[Influence of the birth clinic on breastfeeding]. / Einflussfaktoren der Entbindungsklinik auf den Stillbeginn.

A decrease of breastfeeding culture could be observed since the 1950's. However in the 1980's the WHO and UNICEF began engaging in campaigns for breastfeeding since the benefits for mother and child are evident. In 1990 UNICEF set up the "10 steps to successful breastfeeding" that gave birth clinics around the world "guidelines" that would initiate an unproblematic breastfeeding relationship between mother and child. These guidelines can be understood as measures toward increasing staff motivation, training and instruction as well as actually helping parents and increasing their motivation. Further points cover the optimal beginning of breastfeeding and aspects of complementary feeding. Certification of departments by internationally renowned observers is a means of implementing and securing best quality breastfeeding encouragement in the birth clinics. The positive effects of this promotion on the ratio of mothers breastfeeding and thus in respect to childrens health could be proved by randomised studies. The experience gained in the Obstetrical Department of the Vivantes Humboldt Clinic is described.

[Does breast-feeding prevent breast cancer?]. / Stillen als Brustkrebsprävention--eine Ubersicht.

Many epidemiological studies show clearly the restraining effect of breast-feeding on breast cancer. So it could be shown that breast-feeding for one year reduces the individual risk for premenopausal breast cancer by 45%. The risk of postmenopausal breast cancer in the developed countries could be decreased by 42% by increasing the breast-feeding time in life. Most authors assume that the protective value of breast-feeding is hormone-conditioned. Further theoretical implications result from the increasing knowledge of the immunologic characteristics of the mother's milk. Beside well-known positive effects of breast-feeding on children's health, breast-feeding should also be further promoted from the view of women's health.

[Uterine myomatosis with senile hematometra in a 101-year-old patient]. / Uterus myomatosus mit seniler Hämatometra bei einer 101-jährigen Patientin.

A 101-year-old patient presented with uterine myomatosis and bleeding associated with a large hematometra. An abdominal hysterectomy with adnexectomy was performed following an in-depth consultation with the patient and her daughter. The patient was discharged on the 12(th) postoperative day after a complication-free course. This case report demonstrates not only the current possibilities in the gynecological treatment of very old patients but also the hidden reserves in the gynecological care ot these women.

[Spontaneous cecum perforation following cesarean section]. / Die spontane Zökumperforation nach Sectio caesarea.

There is a certain risk of paralytic distension of the bowel, especially of the coecum, during the initial post-operative days following caesarean section. As can be seen from the overview presented, the possible result is spontaneous perforation of the coecum, which frequently has lethal consequences. Early differential diagnostic consideration for a mother exhibiting early warning post-caesarean symptoms can be life saving. We would recommend as prophylaxis early bowel stimulation with a laxative already on the second day following surgery. By distension of the coecum over 9 cm, as measured by sonography, decompression using either coloscopy or even coecostomy is recommended. Ischemic damage of the intestinal wall, as a result of excessive distension, is the main etiological factor for spontaneous perforation. The declining post partum oestrogen levels and resulting decreased parasympathetic tone, as well as the preceding anaesthesia account for the paralytic bowel symptoms.

Aspiration cytology and E2 content in ovarian tumors.

This study demonstrates the reasonable reliability of fine needle aspiration cytology in ovarian tumors: 91% of benign and 84.5% of malignant tumors were diagnosed correctly by aspiration cytology. The concentration of estradiol-17 beta in cyst fluid may be helpful in distinguishing follicle cysts from neoplastic cysts. Cytologic differentiation of aspirated ovarian tumors was reasonably accurate. With respect to the approximately 1.6% of severe pelvic inflammations in our patients, we suggest that there are few indications for the use of aspiration cytology in ovarian tumors. In spite of a worldwide trend towards cytologic diagnoses by means of aspiration biopsy, there are still few studies on the aspiration biopsy of ovarian tumors. This is surprising because fine needle puncture of ovarian tumors is neither more trouble-some nor more complicated than the well-established cytologic biopsy of the prostate. This paper reports on the reliability of this method and its capability in the differentiation of various types of ovarian tumors. The differentiation of ovarian cysts is of particular interest.

[Treatment of the premenstrual syndrome with a retroprogesterone (Duphaston)]. / Zur Behandlung des prämenstruellen Syndroms mit einem Retroprogesteron (Duphaston).

The symptomatology of the premenstrual syndrome is frequently seen in general and gynecological practice. The aim of this study was to examine the therapeutical effect of dydrogesterone (Duphaston) on the typical premenstrual complaints as depression, headache, edema, mastodynia, dysmenorrhea and bleeding irregularities. Oral administration of 20 mg dydrogesterone b.i.d. during the second half of the menstrual cycle could well relieve the complaints mentioned above. Best results of treatment were obtained in cases of dysmenorrhea, bleeding irregularities, depression and edema. In our patients mastodynia was not influenced by dydrogesterone-therapy. As shown by basal body temperature and progesterone in plasma the menstrual cycles remained ovulatory under therapy. The treatment with dydrogesterone was tolerated well in general, blood pressure and body weight were not altered significantly. The majority of patients wished to continue the treatment beyond the period of this study.

Plasma concentrations of unconjugated and conjugated estrogens and gonadotrophins following application of various estrogen preparations after oophorectomy and in the menopause.

In 55 patients after oophorectomy and 20 women after natural menopause an oral estrogen replacement therapy was performed with estrone-sulfate, estradiol 17-valerate, estriol-succinate, a combination of micronized estradiol and estriol (Estrifam, Trisequens), and natural conjugated estrogens. In 4 patients a 3 mg estradiol per 5 g ointment substance was applied on the abdominal skin. The interindividual variations of estrogen increments during therapy were considerably high. Oral intake of 2 mg estriol-succinate daily was followed by a 500% increase of total (conjugated + unconjugated) estriol. Concentrations of unconjugated estrogens were not altered by this dosage. Following oral application of the other above mentioned preparations, prominent rises--especially of unconjugated estrogens in plasma--were noted. The concentration peaks occurred within 3--6 h after application. Unconjugated estradiol-17 beta in plasma was comparable with values of the follicular phase of a normal menstrual cycle, unconjugated estrone, however, was nonphysiologically high. Consequently, the E1/E2 ratio was greater than one whereas it is normally below one. 12 h after oral estrogen application, plasma estrogens dropped to almost initial values, so that a second medication seems to be necessary in order to guarantee an adequate supplementation over the course of the day. The hormone values determined in this study did not show significant differences between patients after a natural menopause and after oophorectomy. There was a positive correlation between rising estrogen levels and suppressed gonadotrophins during replacement therapy. The occurrence of climacteric symptoms did not exclusively depend on low estrogen and high gonadotrophin levels. Good tolerance of estrogen therapy with significantly elevated estrogen concentrations in plasma can be obtained transcutaneously in the form of estrogen ointments. Such therapy might simulate the physiological estrogen pattern even better than oral application does because of delayed and diluted steroid flow to the liver.

[Late sequels EPH gestosis (author's transl)]. / Uber die Spätfolgen der EPH-Gestose.

The courses of the following three groups of pregnancies were studied in the context of 146 women, with twelve years, on average, having elapsed from their first pregnancies: 1. Normal pregnancies without EPH gestosis (58 cases); 2. Pregnancies with EPH gestosis (58 cases); 3. Pregnancies with eclampsia (30 cases). - All clinical findings and statistical calculations were evaluated by means of electronic data processing. - Average systolic and diastolic blood pressures were established in follow-up checks, usually twelve years from pregnancy. They were normal, following normal pregnancies. Statistically secured blood pressures measured from patients with gestosis or eclampsia during their first pregnancy were higher than those recorded from patients in a control group, but pathological values were established in but few cases. - The following, more specialised checks proved or particular importance for an evaluation of EPH gestosis and its effects on liver function following pregnancy: serum electrophoresis, thymol test, SGOT, SGPT, direct and indirect bilirubin, blood and urinary sugar, serum cholesterol, and total fats. - The above results are likely to show that EPH gestosis and its effects are relatively well tolerated by the liver. However, discrete disorders characterised by dysproteinaemia without cellular decay and icterus may occur in certain instances.

[Diagnosis and monitoring of endangered early pregnancies with determination of oestrone, oestradiol 17beta, oestriol, progesterone and HPL in plasma and the pregnancy test in graduated dilutions of urine (author's transl)]. / Diagnostik und Uberwachung der gestörten Frühschwangerschaft mit Bestimmung von Ostron, Ostradiol-17beta, Ostriol, Progesteron und HPL im Plasma und dem gestuften Schwangerschaftstest im Urin.

Unconjugated oestrone (Oe1), oestradiol-17beta (Oe2), oestriol (Oe3), progesterone (P) and HPL in plasma were determined by radioimmunoassay and the immunological pregnancy-test in urine was carried out in 70 patients with normal pregnancy or imminent abortion from 4th-20th week of gestation. Oe2 and HPL showed the most pronounced rises, Oe3 increased especially after the first trimester. In cases with abortion symptoms and poor prognosis Oe2 and HPL gave the most reliable results concerning the endocrin function of early normal pregnancy. Oe1- and P-values in normal pregnancy did not differ so clearly from concentrations observed during normal menstrual cycles and were thus of less value. The pregnancy-test was positive (greater than 1000 IU/1) even in most cases of dead pregnancy and therefore not reliable. With increasing production of oestrogen precursors in the fetal adrenal cortex after the first trimester determination of Oe3 becomes more important. In cases with abortion symptoms in early pregnancy and subsequent normal development, plasma Oe2- and Oe3- values represented best criteria for a prognosis. -- For the diagnosis and control of the endangered early pregnancy we recommend, as a consequence of this study, determination of Oe2 up to the 13th week of pregnancy and thereafter Oe3 in maternal plasma.

PIP: For 70 patients with normal or threatened pregnancies in the 4th-20th weeks, radioummunoassay tests for free estrone (E1), estradiol-17beta (E2), estriol (E3), progesterone (P), and HPL in plasma were carried out and the immunological human chorionic gonadotropin pregnancy test in urine was performed. E2 increases specifically at the beginning of the second trimester. In cases of threatened abortion symptoms with unfavorable prognosis, E2 and HPL were found to be the most reliable indicators of intact pregnancies. E1 and P values were not as valuable, since even in normal pregnancies they do not deviate significantly from maximal menstrual values. The urine pregnancy test did not prove to be reliable; in cases of proved fetal death it often remained positive for several days (greater than 1000 IU/1). With increasing production of estrogen precursors int he fetal adrenal cortex after the first trimester, determination of E3 becomes more significant for diagnosis. In cases with abortion symptoms in early pregnancy and subsequent normal development, plasma E2 and E3 values represented the best criteria for prognosis. In conclusion, determination of E2 to the 12th week of pregnancy, and thereafter radioummunoassay determination of E3 in maternal plasma is recommended for diagnosing and supervising imminent abortion in early pregnancy. Serial examinations would seem to be more informative than individual values.

Estrogens in maternal plasma following intraamniotic injection of (3H)-dehydroepiandrosterone-sulfate in midpregnancy.

In 4 patients with normal pregnancies between the 18th and 20th week of gestation (3H7alpha)-dehydroepiandrosterone-sulfate ([H]-DHEA-S) was injected intraamniotically. Maternal venous blood was drawn before and at regular intervals for 240 minutes after DHEA-injection. Thereafter, legal abortion was performed by intraamniotic instillation of prostaglandine. The conjugated steroids were hydrolyzed enzymatically and the total steroids were isolated and identified. The following labelled metabolites were determined quantitatively: Estriol (e3, estradiol-17beta (E2-17beta), estrone(E1), 16alpha-hydroxy-estrone, (16alpha-OH-DHEA), ALPHA4-androstenedione (AD) and testosterone (T). The maximal increase of all estrogen fractions in matermal plasma occurred 120-180min after intraamniotic injection of the precursor. The most prominent rise of the C18-steroids could be shown for estriol. 60-70% of all metabolites were C16-hydroxylated.

PIP: Tritiated-7alpha-dehydroepiandrosterone sulfate (DHEA-S) was injected intraamniotically in 4 women with normal pregnancies between the 18th-20th week of gestation, and its metabolities were determined. Maternal venous blood samples were obtained before and at regular intervals for 4 hours after injection of DHEA-S. Abortion was then induced by intraamniotic instillation of prostaglandins. The following labeled metabolities were identified: estriol, estradiol-17beta, estrone, 16alpha-hydroxy-estrone, dehydroepiandrosterone, delta4-androstenedione and testosterone. All estrogen fractions showed a maximal increase in maternal plasma between 120-180 minutes after injection of DHEA-S. Of the c(18)-steroids, estriol showed the greatest increase. Approximately 60-70% of all the metabolites were c(16)-hydroxylated. The results provide valuable information regarding the quantity of fetoplacental steroid metabolism in midpregnancy.