-Case report of clinical and pathophysiological similarities of Moschkowitz disease and HELLP syndrome-. / Kasuistik zu klinischen und pathophysiologischen Gemeinsamkeiten von Morbus Moschcowitz und HELLP-Syndrom.

This case report describes for the first time a manifestation of thrombotic thrombocytopenic purpura (TTP, Moschcowitz's disease) during pregnancy. The characteristic neurologic symptoms of TTP were missing, while the typical clinical signs of the HELLP syndrome could be observed. Furthermore the biochemical proof of TTP was obtained by tracing ultra-large clotting factor VIII (von Willebrand factor) multimers in the patient's plasma. Thus the assumption is supported that TTP and HELLP syndrome are diseases of one pathophysiological entity with different symptomatologies. Because of the frequent relapse of TTP, differentiation between TTP and HELLP syndrome is of great clinical importance, independent of future pregnancies.

[Different forms of hypertension in pregnancy: pediatric and maternal risks]. / Hypertonieformen in der Schwangerschaft: Kindliche und mütterliche Gefährdungen.

Incidence of hypertension in pregnancy is 5 per cent. Half of these 372 cases are gestational hypertensives. 24.4 per cent of the patients had preeclampsia and 20.2 per cent had chronic hypertension, 6 per cent of the patients with hypertension in pregnancy had a coincidental chronic kidney disorder. Only pregnant patients with preeclampsia are risk patients with respect to maternal health as well as to fetal risk.

[Various forms of hypertension in pregnancy and perinatal fetal condition]. / Hypertonieformen in der Schwangerschaft und perinataler kindlicher Zustand.

A prospective study analyses the course of pregnancy and the delivery of 315 women suffering from hypertension during their pregnancy. The perinatal state of the child is analysed as to the prevailing kind of hypertension. Gravidae suffering from gestation and chronical hypertensions, resp. (three forth of all kinds) delivered at birth term an eutrophic child. The proportion of spontaneous deliveries, acidosis morbidity, and of Apgar score was in correspondence with the average of all deliveries per annum without hypertension. The perinatal mortality among all kinds of hypertension was 1.6% caused only by children from gravidae suffering from preeclampsia and chronical nephropathy (corresponding to a quarter of all kinds). In comparison with gestation hypertension, chronical hypertension and the annual average of all deliveries, such gravidae prematurely delivered hypotrophic children of high acidosis morbidity and a worse Apgar score. Gravidae suffering from preeclampsia had an 80% abdominal delivery frequency. The prognosis of the child is made worse by appearance and severity of proteinuria.

[Clinical significance of the classification of hypertensive diseases in pregnancy]. / Klinische Bedeutung der Klassifikation der hypertensiven Erkrankungen in der Schwangerschaft.

In a prospective study we found a hypertonic disease in 5.26% of the pregnant women. The course of pregnancy and delivery in women with chronic hypertension (22.1%) and in women with a pregnancy hypertension (53.3%) was without complications; delivery of eutrophic children was on term. Pregnant women with pre-eclampsia (19.7%) had an early birth of dystrophic, retarded children (below the 10th percentile). The acidosis morbidity (36.4%) and the frequency of Caesarean section (79.2%) were significantly increased compared to other hypertension types. More often we found pathological para-clinical changes. The perinatal mortality occurred in women with pre-eclampsia in 10.4%. It was not increased in all other hypertension types. The emphasis in prepartal monitoring should be on women suffering from pre-eclampsia.

[Ehlers-Danlos syndrome and pregnancy]. / Ehlers-Danlos-Syndrom und Schwangerschaft.

There is reported about pregnancy and delivery of a 31 year old woman with Ehlers-Danlos syndrome type VIII. In the present case there were no complications. Occurrence of perilous injuries in other subtypes is discussed.

[Abdominal metastasis in breast cancer]. / Bauchraummetastasierung beim Mammakarzinom.

Report about three patients which were operated on due to a suspicion of ovarian cancer. In all three cases we could observed metastases of a primary breast cancer. This could be confirmed clinically, mammographically and histologically. In this connection problems of early detection and differential diagnosis have been discussed.

[Illness status, causes for disability and social factors influencing disability in pregnancy. 3. Social factors influencing disability]. / Krankenstand, Arbeitsunfähigkeitsursachen und soziale Einflussfaktoren auf die Arbeitsunfähigkeit während der Schwangerschaft. 3. Mitteilung: Soziale Einflussfaktoren auf die Arbeitsunfähigkeit.

The following statistically significant dependences could be demonstrated. The average duration of unfitness for work higher was with the increasing age. Unmarried pregnant women had a shorter average duration of unfitness for work than married ones. Corresponding to the degree of the professional qualification the average duration of unfitness for work increased. Pregnant women who were working in the industrial production, in the sphere of trade and service and in the educational system had a higher average frequency of unfitness for work than other groups of occupation. In connection with the results possible engagements and behavioural patterns of pregnant women are discussed, especially the correlations between occupation and pregnancy.

[Morbidity status, causes for work disability and social factors influencing work disability in pregnancy. 2. Causes for work disability]. / Krankenstand, Arbeitsunfähigkeitsursachen und soziale Einflussfaktoren auf die Arbeitsunfähigkeit während der Schwangerschaft. 2. Mitteilung: Arbeitsunfähigkeitsursachen.

The higher level of patients of pregnant woman in comparison with non-pregnant ones results from a higher unfitness for work which nearly corresponds to the increase of sicknesses depending on gestation. From all causes of unfitness for work more than 60% were depending on gestation. Causes for the half of the release from work depending on gestation were the three diagnoses threatening abortion, threatening premature birth and bleedings. On the total level of patients of 11.66% they had a share of 5.70% points. Infections of the ureter, the diagnosis' 'Other complications in pregnancy', hyperemesis and gestoses followed. Infections of the upper respiratory tract and influenza were the causes of all releases from work which were not depending on gestation. Their share on the level of patients amounted to 0.9% points. Releases from work because of sicknesses of circulation and of the digestive tract followed in their frequency. A number of further causes of unfitness for work had only a small share on the happenings of unfitness for work.

[Morbidity, causes of work disability and social factors influencing work disability in pregnancy. 1. Morbidity]. / Krankenstand, Arbeitsunfähigkeitsursachen und soziale Einflussfaktoren auf die Arbeitsunfähigkeit während der Schwangerschaft. 1. Mitteilung: Krankenstand.

The level of patients was analysed on 1,100 pregnant women. The average duration of unfitness for work amounted to 25.7 days. Up to the end of the 34th week of pregnancy 65.4% of the working pregnant women were one or several times unfit for work. Two thirds of all releases from work happened between the 17th and 34th weeks. Pregnant women with risk factors had a significantly higher average frequency and duration of unfitness for work. The indications for intensive care of pregnant women are to be set more severely. The professional expositions of pregnant women have to be more organised by labor rights. Individual behavioural patterns from the view of the doctor and of the pregnant women influence on the occurrence of unfitness for work.

[Retroperitoneal tumor in laparotomy]. / Retroperitonealer Tumor bei der Laparotomie.

There is reported on a fifteen-year-old female patient who was operated on under suspicion diagnosis of an ovarian tumour. The internal genital organs were normal, but a retroperitoneal tumour could be found within the pelvis. In this connexion differential diagnostic problems are discussed.