Shaping the System - The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG).

Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system.

Potentially therapeutically relevant differences of antisense oligonucleotide uptake in CD34+ hematopoietic stem cells, leukemic blasts and cancer cells from patients.

Antisense oligonucleotide (ON) technology, e.g. against drug resistance or antiapoptotic factors, may play an important role in future cancer chemotherapy. An unanswered question in this field is the capacity for uptake of antisense molecules in normal and malignant patients' cells. Therefore, we examined the cellular uptake of FITC-labeled phosphorothioate modified ONs in: i) cells from the T-lymphoblastoid cell line CCRF-CEM, ii) CD34+ hematopoietic progenitors from healthy donors, iii) blasts from ALL or AML patients, iv) cells from the ovarian cancer cell line A2780 and v) cancer cells from malignant fluids. The cationic polymer ExGen was taken as a carrier for transfection, while FITC-ON uptake was evaluated by flow cytometry. We found marked differences between these cell types. Cancer cells from the cell line A2780 and from patients showed a distinctly enhanced uptake compared to hematopoietic progenitors and leukemic blasts. Since bone marrow toxicity substantially limits any conventional chemotherapeutic regimen, a better ON uptake in cancer cells compared to hematopoietic precursors might give an advantage for therapeutic approaches using e.g. ON-based chemosensitization.

Vaginitis emphysematosa during immunosuppressive therapy.

We report a case of vaginitis emphysematosa in an immunosuppressed renal transplant patient without detectable infection. Immunological factors may have been involved in the pathogenesis.

[Dopamine antagonists in anovulation?]. / Dopaminolytika bei Anovulation?

Increased hypothalamic dopamine turnover may prevent the ovulatory LH peak by different mechanisms and may in this way result in anovulation. Ten patients with anovulatory menstrual cycles who had been treated with clomiphene citrate without success were given the dopaminolytic drug pimozide (Antalon) at a dose of 5 mg/day orally either from day 7 to day 11 (7 women; group 1) or from day 11 to day 15 of the menstrual cycle (4 women; group 2). One patient from group 2 ovulated during the treatment cycle. A further woman from this group exhibited an LH peak, but did not ovulate, whereas a slow increase of the circulating LH level was recorded in the remaining two patients. Systematic investigations should clarify whether introduction of dopaminolytic therapy in the treatment of hypothalamic anovulation may be justified.

[Ovulation induction using clomiphene conversion]. / Ovulationsinduktion durch Clomifenkonversion.

20 anovulatory and clomiphene resistant patients had been treated by the so called clomiphene conversion. Pregnancies could be achieved in 6 women. 7 further patients reacted by ovulation. In selected cases the clomiphene conversion may be an alternative of therapy with gonadotrophins and GnRH pulsatile.

[Initial experiences in the use of pulsatile Gn-RH administration for ovulation induction]. / Erste Erfahrungen beim Einsatz der pulsatilen Gn-RH-Applikation zur Ovulationsinduktion.

In 9 patients the pulsatile administration of Gn-RH for the induction of ovulation was given in 13 treatments, we used the minipump Zyklomat of the firm Ferring and a Gn-RH pump from ZID Karlsburg. The administration was carried out for 10 to 18 days with dosages from 2.5 to 20 micrograms Gn-RH per pulse. 9 patients did ovulate and 5 patients became pregnant.

[Release of estrogen-induced positive feedback in the follicular phase]. / Zur Auslösung des estrogeninduzierten positiven Feedback in der Follikelphase.

Influence of estradiol on the secretion of pituitary gonadotropins in a sense of positive feedback in formating not until the progress of development of puberty. Appearance of positive feedback mechanism, which cause the secretion of LH and FSH reason of increasing estrogen doses, induces menstrual cycle. In 10 healthy, normally menstruating women plasma LH and FSH have been measured before and every 12 hours after an intramuscular injection of 50 micrograms estradiol benzoate per kg body weight. A positive feedback could be observed between the 5th and 14th day of the menstrual cycle. At first the LH-concentration decreased and then after 36-48 hours estradiol benzoate injection induced an increase of LH.

[Detection of the early pregnancy factor (EPF) in the serum of patients with questionable pregnancy]. / Zum Nachweis des Frühschwangerschaftsfaktors (early pregnancy factor, EPF) im Serum bei Patientinnen mit fraglicher Schwangerschaft.

The early pregnancy factor (EPF) has been detected in sera of 24 women with a doubtful pregnancy by means of the rosette inhibition test using a horse antihuman lymphocyte serum. In all sera of women with an intact early pregnancy the EPF was found, furthermore in a pregnancy ending as abortion and two cases of an Arias Stella phenomenon. In non-pregnant patients the EPF was not detectable with exception of two patients under medication and one patient suffering from dysmenorrhea membranacea.

[Bromocriptine therapy of prolactinoma in pregnancy]. / Bromokriptintherapie in der Gravidität bei Prolaktinom.

A report is given about the course of pregnancy and delivery of two patients with prolactin-producing pituitary adenomas and therapy with bromocriptine. Different views about treatment of prolactinomas in pregnancy are discussed. Pregnancy care has to be in close cooperation between endocrinologists and obstetricians.