When Ernst Navratil (1902-1977) introduced the diagnostic combination of colposcopy, cytology and histopathology in 1946, there was marked progress in gynecopathology at the Graz University Women's Clinic, Austria. This upswing was mainly due to Fritz Bajardi (1918-2006) and Erich Burghardt (1921-2006). During the time of their clinical work, their collaboration yielded essential knowledge on the pathogenesis of cervical cancer. It is thanks in particular to Erich Burghardt that the relevant publications by both men that can be found spread throughout the literature have been summarized in a synoptic work. The trend-setting research results by Bajardi and above all by Burghardt are discussed in the light of the current state of knowledge.

OBJECTIVES:We aim to describe the history of iodine testing of the cervix and identify areas where further work is required. STUDY DESIGN:We conducted a search of PubMed and Google Scholar. Full article texts were reviewed. Reference lists were screened for additional articles and books. 37 basic articles in journals including ones written in German and three basic articles in books were identified. RESULTS:Glycogen staining of the ectocervical squamous epithelium with iodine goes back to Paul Ehrlich (1854-1915). Walter Schiller (1887-1960) examined nearly 200 different dyes and found that vital staining of the cervical squamous epithelium was best achieved with Lugol's iodine solution, which was indicated by Jean Guillaume Lugol (1786-1851) for disinfection of the vagina. In 1928 W. Lahm observed that the glycogen content of a squamous epithelium cell decreases as anaplasia increases. From the outset, H. Hinselmann included the iodine test in the minimum requirements for colposcopy. In 1946 H. J. Wespi first mentioned the finding of an "uncharacteristic iodine negative area." The first international colposcopic terminology from Graz in 1975 lists the "iodine light area" among the different colposcopy findings. The IFCPC nomenclatures from Rome 1990, Barcelona 2002, and Rio de Janeiro 2011 have evaluated the iodine test and classified their findings differently. A breakthrough to effective cervical cancer screening in resource-limited settings in Africa, India, and Latin America was achieved with R. Sankaranarayanan's publication on naked-eye visual inspection of the cervix after application of Lugol's iodine. CONCLUSIONS:This paper is a step toward a better understanding of what we think and do today with iodine testing and what problems and upcoming tasks will arise in future.

Zusammenfassung Durch die Einführung der sog. Krebsfährtensuche mittels Kolposkopie, Zytologie und Histopathologie durch Ernst Navratil (1902–1977) im Jahr 1946 kam es zu einem markanten Aufschwung der Gynäkopathologie an der Grazer Univ.-Frauenklinik. Dieser Aufschwung war im Wesentlichen Fritz Bajardi (1918–2006) und Erich Burghardt (1921–2006) zu verdanken. Diese haben in der Zeit ihrer klinischen Tätigkeit durch ihre Zusammenarbeit wesentliche Erkenntnisse über die Pathogenese des Zervixkarzinoms geliefert. Erich Burghardt ist es im Besonderen zu verdanken, dass die in der Literatur verstreuten diesbezüglichen Publikationen in einem synoptischen Werk zusammengefasst wurden. Es werden die richtungsweisenden Forschungsergebnisse von Bajardi und vor allem von Burghardt im Lichte des heutigen Erkenntnisstandes diskutiert.

Objectives: The history of the diagnosis and treatment of cervical precancer is fragmentary. Findings in the English-speaking and German-speaking areas vary considerably. We aim to describe the history of clinical advances in diagnosis and treatment of cervical precancer and identify areas where further work is required. Study design: We conducted a search of PubMed and Google Scholar. Full article texts were reviewed. Reference lists were screened for additional articles and books. 9 basic articles in German and 13 basic articles in books were identified. Results: The first images of the ectocervix were published by H. Lebert (1812-1879) in the middle of the nineteenth century. R. Meyer's (1864-1947) theory of erosions, which dominated cervical pathology in the nineteenth century, was later refuted in studies by C. A. Ruge (1846-1926) and J. Veit (1852-1917). In 1908 W. Schauenstein (1870-1943) recognized the step-by-step development of cervical cancer. H. Hinselmann (1884-1959) replaced the purely histopathological approach previously with the use of colposcopy. All conization methods applied today can be traced back to amputation of the ectocervix as first indicated by J. Marion Sims (1813-1883) in 1861. In 1928 M. N. Hyams was the first to describe an excision method that employed electrodiathermy. The method of cold knife conization is based on a publication by J.W. Scott from 1957. The final breakthrough to effective electrodiathermy was achieved with the publications of W. Prendiville. Conclusions: This paper is a step toward a better understanding of what we think and do today based on past findings of colposcopists and gynecopathologists. (C) 2020 Elsevier B.V. All rights reserved.

Mit dieser Kurzbiografie soll an den deutschen Gynäkopathologen Carl Gebhard ([Abb. 1]) erinnert werden, der ein bemerkenswertes Oeuvre hinterlassen hat, aber durch seinen frühen Tod in Vergessenheit geraten ist. Sein Hauptwerk, das er in erster Auflage vollenden konnte, war die „Pathologische Anatomie der weiblichen Sexualorgane“ aus dem Jahre 1899 ([Abb. 2]), das er mit den Zeilen begann: „… Meinem hochverehrten Lehrer Herrn Geheimen Medicinalrat Professor Dr. R. Olshausen in treuer und dankbarer Ergebenheit gewidmet …“ [1].

Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (HP) James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (EB, RHY) The authors declare no conflict of interest. Address correspondence to Hellmuth Pickel, MD. E-mail: [email protected].

Hintergrund: Diese retrospektive Untersuchung hat die parametrane Metastasierung in Abhängigkeit von der histologischen Tumorgröße bei Patientinnen mit operablem Zervixkarzinom im FIGO- Stadium Ia1-Ib2 untersucht. Wenn bei kleinen Karzinomen eine parametrane Metastasierung verlässlich seltener auftritt, könnte die Radikalität der Operation reduziert werden.

OBJECTIVE:Maternal mortality still remains a significant problem in obstetrics worldwide. Unchanged or even rising maternal mortality has been reported in several countries. The present study analyzed whether the pattern of maternal mortality has changed over the last five decades at the Department of Obstetrics and Gynecology of the Medical University of Graz.STUDY DESIGN:Starting in 1981, a registry of maternal deaths was established and regularly updated at our institution based on retrospective data. Between 1963 and 2012, a total of 187,917 women delivered. Thirty-five consecutive maternal deaths were observed and subdivided into 10 year cohorts.METHODS:The registry of maternal deaths included deliveries after 28+0 weeks of gestation. Puerperal deaths were defined as deaths up to day 42 post partum.MAIN OUTCOME MEASURES:Clinical data from maternal deaths were extracted from hospital records and autopsy reports.RESULTS:Maternal mortality rates declined from 35.0, 29.0, 2.4, 13.1 to 3.6 per 100,000 deliveries in the five subsequent periods, respectively. Sixty-six percent of women who died were 30 years or older. The cesarean section rate was 49%. Ninety-one percent of the 35 maternal deaths occurred in women with no significant medical history or risk factors. Seventy-five percent of deaths occurred after the 37+0 weeks of gestation. During all study periods, the prevalence of infections and hemorrhage was highest. The main causes of bleeding were uterine rupture and placental abruption, respectively.CONCLUSION:Even nowadays, peripartal maternal deaths occur mainly due to infections and hemorrhage and also in women with no significant medical history.

Die Gründung der Universität Graz erfolgte am 1. Jänner des Jahres 1585 im Zuge der Gegenreformation durch Erzherzog Karl II. von Innerösterreich. Sie beinhaltete ursprünglich nur 2 und später dann 3 Fakultäten, nämlich eine theologische und eine philosophische sowie schließlich eine Sprachenfakultät. Eine juridische und eine medizinische Fakultät fehlten. Die Universität wurde im Jahr 1586 an die Societas Jesu übergeben. Die Jesuiten waren mit der Rekatholisierung der damals mehrheitlich protestantischen Bevölkerung beauftragt und hatten zu dieser Zeit das Monopol für das gesamte Bildungswesen in den österreichischen Erblanden inne. Nach der Aufhebung des Jesuitenordens im Jahre 1773 wurde die bis dahin private Jesuiten-Universität Graz vom Staat übernommen.