[Fatter through lipids or water. Lipohyperplasia dolorosa versus lymphedema]. / Dicker durch Fett oder Wasser. Lipohyperplasia dolorosa vs. Lymphödem.

Lipohyperplasia dolorosa and lymphedema are completely different disease entities, which are both, however, classified under lymphology. While in lipohyperplasia dolorosa a congenital lipid distribution disorder leads to a high volume insufficiency and the corresponding clinical symptoms, lymphedema is characterized by a congenital transport incompetence of the vessels or acquired disorders of transport capacity. Both lymphedemas of different genesis are familial volume alterations of the affected regions and the increase in volume is irreversible if not exclusively still in stage I or II. According to current knowledge the solid increase in volume by lymphedema is due to a malfunctioning biomechanism by which the release of additional proteoglycans in the homeostasis system of the fluid in the interstital space plays an important role. Removal of this tissue and the sponge-like substance of proteoglycans is the aim of therapeutic approaches. Manual lymph drainage and compression can evacuate the sponge but not remove it. Lymphological liposculpture is a successful dermatosurgical measure even for secondary lymphedema. Reduction of the necessity of complex hemostasis therapy to 20% of the initial value and an adjustment of the affected extremity on the healthy side, represent a clear improvement in quality of life of patients. The same dermatosurgical method, lymphological liposculpture, has been known for many years to fulfil the successfully proven purpose for the treatment of lipohyperplasia dolorosa by the removal of subcutaneous fatty tissue, present as hyperplasia and not hypertrophy. Tenderness and the necessity for complex hemostasis therapy are no longer present or no longer necessary after lymphological liposculpture for lipohyperplasia dolorosa. This condition is permanent because the congenital fatty masses do not reoccur following surgical removal. Lipohyperplasia dolorosa is therefore curable by lymphological liposculpture. For secondary lymphedema a drastic improvement in quality of life of the patient can be achieved by this method which is demonstrated by the adjustment of symmetry of the extremities and reduction or even avoidance of complex hemostasis therapy.

[Lymphologic liposculpture]. / Lymphologische Liposkulptur.

Surgical approaches are usually not part of the strand rad approach in lymphologic therapy. Classic therapy is conservative and controls symptoms rather than seeking cures. Plastic surgical tissue reduction results in impaired lymph flow in many cases. Improving the lymphologic disease while reducing the need for complex compression therapy are major therapeutic goals. Lymphologic liposculpture offers a successful way to treat lipohyperplasia dolorosa and offers a new concept in the treatment of secondary lymphedema.

[From dermabrasion to laser. Development of operative-interventional methods in aesthetic dermatology]. / Vom Schleifen zum Laser: Entwicklung operativ-interventioneller Methoden in der Kosmetik.

Many operative-interventional methods are available for aesthetic dermatology. The established high-speed dermabrasion as developed by Schreus has been replaced in many indications by newer approaches. Laser ablation can be effectively used for resurfacing of sun-damaged or scarred skin, but is associated with extensive side effects. Newer developments such as fractionated laser treatment are designed to fill the gap between ablative and non-ablative skin resurfacing. The side effects are much less severe, but the effectiveness must be confirmed in larger studies. Photorejuvenation with intense pulsed light (IPL) offers a wide variety of treatment parameters for a broad spectrum of skin changes. Both superficial and deep structures can be treatment in one session using IPL.

[The tick fauna of eastern Germany]. / Zur Zeckenfauna Ostdeutschlands.

The occurrence of several tick species in selected areas of Eastern Germany is described. From May 1987 till December 1989 8,472 ticks from 430 places were examined. Ixodidae of the genus Ixodes, Dermacentor and Haemaphysalis as well as Argasidae of the genus Argas were identified. The most common species was Ixodes ricinus. Furthermore, an endemic area of Dermacentor reticulatus was detected in the Düben-Dahlen and Annaburg health. Two other species of ticks, which were found frequently and sometimes with a high intensity on the host were Ixodes hexagonus and Ixodes canisuga. On the other side the species Haemaphysalis concinna and Argas vespertilionis were present at only one respectively two places and with a low population density.

[A bioassay for the testing of the oxytocic effect of hormone analogs of the neurohypophysis and the pineal body]. / Ein Bioassay zur Austestung der oxytocischen Wirksamkeit von Hormonanaloga der Neurohypophyse und Zirbeldrüse.

An improved bioassay for the testing of oxytocic compounds by the use of myometrium layer preparations has been developed and proved with synthetic oxytocin. The oxytocic activity of synthetic analogues was testes with this bioassay and compared to oxytocin. The myometrial layer preparation was demonstrated to be reliable, the vitality of the tissue is found for more than 8 hours. The sensitivity of the bioassay is found in the region of 10(-11) Mol/l oxytocin, the maximum of the stimulation of muscle strips varied from 5 X 10(-5) IU/ml to 10(-4) IU/ml oxytocin in the organ-bath. The concentration of the myometrium strips showed two different phases. Only the initial phase can be used for this bioassay. The calculation of the results was afforded planimetrically and by measuring of the concentration-maximum during the testing period. The synthetic hormone analogues [1-desamino-4-alpha-aminobutyric acid] lysine-vasotocin (2) and [4 alpha-aminobutyric acid] lysine-vasotocin had oxytocic activity and the myometrium was activated to contractions at 10(-8) Mol/1. The analogue 2 was 5-10 more active than 3. The contraction maximum for both analogues was found between 5 X 10(-6) and 5 X 10(-5) Mol/l. The induction of the concentration for both analogues varied with the factor 10(5).

[Plasma concentration of PGE2, PGA2 and PGF2 alpha in the course of pregnancy (author's transl)]. / Plasmakonzentrationen von PGE2, PGA2 und PGF2 alpha im Verlauf der Schwangerschaft.

Plasma levels of PGE2, PGA2 and PGF2 alpha were determined by radioimmunoassay in maternal cubital vein blood of 210 women and once during pregnancy. In the course of pregnancy plasma levels of these prostaglandins varied considerably: 0,09-1,83 ng PGE2/ml, 0,12-2,8 ng PGA2/ml and 0,04-0,5 ng PGF2 alpha/ml. At term (40 and 41th week) prostaglandin levels were found to be low and within a range of: 0,15-0,25 ng PGE2/ml; 0,12-0,23 ng PGA2/ml and 0,2-0,3 ng PGF2 alpha/ml. Determination of prostaglandin levels in numerous samples from different women during pregnancy did not show continuous changes nor in the pattern of the distribution of PGE2, PGA2 and PGF2 alpha.

[Plasma levels of PGE2, PGA2 and PGF2 alpha during spontaneous labour]. / Plasmaspiegel von PGE2, PGA2, und PGF2 alpha im Verlauf der Spontangeburt.

Plasma levels of PGE2, PGA2 and PGF2 alpha were determined by radioimmunoassay in maternal venous blood during different phases of uterine contractions. Mean prostaglandin levels during labor were: PGE2 = 2,25 +/- 1,3 ng/ml (mean +/- SD), PGA2 = 2,86 +/- 1,55 ng/ml and PGF2 alpha = 0,58 +/- 0,37 ng/ml. The approximate ratios between the prostaglandin concentrations were: PGE2:PGA2: PGF2 alpha = 1:1-3:0,3. No changes of PGE2 levels were found in the course of concentrations during the first and second stage of labor. At delivery and at the contraction followed by the expulsion of the placenta, PGE2 concentrations rose from the beginning of the contraction (2,21 +/- 0,07 ng PGE2/ml) to the maximum of the contraction (4,31 +/- 0,56 ng PGE2/ml). PGA2 levels did neither show a correlation to the course of contractions nor to the different stages of labor, but were considerably different between patients during the first stage of labor (e.g. 1,9 +/- 1,1 ng PGA2/ml) and during the second stage of labor (3,36 +/- 2,8 ng PGA2/ml). Mean PGF2 alpha concentrations were between 0,21 +/- 0,12 ngPGF2 alpha/ml (1st stage) and 0,81 +/- 0,11 ng PGF2alpha/ml (highest value obtained, 1st stage of labor, too). There was no correlation between PGF2 alpha concentrations and the course of contractions during the different stages of labor.

[On the effect of PGE2 and PGF2 alpha on circular and longitudinal myometrium strips of different corpus uteri tissues of the guinea pig in vitro (author's transl)]. / Die Wirkung von PGE2 and PGF2 alpha auf zirkuläre und longitudinale Muskelstreifen verschiedener Uterussegmente des Meerschweinchens in vitro.

The effects of PGE2 and PGF2 alpha on corpus uteri and cervix strips of guinea pigs were studied in vitro. Myometrium strips developed maximal contraction activity at concentrations of 10(-7) M PGE2 and 5 x 10(-7) M PGF2 alpha in the organ bath, respectively. As for corpus uteri myometrium strips, longitudinal (extern) and circular (intern) layers of the organ wall showed comparable Prostaglandin-induced contractions. On the other hand, longitudinal and circular strips from cervix uteri tissue showed adverse Prostaglandin effects: PGE2 relaxed the cervix strips by lowering the muscle tone, the contraction frequency and a complete stop of contractions within most experiments lasting for an average time of 15 min. PGF2 alpha induced strong contractions of the same kind like corpus uteri strips did. The results indicate a role of PGE2 in the opening of the cervix, whereas PGF2 alpha possibly plays a role in the involution of the uterus post partum.

Combined batchwise and continuous flow mechanization of solid-phase radioimmunoassays.

A new modification of the "coated-tube"-technique for the radioimmunoassay of human placental lactogen is described. Polyvinylchloride capillaries are used as reaction-vessels. Most working steps of the test procedure are mechanized. The possibilities and limitations of the new technique are discussed. The reliability of the method was shown by a recovery test, dilution tests, reproducibility and a comparison of the results for 71 sera, ranging from the 6th to the 42nd week of pregnancy, with those obtained by a conventional assay procedure.

[Pharmacokinetics of piracetam during delivery]. / Zur Pharmakokinetik von Piracetam während der Geburt.

The excretion of Piracetam was monitored by measuring the concentrations in maternal and fetal substrates during labor in nine volunteers. Piracetam was tolerated without side-effects and injected in the maternal cubital vein. Consecutively, maternal plasma and urine samples as well as amniotic fluid portions were collected during labor. at delivery, fetal blood from placenta and the first fetal urines were collected. Biostatistical methods showed that approximately 50% of Piracetam were eliminated 80 minutes after the injection of the drug. In amniotic fluid a continuous rise of Piracetam concentrations was monitored until delivery. In fetal plasma and urines the substance could be detected. The rapid excretion of Piracetam during labor was obviously typical for the situation sub partu; reasons are discussed.

[Observations on prostaglandin effects with myometrium strips of human gravid uterus in vitro. Influence of diclofenac on contractions induced by prostaglandin (author's transl)]. / Beobachtungen über Prostaglandineffekte an Myometriumstreifen vom menschlichen graviden Uterus in vitro. Einfluss von Diclofenac auf Prostaglandin-induzierte Kontraktionen.

The effect of Diclofenac (Voltaren) was studied on PGE2- and PGF2alpha-induced contractions of pregnant human myometrium in vitro. Tests to establish experimental conditions revealed that PGE2 and PGF2alpha affect the myometrium differently from I. and IInd trimenon uteri. PGF2alpha always induced contractions in corpus uteri as well as cervix strips. PGE2 relaxed myometrium strips obtained from superficial muscle layers and from cervix tissue and caused contractions in the myometrium from the central parts of the corpus uteri. Diclofenac (Voltaren) at concentrations of 10(-5) to 10(-4) M inhibited PGE2 and PGF2alpha-induced contractions. The inhibition was demonstrated by planimetric evaluation of the contractions curves. Contraction activity of I. and IInd trimenon myometrium strips was reduced by Diclofenac but not completely inhibited. From uteri at term, three contraction curves showed complete cessation of PGE2-and PGF2alpha-induced contractions by Diclofenac (10(-4) M). The dose-dependent reduction of myometrial contractions induced by exogen prostaglandins indicates that Diclofenac possesses a direct effect on PGE2 and PGF2alpha-induced contractile activity of the uterus.

[Termination of pregnancy during the IInd and IIIrd trimester with Sulproston (SH B 286 AD) (author's transl)]. / Intensivüberwachung von Aborteinleitungen im II. und III. Trimenon mit Sulproston.

Sulproston (SH B 286 AD), a PGE2-derivate, was used for termination of pregnancy in 40 patients during the IInd and IIIrd trimester. Mean abortion time was 12.7 hours (range:4 to 26 hours). Sulproston was given intravenously (150 to 1000 micrograms) or via an extraamnial catheter (200 to 400 micrograms). One single dose of 500 micrograms was sufficient in 26 patients. Five women required a dose of 150 to 400 micrograms, four patients a dose of 500 to 1000 micrograms. The rate of side effects was low and included freezing, nausea, vomiting or abdominal spasms and dyspnea in one case. An obligatory curettage followed the abortion without exception. There was no statistical significance for changes of blood pressure and heart rate during the perfusion of Sulproston and in the course of the abortion.

[Alpha-fetoprotein, HPL, ostriol and SP1 concentrations in prostaglandin-induced mid-trimester abortions (author's transl)]. / Verhalten von Alpha-Fetoprotein, HPL, Ostriol und SP1 bei prostaglandininduzierten Mid-Trimester-Aborten.

Maternal serum concentrations of AFP, HPL, SP1 and Estriol were measured in the course of prostaglandin-induced abortions. Termination of pregnancy between the 13th and 25th week of pregnancy was done for medical reasons. Patients were treated with PGE2, PGF2alpha and with 16-phenoxy-PGE2-methansulfonamid, respectively. Prostaglandins were administered systemically, i. e. intravenously. Current measurement of HPL and AFP-concentrations showed a contrary sense. These changes of concentrations were related to fetal death and membrane rupture in some cases as is demonstrated in four diagrams. Typical and sharply decreasing values of Estriol followed fetal death in patients with intact pregnancies before. As for an anencephalic fetus, AFP-concentrations increased slightly too, HPL values decreased like in other abortions. Only minimal changes of SP1 concentrations were found generally in all patients and during abortion time.

[Coagulation factors and thrombocytes after application of Reptilase in the course of gynecologic operations (author's transl)]. / Gerinnungsfaktoren und Thrombozyten nach Gabe von Reptilase bei gynäkologischen Standardoperationen.

Hemostasiologic effects of intravenous application of Reptilase were investigated in a randomized double blind study in the course of normal abdominal and vaginal hysterectomies. Coagulation factors and thrombocytes were checked before, after, 40 minutes after as well as 24 hours after the operation. Significant shortening of the clot observation time resulted 40 minutes after the injection of 1 ml Reptilase. A small but highly significant decrease of thrombocytes was observed 40 minutes after the end of the operation when Reptilase was injected. Further coagulation screening tests: Quick test, PTT and thrombin time were without statistically differences in both patients groups from the beginning till 24 hours after the operation. A significant decrease in Factor V concentrations resulted 40 minutes after the injection of Reptilase, whereas no changes were seen in the placebo patient group. Too, Factor XIII values and Antithrombin 3 concentrations decreased after the administration of Reptilase. There was no abnormal raise of fibrin-monomers in both groups. Enhanced fibrinolysis with elevated FDP-levels were measured in none of the cases. The administration of Reptilase induced a short lasting augmentation of blood coagulation but without any signs of disseminated intravascular coagulation.

[Symptomatic therapy of primary dysmonorrhea by inhibition of prostaglandin synthesis with indomethacin (author's transl)]. / Symptomatische Therapie der primären Dysmenorrhoe durch Prostaglandinsynthesehemmung mit Indomethacin.

In a controlled trial the effect of indomethacin was studied in 54 patients with primary dysmenorrhea. 34 patients were treated with 3 X 25 mg indomethacin per day orally for 5 days starting 2 days before onset of menstruation. Treatment was continued for 4 months, 20 patients received a placebo preparation. Symptoms of dysmenorrhea were reduced by 66-73% over the control group during all 4 treatment periods. 18 patients of the treated group reported complete relief from symptoms, 10 a marked improvement. Only 3 patients reported no effect of the drug, while in 3 other patients the treatment had to be discontinued due to the well-known untoward effects of indomethacin (nausea, vertigo). The therapeutic efficacy of indomethacin supports the concept of an essential role of prostaglandins in primary dysmenorrhea. The use of prostaglandin-synthetase inhibitors (aspirin-like drugs) is discussed for patient with primary dysmenorrhea who cannot be treated by contraceptive steroids.

[Pharmacokinetic of piracetam during labour influence to acid-base-status in maternal and fetal blood (author's transl)]. / Pharmakokinetik von Piracetam während der Geburt. Einfluss auf den Säure-Basen-Status im maternen und fetalen Blut.

PIRACETAM concentrations in fetal and maternal blood were measured during the first and second stage of labor and the elimination in maternal and fetal blood was studied. Fetal heart-rate, pH- and base-excess of the maternal and fetal blood were investigated to evaluate the influence of PIRACETAM on the acid-base-status of mother and child. PIRACETAM was administered intravenously to 43 patients in a dosage 2 g, 4 g and 6 g. The concentration in the maternal and fetal plasma was measured by gaschromatography. Before and after the injection of PIRACETAM and at delivery, blood was sampled from the mother's earlobe and the umbilical artery and vein, respectively. The results were compared with a control group. There was an exponential fall of PIRACETAM concentration in maternal and fetal blood. Maternal and fetal elimination half-life of PIRACETAM was about 112-98 minutes and 200 minutes, respectively. A fairly good correlation between the concentration of PIRACETAM in maternal and fetal blood was found. The fetal PIRACETAM concentration was about 50% below the maternal values. Fetal heart-rate, maternal and fetal pH- and base-excess-values were not significantly altered following PIRACETAM infusion. It may be concluded, that there exists a transfer of PIRACETAM across the placental barrier. However, the cytoprotective effect of PIRACETAM, as described in animal observations and by investigations in human, could not be verified by the methods and technology used in this study.