Die ovarielle Stimulation mit humanem, menopausalem Gonadotropin unter der hypophysären Suppression mit GnRH-Agonisten hat sich als neues Konzept in der Sterilitätsbehandlung etabliert. Es sollen die Schwangerschaftsverläufe von 134 Schwangerschaften einer kombinierten Applikation von GnRH-Agonisten/ HMG-Behandlung (Buserelin intranasal, Triptorelin i.m. und Leuprorelin subkutan) einem Kollektiv von 56 Schwangerschaften mit alleiniger HMG-Behandlung gegenüber gestellt werden. Es wurden alle Methoden der in vivo, in-vitro-Fertilisation und des intratubaren Gametentransfers zusammengefaßt.

Eyelid myoclonia with absences (EMA) and juvenile myoclonic epilepsy (JME) are two separate epileptic syndromes included in the new classification of epilepsies and epileptic syndromes by ILAE in 2001. Both are idiopathic generalized epilepsies with their clinical onset in the first two decades. EMA is characterized by eyelid myoclonia associated with absences and photosensitivity. Self-induced seizures are frequently seen in EMA. It can be associated with mildly mental retardation and resistance to treatment. JME includes three types of generalized seizures: typical absences, myoclonic jerks and generalized tonic-clonic seizures. The myoclonic jerks occur almost exclusively on awakening, involve preferently the upper extremities, may rarely affect the lower extremities or the entire body. More severe attacks may be accompanied by a fall. The myoclonic jerks occur rarely in EMA. They are usually mild and are freqently restricted to the upper extremities. Generalized tonic-clonic seizures, photosensitivity and generalized polyspike-wave discharges provoked by eye closure are features of both epileptic syndromes. In this study, we describe four female patients with eyelid myoclonia associated with absences, myoclonic jerks causing falling down and rare generalized tonic-clonic seizures. All patients had good school performance and total seizure control under sodium valproate treatment. Their EEGs show generalized polyspike-wave discharges with a frequency of 3.5–6 Hz always appearing a few seconds after eye closure and photoparoxysmal response. These patients show the characterictics of both epileptic syndromes. It is clinically important to make a syndromic diagnosis for an optimum advise on treatment, lifestyle restrictions and prognosis. In this study, we have gathered evidence that EMA and JME are dynamic syndromes that tend to evolve into one another.

All requirements of the conceptus, i.e. the fetus and the placenta are distributed by the maternal blood via the utero-placental vessels. Fetus and placenta need varying amounts of oxygen and nutrients at different stages of pregnancy. In the first half of pregnancy, the placenta, besides growth and development, fulfills the function of an endocrine gland whilst the nutrient supply of the fetus is of minor importance. In the second part of pregnancy, the placenta differentiates into an organ for exchange of gases and nutrients. Placental development may be divided into three stages: Implantation, growth and maturation. In the first half of pregnancy, the placental growth precedes the major fetal growth spurt, whereas, in the second half, the weight ratio placenta: fetus shifts in favour of the fetus and reaches 1:7 to 1:10 at the end of pregnancy. Growth and development of the placenta is the basis for fetal growth and it is not surprising that the weight ratio of the placenta and the newborn is positively correlated at the end of pregnancy. From the morphological point of view the development of the utero-placental circulation is characterized by a loss of the muscular elements in the wall of the peripheral parts of the spiral arteries supplying the endometrium and the intervillous space. These morphological changes functionally correlate with a reduction of resistance in the peripheral vessels. This can be visualized even doppler-sonographically as a reduction of pulsatility in the radial arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Aus früheren Untersuchungen ist bekannt, daß die Graviditätsrate nach hMG-Therapie bei Patientinnen mit hypogonadotroper und normogonadotroper Amenorrhoe zwischen 40 und 50% liegt und damit deutlich höher ist als bei Patientinnen mit einer zyklischen Ovarialinsuffizienz (Zimmermann et al. 1982). In diesen Untersuchungen zeigte sich weiterhin eine längere, latente Follikelphase sowie eine höhere hMG-Gesamtdosis in der Gruppe der normo- und hypogonadotropen Amenorrhoe-Patientinnen im Vergleich zu den Patientinnen mit zyklischer Ovarialinsuffizienz.

bei amenorrhoischen Patientinnen mit niedriger Gonadotropinsekretion,

Human placental villi from both normal and complicated pregnancies were examined by both light and scanning electron microscopy. The findings provide evidence that histological features such as syncytial sprouts, bridges, and a net-like arrangement of villi represent tangential sections of irregularly shaped villi rather than proliferative activity of the villous surface. Hence the two-dimensional appearance of paraffin and semithin sections has to be interpreted three-dimensionally in comparison with the respective scanning electron micrographs. In the light of these findings the various types of villous maldevelopment are summarized in a diagram which may be used as an aid for pathological diagnosis.

Human placental villi from normal and pathological material from the eighth to the 40th week of gestation were examined by light, scanning and transmission electron microscopy. Trophoblastic specializations--such as syncytial sprouts of early and late pregnancy, syncytial knots and syncytial bridges--were classified into proliferative and degenerative processes or artefacts caused by tangential sectioning. In early pregnancy and in diabetes mellitus most syncytial sprouts represent the initial phases in the development of villi. In late pregnancy, in particular in pre-eclampsia, most syncytial knots, sprouts and bridges are histological artefacts, caused by tangential sectioning of the trophoblastic surface. The chance of producing such artefacts is increased with increasing section thickness and with increasing branching and tortuosity of the villi. However, a small proportion of the syncytial knots, sprouts and bridges in the last-trimester placenta, those containing coarse pyknotic nuclei, are trophoblastic specializations of a probably degenerative character.