[Clinical aspects of vaginal hysterectomy]. / Zur Klinik der vaginalen Uterusexstripation.

From 1971-1982 4,179 hysterectomies have been performed by vaginal route on the department of gynecology and obstetrics of the Klinikum Mannheim. 46.5% of these women were between 20 and 40 years old, 7.2% were older than 60 years. The mean age was 41 years, 5.6% of the patients were nulliparae, 21.0% uniparae and 73.4% multiparae. 4.8% had a history of a previous gynecologic operation, adipositas was present in 8.7%, and a severe varicosis was present in 8%. The most frequent indications were uterus myomatosus (36.2%) and descensus uteri (26.8%). In 62% of all patients only hysterectomy was performed, in 31.4% hysterectomy with an additional colporrhaphy was performed. Morcellation of the uterus was necessary in 3.4%. The most frequent intraoperative complication was the lesion of the bladder in 0.4%. The postoperative morbidity was 15.8%, two third of these patients had an inflammatory disease of the urinary tract. The mortality was 0.07%.

[Conization of the uterine cervix. A study of 900 cases]. / Die Konisation der Cervix uteri. Eine Studie über 900 Fälle.

In the years 1968 till 1982, 900 conisations of uterine cervix were performed, 90% of which were diagnostic interventions. During the follow-up period, the mean age of the patients with carcinoma in situ decreased 4 years, the mean age from patients with microcarcinoma 3.2 years. In 64% the conisation was carried out due to a positive or suspekt smear. Conisations, performed during pregnancy, were not associated with any additional complications for mother or child. Taking a big conus resulted more often in a total extirpation of the neoplastic changes, without increasing the complication rate. The average hospital stay was 8.7 days. It was only prolonged in patients with secondary hemorrhage. 33% of all neoplastic changes were extirpated totally. In 85% of the women who had follow-up only after incomplete extirpation of the neoplasia by conisation, there was no recurrence. The rest did show the neoplasia again, often in a more serious way. The overall complication-rate was 7.4%.

[Cesarean section with subsequent hysterectomy]. / Sectio caesarea mit nachfolgender Hysterektomie.

We had 65 Caesarean hysterectomies from 1960-1982 at our hospital. 43 patients were elected for various reasons: contraception 26, fibromatosis 13, intraepithelial neoplasia 4. 22 had vital indications: rupture of the uterus 12, placenta increta/percreta 5, abruptio placentae 3, atony 2. The time we needed for the operation was up to 100 minutes in the elective group, 160 minutes in the non-elective group. In vital indications, postoperative morbidity was higher than when treatment was elective. In the group of vital indication, 4 patients died, whereas no patient died if operation was performed on an elective basis.

Carcinoma of the cervix stage T1b. A 15 years review of 256 cases.

256 patients of the years 1965-1979 who suffered from collum carcinoma stage T1b were reviewed. Most of the neoplasmas were squamous cell carcinoma (81%). By tumor screening only 21% of the carcinomas were detected. The treatment was in most of the cases a radical hysterectomy (Wertheim-Meigs). Postoperative radiotherapy was performed in cases of poor differentiated carcinoma of if lymphatic nodes had been occupied by the tumor. Thus only 43 patients had no radiotherapy. A 5 year-follow-up was possible in 151 cases. Women older than 40 year showed a better prognosis than younger women. Patients treated only by radiotherapy had a five year survival rate of 88%. No difference in prognosis was observed, if radiotherapy was additionally performed. There was no significant difference of severe complications in either forms of treatment.

[Value of cervix cerclage]. / Der Stellenwert der Zervix-Cerclage.

Between 1965 and 1980 we performed 512 Shirodkar operations. Mean age of the patients was 28.4 years. The most frequent diagnosis was incompetence of the internal cervical os, which accounted for 74% of the operations, the remaining 26% being prophylactic. Sutures were performed between the 12th and the 18th week of gestation and 76.3% of these patients had normal births (mean gestation time 39 weeks). Without Shirodkar operations, out of 748 pregnancies studied, 23.1% resulted in normal birth; whilst with Shirodkar 90.5% of 462 pregnancies were successfully delivered at term.

Intermediate filaments of normal and neoplastic tissues of the female genital tract with emphasis on problems of differential tumor diagnosis.

Cytokeratins of normal epithelia and of some neoplasms of the female genital tract were studied by immunofluorescence microscopy of frozen sections and by two-dimensional gel electrophoresis of cytoskeletal proteins from microdissected tissues. All normal epithelia were stained with the monoclonal cytokeratin antibody KG 8.13 whereas certain monoclonal antibodies stained only simple epithelia. As revealed by gel electrophoresis the normal epithelia of the ovarian surface, oviduct, endometrium and endocervix contained cytokeratin polypeptides Nos. 7, 8, 18 and 19. In contrast, stratified exocervical epithelium showed a much more complex pattern (polypeptides No. 1, 2, 4, 5, 6, 11, 13, 14, 15, 16, 17 and 19). A similar pattern was found in the vagina. All epithelial neoplasms studied, regardless of the degree of histologic differentiation, were stained with antibody KG 8.13 as well as with conventionally obtained guinea pig antibodies to bovine muzzle prekeratins. The ovarian, endometrial and endocervical epithelial tumors maintained the pattern of their cells of origin, i.e. they expressed only cytokeratins Nos. 7, 8, 18 and 19. In one type of endocervical adenocarcinoma an additional cytokeratin polypeptide (No. 17) was detected. In contrast, the epithelial tumors of the lower genital tract showed a more complex pattern which also showed some differences with respect to that described for the corresponding normal tissue. Thus, in non-keratinizing squamous cell cervical carcinomas, cytokeratins Nos. 5, 6, 7, 8, 13, 14, 15, 16, 17, 18 and 19 were present, whereas the keratinizing cervical cancers showed polypeptides Nos. 5, 6, 13, 14, 16, 17 and 19.(ABSTRACT TRUNCATED AT 250 WORDS)

[Histological reaction of the endometrium to irritation by a probe in relation to the problem of embryo transfer during in-vitro fertilization]. / Die histologische Reaktion des Endometriums auf Sondenreizung im Hinblick auf die Problematik des Embryonentransfers bei der In-vitro-Fertilisation.

The purpose of this study was to try to explain morphologically why a high percentage of artificially inseminated embryos fail to implant after intrauterine transfer. To investigate the problem we irritated with a probe the endometria of 31 women of child-bearing age a few days before their scheduled hysterectomies. Our histological studies of the uteri were directed towards learning whether a localised decidual change had developed at the site of mechanical irritation. In addition, we measured the serum values of FSH, LH, prolactin, progesterone, beta-estradiol, and cortisol of 22 of the patients on the day of mechanical irritation of the endometrium and on the day of hysterectomy. At the time of probe insertion six patients were in the proliferative phase. In three the endometrium responded with a slight crowding of enlarged stromal cells in the region of mechanical irritation. In three it failed to respond. In five patients who had continued to take oral contraceptives until their hysterectomy the endometrium also showed no response. In twelve patients of 17 in the secretory phase we found a focal predecidual to decidual change of the stroma. The hormonal values of these women were within normal limits. In the remaining five patients we found a deficient secretory phase without any evidence of decidual change. The serum values of progesterone for these patients were low. The results allow us to suggest that the mechanical irritation from transfer of an in vitro fertilised embryo in the early secretory phase might induce a premature decidual change, which could inhibit implantation of the embryo.

[Spontaneous rupture of a deciduoma with intra-abdominal hemorrhage]. / Spontanruptur eines Deziduoms mit intraabdominaler Blutung.

A so-called Deciduoma caused severe intraabdominal haemorrhage in third trimester of pregnancy. The bleeding from the hypervascular tumor resulted in the decompensation of balanced placental insufficiency and thus led to fetal distress.

[Vaginal hysterectomy with bilateral adnexectomy]. / Vaginale Uterusexstirpation mit bilateraler Adnexektomie.

102 bilateral adnexectomies in simple vaginal uterectomy (UE.A.) were researched between 1975-1980 and compared to the same number of patients who had vaginal uterectomy without adnexectomy (VK). The average age of the UE.A. was 51.9 years and of the VK 36.8 years of age. The parity of both groups was balanced. The most frequent indication for operation of both collectives was uterus myomatosus. In 52.9% we found a pathology of the ovar: In 46% benign ovarial tumor, in 4.9% ovarial tumor, in 4.9% ovarial endometriosis, in 0.9% ovarial metastasis of breast carcinoma and in 0.9% tubal carcinoma with micrometastasis at the ovar of the same side. The most frequent postoperative histological diagnosis of both groups was uterus myomatosus. The number of complications (post operative bleeding, course of fever more than 38.5 degrees C) was the same in both groups.

[Hemorrhaging in early pregnancy]. / Blutungen in der Frühschwangerschaft.

283 patients with vaginal bleedings in the first three months of pregnancy were included in an analysis and compared to a control group. We could not find a correlation between bleeding in the early weeks of pregnancy and the age of the mother, the onset of menarche, parity, and preceded premature deliveries. On the other hand we found a significantly high number of bleedings in women, who already had abortions before, and diseases during pregnancy (infections, hyperemesis gravidarum). No statistical differences could be discovered in relation to the control group referring to the course of labour (rupture of membranes, changes of the amniotic fluid, operative deliveries, obstetrical presentation, first and second stage of labour, and complications of the delivery). The average birth weight was significantly lowered because of the large amount of premature births. We could not prove any increase of the rate of deformity after bleeding in the early weeks of pregnancy.

[Hysterectomy in young women]. / Hysterektomie bei jungen Frauen.

It is reported upon 1345 hysterectomies on patients up to 35 years of age between 1966 and 1981. Proportionately these young women were 16% of all hysterectomies. 69.4% of the patients were between 31 and 35 years of age. 77.4% were operated vaginally. The preoperative morbidity was 46.3%, adipositas was the most frequent one of these with 15.6%. The most frequent indication to operate was uterus myomatosus (33%) followed up by premalignant and malignant change of the uterus (13.8%). The rate of intraoperative complications was 4.2% and the postoperative one was 21.2%. The mortality was 0.37%.

Cytokeratins of normal epithelia and some neoplasms of the female genital tract.

Cytokeratins are a family of polypeptides of intermediate filaments which in diverse epithelia are expressed in different, yet specific, combinations. We have studied the cytokeratins present in normal epithelia of the female genital tract, in comparison with those present in genital tract carcinomas, by two-dimensional gel electrophoresis of cytoskeletal proteins from microdissected tissues and by immunofluorescence microscopy. Cells of ovarian mesothelium, oviduct, endometrium, and endocervix contain cytokeratin polypeptides nos. 7, 8, 18, and 19. By contrast, tonofilaments of the stratified squamous epithelia of vagina and exocervix contain cytokeratins 4, 5, 6, 13, 14, 15, 16, and 19. Exocervical regions distant from the endo-exocervical junction as well as vagina contain, in addition, the large (Mr 68,000) and basic cytokeratin component no. 1, previously described in epidermis. Endocervical squamous metaplasia at the endo-exocervical border displays a complex cytokeratin pattern, probably due to cell-type heterogeneity. Similar cytokeratin patterns are also observed in genital tract epithelia of the cow and mouse. In human carcinomas of the female genital tract, two main types of cytokeratin patterns can be distinguished. Ovarian carcinomas and endometrial adenocarcinomas express cytokeratins 7, 8, 18, and 19 and, thus, maintain the pattern of the cells of their origin. In endocervical adenocarcinomas the additional presence of component no. 17 has been noted. Nonkeratinizing squamous cell carcinomas of the cervix show a very complex pattern (cytokeratins 5, 6, 7, 8, 13, 14, 15, 17, 18, and 19). Keratinizing squamous cell carcinomas of the cervix display lower complexity and lack cytokeratins 7, 8, and 18. When frozen sections are examined by immunofluorescence microscopy, all epithelia of the genital tract are stained with the monoclonal cytokeratin antibody KG 8.13. Simple epithelia but not the stratified epithelia of vagina and exocervix also react with monoclonal antibodies specific for cytokeratins 8 or 18. The value of cytokeratin polypeptide patterns in distinguishing diverse epithelial cell types of the female genital tract, in elucidating the histogenesis of neoplasms, and in providing a new tool for the differential diagnosis of tumors is discussed.

[Diagnostic evaluation of drill biopsy]. / Der diagnostische Wert der Drillbiopsie.

This report describes the procedure of drill biopsy in 100 patients with palpable breast tumours. In 99% of the biopsies the lesion was accurately diagnosed, in 61% as invasive carcinoma.

[Premature birth. Retrospective study of 2000 premature births at the Gynecological Clinic of the University of Mannheim. 2: Postpartum period, morbidity and mortality of premature infants]. / Die Frühgeburt. Eine retrospektive Studie über 2000 Frühgeburten an der Universitäts-Frauenklinik Mannheim. Teil 2: Die postpartale Periode, Morbidität und Mortalität der Frühgeburten.

During a period from 1966 to 1977 a retrospective study on 1982 premature births was conducted. 9,4% of the premature births were dead born; from the births, who died in the postnatal period, 94% died within the first 7 days, perinatal mortality was 27%. Most common cause of death was immaturity (25%), followed by respiratory distress syndrome (16%), in 31% cause of death was unknown. The most common complications of the immature births were icterus neonatorum (25,3%), aspiration (21,3%) and asphyxia (8,9%).