[Selectivity of glomerular proteinuria and liver function in gestosis]. / Selektivität der glomerulären Proteinurie und Leberfunktion bei Gestose.

Proteinuria in preeclamptic women was qualitatively differentiated and in cases of pure glomerular proteinuria three groups according to the low-, medium- or high selectivity of glomerular proteinuria were formed. In these patients the incidence of liver dysfunction and severe proteinuria together with an increase in mean arterial blood pressure was investigated. The aim of this study was to find out if there is any connection between glomerular proteinuria of different selectivity and disturbed liver function. In patients with EPH-gestosis a pure glomerular proteinuria in SDS-PAA-disc electrophoresis of the urine was found. Together with the increase in glomerular selectivity an increase in quantitative urinary protein loss was found. In patients with high selective glomerular proteinuria the extent of proteinuria was about three times higher than in patients with low selectivity. In all patients a moderate elevation of the liver enzymes was found. In all patients disturbed liver function returned to normal within a few days after delivery. We conclude from these data that glomerular functional lesions pregnancy in patients with preexisting glomerulopathies or pregnancy induced renal dysfunction are accompanied in a high rate by moderate disorders of liver function.

[Effect of stress incontinence surgery on urodynamic parameters. 2. Are various surgical methods comparable?]. / Der Einfluss von Stresstinkontinenzoperationen auf urodynamische Parameter. 2. Teil: Sind unterschiedliche Operationsmethoden vergleichbar?

This study examines the pre- and postoperative clinical data of 215 women operated on during 1983-87 at the University Hospital of Freiburg for stress incontinence. The following procedures were used: Anterior colporrhaphy (n = 27), anterior colporrhaphy in combination with a ventral levator plasty (n = 61), sling procedure with the Lyodura sling (n = 44), and a colposuspension within the total abdominal concept (n = 83). All the procedures, with the exception of anterior colporrhaphy, were followed by a decrease in maximum urethral pressure. The functional urethral length was not changed by any of the methods. Colposuspension showed a marked postoperative improvement of urethral stress profile parameters in the proximal and midurethra, the sling had a steep, unphysiological increase of pressure transmission ratio in the proximal urethra. The vaginal methods did not improve pressure transmission to the proximal section of the urethra, their effect was only measurable in the mid section. The urodynamic effects of different types of surgery were very individual, a fact which may be helpful in the selection of the surgical approach.

[Effect of stress incontinence operations on urodynamic parameters. 1. Is surgical success measurable?]. / Der Einfluss von Stress-inkontinenz-Operationen auf urodynamische Parameter. 1. Teil: Ist der Operationserfolg messbar?

Urodynamic parameters are changed by stress incontinence surgery. Our study, comparing pre- and postoperative measurements in 141 women with urinary stress incontinence, shows an increase of the transmission ratio in the proximal urethra and a decrease of depression factors in the proximal and mid urethra after surgery. The functional urethral length remains unchanged while the maximum urethral pressure decreases. Except for the maximum pressure decrease, these changes were only found after successful surgery and not in failures. Thus, effectiveness of operations can be quantificated by urodynamic measurements. The unfavourable prognostic influence of a preoperative hypotonic urethra on the results of surgery was confirmed by this study.

Urinary protein patterns and preeclampsia.

A retrospective study of urinary protein patterns, as determined by SDS-PAA-disc-electrophoresis was performed in 107 patients in third trimester of pregnancy because of preeclampsia. The aim was to determine whether the protein patterns allow a differentiation between nephropathies associated with genuine toxaemia of pregnancy and those in which toxaemia was superimposed on preexisting renal glomerular or tubular disease. The magnitude and type of proteinuria was related to the mean arterial pressure (MAP). 47% of all patients showed a mixed protein pattern independent of the MAP-severity. This form of proteinuria is probably associated with a genuine toxaemia of pregnancy. It was not possible to determine if pure glomerulopathies whose frequency rose with MAP, had already been present before pregnancy. In a third of the 22 patients followed-up post-partum pathological protein patterns or increased protein excretion was detected. This implies that 35% of the nephropathies were present before pregnancy. However, differentiation between preexisting and toxaemia associated nephropathy was not always possible. SDS-PAA-analysis of urinary protein should be carried out in earlier stages of pregnancy in cases of increasing MAP and proteinuria.

[Morphological and stereological examinations of placenta of patient with unruptured tubal pregnancy at full term (author's transl)]. / Morphologische und stereologische Untersuchungen an einer Plazenta bei nichtrupturierter Eileiterschwangerschaft am Termin.

Optimum conditions for foetal life were recorded from morphological and stereological findings obtained from a patient at full-term tubal pregnancy. Basiotrophic implantation, no reduction of chorion frondosum, large placental exchange surface, and extremely good capillarisation of chorionic villi proved to be the conditions for survival of the child.

[The mean blood pressure in the second trimester (map-2) as a valuable aid in the early recognition of the pregnancies with a risk of hypertension (author's transl)]. / Der mittlere Blutdruck im 2. Trimenon (MAP-2) als wertvolle Hilfe bei der Früherkennung von hypertoniebedrohten Schwangerschaften.

The mean blood pressure in the second trimester of pregnancy was calculated with a formula (Formula: see text) which stands for systolic pressure plus twice diastolic pressure divided by 3 equals mmHg. In 285 patients 43% had a MPA-2 value of 85 mmHg. or higher. At this threshold value 89% of all later hypertensions were recognized. An MAP-2 value of 90 mmHg. was found in 21% of the patients. In this group 63% became hypertensive. However, this group contained 10 of the 11 moderately severe and severe cases. In the outcome of the pregnancies there was a significant increase in prepathological fetal monitoring changes and a significant increase in suspicious Apgar values. The calculation of the MAP-2 value should become a part of routine prenatal care.

[Unruptured tubal pregnancy at full term with survival of mother and child (author's transl)]. / Bericht über eine nichtrupturierte Eileiterschwangerschaft am Termin mit Uberleben von Mutter und Kind.

A clinically intact child was delivered from breech presentation in the 40th week of pregnancy. The amniotic sac was removed by salpingectomy. Basiotrophic implantation, the absence of chorion frondosum reduction, and the presence of amniotic fluid appeared to have been major prerequisites for unimpaired development. Diagnostic possibilities and symptoms of complete tubal pregnancies are discussed.

[The uptake of tritiated thymidine in human fetal membranes during the last third of pregnancy (author's transl)]. / Histioautoradiographische Untersuchungen über das Proliferationsverhalten der menschlichen Eihaut und Dezidua im letzten Schwangerschaftsdrittel.

Eighty-four fetal membranes--amnion, chorion and adhaerent decidua--were investigated with the in vitro uptake of tritiated thymidine in the last trimester of pregnancy. Labelling patterns were observed in each component of fetal membranes and decidua. The proliferation activity of the cells was determined by the 3H-thymidine labelling index. Significant correlation was found between labelling activity of chorion and decidua. The cells of the chorion layer and decidua showed linear decreasing uptake of tritiated thymidine from 200th to 300th day of pregnancy. The cellular growth of the chorion epithelium seems to be directed from the pseudobasement membrane to the decidua layer. There was also a significantly increased DNA-synthesis in decidua cells when labelled endothelium-cells of decidua vessels were observed. In the same cases we found significant correlation to mean placental weight. When fibrinoid deposits between the chorion and decidua layer were found the mean tritium index of the chorion layer was significantly lower than when fibrinoid material was missing.

[Histoautoradiographic examinations of benign and malignant cells and tissues during therapeutic interventions in gynecology]. / Histoautoradiographische Untersuchungen benigner und maligner Zellen und Gewebe während therapeutischer Massnahmen in der Gynäkologie.

The alteration of the proliferation activity of different tissues of the female genital tract was studied with the histo-autoradiographic method. Tissue samples from 1. the normal endometrium before and under treatment with the sequential oral contraceptive Ovanon, 2. carcinomas of the vulva before and under treatment with Bleomycin, 3. cervical carcinomas stage I-III before and under Co 60-radiation, and fluid material of cystic ovarian tumors and effusions before and under treatment with alkylating agents were incubated in 3H-thymidine. Morphologic and histo-autoradiographic alterations were observed during all investigations. It was demonstrated that the histo-autoradiographic method 1. gives informations about the proliferation activity of tissues of the female genital tract, 2. quantifies the success of treatment, 3. and allows prognosis about therapeutic results, as it was shown in the case of radiation sensitivity of cervix carcinomas.

[Quantitative investigations of the human placenta under normal conditions and in case of preeclampsia correlated to the human placenta-lactogen blood-level in the last third of pregnancy (author's transl)]. / Quantitative Untersuchungen der menschlichen Plazenta bei normaler Schwangerschaft und EPH-Gestose in Beziehung zum HPL-Serumspiegel im letzten Trimenon der Schwangerschaft.

Thirty-two human placentas from normal and from pregnancies complicated by preeclampsia in last third of gestation were morphologically and morphometrically examined and correlated with human placenta-lactogen blood-level. HPL was determined by the radio-immunoassay (Carbon-Dextran-method). HPL-values, placenta villous surface, the weight of the newborn and placenta showed significant correlation. The placentas were classified according to the morphologic degree of severity (placenta-morphological-index) and compared to preeclamptic index (Goecke) and HPL-values. The results showed correlation between the studied datas according to the severity of preeclampsia. The significance of these results is discussed.

[Histologic and radioautographic studies of the human endometrium under sequential oral contraceptive conditions (author's transl)]. / Histologische und autoradiographische Untersuchungen am menschilchen Endometrium unter der 2-Phasen-Therapie mit Mestranol--Lynestrenol.

PIP: To determine the effect of the 2-phase (mestrenol-lynestrol) ovulation inhibitor on the condition and proliferative activity of the human endometrium in different phases of the cycle and after different durations of therapy, 28 females (25-48 years old) on the sequential preparation were studied during 305 cycles. 97 biopsies were examined by light microscopy for morphological changes, and DNA-synthesis was investigated by radiography. In contrast to other studies, it was concluded that the sequential therapy does not imitate the usual endometrium alterations of a normal cycle. With estrogen administration up to Day 10, a proliferating endometrium was observed without glandular secretion. With subsequent combined application of gestagen-estrogen from Day 10, retronuclear secretory vacuoles appeared. The condition resembled abortive (undatable) secretion with suppressed glands, rather than the normal situation. At the end of the cycle atrophic cells and regressive alterations were observed. With prolongation of treatment the condition remained essentially the same with no increase in atrophy. This type of endometrium is unsuitable for nidation, and a nidation-inhibiting effect of the sequential preparation is assumed. Concerning DNA synthesis, intensified DNA synthesis activity was detected in the proliferation phase in the gland and surface epithelium with a sharp decrease in the secretion phase. Thymoid incorporation was observed during all cyclic phases in the stroma.^ieng