[Site resolution study of venous outflow velocity and capacity by imaging plethysmography systems]. / Ortsaufgelöste Untersuchung der Venenentleerungsgeschwindigkeit und -kapazität durch bildgebende Plethysmographiesysteme.

Two imaging systems designed for plethysmography purposes are used to investigate venous capacity as well as maximum venous outflow. A series of pictures of the extremity are taken during a subsystolic blood obstruction. As a result, capacity as well as maximum outflow can be plotted as locally resolved profiles alongside the axis of the extremity. The advantage of the new method compared to conventional plethysmography is discussed.

[Prenatal diagnosis of sialidosis, a defect of the lysosomal enzyme neuraminidase]. / Pränatale Diagnostik der Sialidose, eines Defektes des lysosomalen Enzyms Neuraminidase.

Sialidosis, a lysosomal storage disease, ranged as oligosaccharidosis, is a genetic enzyme defect with a significantly restricted survival rate of the child concerned. After the preceded birth of a child who died of sialidosis, we succeeded in the correct prenatal exclusion of the disease with the prediction of a heterocygotic carrier status by biochemical analysis of cultivated amnion cells. The growth of these cells as well as the postnatal examined fibroblasts was significantly reduced. The possibility of the prenatal diagnosis of sialidosis allowed a pregnancy following the birth of a diseased child.

The importance of volumetry, lymphscintigraphy and computer tomography in the diagnosis of brachial edema after mastectomy.

Arm volumes of 360 patients with breast cancer were determined by a new optoelectronic technique. About 42% developed swelling of the arm after modified radical mastectomy which varied from mild (edema-volume 150-400 ml), moderate (400-800 ml), to severe (more than 800 ml) lymphatic edema. Lymphscintigraphy and computer tomography of the arms was also studied in different grades of lymphatic edema. Two years after operation and telecobalt-irradiation, one half of the patients without arm edema showed marked signs of a decreased capacity of lymphatic transport. In patients with severe lymphatic edema, the dynamic as well as the static evaluation of the lymphscintigrams revealed delayed transport, lack of radioisotope accumulation in the axillary region and notable congestion in the upper arm and forearm. Computerized tomography displayed a shift of fluid volume in the epifascial and subfascial tissue compartments and detected progressive structural changes in the soft tissue. Moderate edema not only increased the epifascial but also the subfascial compartments. In severe postmastectomy arm lymphedema, however, expansion of the epifascial space was paradoxically sometimes associated with a decrease in the subfascial compartment.

[Sonographic detection of an intragastric blood clot in neonatal hemorrhage disease]. / Sonographischer Nachweis eines intragastralen Blutkoagels bei Morbus hämorrhagicus neonatorum.

Caused by a hemorrhagic disease of a newborn without laboratory findings of coagulopathy, a dramatic blood loss due to gastrointestinal bleeding was observed in a high risk female newborn of 37. weeks of gestational age. By ultrasound the globular 3 centimeter diameter tumor in the stomach was defined as a blood clot. It disappeared in the following days under ultrasound observation.

[Objective measurement of lymphedema after mastectomy]. / Objektivierung des Lymphödems nach Mastektomie.

A new optic-electronic method for measuring arm volume was used on 275 women before and after mastectomy for carcinoma of the breast. Two weeks after modified radical mastectomy, an increase of over 150 ml in arm volume over the preoperative value was recorded in 12% of patients. Lymphoedema was demonstrated on average 19.3 months after the operation and telecobalt treatment in 42% of 200 women so treated; in 17% it was of moderately severe to severe degree (over 400 ml). In patients with severe lymphoedema a 15-day period of treatment reduced the oedema volume on average by 383 ml (62.1%). The described optic-electronic volumetric method makes it possible to obtain an objective comparison of swelling of the arm and thus early recognition and treatment of lymphoedema, as well as providing a means of assessing the effectiveness of any treatment.

[Vaginal closure using the purse string suture method in elderly women with total prolapse]. / Scheidenverschluss durch Schnürnaht bei alten Frauen mit Totalprolaps.

The occlusion of the vagina by a shirodkar type string suture is an emergency procedure. As a temporary measure in old patients with procedentia this procedure relieves the symptoms of the prolapse during the time needed to prepare the patient for surgery or the time needed by the patient to decide to have the operation performed. For severely ill in-operable patients the purse string occlusion of the vagina is a simple method to eliminate the discomfort of the procedentia. The procedure can be done under local anaesthesia and can be repeated.

[The informed patient. Efficacy of detailed information in patients with gynecological operations (author's transl)]. / Der aufgeklärte Patient. Effizienz eingehender Aufklärung bei gynäkologischen Operationen.

In medical routine the accusation of lack of information is raised more and more frequently. In the present studies the efficacy of detailed oral and written explanation was examined in 100 patients with gynecological operations. On admission to hospital 79% of the women stated they had been given information on the planned intervention by the doctor referring them to hospital. A written questionnaire on discharge showed, however, that the intensive and extremely individual efforts to inform them during the period of hospitalization are unsuccessful in about one third of the patients. Possible causes for this are the great confidence in the doctor, the psychic tension in the preoperative phase and lack of preparation for the operation. The observations give rise to new aspects for the assessment of declarations of consent for medical interventions.

[Influencing the maternal energy metabolism via infusion of xylite during childbirth (author's transl)]. / Beeinflussung des mütterlichen Energiestoffwechsels durch Xylitinfusion während der Geburt.

During parturition, there is an increase in the glucose, pyruvate and lactate levels in the maternal venous blood, as well as an increase in the concentrations of free fatty acids, d-(-)-3-hydroxybutyrate and acetoacetate. Peripartal acetonaemia in the mother can be reduced by infusing solutions which contain xylite. No essential increase in blood lactate levels was seen following in fusion of 0.4 g xylite/kg body weight. The acetone bodies reach the foetal blood via the placenta. It remains to be clarified as to how far they are an important source of energy during the newborn period.

[Tubal sterilization with the tupla-clip per laparoscopiam (author's transl)]. / Der Tupla-Clip zur Tubensterilisation per laparoscopiam.

This study refers about a newly developed plastic clip which has been used with good results for the past three years in tubal sterilization. By applying this method, heat or thermal injuries are avoided and a greater possibility of refertilization is indicated. This clinical evaluation consists of experimental data of 243 women who underwent sterilization in the local OB/GYN clinics at Fulda and at Bremerhaven. 59 women were sterilized during puerperium, and 184 were sterilized irrespective of pregnancy. As complications, 2 pregnancies were observed, further 3 hematomae within the broad ligament; 11 clips dropped into the free adbominal cavity while 5 clips broke during application. After the initial difficulties, the authors of this study recommend a sterilization with this tubal clip as an alternative to the usual methods of sterilization.

[The importance of hemorrhoids in gynecology and obstetrics (author's transl)]. / Die Bedeutung des Hämorrhoidalleidens in Gynäkologie und Geburtshilfe.

Hemorrhoids are of enough importance in gynecology and obstetrics that the gynecologist should be well versed in proctologic diagnosis and treatment. In the gynecological office practice about 19% of the patients and in the antenatal practice about 46% of the patients have hemorrhoids which require treatment. Prior to treatment an exact examination with the exclusion of carcinoma of the rectum is important. The indications for different modes of treatment are discussed. Minor hemorrhoids require only general and conservative measures. Recurrent and severe hemorrhoid problems require specific treatment. The specific treatment should be as tolerable for the patient as possible, have few recurrences and be economic regarding time and money. These requirements are best fulfilled by aspiration rubberband ligature or the combination of this ligature with cryotherapy.

[Combined rubber band ligation and cryosurgery of hemorrhoids (author's transl)]. / Kombinierte Gummibandligatur und Kryochirurgie von Hämorrhoiden.

By means of the combined rubber band ligation and cryosurgery of hemorrhoids a good therapy result was achieved on more than 200 patients. For the treatment of not too large hemorrhoid nodes and confluent hemorrhoids the aspiration ligation is quite sufficient. In third degree hemorrhoids, particularly in large prolapsing hemorrhoids, the rubber band ligation should include also the cryodestruction. In some cases two or three weeks later the cryodestruction has to be carried out again, depending on the finding and stage progredience. The advantage of this combined method is that the treatment can be performed on outpatients, and without much pains it is an effective therapy in any kind of hemorrhoid ailments. In addition, the postoperative complaints are less than by using the cryosond only. The application of cryotherapy shows also good results in the case of marriscae and anal fissures.

[Iron therapy and hemoglobin regeneration in pregnancy anemias and postpartum anemias (author's transl)]. / Eisentherapie und Hämoglobinregeneration bei Schwangerschaftsanämien und postpartalen Anämien.

The influence of oral doses of iron on the hemoglobin regeneration of pregnancy anemias and postpartum anemias was examined. The examinations were carried out in 45 pregnant women and in 70 puerperae. Other hematologic parameters besides hemoglobin were determined before, and 4 and 6 weeks during treatment with 110 mg iron sulfate daily. In pregnancy anemias, hemoglobin regeneration took place at a much slower rate under the iron therapy than was the case in postpartum anemias. Postpartum anemias of medium severity require for elevating the hemoglobin values to 12.0 g% at iron absorption rate of 22%, a treatment period of 35 days with a total amount of 3.8 g ferrous sulfate. In milder forms of anemia iron absorption diminished to 15% as hemoglobin conditions improved. An iron treatment course of 6 weeks will not be sufficient to cover the maternal iron deficiency during pregnancy and lyingin. To achieve optimum iron compensation, the daily supply of 100 mg iron will be necessary during pregnancy from the 16th week until delivery. In mild to medium anemias, postpartum iron treatment of 10 to 18 weeks' duration will be necessary until the exhausted iron deposits have been replenished.

[Iron or combined iron-folic acid-vitamin B12 therapy during pregnancy? (author's transl)]. / Eisen oder kombinierte Eisen-Folsäure-Vitamin-B12-Behandlung in der Schwangerschaft?

128 women with mild anemias below 12 g% Hb received 100 mg iron or 100 mg iron, 0.44 mg folic acid and 0.66 mg vitamin B12 daily from the 20th to the 24th weeks of pregnancy until confinement. With pure iron therapy the maternal hemoglobin, erythrocyte, hematocrit and serum levels rose significantly, whereas in the placebo group (37 pregnant women) they fell markedly. Iron-folic acid-vitamin B12 administration led to no improvement in the hemoglobin regeneration or in the serum iron. After 60 days' treatment with the combined iron preparation, a rise in the serum and erythrocyte folate levels had already been achieved in the pregnancy women.

[Comparison of temperature measurements during laparoscopic sterilization and the histologic findings of the cauterized segments of the fallopian tube (author's transl)]. / Temperaturmessungen und histologische Tuben-befunde bei laparoskopischer Sterilisation

During laparotomies the temperature generated by tubal sterilization with the laparoscopic equipment was measured continually in 32 fallopian tubes. The thermal damage to the fallopian tube caused by different energies and coagulation durations was examined microscopically. During the coagulation of the fallopian tube, with an energy of 20-30 watt temperatures of around 100 degrees C are produced at the point of coagulation. The effective coagulation time is dependant upon the energy created and the duration of the coagulation. The best histologic results were obtained with a duration of the coagulation of 60 seconds at an energy of 30 watts. This corresponds to an effective coagulation time of 50 seconds. The temperature of the coagulation instrument becomes normal within 1 to 2 minutes after the coagulation. If the electric energy is increased to 50 or 100 watt, sparking is observed almost consistently. With these energies, temperatures up to 600 degrees C are observed. The temperature of the metal parts of the coagulation forceps then become normal after 3-4 minutes. In order to avoid burns during laparoscopic tubal sterilizations and in order to obtain a good histologic result the procedure should be done with an electrical energy of 30 watt and a duration of the coagulation of 60 seconds.

PIP: Temperatures generated by laparoscopic equipment during tubal sterilization were measured continually in 32 Fallopian tubes. Thermal damage to the tubes caused by varying energies and coagulation durations was examined microscopically. Energies of 20-30 watts produce temperatures of about 100 degrees C at the point of coagulation. The best histologic results were obtained when coagulation took 60 seconds at 30 watts (effective coagulation time of 50 seconds). Instrument temperature returns to normal 1-2 minutes after coagulation. At higher energies, sparking occurs consistently, tubal temperatures up to 600 degrees C are observed, and instrumental temperature remains high for 3-4 minutes. To avoid burns and to obtain good histologic results during laparoscopic tubal sterilization, energies of 30 watts should be used with a 60-second coagulation time.