[Improvement of Doppler ultrasonography findings following transcutaneous electrostimulation in women with placental insufficiency]. / Zur Verbesserung der Doppler-Sonographiebefunde nach transkutaner Elektrostimulation bei Frauen mit Plazentainsuffizienz.

Previous perinatal trials using Doppler ultrasound have demonstrated a favorable correlation between abnormal blood flow spectra and feto-maternal problems. 33 patients with manifest placental unsufficiency were subject to daily transcutaneous nerve stimulation in a 2-week therapeutic course. 23 patients of the control group were treated by bed rest over 2 weeks. The patient group with transcutaneous nerve stimulation (TNS) showed significant improvement of the investigated blood flow parameters (A/B ratio) of the umbilical artery and fetal aorta (p less than 0.01). In the placebo group there were no significant alterations of blood flow parameters. The clinical findings (improved flow parameters and perinatal outcome) are not expected to yield any significant improvement when placental insufficiency is treated with bed rest alone.

[Color Doppler flow measurements in uterine cancers]. / Farbdoppler-Flussmessungen bei Kollumkarzinomen.

Pulsed Doppler Flow Measurements in patients suffering from collum cancer using a coloured pulsed Doppler technique measurements of blood flow of the uterine artery were performed in a group of 35 patients suffering from an inoperable collum cancer (stage II and III according FIGO) and compared with a collective of 30 healthy women with normal anamnesis. The mean pulsatility index (PI) was significantly lower in the sick group (stage II 1.6 +/- 1.17, stage III 0.76 +/- 0.21) than in the healthy group (PI = 3.18 +/- 0.99) (p less than 0.01). In 14 subjects of the last group there was no significant difference in PI between the left and right uterine artery (left: PI 2.81 +/- 0.83), right: PI 2.78 +/- 0.76).

[Comparative study of introital sonography and the urethrocystogram in women before and after surgery for stress incontinence]. / Vergleichende Untersuchung zwischen Introitus-Sonographie und UCG bei Frauen vor und nach Stressinkontinenzoperationen.

In a prospective study of sonographic and radiographic methodologies we compared morphologic bladder data in 30 patients before and after stress incontinence surgery. 18 women were subject to colposuspension according to Burch due to recurrent stress incontinence, 12 women underwent anterior colporrhaphy. Visualisation of bladder, urethra and beta-angle was adequate with both methods. The good visualisation of the anatomical and functional situation of the vesico-urethral area is a major benefit of introital sonography.

[Effects of primary radiotherapy on uterine circulation in advanced cervix cancer]. / Die Auswirkungen einer primären Strahlentherapie auf die Uterusdurchblutung bei fortgeschrittenen Zervixkarzinomen.

We examined 11 patients suffering from advanced cervical carcinomas, who were treated primarily with radiation. The blood flow through the uterus was established by measuring the Doppler pulse flow through the arteria uterina before and after radiotherapy. In a reference group of 25 women, free from cervical carcinomas, we established a median PI of the arteria uterina of 3.52 (+/- 1.10) with values between 1.64 and 5.06. In contrast, the group of 11 patients suffering from inoperable cervical carcinomas, were found to have a PI of 1.80 (+/- 1.40), with values between 0.41 and 4.41 (Wilcoxon Test: p = 0.001). After completion of the radiotherapy, 7 of the 11 patients showed no measurable pulsations of the arteria uterina, 3 patients had only systolic blood flow and only one patient had the same unchangingly high rate of blood flow as registered before radiotherapy. The significantly reduced flow of blood through the tumour tissue after radiotherapy, indicates a very limited response to chemotherapy. Therefore, chemotherapy should be administered before radiotherapy.

Ultrasonic Doppler flow studies of the uterine arteries in women with cervix cancer.

The main characteristic of malignant tumors is their capacity for local destructive spread as well as infiltration into the adjacent tissue. The present study was carried out to evaluate the hemodynamic alterations in patients with advanced cervix cancer. Data of 34 patients with cervix cancer are compared to 30 healthy women with normal history. The mean pulsatility index (PI) was significantly lower in cancer patients (PI = 1.75 +/- 1.27) than in controls (PI = 3.18 +/- 0.99). Use of noninvasive Doppler ultrasound study physiology of uterine hemodynamics in patients with cervix cancer is of great clinical relevance and paves the way for further investigations in screening programs for cervix cancer.

Various effects of abdominal and vaginal hysterectomy in benign diseases.

The relative advantages and disadvantages of the transabdominal versus the transvaginal approach to hysterectomy were evaluated and the two procedures were compared for differences in hospitalization, patient age, bowel activity and operating time on the basis of a material of 94 hysterectomized patients. Intestinal complications such as subileus were noted only in subjects who were treated by abdominal hysterectomy. This corresponded with the significant decrease in potassium in abdominally operated patients on the second post-surgical day. Transvaginal hysterectomy was found to be superior in terms of all of these parameters. Complications associated with the two procedures were also compared. Of eight potential complications, seven were found to be confined to laparotomy, while only one occurred after transvaginal hysterectomy which was, however, invariably combined with colporrhaphy. The conclusion from the above should, therefore, be not to select patients indiscriminately for either the transvaginal or the transabdominal approach, but rather to use both routes of access as best fits the circumstances.

[Practical use of blood flow measurement with pulsed ultrasound in the 3d trimester of an at-risk pregnancy]. / Praktische Anwendung der Blutflussmessung mit gepulstem Ultraschall im 3. Trimenon bei Risikoschwangerschaft.

Using a pulsed Doppler technique measurements of blood flow of the arcuate artery, umbilical artery and foetal aorta were performed in the third trimenon in a group of 163 patients with risk pregnancies and compared with the weights of the newborn. In normal values of blood flow of the arcuate artery (n = 144) less than 10% of the weights of the newborn were below the tenth percentile. In pathological values (n = 19) about 42% newborn werde below the tenth percentile. In normal values of blood flow of the umbilical artery (n = 158) about 10% of the newborn were below the tenth percentile. In pathological values (n = 5) all newborn were below the tenth percentile. In normal values of blood flow of the foetal aorta (n = 139) about 12% of the newborn were below the tenth percentile. In pathological values (n = 4) all newborn were below the tenth percentile. Of the group with "normal" blood flow data a sub-group was formed with flow values between the first and second standard deviation. These were labelled "suspicious" and had shown a significant correlation with the birth weights of the newborn. Based on these experiences a schema was prepared comprising the blood flow measurements and cardiotocography, from which recommended clinical procedures were derived.

[Psychosomatic aspects of females with placental insufficiency]. / Zur Psychosomatik von Frauen mit Plazentainsuffizienz.

Significant differences occurred on various scales by comparing 30 pregnant women who suffered from dysfunction of placenta chosen at random. Comparison was made by means t-tests and cross tables in GT, FPI, SSG sociological and medical data. Additionally a controlled experiment was performed. Dominating parts on a body level are the masochistic and the rigid one, both high charged structures. They seem to be more frequent than schizoid, oral and psychopathic parts. Looking to psychosomatics of dysfunction of placenta aggressive wishes against the child could be found.

[Sonographic detection of increased perfusion in placental insufficiency following TNS therapy using pulsed Doppler ultrasound]. / Sonographischer Nachweis der Durchblutungssteigerung bei Plazentainsuffizienz nach TNS-Therapie mit Hilfe des gepulsten Doppler-Ultraschalls.

In the last years transcutaneous electric nerve stimulation (TNS) has been used at the first Department of Gynaecology and Obstetrics in Vienna for the therapy of placental insufficiency. With the new method of Doppler Ultrasonography a direct measurement of blood flow in the Arteriae umbilicales is possible. In 16 patients with reduced placental perfusion between 34 to 38 weeks of pregnancy TNS-therapy has been monitored by Doppler Ultrasonography. In 14 patients an impressive improvement to normal values of perfusion could be observed. Only 2 patients with morphological changes in the placenta were resistant to therapy. A control group of 16 patients with normal values of perfusion did not show any response to TNS-therapy as expected. Therefore this safe and simple method of TNS is recommended for the therapy of functional placental insufficiency.

[Attempt to diagnose a "small" placenta by HPL determination before the 18th week of pregnancy]. / Versuch der Diagnose einer "kleinen" Plazenta durch HPL-Bestimmung vor der 18. SSW.

In a prospective study covering 175 gravidae it was investigated whether the risk of a "small" placenta could be detected by determining HPL or serum estriol once during the first 18 weeks of pregnancy. The results show that neither the HPL value nor the serum estriol value correlate with the weight of the placenta or the child. Therefore, the problem of early detection of a "small" placenta cannot be resolved with these hormone parameters.

Radioimmunoscintigraphy using monoclonal antibodies before second-look surgery in patients suffering from ovarian cancer.

19 patients with a known history of ovarian cancer were investigated by radioimmunoscintigraphy (RIS) to look for recurrent disease a few days before second-look surgery. The tumor-associated monoclonal antibody HMFG-2 (400 micrograms/patient) was injected intravenously after labeling with radioactive 123I (0.5-2.2 mCi/patient). Scans were reviewed for activity accumulations due to uptake of the tumor-associated antibody by tumor sites. In 15 out of the 19 cases the scan results correlated with the intraoperative findings. There were 2 false-positive and 2 false-negative scans, the latter in patients with subclinical disease. The smallest lesion detected by radioimmunoscintigraphy had a diameter of 1.5 cm. In 3 patients, tumor sites were identified that had been missed by all other routinely performed methods of investigation including transmission computed tomography. These data indicate that RIS is of considerable clinical value in the early detection and localization of recurrent ovarian cancer and may, therefore, improve the management of these patients.

[Pregnancy and labor in 12 to 14-year-old girls]. / Schwangerschaft und Geburt bei 12-14 jährigen Mädchen.

This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.

[Modification of uteroplacental circulation by solcoseryl]. / Die Beeinflussung der uteroplazentaren Durchblutung durch Solcoseryl.

Pulsed ultrasonic doppler flow measurements both on uterine arcadic arteries and umbilical arteries have been done in 10 pregnant women suspected for intrauterine fetal growth retardation before, during and after Solcoserylinfusions for ten days. Improvement of maternal uteroplacental blood flow may be caused by changed rheologic blood properties as well as by physical inactivity. Fetal umbilical cord blood flow could not be influenced by Solcoseryl.

[Afterloading short-term irradiation of the vagina following radical surgery of uterine cancer]. / Die Afterloading-Kurzzeitbestrahlung der Scheide nach Radikaloperation des Korpuskarzinoms.

A report is given of results and complications following postoperative irradiation in endometrial carcinoma via monitored high-dose afterloading therapy (iridium 192). Intravaginal irradiation was performed in all operated cases. In advanced cases or in cases with poor prognosis (deep infiltration of the myometrium, tumour grading 1-2) percutaneous irradiation (cobalt 60) was employed additionally. 327 patients with endometrial carcinoma were treated by postoperative irradiation between 1981 to 1985 and could then be followed up for at least 12 months to 5 years. Evaluation was done with regard to recurrence-free survival rate and side effects. With the postoperative afterloading iridium 192 technique, the 3-year recurrence-free rates were 91% in stage I and 78% in advanced stages. All of the patients in stage I with a control time of 5 years survived. The incidence of radiation side effects in the overall group was: cystitis 4%, proctitis 7% and fistulas 0.6%. No further severe complications occurred with the optimal intravaginal fraction dose of 700 cGy (twice). The afterloading therapy with high dose rates and remote control monitoring reduces the risk of radiation exposure of the medical staff and also places less strain on the patients because of the short-term irradiation. Intravaginal applications were performed without anaesthesia or any drugs, and treatment on an outpatient basis was possible in almost all of the cases.