[When children "have children"--reproduction biological problems in girls between 11 and 15 years of age]. / Wenn Kinder "Kinder kriegen"--Reproduktionsbiologische Probleme bei Mädchen zwischen 11 und 15 Jahren.

The aim of the present study was to evaluate the obstetric risk in pregnant adolescents under 16 years of age. From July 1, 1970 to June 30, 1993, 188 girls aged 11-15 years were delivered at the 2nd Department of Obstetrics and Gynaecology, Vienna; 4569 primiparous women between 20 and 24 years with singleton pregnancies served as a control group. No significant differences between the two groups were found for the frequency of pregnancy-induced hypertension (2.1% vs. 3.5%), premature delivery rates (24.4% vs. 29.8%), percentage of babies weighing less than 2500 g (10.1% vs. 9.1%), mean birthweight (3082 g vs. 3117 g), frequency of intrauterine growth retardation (2.1% vs. 2.4%) and malformations (1.6% vs. 3.1%) and perinatal mortality to the end of the first week (1.1% vs. 0.5%). Adolescent mothers were found to have more spontaneous deliveries (85.1% vs. 74.9% in the control group, p < 0.005), lower Caesarean section rates (6.4% vs. 11.3%, p < 0.05) and fewer babies with a birthweight exceeding 4000 g (1.1% vs. 4.3%, p < 0.05). For the first time, the pregnancy outcome of European adolescents was studied over a period of 23 years. We conclude on the basis of our results that maternal and neonatal risk in mothers under 16 years of age does not exceed the obstetric risk in adult mothers.

[Does the risk of complications after amniocentesis depend on the indications for intervention? An evaluation of 2,066 punctures]. / Ist das Komplikationsrisiko nach Amniozentese von der Indikation zum Eingriff abhängig? Eine Auswertung von 2066 Punktionen.

Data from 2066 amniocenteses were analysed retrospectively to test the hypothesis whether the indications for amniocentesis influence the risk of post-procedural complications. Compared to the reference group of 35-39 year-old gravidae, the complication rates were similar in women with a previous child with chromosomal abnormality, in cases with maternal disease, abnormal biochemical markers, maternal anxiety, and translocation carriers. If the maternal age was 40 years and over, only the percentage of pregnancy terminations for fetal abnormalities was higher than in the reference group; high parental age was associated with a significantly decreased fetal loss rate. In the group of amniocenteses performed for sonographic evidence of fetal malformation, the highest total complication rates and the highest fetal loss rates were observed.

Umbilical arteries of babies born to cigarette smokers generate less prostacyclin and contain less arginine and citrulline compared with those of babies born to control subjects.

OBJECTIVE: The hypothesis of this study was that umbilical arteries of babies born to smoking mothers produce less nitric oxide and prostacyclin than do those of nonsmoking mothers. STUDY DESIGN: L-Arginine, L-citrulline, L-cysteine, and prostacyclin were measured in the umbilical arteries of 11 babies born to smoking mothers and 16 infants born to nonsmoking controls. The concentrations in the two groups were compared with the modified t test. RESULTS: The generation of prostacyclin was reduced in the umbilical arteries of infants of smoking mothers. Similarly, L-arginine and L-citrulline, but not L-cysteine levels, in these arteries were suppressed compared with those of the nonsmoking controls. CONCLUSION: Along with the known direct vasoconstrictive effect of nicotine, nitric oxide and prostacyclin deficiency may affect the uteroplacental blood flow and contribute to the impaired fetal nutrition and increased perinatal mortality of babies born to women who smoke.

[Prenatal management of fetofetal transfusion syndrome]. / Pränatales Management des fetofetalen Transfusionssyndroms.

The twin-twin transfusion syndrome is a rare but severe complication in monozygotic twins. A total of 172 twin pregnancies were investigated in our hospital between January 1990 and August 1993. The patients were divided into 4 groups: Group I: Normal twin pregnancy, treatment only in our hospital. Group II: Twin-twin transfusion syndrome, treatment only in our hospital. Group III: Normal twin pregnancy, delivery in another hospital. Group IV: Twin-twin transfusion syndrome, after treatment and therapy delivery in another hospital. These cases were analysed concerning prenatal management and perinatal outcome. The perinatal mortality rate in group I-IV was 17%, 58%, 18% and 60%, respectively. A benefit of aggressive amniocentesis in case of polyhydramnios, administration of digoxin and timing of labour could be demonstrated.

Sonographic depiction of fetal tooth germs.

Recently, sonography of the fetal face has gained increasing importance in prenatal diagnosis. It is not yet clear whether sonographic depiction of fetal tooth germs would have an influence on the prenatal diagnosis of ectodermal dysplasia syndromes. During routine malformation screening, horizontal sections of fetal jaws were visualized and examined for tooth germs in 124 pregnant women following sonographic 'facing'. Histological jaw sections of fetuses that had died in utero at various gestational ages were produced in order to examine the degree of correspondence between the sonographic and histological findings. At least four tooth germs were found in the jaws of all fetuses between 19 and 34 gestational weeks (n = 104). Although jaw visualization was possible between 14 and 18 gestational weeks (n = 20), the exact number and location of the tooth germs could not be determined. Assessment of tooth germs may become increasingly important, as aplasia of the tooth germs is one of the principal signs of various hereditary ectodermal diseases.

[Ultrasound diagnosis of fetal tooth anlagen and their histologic correlates]. / Ultraschalldiagnostik fetaler Zahnanlagen und deren histologische Korrelate.

AIM: The present study was to examine the radiographic and histologic correlation of the respective ultrasonographic findings. METHODS: Histologic examinations were performed in 12 fetuses who had died in utero between 16 and 34 weeks of gestation. The fetuses had been examined by intrauterine sonography for tooth germs and had been subjected to additional radiographic examinations post abortum or partum. During autopsy, the tooth germs were again examined sonographically and radiographically, and non-decalcified histological sections were obtained by means of the sawing and grinding technique. RESULTS: The results obtained by histologically examining the 12 fetal jaws in the ultrasonic plane corresponded in all cases to those examined by sonography and radiology. CONCLUSION: Sonographic proof of tooth germs might gain increasing importance in future because agenesia of tooth germs is one of the principal signs of a variety of hereditary syndromes, particularly those of ectodermal origin.

[Prenatal diagnosis of isolated, unilateral anophthalmia]. / Pränatale Diagnostik der isolierten, unilateralen Anophthalmie.

Report on prenatal sonographic diagnosis of an isolated, unilateral anophthalmia. In the 27th week of gestation, unilateral anophthalmia without associated malformations was demonstrated in a fetus with male karyotype. The boy was delivered at 39 weeks' gestation. Post partum evaluation confirmed prenatal diagnosis. The child is developing normally to date.

[Electro- versus laser surgery for conservative laparoscopic revision of tubal pregnancies]. / Elektro- versus Laserchirurgie zur konservativ laparoskopischen Sanierung von Tubargraviditäten.

The objective of this study was to determine possible benefits of carbon dioxide laser over electrosurgical usage in conservative laparoscopic treatment of ectopic pregnancies (EP). 41 ectopic pregnancies managed by laparoscopic surgery were analysed retrospectively in regard to operation time, intraoperative blood loss and postoperative complications. No significant differences between both groups were observed. According to our data no advantage of the CO2 laser over electrosurgery in the conservative laparoscopic management of EP's could be demonstrated.

Development of ovarian pathology after hysterectomy without oophorectomy.

This study was done to determine the occurrence of disease in retained ovaries after hysterectomy. A retrospective analysis of patient charts was performed, comparing the patient reports of women who had secondary ovarian lesions with those whose ovaries showed no pathologic findings during the ten year period of observation (1980 to 1990). The study included 1,265 women with at least one ovary saved after hysterectomy for benign indications. Main outcome measures were ovarian pathologic findings after hysterectomy requiring repeat operation. The overall incidence of lesions in retained ovaries was 3.95 percent. There was a 3 percent risk of having secondary ovarian pathologic findings within three years after hysterectomy, with a decreased risk for the following seven years (mean follow-up time of 60 months, range of three to 120 months). Histologic findings at reoperation included common benign conditions of the ovary. No instance of carcinoma of the ovary was found. The risk of having pathology in the retained ovaries after hysterectomy was significantly higher in women who had only one ovary saved, compared with those who had both ovaries saved (7.63 versus 3.47 percent; p < 0.05). The mean age at hysterectomy was significantly lower in women who had ovarian disorders subsequent to hysterectomy than in those who did not (39.3 versus 43.9 years; p < 0.001). In the group of women with secondary ovarian lesions, mean parity was significantly lower than in those without reoperation (1.22 versus 1.94; p < 0.0001). Women with unilateral oophorectomy at the time of hysterectomy had twice the risk of secondary ovarian lesions, compared with those without oophorectomy at hysterectomy. Determinants, such as age, parity and gravidity must be considered when deciding whether or not to perform oophorectomy at hysterectomy.

Diagnosis and treatment of fetal anemia due to isoimmunization.

45 pregnant women affected by rhesus incompatibility were treated at the Department of Prenatal Diagnosis and Therapy, Vienna, between January 1992 and March 1993. 32 patients had a cordocentesis and on 21 fetuses, anemia requiring treatment was diagnosed. A total of 71 intravascular transfusions via the umbilical vein was given. The mean number of transfusions per fetus was 3.4 (range 1-11). Of the 7 fetuses who had already developed hydrops when therapy was started (hematocrit < 13%), 5 (71%) survived. The survival rate of non-hydropic anemic fetuses was 93% (13/14). By using intravascular transfusion for treatment of severe fetal anemia, a success rate of 86% (18/21) was achieved.

Agricultural work and male infertility.

Data from couples (n = 103) seeking artificial insemination with donor sperm because of poor sperm quality and a control group of couples treated by in-vitro fertilization due to female causes were analysed according to the occupations of the spouses. Comparison of occupational categories revealed a significant difference in the prevalence of agricultural occupation (11/103 vs. 1/103, p < 0.01) between the group with male factor infertility and the normospermic controls. These patients also reported more long-term exposure to several insecticides and other pesticides. These toxic chemicals probably have a detrimental effect on male fertility and therefore we suggest more caution in the way they are handled.

[Lead, mercury and cadmium in newborn infants and their mothers]. / Blei, Quecksilber und Cadmium bei Neugeborenen und deren Müttern.

The objective of the present study was to determine the toxic trace element status of 51 healthy Austrian women and their newborn babies. Lead, mercury and cadmium content of early breast milk, blood and urine were measured post partum by atomic absorption spectrophotometry. None of the toxic trace elements could be found in elevated concentrations; the content of mercury and cadmium in milk was below limits of detection. Mean lead concentration in breast milk was 35.8 (SD:15.0) micrograms/l. Whole blood content of lead was 37.0 (SD:12.7) micrograms/l in mothers and 26.3 (SD:11.6) in newborns. High blood concentrations of mercury were found both in mothers (4.46 micrograms/l, SD:1.95) and in umbilical cord blood (5.58 micrograms/l, SD:2.33). The corresponding values for cadmium were 0.44 (SD:0.4) micrograms/l and 0.08 (SD:0.16) micrograms/l. Urine excretion of the elements assayed was normal. Significant correlations between maternal and neonatal blood toxic mineral levels could be demonstrated in lead (p < 0.001).

[Isolated amyloidosis of hilar lymph nodes]. / Isolierte Amyloidose der Hiluslymphknoten.

Pseudotumoral mediastinal and pulmonary amyloidosis occur infrequently and may be confused with other tumors that are found more commonly in this region. Enlargement of hilar lymph nodes in the absence of pulmonary involvement is extremely rare. We report a case of nodular amyloidosis of the hilar lymph nodes that was studied using different diagnostic and radiologic methods. A previously healthy 79-year-old man presented with a large right hilar mass detected on routine chest roentgenography. The extensive mass behaved like a solid tumor and mimicked a bronchogenic carcinoma. At thoracotomy, frozen sections revealed the tumor to consist of kappa-light-chain amyloid. In light of the irresectibility of the tumor, thoracotomy was ended as open biopsy. Immunoelectrophoretic analyses of the plasma and urine showed no evidence of a paraprotein immunoglobulin or light chains. The patient was discharged without symptoms of disease. Different diagnostic procedures before and after surgery are discussed.

[Effectiveness and tolerance of tramadol with or without an antiemetic and pethidine in obstetric analgesia]. / Wirksamkeit und Verträglichkeit von Tramadol mit oder ohne Antiemetikum sowie von Pethidin zur geburtshilflichen Analgesie.

The aim of this prospective, randomised, blind study was to investigate the analgesic potency and tolerance of intramuscular Tramadol compared to a standard obstetric analgesia with Pethidine. Triflupromazine was administrated in combination with the two tested analgesics in order to study its efficacy in alleviating the emetic side effects of the tested analgesics. 66 parturients were randomly assigned to three groups: group A: 100 mg Tramadol (Tramal), group B: 100 mg Tramadol (Tramal) and 10 mg Triflupromazine (Psyquil), group C: 50 mg Pethidine (Alodan) and 10 mg Triflupromazine (Psyquil). No significant differences concerning duration of labour, FHR-alterations, umbilical cord blood gases, respiration pattern and Apgar Scores of the neonate occurred. In all three groups the analgesic effect was equally good. Combination of the analgesic with the antiemetic showed no reduction of the incidence and severity of side effects.

Prognostic appraisal of success and failure in an in vitro fertilization program by transvaginal Doppler ultrasound at the time of ovulation induction.

In 323 stimulated cycles of women participating in in vitro fertilization treatment, a transvaginal Doppler examination was performed on the day of ovulation induction to investigate the value of blood flow velocimetry of the uterine artery. The results showed a significantly lower pulsatility index in patients who conceived (n = 42) compared with those who did not become pregnant (n = 272). The differences were especially marked during the first cycles. These results suggest that studies of the uterine hemodynamic response are useful in appraising the likelihood of success of implantation after embryo transfer.

[Vaginal ultrasonographic observation of uterine contractions in embryo transfer and its relevance to treatment success]. / Die vaginosonographische Beobachtung von Uteruskontraktionen beim Embryotransfer und ihre Relevanz im Hinblick auf den Behandlungserfolg.

441 patients were treated by in-vitro fertilisation and embryo transfer (ET) from January 1989 to May 1990. Transvaginal ultrasound allowed pre-transfer assessment of the uterine architecture and confirmation of successful transfer after the procedure. The length and direction of the cervical and uterine cavity were noted. The real-time image was observed for one minute to see, if uterine contractions occurred. These can be clearly seen as pulsatile movements, which can be distinguished from breathing motions. We also recognised the localisation and the movement of the transferred air bubble. A "double bubble sign" occurs as a result of the two air bubbles being seen in sagittal transvaginal ultrasound. The embryos are sandwiched between the two visible bubbles. As far as the subjective methods used permit a definitive statement, there is no connection between contractions, localisation and movement of the air bubble with the success or failure of the E.T.

[Side effects of oral contraceptives in the first treatment cycle]. / Nebenwirkungen oraler Kontrazeptiva im ersten Einnahmezyklus.

In order to compare the secondary effects of oral contraceptive pills during the first cycle of application, 308 women between the age of 25 and 45 were interrogated by questionnaires about their subjective complaints. The patients received a contraceptive within an In-vitro-Fertilization-program (IVF-program) in preparation for a stimulation treatment to follow. The study consisted of two parts: at the beginning a pilot study was carried out in which retrospectively a pill containing 0.150 mg Desogestrel and 0.030 mg Ethinylestradiol and a contraceptive containing 0.075 mg Gestoden and 0.030 mg Ethinylestradiol were compared. In a following prospective randomized examination a product, new on the market, containing 0.250 mg Norgestimat and 0.035 mg Ethinylestradiol, was included. The most common secondary effects, occurring in 34% of our patients, were spottings and break through bleedings. Regarding the secondary effects--during the first cycle of application--no significant difference between the contraceptives could be established.

Effects of extracellular nucleotides on electrical properties of subconfluent Madin Darby canine kidney cells.

ATP and ADP but not AMP lead to sustained hyperpolarization of Madin Darby canine kidney (MDCK) cells. The present study has been performed to test for an influence of other nucleotides on the potential difference across the cell membrane (PD) in subconfluent MDCK cells. PD has been continuously monitored with conventional microelectrodes during rapid exchange of extracellular fluid. Application of 1 mumol/1 UTP leads to a rapid (less than 2 s) hyperpolarization of the cell membrane by -17.0 +/- 0.4 mV (from -50.1 +/- 0.6 mV), a reduction of cell membrane resistance and an increase of the sensitivity of PD to alterations of extracellular potassium. The concentration needed for half maximal effect of UTP is approximately equal to 0.2 mumol/1. ITP is similarly effective, whereas UDP, GTP and GDP are less effective. Up to 1 mmol/1 UMP, GMP, TTP or CTP do not significantly alter PD. In calcium-free extracellular fluid the hyperpolarizing effect of UTP is blunted (-11.6 +/- 2.3 mV) and only transient. In conclusion, UTP similar to purine triphosphates hyperpolarizes MDCK cells by increasing the potassium conductance. The activation of potassium channels requires calcium, which is apparently recruited from both intra- and extracellular sources.