages, premature delivery and small for date babies. In a first study 10 pregnant women with hypotension and severe orthostatic dysregulation were treated with norfenefrinehydrochloride (3 x 45 mg p. os/day). To investigate the effects of this therapy we monitored maternal blood pressure, subjective well being, CTG and furthermore fetal circulation by using pulsed doppler sonography. An average 4.2 days of treatment were required for complete alleviation of symptoms. Blood flow volume and resistance-index were determined for the fetal aorta descendens, and were found to be the same as in normal pregnancies. In addition no difference in fetal Outcome was seen and there was no occurrence of premature contractions.

We report on biometric measurements of the fetal heart with the TM-technique; these measurements were carried out between the 20th and 40th gestational week. The right and left endsystolic atrial and ventricular diameters were, measured, as well as the diameters of the large vessels, i.e. aorta and pulmonary artery; finally, the septal thickness was determined. Our measurements show a linear progression of the diameters in question, the right-left ratio of the atria and ventricles was close to one, so was the ratio between aorta and pulmonary artery. Our results are compared, as far as possible, to the literature.

In 3 cases of severe twin transfusion syndrome we demonstrate that the concentration of atrial natriuretic factor (ANF) in the cord blood of recipient twins is significantly elevated compared to that of donor twins. The discrepancy between recipient and donor concentration correlates with the volume of transfusion. The following pathophysiological mechanism for explaining polyhydramnios in recipient twins is proposed: chronic overload in recipient twins causes enhanced release of ANF from the fetal heart. Consequently, increased fetal urine production leads to polyhydramnios, which is additionally enhanced by inhibition of ADH release.

A retrospective study was conducted comprising 78 cases of fetal urinary tract obstructions diagnosed by ultrasound. Thirteen of the obstructions were subvesical and 65 supravesical. In only one fetus with a subvesical obstruction leading to megacystis was a puncture of the fetal bladder performed--in the 17th week of gestation--resulting in restitution of the bladder to its normal size. In all of the remaining fetuses the kidneys, lungs, and bladder changes had already reached an advanced stage by the time the ultrasound diagnosis was made. In the 65 fetuses with supravesical urinary tract obstructions in utero puncture to relieve a rapidly developing hydronephrosis only seemed advisable in two cases. All of the prenatal diagnoses were confirmed postpartum with the exception of two Potter IIa kidneys, which had been interpreted as being hydronephrosis. The time and method of postnatal management are described. The results of the study indicate that in utero intervention is only indicated in the very rare case. Nearly all of the supravesical obstructions remained unchanged, some even for months. In these cases there was no evidence of cystic-dysplastic renal changes after delivery.

The amount of amniotic fluid was determined semiquantitatively in 600 pregnancies between the 12th and 41st week of gestation. Pregnancies at risk were excluded. The largest amniotic fluid area was measured sonographically in two dimensions. The mean plus/minus standard deviations are correlated with gestational age. A diagram has been prepared.Our results show good correlation with values from invasive quantitative examinations of amniotic fluid amount. However, our procedure is easy to perform and without hazard for the pregnancy, since it is non-invasive.

The amount of amniotic fluid was determined semiquantitatively in 600 pregnancies between the 12th and 41st week of gestation. Pregnancies at risk were excluded. The largest amniotic fluid area was measured sonographically in two dimensions. The mean plus/minus standard deviations are correlated with gestational age. A diagram has been prepared. Our results show good correlation with values from invasive quantitative examinations of amniotic fluid amount. However, our procedure is easy to perform and without hazard for the pregnancy, since it is non-invasive.