[Acute disease of the pelvis: differentiation between gynecologic and surgical cause]. / Akute Erkrankung im Unterbauch: Differenzierung zwischen gynäkologischer und chirurgischer Ursache.

An acute disorder of the lower abdomen requires early clarification, whether or not it is of gynaecological or surgical origin. With non-gynaecological affections, beside diverticulitis, Crohn's disease, perforations, bowel obstructions, yersiniosis, vascular diseases (acute embolism, thrombosis or dissection), urological disorders or hernias, acute appendicitis has firstly to be considered. The systematic use of the different diagnostic instruments is discussed.

[Differentiation between a gynecologic and surgical origin in pathological pelvic resistance]. / Differenzierung zwischen gynäkologischer und chirurgischer Genese bei pathologischen Unterbauchresistenzen.

Besides typical gynaecological tumours colorectal neoplasms, Crohn's disease, dystopic kidneys, mesenteric cysts, tumours of the small bowel, perityphlitic abscesses, retroperitoneal sarcomas, lymphomas of the ileocoecal region and, in aged patients, aneurysmatic lesions of the iliac arteries have to be considered as source of the symptoms. The systematic use of various diagnostic procedures is discussed.

[Postoperative ileus]. / Der postoperative Ileus.

When the causes and pathophysiology of the various types of ileus are known there are numerous possibilities of preventing them and logical therapeutic approaches, in particular in the case of functional ileus. Careful postoperative monitoring is obligatory! With regard to stimulation of bowel function, the principle of elimination of inhibition of motility by sympathicolysis has a place alongside the well-known nonspecific measures and direct stimulation. If conservative measures fail laparotomy must be repeated as soon as possible to procure relief. In the treatment of ileus associated with peritonitis the numerous new methods of flushing the abdomen, the involvement of anaerobes in some cases, and the possibilities offered by new antibiotics should be kept in mind. The involvement or predominance of mechanical ileus factors in the clinical picture must be recognized early and surgery performed without delay. Early consultation of an abdominal surgeon is recommended.

[Chemical methods of abortion]. / Medikamentöse Methoden.

PIP: Medicaments are used to prepare for instrument abortions in the 1st trimester and as inducers of abortion in the 2nd trimester. The effects, side effects, and dangers depend on the substances used and the route of application, which can be vaginal, cervical, injection, instillation, extraamniotic, intraamniotic, intravenous, or intramuscular. In the past, intraamniotic instillation of a 20% salt solution was the most common 2nd trimester method in Japan, the US, and Eastern Europe, giving a success rate of 90%. Serious side effects prompted substitution of extraamniotic instillation, which rarely produces serious side effects. Instillation of a 60% urea solution into the amniotic fluid in combination with oxytocin or prostaglandin produces an abortion in 13-21 hours, with a failure rate of 3% and a frequency of cervical laceration of under 1%. Extraamniotic use of a .1% solution of rivanol yields a success rate of about 85%, with a relatively long average time to explusion of 24-41 hours. In case of failure the procedure can be repeated. The advantage of the Rivanol method is the rarity of infectious complications. Alcohol is not used as a human abortifacient because it produces necrosis in the decidua and placenta. Prostaglandins are used in most 2nd trimester abortions. Research is underway to identify derivatives that will have an extended uterine impact without serious side effects. Different routes of administration have different effectiveness rates and dangers. All prostaglandins cause side effects including pain during uterine contractions, gastro-intestinal reactions, nausea, vomiting, fever, and headaches. Specific preparations are associated with other effects, some of them life-threatening. Emergency treatment should be available when these substances are used. Adjuvant measures may be employed before adminstration of an abortifacient agent to soften the cervix, or after administration to hasten the procedure. The choice of procedure depends upon the personality, health, and other characteristics of the woman and the experience of the doctor and the clinic.^ieng

[Xenotransplantation of human breast cancer in athymic nude mice]. / Xenotransplantation menschlicher Mammacarcinome auf thymusaplastische Nacktmäuse.

Of 150 human breast cancers, 90 (60%) were successfully transplanted onto thymusaplastic nude mice without the use of adjunctive immunosuppressive therapy. Four months after transplantation, 12 rapidly growing tumors had diameters of 2.5-3.5 cm. Investigations revealed a high correlation between the histology of original tumors and xenografts. We conclude that the nude mouse may be used as an animal model for studies such as this, or in determining the sensitivity of transplanted tumors to cytostatic drugs, steroid hormones, and radiation.

[Treatment of vulvar cancer (author's transl)]. / Zur Therapie des Vulvakarzinoms.

This is a report on 120 cases of vulvar cancer. The mean age at diagnosis was 66.5 years. 25% were younger than 60, and 10% younger than 50 years. 95% were squamous cell carcinoma. The main site of the primary lesion were the labia (71%). 55 patients had palpable nodes in the groins. 12% of all women (=28% of those treated by radical vulvectomyl) had metastases in the groins. 54 (45%) were treated by radical vulvectomy, of which 23 (43%) received postsurgical radiation. 63 patients had minor operation with consecutive radiation in 51 (81%) of them. The overall 5 year survival rate was 43%. It was 65% in the group treated by radical surgery and 24% in the group of minor surgery and radiation. The radical vulvectomy with bilateral inguinal and femoral lymphonodectomy is recommended as treatment of choice in all suitable cases. The radiation cannot replace radical surgery.