[On the problem of the definition of ovarian pregnancy]. / Zur Frage der Definition einer Ovarialgravidität.

We report on a case of true ovarian pregnancy, and discuss the anatomical criteria required for the diagnosis of this rare type of ectopic pregnancy.

Fetal kidney volume and urine production in cases of fetal growth retardation.

The amount of amniotic fluid has a close correlation to the function of the fetal renal system. In many cases of fetal growth retardation oligohydramnios is obvious. The aim of this study is the investigation of the hourly fetal urine production rate (HFUPR) and the growth of fetal kidneys during pregnancy in cases of fetal growth retardation and to evaluate the renal participation in the origin of oligohydramnios in cases of growth retardation. In 52 healthy pregnancies and 27 cases with known fetal growth retardation, the volume of the fetal kidneys was measured sonographically and the hourly rate of fetal urine production was determined. Two third of the patients with fetal growth retardation had obvious oligohydramnios. In cases of fetal growth retardation the volume of the fetal kidneys was significantly smaller when compared to the control group, and the volume of fetal urine production was significantly lower. The reduced perfusion of the fetal kidneys in those cases with fetal growth retardation may be the reason for the reduction of the HFUPR. Due to the fact that HFUPR is a dynamical parameter and in close relationship to the perfusion of the fetal kidneys, the identification and measurement of this parameter may help to detect subacute and imminent fetal distress in cases of sonographically proven fetal growth retardation.

[Relevance of palpatory, mammographic and thermographic assessment criteria in benign and malignant structural changes in the female breast]. / Zur Relevanz palpatorischer, mammographischer und thermographischer Beurteilungskriterien bei gut- und bösartigen Strukturveränderungen der weiblichen Brust.

The correlation between clinical findings, mammography and thermography on the one hand and histological structure of the breast on the other hand, was investigated in 133 women. Palpable changes in the breast parenchyma indicated excision biopsy in all cases. The following criteria were employed for palpatory assessment: size, differentiation, nodular mobility and consistency. For mammography, criteria such as calcification, opacity, contralateral comparison and skin thickening were used. For thermography, a modified "Gautherie score" was employed. All three palpatory parameters, however, do not provide reliable differentiation between benign and malignant tumours, since the palpatory findings in fibrocystic disease are similar to those in large malignant growths. Small malignant growths, in turn, may resemble benign tumours. Furthermore, the group of fibrocystic disease markedly reduces the specificity of the radiological findings. However, as aid to differential diagnosis it may be said that apart from the shape of the shadow, contralateral difference in appearance is more likely to occur with benign and malignant tumours than with fibrocystic disease. With regard to thermography a low score i.e. an unconspicuous picture of heat distribution is unlikely to signify a malignant growth. It is, however, impossible to distinguish between mastopathy and malignant tumour. Additional investigations i.e. mammography and thermography do not rule out the existence of a malignant growth.

[Value of anamnesis and the clinical stress test in the diagnosis of incontinence before gynecologic operations]. / Die Aussagekraft von Anamnese und klinischem Stresstest in der Inkontinenzdiagnostik vor gynäkologischen Operationen.

In a study comprising 471 patients the clinical value of a standardized questionnaire (Gaudenz questionnaire) and the standing clinical stress test were determined in the diagnosis of urinary incontinence. The sensitivity, specificity and predictive value of the positive and negative test of both methods were ascertained. As opposed to the final urodynamic result the clinical stress test alone showed a sensitivity of 48% (specificity 70%) in the diagnosis of genuine stress incontinence. 82% of all patients with stress incontinence were ascertained by the questionnaire, but only 54% were classified correctly as negative. The specificity of both methods combined was 94% and the predictive value 89%. On the other hand the questionnaire's predictive value in the diagnosis of urge incontinence was 9% (specificity 58%). However, the predictive value of both questionnaire and standing clinical stress test, combined, rose to 15%. Our results statistically demonstrate that the use of both methods together provides more significant information than the use of either separately.

[Length of the uterine cervix toward the end of pregnancy--a sonographic study]. / Die Zervixlänge gegen Ende der Schwangerschaft--eine sonographische Studie.

In the last weeks of gestation a progressive effacement of the uterine cervix can be observed. 28 patients underwent sonographical investigation weekly between 30th and 40th week of gestation for measuring the cervical length. We found a significant shortening of the uterine cervix in primiparae by about 34.4%, in multiparae by about 41.9%. Sonographic measurement enables objective determination of the length of the uterine cervix and can be helpful in observing the course in cases of imminent preterm delivery.

[Correlation of labor onset, membrane rupture and birth with meteorological events]. / Korrelation von Wehenbeginn, Blasensprung und Geburt mit meteorologischen Ereignissen.

UNLABELLED: The birth-physiological events: beginning of labour, rupture of membranes and delivery of 6 539 cases in the years 1976 to 1981 can be correlated with five groups of weather situations: no definite pressure gradient, anticyclonic, meridional, zonal mild maritime, and cyclonic. THE RESULTS: temporary increase of the frequency of births in weather with no definite pressure gradient in summer, in anticyclonic weather in winter and in cyclonic weather in the first half of the year, correspond only partly (namely for the changes within the group of cyclonic weather) with the temporarily increasing number of births during a weather front, as it ist known from experience. The causes of the correlations found out are unknown, and the setting up of a statistical model and consequently an obstestrical-metereological forecast is impossible for the time being.

[Diagnosis of breast cancer in the clinical stage T1]. / Zur Diagnose von Mammakarzinomen im klinischen Stadium T1.

52 women with stage T1 breast cancer were investigated by thermography, mammography and ultrasound and the results compared with the patients age, histological tumour type and the degree of malignancy. The best results were achieved by mammography (sensitivity: 85%). In tumours with a large amount of connective tissue (scirrhous or invasive lobular cancer) sensitivity rose to 94%, whilst in tumours with little connective tissue (solid, medullary, adenomatous and papillary) sensitivity decreased to 69%. The respective values for thermographic sensitivity were 44% and 77% and for ultrasound sensitivity in palpable tumours 85% and 65%, respectively. On mammography 3 carcinomas were not recognized, all three in younger patients; on thermography also three false negative results were obtained, but all in older patients. The sensitivity of thermography increases in parallel with increasing degree of tumour malignancy. Whilst ultrasound is a valuable aid for differential diagnosis in palpable tumours only, screening results can evidently be improved by a combination of thermography and mammography.

[Velamentous insertion--epidemiology and clinical aspects of the pathological insertion of the umbilical cord]. / Insertio velamentosa--zur Epidemiologie und Klinik der pathologischen Nabelschnurinsertion.

Among 9460 birth an incidence of 1.6% of velamentous insertion of the umbilical cord is recorded and the clinical relevance of this anomaly is examined. Apart from statistical confirmation of well-known connections between membranous insertion of the umbilical cord on the one hand, and malformations, multiple pregnancies and bleeding sub partu on the other hand, the present investigation is mainly concerned with premature births and/or placental insufficiency in the case of velamentous insertion of the umbilical cord, which is associated with "late premature births" in the 35th, 36th and 37th week of pregnancy as characteristic finding.

[Role of endorphins in the function of the lower urinary tract]. / Rolle der Endorphine für die Funktion des unteren Harntrakts.

In order to investigate the influence of the endorphins on lower urinary tract function we antagonized the endogenous opiates with naloxone. We performed urodynamic examination in 17 incontinent women, administered intravenously 0.4 mg naloxone, and repeated the urodynamic examination. Bladder volume and pressure were not influenced by naloxone; the maximum urethral pressure showed a slight and urethral closure pressure a significant rise after naloxone treatment. Contrary to other authors, our results do not support a role of endorphins in lower urinary tract function.