[Medical expert assessment in civil and criminal law from the legal liability viewpoint]. / Arztliche Begutachtung in Zivil- und Strafrecht aus haftungsrechtlicher Sicht.

In view of the wide range of liability claims, expert medical reports constitute part of the basis of the work of liability insurers. However, the very different qualifications of experts often present the so-called "corporate physician" with great problems, since some expert reports are hardly acceptable, as the author discovered during many years of study of a large number of liability files. In addition, the most striking and frequently occurring criteria are discussed.

Use of human chorionic gonadotropin and alpha-fetoprotein radioimmunoassays: specificity and apparent half-life determination after delivery and in patients with germ cell tumors.

The specificity of commercially available hCG and hCG-beta antibodies (anti-hCG-beta from N.I.A.M.D.D. (SB6), Serono (S), Biosigma (B), Union Carbide (UC) (I.R.E.) and anti-hCG from Union Carbide) were compared. Using 125I-hCG (CR 115), the crossreactivity with LH (LER 960) was 5.5% for SB6, 0.25% for S and 0.3% for B. In the homologous hCG system UC, crossreactivity was 0.06% with hCG-beta and 1.2% with LH, in the hCG-beta system UC, it was 2.2% with hCG and 0.01% with LH. Parallel standard curves for hCG, the 2nd I.R.P. hCG and hCG-beta were found exclusively with the 125I-hCG, anti-hCG-beta system S. Consequently accurate estimates of the total hCG or hCG-beta content in serum and standardization with the 2nd I.R.P. is possible. This system is the most useful for clinical purposes. The serum half-life of hCG was calculated in 10 pregnant women after delivery and was found to be 10 to 34 h. AFP half-life time, determined by the double antibody radioimmunoassay was 4.0 +/- 1.8 (+/- SD) days in pregnant women after delivery (n = 60) and 3.8 +/- 0.9 days in neonates during the first 16 days of life (n = 26). Altogether, apparent half-life determinations were carried out in 29 patients with nonseminomatous germ cell tumors. The results indicate that half-life determinations of hCG and AFP may have a predictive value with respect to the monitoring of therapy.

[Gynecology in childhood and adolescence. 2. Surgical interventions, contraception for adolescents, legal questions]. / Gynäkologie im Kindes- und Jugendalter. 2. Chirurgische Eingriffe, Antikonzeption bei Jugendlichen, Rechtsfragen.

PIP: Several lectures are summarized and compiled to provide an overview of gynecological considerations in cases of child and adolescent patients. Gynecological operations performed on children and adolescents are divided into congenital defects, tumors, and injuries. The question of contraceptive use among youth and adolescents is also of importance to gynecologists. The use of biological and hormonal methods has decreased among girls 14-18 years of age, while intravaginal methods have become more popular. There are also legal considerations for gynecologists treating minor patients, concerned mostly with the question of consent. In the case of minors, the consent of the legal guardian is always necessary. The possible side effects and complications of contraceptive use must be made clear to the patient. Regular check-up examinations should be arranged. For sterilization, abortion, or cosmetic operation, the doctor must make sure that the minor is capable of understanding the nature and possible dangers of the operation. The consent of the parents is obligatory for all operations involving minors.^ieng

[Representation of gynaecological fistulas by wick urethrocystocolporectography (author's transl)]. / Darstellung gynäkologischer Fisteln im Docht-Urethrozystokolporektogramm

In connection with gynaecological diseases and/or their therapy, genital fistulas constitute a grave complication. Accurate representation of these fistulas in conjunction with the adjacent hollow organs is of curcial importance for their successful removal. A modified kind of wick urethrocystocolporectography, which is a method that has proved efficient in cases of a dislocation in the female genital tract and also in cases of insufficiency of locking of the urinary bladder, provides these preconditions for an efficient therapy. That is, through the difference in the course of motion during holding and pressing in comparison with rest there are detected not only any valve mechanisms present but also dislocations, if any. Moreover, the method, easy to apply as it is and involving only little strain, provides an advantage which cannot be overlooked.

[The late bladder reaction following radiotherapy of a cervix carcinoma]. / Zur späten Harnblasenreaktion nach Bestrahlung des Kollumkarzinoms

This study presents the cystotonometric checks of trends in 102 patients with irradiated carcinoma of the cervix up to the time of the so-called five year survival recovery. As compared with a standard control group concerning the function of the urinary bladder a distinct tendency to hypertonia is realized and attributed as inevitable to radiotherapy. The moderate load being present before the onset of irradiation is mentioned, resulting from diagnostic operations and from the primary disease. Based on these observations, functional findings which allow objectivation appear to be indicated, the aim being to recognize, as early as possible, the increase of vesical reactions with regard to gynecologic radiotherapy and later follow-up care.

[Demonstration of position variations of the female ureter in the work urethrocystocolporectogram]. / Darstellung von Lageveränderungen der weiblichen Harnröhre im Docht-Urethrozystokolporektogramm

With wick urethrocystocolporectography, an improved type of colpocystorectography, the form and undisturbed function of the urethra at rest, and during holding and pressing, may be optimally observed. The simultaneous picture of the female pelvic organs allows conclusions to be drawn as to the statics and dynamics of the viscera, as well as the functional strength of the pelvic floor. Illustrations show the behavior of the female urethra accompanying vertical and rotatory descensus, and prolapse.

[Functional risks in the surgical therapy of urinary incontinence and prolapse (author's transl)]. / Funktionelle risiken bei der therapie der harnblasen-verschub-insuffizienz oder des deszensus

In addition to the known surgical risks in the treatment of incontinence or prolapse there exists a functional risk inherent in the surgical methods, which can even cause a deterioration in the functional condition if the surgical aim is not achieved. The vaginal bladderneck sutures are only worth as much as the tissues they hold together. The surgical treatment of certain cases of prolapse can eliminate the stopcock mechanism of the urethra and lead to the manifestation of a preoperatively-existent incontinence. With the sling operations success depends, among other factors, on the degree of restraint and the correct placement of the sling. The outcome of hysterectomy is endangered by failure to recognize a coexistent prolapse or enterocoele. With Ward's manipulation, high peritonization and adequate treatment of the overextened posterior vaginal vault, the involved functional risks can be minimized. Typical examples are mentioned in the text. Particular emphasis is placed on the necessity of exact knowledge of the circumstances threatending the functional success and their recognition by means of wick-urethrocystocolporectography. For the maintenance of a good doctor-patient relationship, the patient may receive prior to surgery an understandable explanation of the limitations of the methods used in achieving a functional cure.