[Premature rupture of fetal membranes at term: sequelae of conservative management. An analysis of a personal patient sample]. / Der vorzeitige Blasensprung am Termin: Folgen des abwartenden Vorgehens. Eine Analyse des eigenen Krankengutes.

Few procedures are less standardised than the procedure in case of pre-labour rupture of the membranes at term (PROM). We propose that management should be reviewed regularly on the basis of one's own data and be modified accordingly if necessary. For the duration of three months we analysed 400 pregnancies retrospectively. Patients with PROM were observed expectantly for 24 hours. If there were no spontaneous uterine contractions, labour was induced, depending on the degree of cervical dilatation. 10 percent of the cases studied had PROM. Of these a high proportion of 73 percent were primigravida, likewise 73 percent had an unripe cervix. The average time between PROM and delivery was 27 h. 50 percent of the babies were born 24 h after PROM. If delivery occurred more than 24 h after PROM, the rate of caesarean section (15 vs. 30 percent), the rate of forceps deliveries (11 vs. 20 percent), the rate of amnionitis (16 vs. 35 percent) and the number of admissions to the newborn-ICU (16 vs. 25 percent) almost doubled. The patients were examined vaginally relatively often prior to delivery (up to 18 times, with a mean of 8 times). We therefore recommend active management 6-8 h after PROM, should there be no onset of spontaneous uterine contractions. This is particularly beneficial to primigravida with an unripe cervix.

[Prevalence of lupus anticoagulant, autoimmune hemolysis, thrombocytopenia and disorders of platelet function in unselected patients with SLE]. / Prävalenz von Lupusantikoagulans, Autoimmunhämolyse, Thrombozytopenie und Plättchenfunktionsstörungen bei unselektionierten Patienten mit SLE.

Prevalence of lupus anticoagulant (LA) in patients with systemic lupus erythematosus (SLE) and clinical manifestations vary widely between different clinical series. We investigated the relation between LA, autoimmune hemolytic anemia (AIHA), thrombocytopenia and platelet dysfunction in 80 unselected patients with SLE. AIHA was found in 6 patients (7.5%) and thrombocytopenia in 10 patients (12.5%), which was not related to platelet aggregation abnormalities. Compared to controls, patients with SLE showed significantly prolonged aPTT and kaolin clotting time (KCT), but platelet aggregation induced by both collagen and thrombin was not impaired. LA activity as defined by Rosner et al. (index for LA/ICA) was found in 15 patients (18.9%). Only 7 of these patients showed a positive platelet neutralization test (Triplett) and 9a positive tissue thromboplastin inhibition test (Schleider). In our SLE patients 23.7% have suffered from at least one thrombotic complication. In patients with LA activity thromboembolic complications were increased (p < 0.05). Thrombocytopenia was found in 6% of LA-negative but in 20% of LA-positive patients.

Conduction velocities of pyramidal tract fibres and lumbar motor nerve roots: normal values.

Measurements of spinal cord and individual lumbar nerve root lengths were performed in 20 dissected cadavers. These data were correlated with the pyramidal tract and motor root conduction times obtained in 53 healthy subjects using motor evoked potentials. The distance between motor cortex and the level of the anterior horn cells ranged from 50.2 +/- 3.0 cm (mean +/- standard deviation) for the L1 segment to 54.4 +/- 3.6 cm for the L5 segment. The length of the motor roots from their exit from the myelon to their exit from the intervertebral foramen ranged from 10.3 +/- 1.7 cm in the L1 root to 17.5 +/- 1.9 cm in the L5 root. The central motor conduction velocity calculated for the distance motor cortex - anterior horn cells of the L5 segment was 50.1 +/- 4.5 m/s. The proximal peripheral conduction velocity of the motor nerve root between its exit from the spinal cord and its exit from the intervertebral foramen was 75.9 +/- 29.0 m/s. The overall conduction velocities between motor cortex and exit of the nerve roots from the intervertebral foramen were 57.4 +/- 6.3 m/s for the L4 fibers to the quadriceps femoris and 57.3 +/- 6.1 m/s for the L5 fibers to the anterior tibial muscle.