Unruptured tubal pregnancy: local low-dose therapy with methotrexate under transvaginal ultrasonographic guidance.

Thirty patients with unruptured ectopic pregnancy (4-10 weeks' gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development of an increasing peritubal hematoma (n = 4). Patients with an outer trophoblast diameter < or = 1.5 cm could be treated successfully in all cases (25/25). In patients with hCG values > 5,000 mIU/ml the success rate was 70% (7/10) and in patients with demonstration of cardiac activity of the embryo 63% (5/8). The fluid aspirated from the ectopic cavity showed an average hCG concentration that was 53 times higher than in the serum. The decline in hCG to values below 10 mIU/ml ranged between 7 and 75 days (mean 28 days). The hysterosalpingography performed 4-6 months after MTX therapy showed tubal patency on both sides in 85.7% of the patients examined. In the meantime 4 of these patients gave birth to healthy children.

[Minimal invasive surgery--future prospects]. / Mikroinvasive Chirurgie (MIS)--Ein Ausblick.

Future developments of MIS will strongly depend on economic conditions in the managed care system. There are clear indications for benign diseases but in malignant tumors well defined oncologic standards are mandatory to maintain.

[Intrafascial hysterectomy ("CISH" method; cervical intrafascial Semm hysterectomy)--can the risk of cervix stump carcinoma be calculated?]. / Die intrafaszial Hysterektomie ("CISH"-Methode) - Ist das Risiko eines Zervixstumpfkarzinoms kalkulierbar?

The incidence of the carcinoma of the cervical stump is reported in the literature between 0.1-3%. The operative treatment as well as the radiation therapy is more difficult and complicated in relation to the cervical malignancy of an "intact" uterus. On the other hand the supracervical uterus-amputation offers advantages versus the classical hysterectomy. So many endoscopic experienced groups prefer this operative technique. SEMM performs an additional stanza of the cervix and corpus in order to remove the cervical adenocells. This procedure was simulated with the help of an in vitro model to answer the question of facultative adenocells in the remaining cervix. 41 uteri and the resected stanzas were histologically examined. Adenocells could be detected in 68.3 % of the cervical hulls. The transformation zone could be resected totally in all cases. Taking into account these results we can conclude, that the combination of the supracervical hysterectomy with a cervix-corpus-stanza could reduce the risk of a cervical stump-carcinoma. Because of remaining adenocells in the cervical hull, this special carcinoma-risk can't be excluded after an interval of at least 20-25 years.

[Minimally invasive therapy of peritoneal leiomyomatosis. A case report of diagnostic and therapeutic problems]. / Minimal invasive Therapie bei peritonealer Leiomyomatose. Ein Fallbericht über die diagnostische und therapeutische Problematik.

Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease characterised by the presence of multiple intraabdominal nodules, consisting of benign smooth muscle. LPD has only been found in women, predominantly in their late reproductive age. There is a very high association with excess exogenous and endogenous female gonadal steroids, specifically oestrogen and progesterone. Since it is grossly indistinguishable from diffuse carcinomatosis of the peritoneum, several unnecessary radical procedures have resulted. We describe the 44th documented case and the first case of minimal invasive surgery in a 42-year-old women with peritoneal leiomyoma on the right pelvic wall and uterine subserous and submucous leiomyoma.

Histochemical demonstration of zinc in the spermatotheka of Salamandra salamandra (L.) (Amphibia, Urodela).

Zinc has been localized histochemically in the spermatotheka of the salamander Salamandra salamandra using a modified dithizone method. Results are discussed regarding the specificity of the method as well as the significance of Zn for long sperm storage and for possible reactivation of spermatozoa.

[Distribution of heavy metals in human ejaculate--a histochemical study]. / Die Schwermetallverteilung im menschlichen Ejakulat--eine histochemische Studie.

With the help of a modified dithizone method, heavy metals could be demonstrated in the sperms, the ejaculate fluid, and the spermatogenic cells of men. The heavy metals were localized in the sperms in form of small red granules particularly in the mid piece with a distribution like a "string of pearls". The sperms with a lower motility index often did not show any heavy metal granules in the mid pieces. The absence of essential heavy metals like zinc, iron or manganese may lead to the inhibition of enzyme systems in the mid pieces of the sperms, which are essential for the motility.

Zinc transport through residual bodies in the rat testis; a histochemical study.

The aim of the present report was to study the zinc localization in rat testis with the help of a modified selective histochemical method (dithizone method). To achieve a selective demonstration of zinc, 16 microns thick serial cryostat sections of the Wistar rat testis were incubated with dithizone solution followed by a treatment with a "complexing buffer". PAS-reaction with haematoxylin was performed to determine the stages of spermatogenesis. During the maturation phase (from stage III onwards) the red coloured zinc dithizonate granules are observed in the mid piece and tail of elongated spermatids; the number and the stain intensity of zinc granules increase continuously till the stage VII. During the stages IX--X the zinc granules, present in the residual bodies, migrate from the adluminal to the basal Sertoli cell compartment. Thereafter, the zinc granules are observed only in the boundary tissue till the stage XIV. The results lead to suggest that the residual bodies play an essential role in the zinc transport.