[Water birthing: retrospective review of 2625 water births. Contamination of birth pool water and risk of microbial cross-infection]. / Partorire in acqua: esperienza dopo 2.625 parti in acqua. Contaminazione dell'acqua nella vasca da parto e rischio di infezione con diversi microrganismi.

UNLABELLED: The aim of this study was to document the practice of 2625 water births at Vipiteno over the period 1997-2009 and compare outcome and safety with normal vaginal delivery. The microbial load of the birth pool water was analyzed, and neonatal infection rates after water birth and after land delivery were compared. Methods. The variables analyzed in the 1152 primiparae were: length of labor; incidence of episiotomies and tears; arterial cord blood pH and base excess values; percentage of pH<7.10 and base excess values >/=12 mmol/L. In all 2625 water births, the variables were: analgesic requirements; shoulder dystocia/ neonatal complications; and deliveries after a previous caesarean section. Bacterial cultures of water samples obtained from the bath after filling (sample A) and after delivery (sample B) were analyzed in 300 cases. The pediatricians recorded signs of suspected neonatal infection after water birth and after conventional vaginal delivery. RESULTS: There was a marked reduction in labor duration in the primiparae who birthed in water; the episiotomy rate was 0.46%. Owing to the pain relieving effect of the warm birth pool water, pain relievers (opiates) were required in only 12.9% of water births. Arterial cord blood pH and base excess values were comparable in both groups. Shoulder dystocia/neonatal complications were managed in 4 water births; 105 women with a previous caesarean section had a water birth. In sample A, the isolated micro-organisms were Legionella spp. and Pseudomonas aeruginosa; in sample B, there was elevated colonization of birth pool water by total coliform bacilli and Escherichia coli. Despite microbial contamination of birth pool water during delivery, antibiotic prophylaxis, as indicated by clinical and laboratory suspicion of infection, was administered to only 0.98% of babies after water birth versus 1.64% of those after land delivery. CONCLUSIONS: Results suggest clear medical advantages of water birthing: significantly shorter labor duration among the primiparae; a net reduction in episiotomy rates; and a marked drop in requests for pain relievers. During expulsion of the fetus at delivery, fecal matter is released into the birth pool water, contaminating it with micro-organisms. Despite this, water birthing was found to be safe for the neonate and did not carry a higher risk of neonatal infection when compared with conventional vaginal delivery.

[Giving birth in the water: experience after 1,825 water deliveries. Retrospective descriptive comparison of water birth and traditional delivery methods]. / Gebären im Wasser: Erfahrung nach 1825 Wassergeburten. Retrospektiv deskriptive Vergleichsanalyse zwischen Wassergeburten und traditionellen Geburtsmodalitäten.

OBJECTIVE: We reviewed 1,825 water births at a single institution over a 9-year period. METHODS: We compared 830 primipara deliveries in water with 424 primipara deliveries in the traditional bed and 136 on the delivery stool. We also evaluated the duration of labour, arterial cord blood pH and base excess in the primiparae, and perineal trauma, shoulder dystocia and deliveries after preceding caesarean section as well as rates of neonatal infection in all the 1,825 water births. RESULTS: The duration of the first stage of labour was significantly shorter with water births than with the other delivery positions. The episiotomy rate for all water births was found to be much lower compared to deliveries carried out in the bed or on the birthing stool. The rate of perineal tears was similar. There were no differences in the duration of the second stage, arterial cord blood pH and base excess. No woman using the water birth method required analgesics. There were 3 shoulder dystocias with water births. Sixty-eight women delivered in water after a preceding caesarean section. CONCLUSION: Water births appears to be associated with a significantly shorter first stage of labour, a lower episiotomy rate and reduced analgesic requirements when compared with other delivery positions. If women are selected appropriately, water birth appears to be safe for both the mother and neonate.

[Water contamination and infection rate after water births]. / Die Kontamination des Wassers und die Infektionsrate bei der Wassergeburt.

OBJECTIVE: This study aimed at examining the water of the birthing tub for pathogenic germs and at comparing the infection rates of the children born conventionally. METHOD: In a prospective study, the germs found in the water of 300 water births were determined . The tub water was sampled twice: sample A was taken after filling the tub with tap water, sample B after the water delivery. In addition, the paediatrician documented any signs of infection of the neonates during their hospital stay. RESULTS: The A samples contained Legionella in 29%, Pseudomonas aeruginosa in 22%, enterococci in 18%, colibacilli in 32% and Escherichia coli in 8%. After fitting a filter system, no Legionella was detected any more. P. aeruginosa was found in only 3% of the samples. In the B samples, we found an increased contamination by colibacilli in 81%. A marked burden with E. coli was detected in 58% of the samples. Due to a clinically an biochemically suspected beginning infection, 1.15% of the water-born children (14 out of 1,215) were given antibiotics. In contrast, 2.30% of the conventionally born neonates (19 out of 817) were treated with antibiotics. CONCLUSION: It is evident that during the bearing-down phase faeces are discharged into the birthing tube and that the water is contaminated mainly by E. coli and colibacilli, but also slightly by Staphylococcus aureus. The contamination of the tap water by Legionella and Pseudomonas could clearly be reduced by installation of a filter system into the supply hose of the birthing tub. Neonatal infections were not more frequent after water births than after conventional deliveries.

[Water birth and neonatal infections. Experience with 1575 deliveries in water]. / Partorire in acqua e rischio di infezione. Esperienza dopo 1575 parti in acqua.

AIM: The aim of our study is to provide an answer on the advantages offered by water births, to compare them with 2 other delivery positions and to analyse the pathogenous microorganisms present in the water from the bath. METHODS: We compared 725 primiparae deliveries in water, 407 primiparae deliveries in bed and 142 on the delivery stool over the last 7 years. We evaluated the duration of labour, perineal trauma, arterial cord blood pH, shoulder dystocia and postpartum maternal hemoglobin levels. We have evaluated 200 water samples, taken from the bath after filling it and after delivery, and analyzed the pathogenous microorganisms and the possibility of neonatal infections. RESULTS: The duration (first stage) of labour and the rate of episiotomies was significantly reduced in primiparae delivering in water compared with the other delivery positions. Nevertheless, the percentage of perineal trauma was not increased. There were no differences in the duration of the second stage and arterial umbilical cord blood pH. Postpartum maternal hemoglobin levels remained unchanged. No woman delivering in the water required analgesics. Infections after water births do not occur more frequently than after traditional births. CONCLUSIONS: Our results show that water birth has major advantages compared with traditional delivery methods. It is associated with a significantly shorter first stage of labour, a lower episiotomy rate and reduced analgesic requirements when compared with other delivery positions. Provided that the women are selected appropriately, and the hygiene rules are respected, water birth is safe for mother and neonate.

[Birth in water. A comparative study after 555 births in water]. / Partorire nell'acqua. Studio comparativo dopo 555 parti in acqua.

BACKGROUND: The object of our study is to research into the quality of the different delivery positions, offered in our hospital with special focus on the advantages for birth in water. METHODS: From February 1997 to 1 October 2000 we do research retrospectively on data of 555 deliveries in water, 320 on the traditional bed and 125 on the delivery stool give us the possibility to investigate about duration of birth, rate of episiotomies and perineum lacerations, consumption of painkillers, arterial umbilical cord pH and haemoglobin postpartum. RESULTS: In our comparing analysis of the duration of birth we could show a relevant reduction especially for primiparae which had delivered in water. The reduction is only significant for the first part of labor (360 minutes in the pool, 445 minutes on the traditional bed and 420 minutes on the stool) whereas there is no difference for the second part of labor. The significant reduction on episiotomies (1%) in comparison to the one on the traditional bed (20%) or on the stool (10%) for primiparae in water doesn t mean an increase at perineum lacerations. (each 25%). In water we saw no lacerations/injuries of the perineum for 58% of primiparae, on the traditional bed 36% and on the stool 43%. No woman in labour needed a painkiller in the pool. There was no difference found between the three groups referring to the arterial umbilical cord pH or the haemoglobin postpartum. CONCLUSIONS: Our study shows relevant medical advantages for a delivery in water: and a significant reduction of the duration of the first part of labour, significant less episiotomies and perineum lacerations and no need for painkillers. The security of the neonate is guaranteed under attention to the known contraindications.

[Cardioprotection in chemo- and radiotherapy for malignant diseases--an echocardiographic pilot study]. / Kardioprotektion bei Chemo- und Radiotherapie für maligne Erkrankungen--eine echokardiographische Pilotstudie.

AIM: Pilot study, examining the cardioprotective effect of an antioxidant regimen in patients with malignancies receiving high dose chemo- or radiotherapy. PATIENTS AND METHODS: 14 patients with chemotherapy and 10 patients with radiotherapy were randomized in a double-blind fashion (placebo versus vitamin E and C and N-acetylcysteine). Systolic and diastolic echocardiographic parameters were determined before and within three weeks of treatment completion. RESULTS: Left ventricular ejection fraction fell significantly in patients receiving placebo (radiotherapy: 67 +/- 6 to 56 +/- 2%, p = 0.008, chemotherapy: 67 +/- 7 to 60 +/- 8%, p = 0.05). Patients on antioxidants showed no significant fall in EF (radiotherapy: 63 +/- 8 to 61 +/- 7%, chemotherapy: 67 +/- 5 to 64 +/- 6%). CONCLUSION: The small number of patients in the study precludes a definitive statement. The preliminary results, however, suggest efficient cardioprotection by this cheap and safe antioxidant combination, so that larger studies are warranted for confirmation.

[Radiotherapy in malignant lung tumors]. / Radiotherapie bei malignen Lungentumoren.

Radiation therapy is performed in many different lung cancer situations, often in combination with chemotherapy and surgery. The indications for radiotherapy are limited disease in small cell lung cancer, postoperatively in not completely operated non-small cell lung cancer, medically inoperable lung cancer and not resectable locally advanced disease. Combined-modality approaches using various permutations of three treatment modalities, namely surgery, chemotherapy and radiotherapy, are currently under investigation. Palliative radiation therapy is able to reduce life-threatening symptoms from intrathoracic tumor as well as from distant metastases.

Prognosis of human chorionic gonadotropin-producing seminoma treated by postoperative radiotherapy.

PURPOSE: To clarify the controversy about the management and prognosis of human chorionic gonadotropin-producing seminoma, the records of 132 patients with abnormal human chorionic gonadotropin values treated with radiotherapy were analyzed. METHODS AND MATERIALS: The records of 1169 patients with pure seminoma treated in 10 institutions were screened for serum or urinary human chorionic gonadotropin. One hundred and thirty two patients with elevated human chorionic gonadotropin were found: 96 Stage I, 20 IIA, 7 IIB, 8 III and 1 IV. Median age was 34 y., mean follow-up was 5.0 years [range 1-12 y]. All received infradiaphragmatic radiotherapy (median dose 30 Gy), 25 (2 Stage I, 11 IIA, 5 IIB and 7 III) supradiaphragmatic radiotherapy (median dose: 28.5 Gy) and 10 had also initial chemotherapy (3 Stage IIB 6 III and 1 IV). Patients were allocated to three groups according to human chorionic gonadotropin values: (a) moderate elevation: up to 10 times (104 pts), (b) high elevation: 10 to 100 times (20 pts), (c) very high elevation: over 100 times the upper limit of normal value (8 pts). RESULTS: The proportion of Stage I, II and III was 76%, 19%, 5% in the ME group versus 50%, 35%, 15% in the high elevation group (p < 0.05). In the very high elevation group there were 7 Stage I and 1 Stage IV. Of 132 patients, six died (three dead of disease, two suicides, one acquired immunodeficiency syndrome). The 5 years overall survival probability was 94%. There were seven recurrences (initial stage: 1 Stage I, 2 IIB, 3 III and 1 IV). Of these, there were one in-field recurrence, 3 out of field and 3 in both sites. In 5 of 7, the human chorionic gonadotrophin level was again elevated at recurrence. The 5 years recurrence-free-survival probability was 94% (98% for Stage I, 100% for Stage IIA and 65% for Stage IIB and III [p < 0.001 between I and IIB + III, p < 0.05 between IIA and IIB + III]). Four of the 7 recurrences were salvaged by chimiotherapy +/- radiotherapy. In the high elevation and very high elevation groups, the 5 years recurrence-free-survival was 88%, vs. 96% for the moderate elevation group (p = 0.10). CONCLUSION: Based on this series of patients, human chorionic gonadotropin production is not an unfavorable prognostic factor in pure seminoma. Even in the subgroups with high or very high human chorionic gonadotropin levels (who had a higher proportion of advanced stages), the prognosis remained excellent. In Stage I and IIA seminoma with abnormal human chorionic gonadotropin levels, recurrence rate after post-operative radiotherapy alone is extremely low.

[Sphincter-preserving radiotherapy of anal carcinoma]. / Sphinktererhaltende Strahlentherapie des Analkarzinoms.

During the last decade radiotherapy, in combination with chemotherapy, has become the treatment of choice in cure of anal carcinoma with preservation of anal function, and has replaced abdominoperineal resection (APR). From 1979-1990 54 patients with anal carcinoma were treated by radiotherapy. 24 patients received radiotherapy after APR (12 adjuvant, 12 after recurrence). 11 received palliative radiotherapy without prior APR. 19 patients were treated curatively, 17 of whom received a combination of external irradiation followed by interstitial iridium implantation in a split course regimen. 11 of the 19 patients received short simultaneous chemotherapy (mitomycin C and 5-fluorouracil). All 19 patients had a complete remission. 18/19 patients had no local recurrence after mean 14 months' follow-up. 2 patients developed regional recurrence. 3 patients died of other causes. Colostomy was necessary in 5/19 patients with anal necrosis which was dose-related. The maximum tolerated dose was 71.4 Gy. Our results support the recommendation in the literature of primary, curative, radiotherapy and chemotherapy of anal carcinoma with preservation of the anal sphincter.

Radionephrographic follow-up with hypertensive patients after angioplasty of renal artery stenosis.

Radionephrographies were performed in 23 hypertensive patients before and after 28 transluminal dilatations (PTD) of their stenosed renal arteries. The changing clearances for both kidneys (global = Clgl) and for stenosed and contralateral kidneys (Clst and Clco) were followed for three groups, dependent on their clinical outcome, as well as the parenchymal transit time (re-entry time) for the diseased (Rtst) and contralateral kidneys (Rtco): (A) Normalized hypertension: for 9 patients the preoperative Clco was never lower than 150 ml/min, but increased significantly after PTD. Rtst fell significantly, Rtco remained constant. Mean increase in Clgl = 91 ml/min (+25%). (B) Improved hypertension: in 12 patients Clst and Clco had been lower than with those in group A; postoperatively Clst increased, Rtst fell significantly. The Rtco was prolonged early after PTD but normalized later. (C) Permanent hypertension: for 7 of these patients there were no preoperative criteria for a discrimination against the other groups. But in all Rtst did not normalize, and Rtco increased early after PTD. Even in later examinations Rtco remained higher than preoperatively. These results imply that the success of PTD depends mainly on the behavior of the contralateral kidney. The examination 1 day after the PTD gives an optimal prognosis concerning the end result.

Histiocytosis-X in gynecology.

(1) Histiocytosis-X can manifest itself in virtually every organ, but in gynecology it is an absolute curiosity. (2) Differential diagnosis must exclude specific and nonspecific ulcerations and granulations such as syphilis, tuberculosis, Boeck's disease, and also neoplastic processes like lymphomas, sarcomas, carcinomas, and malignant diseases of the hemopoietic system. (3) The diagnosis by light microscopy alone, as in our case, may be insufficient; therefore, electron microscopy should be used. As soon as the diagnosis is confirmed histologically, an extensive examination of all organs is necessary in order to establish an exact prognosis and an optimal plan of therapy. (4) Because of the unknown etiology of histiocytosis-X, a causal treatment is not yet possible. In spite of this, with a symptomatic, individualized therapy by means of excision, low-dose irradiation and cytotoxic agents a 5-year survival of 90% was obtained for the patients. (5) Because of its rarity and multidisciplinary character, histiocytosis-X is a challenge to interdisciplinary and interregional cooperation. Though not being a malignoma in the strict sense, diagnosis, therapy, and in part prognosis are not essentially different from a malignant disease.

[Epidemiology of endometrial carcinoma in the tyrol]. / Epidemiologie des Endometriumkarzinoms in Tirol.

The incidence rates of endometrial cancer during 1955-1980 were calculated for Tyrol and its political areas. The tumor registry of the Department of Obstetrics and Gynecology, University of Innsbruck, and the population statistics of the Austrian Central Office of Statistics were the sources of our data. We found a rising incidence although the increase was different in the various areas of Tyrol and during the time of observation. The age specific incidence rates were maximal in the age group 70 years and older in the last decennium of the observation time. The rising incidence of endometrial cancer can be explained partly by the changing age related structure of the population and by the better diagnostic efficiency, partly it is due to a factor which is not known until today.

[Ectopic pregnancy: changes in diagnostic procedures? (author's transl)]. / Zur Frage der Diagnose der ektopischen Schwangerschaft.

Patients with ectopic pregnancy and those suspected having ectopic pregnancy were reviewed in a twenty years interval (1957-59, 1977-79). These patients were evaluated with regard to medical history, clinical and laboratory findings, diagnostic procedures, and clinical course. The diagnostic usefulness of symptoms and diagnostic procedures is expressed in terms of sensitivity and specificity. According to our results laparoscopy is an ideal procedure for early diagnosis of ectopic pregnancy. Nevertheless, puncture of the Douglas pouch in our experience has its place as a diagnostic tool in the diagnosis of ectopic pregnancy.