Instruments for surgical treatment of female urinary incontinence with at least one arcuately curved in the longitudinal direction of the needle (10) having a distally disposed conical penetrating tip (11) which is configured in length and shape such that they are abdominally inserted through the abdominal wall of the patient, are guided along the pubic bone rear wall and exit vaginal, and a proximal needle connector part (12), a belt (30) each having a band connecting element (33) at its two ends, a feeding aid with insertion tool connector parts (22) with the needle connector part (12) and with the tape connector parts (33) in each case directly or by means of an adapter (40) are detachably coupled, characterized in that the feeding aid (20) consists of a flexible strand (21), the is so long that the feeding aid are guided with their ends of abdominal through the body of the patient and exit vaginal may thereby abdominal remains tangibly and at each end a feeding aid connector part (22).

Die Mechanismen, die in der Gravidität die Entwicklung eines immunologischen Gleichgewichtes zwischen Mutter und Fetus gewährleisten, sind trotz großen wissenschaftlichen Interesses noch unzureichend geklärt. Aufgrund der Bedeutung der HLA-Antigene in der Transplantationsmedizin wurden HLA-assoziierte regulative Mechanismen auch in der Schwangerschaft vermutet. Das spezifische Expressionsmuster der HLA-Antigene auf der Plazenta gilt als entscheidend für die maternale immunologische Akzeptanz des Feten. Darüber hinaus werden verschiedene indirekte Effekte klassischer HLA-Antigene oder HLA-assoziierter Gene auf Fertilität und Schwangerschaftsverlauf postuliert.

In this survey, findings relating to the control of infiltration by the cytotrophoblast during human placentation are reviewed, with particular reference to immunology and tumour biology. Possible effects on pregnancy and parturition due to failure of the regulatory processes involved in placentation are discussed.

Objective: To determine whether the unusually high number of CD56+ large granular lymphocytes (LGL) in the decidua of early human pregnancy arises from selective migration or in situ proliferation.Design: Controlled clinical study.Setting: Academic research environment.Patient(s): Thirty healthy women undergoing therapeutic abortion of an intact pregnancy at 5-11 weeks' gestation.Intervention(s): Decidua was obtained by suction curettage; tissue and isolated cells were subjected to immunohistochemical and flow cytometric investigation.Main Outcome Measure(s): Proliferation rate of LGL.Result(s): The proportion of CD56+ cells positive for the proliferation-associated Ki-67 antigen was found to be 7%-23.5% by three different methods of investigation. These findings are consistent with those of how cytometric analysis of the nuclear phase, which revealed 6%-22% of the LGL nuclei to be in the phases S + G(2) + M.Conclusion(s): The various methods of investigation revealed marked proliferative activity in the LGL of early pregnancy decidua. This finding suggests that in situ proliferation may be responsible for the high density of these cells in the decidua. (C) 1998 by American Society for Reproductive Medicine.

Zum Thema Im Rahmen der Implantation und der Ausbildung der frühen Plazenta nimmt das dezidualisierte Endometrium (Dezidua) zwangsläufig eine zentrale Rolle ein, da es an diesem anatomischen Ort zu einer Infiltration durch invasive Zytotrophoblastzellen embryonaler Herkunft kommt. Da dieser Vorgang in der Regel zeitlich und räumlich kontrolliert verläuft, stellt sich – insbesondere bei pathologisch verlaufenden Schwangerschaften – die Frage nach der Beteiligung des mütterlichem Immunsystems an dieser Regulation. In der folgenden Übersicht wird der aktuelle Erkenntnisstand über die Rolle von zellulären und humoralen Immunvorgängen im Rahmen der Dezidualisation und der frühen Ausbildung der Plazenta zusammengefaßt. Darüber hinaus werden die bislang publizierten Daten zu pathologischen Schwangerschaftsverläufen als mögliche Folge von immunologischen Fehlregulationen im Rahmen der Plazentation kritisch diskutiert.

In human placentation, anchoring villi develop to attach the placenta to the wall of the uterus. This attachment is brought about by extensive infiltration of the maternal tissue by cytotrophoblast cells of fetal origin. As trophoblast cells do not express classical histocompatibility antigens (HLA antigens), increasing doubt has been cast upon the "transplantation" model of pregnancy. However, more recently discovered, previously unknown HLA antigens on the invasive cytotrophoblast cells could lead to maternal immune responses similar to those observed following organ transplantation. Nevertheless, the biological behaviour of the invasive cytotrophoblast cells suggests more parallels with the processes of invasion and metastasis seen in malignant tumours, although there is regulation of the timing and extent of cytotrophoblast invasion of the uterus in normal pregnancy. In this survey, findings relating to the control of infiltration by the cytotrophoblast are reviewed, with particular reference to immunology and tumour biology. Possible effects on pregnancy and parturition due to failure of the regulatory processes involved in placentation are discussed.

This study was undertaken to test the accuracy of formulas we recently developed for the sonographic estimation of the weight of very preterm fetuses. The formulas were used to determine estimated weights from prenatal sonographic data for 62 premature infants born at 23-29 weeks of gestation, weight < or = 1,400 g. The mean absolute deviation of the actual birth weight from the estimated weight was 75.8 +/- (SD) 68.5 g, the mean percent deviation +0.60% and the absolute mean percent deviation 8.1 +/- (SD) 5.6%; 90.3% of the birth weights lay within 15% of the estimated weight. The model described represents an accurate method for prenatal estimation of the weight of very preterm fetuses.

Das Mammakarzinom ist die häufigste Krebserkrankung bei Frauen. Eine Senkung der Mortalität ist derzeit nur durch eine Verbesserung der Frühdiagnostik zu erzielen. Bislang galt die Mammographie als einzige Methode, die eine Früherfassung des Mammakarzinoms erlaubt. Die hierdurch zu erzielende Senkung der Mortalität wurde in den letzten dreißig Jahren weltweit durch zahlreiche Mammographie-Screeningstudien belegt [1]. Insgesamt erlaubt die Mammographie eine Mortalitätssenkung um etwa 30 % im Screening-Kollektiv. In einigen Studien wurde nach prä- und postmenopausalen Patientinnen gesondert untersucht. Bei Frauen ab dem 50. Lebensjahr zeigt sich ein noch deutlicherer Screeningerfolg. Dagegen erzielt die Mammographievorsorge bei Frauen vor dem 50. Lebensjahr keine Effektivität. Dies liegt daran, daß bei jungen Frauen das Drüsengewebe meistens dichter ist und eine höhere Strahlenabsorption aufweist. Dadurch verbergen sich häufig tumoröse Verdichtungen und sogar MikroVerkalkungen. Dies reduziert die Sensitivität der Mammographie bei prämenopausalen Frauen [10].

Heat shock proteins are highly conserved proteins present in organisms ranging from bacteria to man. They are both dominant microbial immunogens and among the first proteins produced during mammalian embryo development. Since bacterial and human heat shock proteins share a high degree of amino acid sequence homology, it has been suggested that sensitization to bacterial heat shock proteins during an infection may result in autoimmunity to human heat shock proteins. Infertile couples seeking in vitro fertilization (IVF) may have been previously sensitized to bacterial heat shock proteins as a consequence of an asymptomatic upper genital tract infection. Due to daily clinical monitoring and precisely timed fertilization these patients are an ideal study group to investigate the effect of prior sensitization to heat shock proteins on preimplantation embryo development and implantation failure. Immune sensitization at the level of the cervix to the 60 kD heat shock protein (hsp60) has been associated with implantation failure in some IVF patients. Similarly, the highest prevalence of circulating hsp60 antibodies among IVF patients was found in the sera of women whose embryos failed to develop in vitro. To more directly assess whether humoral immunity to hsp60 influenced in vitro embryo development, a mouse embryo culture model was established. Monoclonal antibody to mammalian hsp60 markedly impaired mouse embryo development in vitro. These data suggest that immune sensitization to human hsp60, possibly developed as a consequence of infection, may adversely affect pregnancy outcome in some patients.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 104, Issue 4 p. 503-505 Prenatally detected reversal of donor—recipient roles in twin-to-twin transfusion syndrome following in utero treatment Gunther Mielke, Corresponding Author Gunther Mielke Consultant (Obstetrics and Gynaecology/Prenatal Medicine) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanyCorrespondence: Dr G. Mielke, Department of Obstetrics and Gynaecology, University of Tuebingen, Schleichstrasse 4, D-72076 Tuebingen, Germany.Search for more papers by this authorRuth Mayer, Ruth Mayer SHO Institute of Pathology, University of Tuebingen, GermanySearch for more papers by this authorHeiko Franz, Heiko Franz Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanySearch for more papers by this authorMarkus Gonser, Markus Gonser Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanySearch for more papers by this authorKlaus Marzusch, Klaus Marzusch Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Wuerzburg, GermanySearch for more papers by this author Gunther Mielke, Corresponding Author Gunther Mielke Consultant (Obstetrics and Gynaecology/Prenatal Medicine) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanyCorrespondence: Dr G. Mielke, Department of Obstetrics and Gynaecology, University of Tuebingen, Schleichstrasse 4, D-72076 Tuebingen, Germany.Search for more papers by this authorRuth Mayer, Ruth Mayer SHO Institute of Pathology, University of Tuebingen, GermanySearch for more papers by this authorHeiko Franz, Heiko Franz Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanySearch for more papers by this authorMarkus Gonser, Markus Gonser Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Tuebingen, GermanySearch for more papers by this authorKlaus Marzusch, Klaus Marzusch Consultant (Obstetrics and Gynaecology) Department of Obstetrics and Gynaecology, University of Wuerzburg, GermanySearch for more papers by this author First published: 19 August 2005 https://doi.org/10.1111/j.1471-0528.1997.tb11505.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume104, Issue4April 1997Pages 503-505 RelatedInformation

anatomic approach developed by Delancey in the "hammock hypothesis."It is also possible to suspect pudendal nerve damage with a clinical examination and easy to confirm it with electrophysiologic exploratory procedures.Releasing these nerves with Shafik's procedure is the most appropriate and best-adapted solution to this type of problem. 3 This procedure, easily associated with suburethral sling and vaginal lifting procedures, brings about a better muscular control of both urinary and anal continence.Subsequently, the future, as conceived by Delancey, over the next 10 years is in many respects for us already reality.This reality, however, is still limited to a few practitioners who did not buy into Enhorning's theory.By not succombing to fashion and trends, they pursued the anatomic approach, which had guided their masters before them.

Numerous studies have suggested that interferon-gamma (IFN-gamma) exhibits an inhibitory effect on conceptus development during pregnancy, and recent investigations have shown that decidual CD56(+ +), CD16(-) large granular lymphocytes (LGL) contain mRNA for IFN-gamma. We have investigated the influence of exogenous interleukin-12 (IL-12) and interleukin-2 (IL-2) on IFN-gamma secretion by cultivated LGL and macrophages isolated from first trimester human decidua. The effect of decidual macrophages on IFN-gamma secretion by LGL was also assessed using co-incubation experiments. Neither IL-12 nor IL-2 stimulated the secretion of IFN-gamma by decidual macrophages. IL-12 alone, but not IL-2 alone, stimulated the release of IFN-gamma by LGL. However, IL-2 acted synergistically with IL-12 to enhance the release of IFN-gamma by LGL. Unstimulated and IL-12- and IL-2-stimulated LGL incubated with macrophages exhibited a marked increase in secretion of IFN-gamma compared to those in monoculture. This effect was also seen when the LGL and macrophages were separated by a semi-permeable membrane. The results suggest that interactions between decidual LGL and macrophages, possibly mediated by soluble factors, could play a role in regulating IFN-gamma secretion at the materno-fetal interface and thus contribute to the control of invasion by the trophoblast.

Background. Antiphospholipid antibodies, unassociated with an underlying connective tissue disease, have repeatedly been detected in women suffering from recurrent spontaneous abortions. Several therapeutic regimens have been advocated for pregnant women with recurrent fetal loss and antiphospholipid antibodies. However, most of these approaches were empirical, using several drugs simultaneously, and most reports describe single cases or limited series.

The aim of this study was to characterize the expression of the rhesus HLA-E ortholog Mamu-E, particularly at the maternal–fetal interface. Mamu-E expression was confirmed by locus-specific RT-PCR in the placenta as well as in peripheral blood mononuclear cells (PBMC) and other organs. We evaluated the utility of antibodies recognizing HLA-E (MEM-E/06 against native HLA-E, MEM-E/02 against denatured HLA-E) to detect Mamu-E by flow cytometry/immunofluorescence, Western blot, and immunohistochemistry (IHC). Western blot analysis of cells and selected transfectants confirmed the recognition of Mamu-E but not Mamu-AG by antibodies MEM-E/06 and HC10 but not MEM-E/02. Immunohistochemical staining of frozen sections of rhesus placenta with the MEM-E/06 antibody demonstrated expression in most populations of rhesus monkey trophoblast cells, including villous cytotrophoblasts (strong positive staining), apical membrane of syncytiotrophoblasts (light to moderate staining) and extravillous cytotrophoblasts (moderate to strong staining, especially endovascular trophoblasts in early pregnancy). Expression was not trophoblast cell-specific, especially at term, when endothelial cells in both the chorionic plate and placental villi showed strong staining for Mamu-E. Staining of rhesus extravillous trophoblast cells suggested the co-expression of Mamu-E and Mamu-AG (the rhesus HLA-G homolog) on these cells. MEM-E/06 was shown also to react with differentiating rhesus placental syncytiotrophoblasts in primary culture, detecting intracellular and weak surface expression of Mamu-E. We conclude that the gestation-dependent co-expression of Mamu-E with Mamu-AG in villous and extravillous trophoblast cells suggests important and perhaps complementary but distinct roles of these two non-classical MHC class I loci in pregnancy at the maternal–fetal interface. In addition, the MEM-E/06 antibody will be useful for the detection of Mamu-E at the maternal–fetal interface in the rhesus monkey.

Background: Matrix metalloproteinases have been shown to play an important role both in the invasive growth of malignant tumors and in human placentation. However, unlike tumor cell invasion, cytotrophoblast invasion is strictly controlled in its extent. Tissue inhibitors of metalloproteinases (TIMP) may play an important role in the modulation of cytotrophoblast growth into maternal tissue. Study Design: We have undertaken an immunohistochemical study of the distribution of TIMP-2 in the decidua of first trimester human pregnancy. Results: Moderate to strong staining for TIMP-2 was found in decidual stromal cells and the walls of blood vessels in all cases. No unequivocal staining of decidual leukocytes was seen. Conclusion: These findings suggest that TIMP-2 secretion in first trimester human decidua is confined to certain cell populations. Decidual stromal cells are probably an important source of TIMP and may contribute to the regulation of human cytotrophoblast invasion in vivo.

Background. Antiphospholipid antibodies, unassociated with an underlying connective tissue disease, have repeatedly been detected in women suffering from recurrent spontaneous abortions. Several therapeutic regimens have been advocated for pregnant women with recurrent fetal loss and antiphospholipid antibodies. However, most of these approaches were empirical, using several drugs simultaneously, and most reports describe single cases or limited series. Patients and interventions. In a pilot study, thirty‐eight women with a history of three or more consecutive first trimester spontaneous abortions and antiphospholipid antibodies were treated with intravenous immunoglobulin. As soon as pregnancy had been confirmed, intravenous immunoglobulin was administered at a dose of 300 mg/kg bodyweight, and infusions were repeated at three‐weekly intervals until the 16th–17th week of pregnancy. Results. Pregnancy proceeded beyond the first trimester in 34 of the patients (89.4%), and 31 patients (81.4%) gave birth to healthy infants at 37 to 42 weeks' gestation. Conclusions. Although the results are promising, randomized placebo‐controlled trials are necessary to exclude the influence of other factors (e.g. intense obstetric supervision and psychological factors) on pregnancy outcome and confirm the effectiveness of intravenous immunoglobulin in patients with recurrent spontaneous abortions and antiphospholipid antibodies.