[Hemoperitoneum after early abortion of an abdominal pregnancy--reduced therapeutic options in case of delayed diagnosis]. / Hämoperitoneum durch frühen Abort einer Abdominalgravidität--suboptimale Therapiebedingungen bei später Diagnose.

BACKGROUND: Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. CASE: A 30- year-old woman (II-gravida, I-para) suffering for about 18 hours from "upper abdominal pain" was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a hemorrhagic shock, she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a intraabdominal bleeding (such as spleen rupture or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated. CONCLUSIONS: Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.

Elevated keratin 18 protein expression indicates a favorable prognosis in patients with breast cancer.

This study was performed to determine if keratin 18 (K18) has prognostic significance in breast cancer cell lines and patients with breast carcinoma. Paraffin sections of primary breast carcinoma tumors and human breast carcinoma cell lines were examined for K18 expression by immunohistochemical staining with the monoclonal antibody CK2. K18 protein expression was low in highly metastatic cell lines and, conversely, high in weakly metastatic cell lines, suggesting that it may function as a prognostic indicator. K18 expression was consequently examined in 134 patients with breast cancer. The staining intensity was compared with clinicopathological variables and follow-up data spanning 8 years. A definitive positive staining was observed in 22 (16.4%) women. The mortality rate was 4. 5% in the K18-positive group and 44.6% in the K18-negative group. Multivariate analysis found K18 expression to be an independent and significant predictor for overall survival.

Hepatocellular carcinoma as a rare cause of an excessive increase in alpha-fetoprotein during pregnancy.

A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase in alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of pregnancy. The amniocentesis revealed a normal AFP level in the amniotic fluid. Liver sonography in the 21st week of pregnancy showed a 5-cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of pregnancy, there was growth to 12 cm. The subsequently performed magnetic resonance imaging and fine-needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of pregnancy by cesarean section, and surgical therapy of the HCC followed.

[Prevention of neonatal risk by general screening for diabetes in pregnancy, intensive diagnosis and subsequent therapy]. / Vermeidung kindlicher Risiken durch ein generelles Gestationsdiabetes-Screening, intensivierte Diagnostik und konsequente Therapie.

Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.

[Adolf Gusserow (1836-1906), founding of the 2d University Gynecologic Clinic of the Charité and the Berlin Society of Obstetrics and Gynecology. IV]. / Adolf Gusserow (1836-1906), die Gründung der II. Universitäts-Frauenklinik in der Charité und die Berliner Gesellschaft für Geburtshilfe und Gynäkologie. IV. Mitteilung.

Adolf Gusserow was one of the outstanding German gynecologists at the end of the XIX. century. Although interested in the entire discipline of obstetrics and gynecology including related areas, he is merely unknown today. This paper describes the biography of Prof. A. Gusserow, but also his importance for the Berlin Society of Obstetrics and Gynecology.

[Our gynecologic heritage. Robert von Olshausen (1835-1915), pioneer in surgical gynecology. 5th contribution on the history of the Berlin Society of Obstetrics and Gynecology]. / Das gynäkologische Erbe. Robert von Olshausen (1835-1915), Wegbereiter der operativen Gynäkologie. V. Mitteilung zur Geschichte der Berliner Gesellschaft für Geburtshilfe und Gynäkologie.

Robert von Olshausen was an outstanding German gynecologist at the turn of the century and a pioneer of operative gynaecology. His fields of excellency were ovarotomy, the problems of asepsis, carcinoma therapy and the development of obstetrics in general. Under his chairmansship, the Berlin Department of Obstetrics and Gynecology (Universitäts-Frauenklinik) became the leading Clinic in Germany. For many years Olshausen was the chairman of the Berlin Society of Obstetrics and Gynecology, since 1894 as honorary chairman. The present paper is a biography of Robert von Olshausen, showing his importance for the development of the modern gynaecology in Berlin and Germany.

[115 years Berlin Society of Obstetrics and Gynecology: Carl Ludwig Ernst Schröder, progress and effect. Part III]. / 115 Jahre Gesellschaft für Geburtshilfe und Gynäkologie zu Berlin: Carl Ludwig Ernst Schröder, Werden und Wirken. III. Mitteilung.

115 years age (1876) in Berlin the Society of obstetrics and gynaecology was founded by fusion of the society of obstetrics (1844) and the society of gynaecology (1873). As first president was elected Carl Schröder, the new ordinarius of the Gynaecological Department (Universitäts-Frauenklinik). The present paper descirpt the live and work of Carl Schröder on the background of Berlin Gynaecology in last decades of the XIX. century.

[Pregnancy after successful therapy of HBV-associated hepatocellular cancer--a case report]. / Schwangerschaften nach erfolgreicher Therapie eines HBV-assoziierten hepatozellulären Carcinomas (HCC)--eine Kasuistik.

Malignant tumors are a difficult problem in obstetrics, both in pregnancy but also after an successful therapy, especially, if the patient wishes to be pregnant. However, there are borderline cases of medical and ethical regions. In the present paper the case of a young women (21 years old) with HCC is described. In the age of 16 years a solid hepatocellular carcinoma was found and treated by partial resection of the right lobus hepaticus. Anamnestically a blood exchange transfusion caused by a neonatal Rh-incompatibility and a hepatitis B in the age of 11 months are known. 3 and 6 years after the treatment, she was successfully pregnant and is today mother of 2 children.

[C-1 esterase inhibitor deficiency as an obstetric problem: a case report]. / C-1-Esterase-Inhibitor-Mangel als geburtshilfliches Problem: ein Fallbericht.

The present paper reports a case of C-1-esterase-inhibitor-deficiency in pregnancy. After preoperative i.v. application of 500 E-1-esterase the section caesarean was performed. Problems of this disease, relevant for obstetrics have been described. An interdisciplinary cooperation between obstetrics, anaesthetics and dermatologists is important.