Prenatal diagnosis of an uncommon syndrome: thrombocytopenia absent radius (TAR).

The prenatal diagnosis of the thrombocytopenia absent radius (TAR) syndrome using ultrasound and cordocentesis at the 34th week of gestation is established. Two basic components of the syndrome, bilateral absence of radius and thrombocytopenia at a level 12.000/mm3 were detected. No complication during the cordocentesis and delivery occurred due to thrombocytopenia. This case report, to our knowledge, is one of a limited number of cases emphasized on prenatal diagnosis of TAR syndrome in the world.

A review of trophoblastic diseases at the medical school of Dicle University.

Gestational trophoblastic disease cases encountered in 88 pregnant women during a period between January 1985 and June 1992 were retrospectively studied. During the same period we had 6800 deliveries. The incidence of gestational trophoblastic diseases was 12.9 per 1000 deliveries. Of these cases 72 (81.8%) were diagnosed as hydatidiform mole and 16 (18.2%) were diagnosed as choriocarcinoma in histopathological investigations. The preferred method of treatment for cases of hydatidiform mole was termination with suction curettage and oxytocin perfusion. Trophoblastic diseases were common in women with five or more pregnancies from rural areas and our incidence was higher when compared with similar studies. Moreover, our patients had low socio-economic and poor educational status. All these factors seem to be etiologic reasons, besides multiparity.

Postpartum subcutaneous emphysema with pneumomediastinum.

Spontaneous subcutaneous emphysema with pneumomediastinum occurs rarely in the setting of labour and delivery. We report the following occurrence in a 17 year old woman following delivery. Signs, symptoms, and pathophysiology are reviewed and treatment is discussed.

Treatment of chronic cervicitis: the loop electrosurgical excision procedure.

The effectiveness and morbidity of excisional biopsy of cervical tissue using the electrosurgical excision procedure for the treatment of chronic cervicitis was investigated. In this study, loop diathermy was used in the treatment of one hundred patients with chronic cervicitis. Before the procedure, cervical smear and colposcopic examination were done. Then the loop diathermy was performed under local anesthesia. All the removed specimens were evaluated histopathologically. The mean operation time was 6.34 +/- 1.37 minutes. The complication of bleeding and secondary infection were 5% and 4%, respectively. All the patients had normal cervical smear (Papanicolaou class I or II). In the microscopic evaluation, thermal damage of the removed specimens were negligible. Six cases (6%) with CIN (CIN I = 4, CIN II = 2) were determined and the others (94%) were reported as chronic cervicitis in the histopathologic examinations of the removed specimens. After the operation, these cases with CIN were followed up for one year with cervical smears and colposcopic examinations. One of the six patients with CIN had recurrence and underwent cold-knife conization. This new technique is simple, quick and cheap. It can be used confidently to provide both diagnosis and treatment with minimal thermal tissue injury in cases with chronic cervicitis.

[Megalourethra caused by coitus]. / Megalourethra durch Koitus.

Megalourethra due to urethral coitus is a very rare phenomenon in women. Anatomy, pathology and clinic are discussed.

Postpartum HELLP syndrome.

Presented is a case of postpartum pre-eclampsia-eclampsia associated with hemolysis, elevated liver enzymes and low platelet count.

[Malignant teratoma of the ovary in childhood and adolescence--a case report]. / Malignes Teratom des Ovars im Kindes- und Jugendalter--Eine Falldarstellung.

This is a report on a 15 year old patient with malignant teratoma grade III of the right ovary in stage Ia (FIGO). The adequate treatment of this rare tumors which occurs preponderant in children and adolescents supposes an accurate and thorough histologic analysis. Our patient was treated initially by unilateral oophorectomy followed by an polychemotherapy with Vincristine, Actinomycin D and Cyclophosphamide. Regular monitoring of the tumor markers AFP and beta-HCG before and after surgery is indispensable to control the development.

[Manual palpation of the uterine scar following vaginal delivery in previous cesarean section--is it really necessary?]. / Die manuelle Nachtastung der Uterusnarbe nach vaginalen Entbindungen bei vorausgegangenem Kaiserschnitt--ist sie wirklich nötig?

85 vaginal deliveries following a previous cesarean section were registered during a period of 10 years. After 43 deliveries a palpation of the uterine scar had been carried out. In 42 cases the observation of clinical progress and of the laboratory parameters was preferred. An uterine rupture did not occur. This appears to justify the more expectant attitude in controlling the uterine status after vaginal deliveries following a previous cesarean section.

[Hygroma colli--sonographic indication of fetal chromosome abnormality. A case report]. / Hygroma colli--Sonographischer Hinweis für eine fetale Chromosomenanomalie. Eine Falldarstellung.

Transvaginal sonography has been developed as an useful tool to recognize and define structural defects in the first trimester fetus. Fetal cystic hygromas as an manifestation of malformation of the lymphatic system are often the only sign of an severe fetal anomaly. In 70-80% of cases cystic hygroma is associated with a Turner-Syndrome (45,XO). We report a case in which transvaginal sonography has been the only instrumental in the prenatal diagnosis of a nuchal cystic hygroma. Based on this sonographic finding the pregnancy has been terminated. We point to the value of early and subtle ultrasound examination as an excellent method in finding hints for chromosome abnormalities.

[Complete closure or open healing of the skin of the vaginal stump in vaginal hysterectomy]. / Kompletter Verschluss oder Offenlassen der Haut des Scheidenstumpfes bei vaginaler Hysterektomie.

This retrospective study covers a period of 10 years (1977-1986) during which a vaginal hysterectomy with or without colporrhaphy was carried out in 431 women. In 317 patients the skin at the end of the vaginal stump was closed primarily, whereas it was left open in 114 patients. Comparing both groups less morbidity-, secretion-, infection- and bleeding-rates can be found in the group with primary closure of the vaginal stump. The healing of the operative wound is much better when closed primarily. Fear of entrapped secretions or formation of abscess or hematoma is not justified.

[One or two-point devitalization of the fallopian tubes? A study of methods of bipolar high-frequency coagulation]. / Ortlich ein-oder zweimalige Devitalisierung des Eileiters? Eine Untersuchung zur Methodik der bipolaren Hochfrequenzkoagulation.

122 women were sterilized by laparoscopic electrocoagulation of the fallopian tube using bipolar high-frequency current. In 59 cases the coagulation was performed only once in the isthmic part of each fallopian tube, whereas in 63 cases this was done twice at a distance of 2 cm. Only in the first group of women 3 cases of spontaneous recanalization were registered which means a failure rate of 5%. The histologic examination revealed a completely regenerated regular mucous epithelium. The total rate of complications for both groups amounts to 0.8%. Consequently, in its security, the method of burning twice each fallopian tube is definitely superior to the practice of one-point devitalization only.

[Prenatal ultrasound diagnosis in a case of urethral atresia]. / Pränatale Ultraschalldiagnostik bei einem Fall von Urethralatresie.

Presented is a rare case of obstruction of the lower urinary tract system due to urethral atresia, which was diagnosed by ultrasonography in the 21st week of pregnancy. Diagnosis, pathophysiology and therapy are discussed.

[Amniotic band syndrome with anencephaly--a case report]. / Amnionbändersyndrom mit Anenzephalie--eine Falldarstellung.

The rare case of a severe amniotic band syndrome associated with anencephaly, hypoplasia of adrenal glands and limb deficiencies is presented and discussed with regard to its probable pathogenesis. Impressive photo- and sonographic material can be shown. Early rupture of amnion seems to be the most probable explanation for this combination of anomalies.

[Transcervical extra-amniotic induction of abortion in the 1st trimester of pregnancy with 200 micrograms of sulprostone in a hydroxyethylcellulose gel vehicle]. / Transzervikal-extraamniale Abortinduktion im I. Schwangerschaftstrimenon mit 200 micrograms Sulproston in Hydroxyethylzellulose-Gelzubereitung.

In 104 patients in the first trimenon termination of pregnancy was induced by the extra-amniotic instillation of sulproston prepared in a hydroxyethylcellulose jelly mixture. 89 women got a dose of 100 micrograms Sulproston, 15 a dose of 200 micrograms. In each group of patients the rate of side effects was almost the same. Apart from an average infection rate of 8% there were hardly any peri- or postoperative complications. Also the average abortion score was almost the same in both groups of patients. The average abortion induction interval using the double dose of Sulproston was 8.7 hours, just 1.5 hours shorter in duration as if a dose of only 100 micrograms Sulproston was given. The 100 micrograms dose leads to a 15% failure rate of induced abortion, whereas a 0% failure rate is found when applying a 200 micrograms dose. This advantage together with constant rates of complications and side effects makes the first trimenon termination of pregnancy by extra-amniotic instillation of 200 micrograms Sulproston prepared in a hydroxyethylcellulose jelly mixture appear more favourable than using only a 100 micrograms dose.

[Congenital hypoplastic left ventricle--a case report]. / Der kongenital hypoplastische linke Ventrikel--eine Falldarstellung.

A case of congenital hypoplasia of left heart ventricle is presented with regard to its clinical and pathophysiological aspects. A detailed prenatal ultrasonic or echocardiographic diagnosis seems to be absolutely necessary. Each sonographer should at least be able to advise of any suspicion of fetal heart abnormalities.