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The suitability of different carrier materials for absorption of serum was investigated with respect to a centralised screening for AFP serum levels in pregnant women, which needs a transmission of the samples. AFP was quantified in an indirect two-site binding enzyme immunoassay. AFP concentrations of native serum and of the eluate from the samples dried on filter paper were in a good agreement with a coefficient of correlation of 0.902. But storage of dried serum samples should not exceed one week because a two week storage diminished the coefficient of correlation to 0.766 and AFP concentrations of paper dried samples were overestimated.

In this paper we summarize requirements for archiving in hospitals. Furthermore, we present solutions how digital archives can be built up. Archiving in hospitals requires medical documentation, which should take place preferably in a computer-based way. Requirements for electronic archiving include functionality, integration into the hospital information system, robustness, performance, usability and the ability to meet legal obligations. The latter issue is essential if the conventional archiving of paper records and non-digital images shall be abandoned.

We report on papers concerning in topic "Diseases of the breast", which were published in the Zentralblatt für Gynäkologie during the first half of the 20th century. Only 26 publications about senologic problems were found in 44 years. Papers about the mammary theory of eclampsia, mastitis, plastic operations and breast cancer are reported.

The investigation of cervix carcinoma with magnetic resonance tomography (MRT) is still controversially discussed with regard to its diagnostic value as well as for planning radiation therapy. The purpose of this article is to present and discuss papers published between 1993 and 1997 in this field with respect to the technique used, the contrast media applied and its clinical value. A literature search using three different databases (Medline, Embase, Cancerlit) identified 39 publications, which were then analysed. Despite the partially suboptimal presentation of results in these papers MRT proved superior to other imaging modalities. Due to better demarcation of cervix carcinoma with MRT, it was possible to calculate tumor value as well as to correctly judge the infiltrative character. This allows for a more precise treatment and staging of the patient's prognosis. In the future, MRT might be useful in diagnosing recurrence at relatively early stage. Unfortunately lymphatic nodes can only be insufficiently verified using MRT.

Medical knowledge doubles every five years. Electronic media are necessary to manage these volumes. "Multimedia" and "information highway" are buzz-words and also concern medicine. Medical informatics tries to build a bridge between medical research which generates knowledge and daily practice in hospitals, ambulatory care and public services. Knowledge is used in different representations for multiple purposes and functions. Expert systems are mostly designed to fulfil certain functions and to support routine clinical practice. This paper tries to point out some important functions and to explain the capabilities by means of two example systems which can be used in several medical units. The main problem in using expert systems is, besides the quality of knowledge, the availability of patient data. For this reason the existence of an electronic patient record is another area which will be described in this paper. Expert systems are specialised medical information systems and have to fulfil the same success criteria as all the other systems, e.g. the integration into the daily routine as a trusted tool.

Bleeding disorders are one of the most frequent gynecological problems. The causes of bleeding disorders, and their frequency in particular, vary depending on the age of the woman affected. In premenopause and perimenopause, the most frequent causes are hormonal, in up to 90 % of cases, as well as organic changes in the uterus such as myomas, adenomyosis uteri, or endometrial polyps, in up to 70 % of cases. Coagulation defects cause increased bleeding, particularly in girls and young women, with no other recognizable cause. The treatment of bleeding disorders is causally based, although if the woman does not wish to have children, the therapeutic algorithm in many cases leads to similar symptomatic measures. The following therapeutic approaches, listed in order of increasing efficacy, are mainly used in the treatment of increased bleeding: gestagen, estrogen-gestagen combination, levonorgestrel (Mirena) and endometrial ablation or myoma enucleation, with comparable success rates, and finally hysterectomy. Embolization of the uterine artery in myomas or adenomyosis uteri, nonsteroidal anti-inflammatory drugs, and antifibrinolytic agents represent alternatives that may be useful in individual cases. The paper provides an overview of the various causes, useful diagnostic measures, and treatment options in uterine bleeding disorders.

Laparoscopy holds a key role in daignosing and treating endometriosis. The present paper aims at clarifying the correct indication for this procedure. To this end, relevant guidelines as well as considerations regarding incidence, pathogenesis as well as diagnostic and therapeutic alternatives are presented. An algorithm for clinical practice is presented.

This paper focuses on the controversies surrounding management of endometrial cancer, the most common carcinoma of the female genital tract. We discuss current management strategies, especially the importance of surgical staging and briefly describe ongoing prospective randomized trials. Actual treatment suggestions are attached as tables. Adenocarcinomas represent the majority of endometrial cancers. In contrast, papillary-serous and clear cell carcinomas comprise 1-10 % of endometrial cancers. While adenocarcinomas may well be treated by surgery and radiation therapy, identifying appropriate treatment modalities for patients with papillary-serous and clear cell carcinoma and poor prognosis is of critical importance. Data on radiation therapy or chemotherapy, to date, are of limited value secondary to small sample sizes and the heterogeneous treatment modalities that many times were applied. Individualized treatment strategies have to take into account accompanying co-morbidities, more importantly, though, whether the patient underwent surgical staging. Co-operative, prospective randomized trials across borders are needed more than ever to answer remaining questions.

Breast cancer is the leading cause of cancer death and morbidity among women worldwide. In Germany an estimated 46,000 women are diagnosed with breast cancer every year, and 18,000 die of the disease. So far, limited information is available on possible epidemiological and clinical differences between women of German origin and other ethnic or national groups in Germany. Such differences between migrants and the general population could hint to underlying causes of disease and to differential access to medical care. In this paper we present epidemiological information on breast cancer among Turkish women in Germany and describe a future research agenda addressing these questions.

The separate in vitro cultivation of isolated and purified human endometrial glands and stromal cells seems to be the most attractive experimental way of studying the endometrial function on cellular level. In this paper a new method has been described to establish monolayer cultures of isolated endometrial stromal and epithelial cell populations. After a first collagenase digestion, stromal and epithelial cells were separated by filtration. The glandular epithelial cells were further purified with two collagenase digestion steps, filtration, a differential sedimentation at unity gravity and a Ficoll gradient centrifugation. Stromal cells were isolated with the use of erylyse-buffer, filtration and differential sedimentation at unity gravity. A significant higher inhibin production was observed during late secretory compared to proliferative and early secretory phase. Therefore, glandular epithelial cells maintain in vitro their initial differentiation. The higher inhibin concentration during secretory phase implicates a substantial role in endometrial function and maturation. Therefore, inhibin could be used as a marker of endometrial differentiation. Experiments on isolated glandular epithelial cells should be performed within two weeks. The method described here allows the propagation in vitro of separate endometrium cell types which can be used to study endometrial function as well as implantation mechanisms.

There is no doubt, oral contraceptives are a safe, reversible and commonly used method of contraception. Ever use is about 80 % in developed countries and current use of OCs about 40 %. Almost all information about prevalence of OC use came from cross-sectional studies and did not distinguish between high- and low-dose OCs. This paper deals with the prevalence of OC use as it was observed during lifetime of a large cohort of German women by calendar year and estrogen content.The prevalence of OC use between 1980 to 1999 was analysed on occasion of an interim analysis of the German cohort study on women's health. This analysis is based on more than 10 000 women with about 390 000 women-years of observation.The proportion of women under the age of 50, that ever used OCs, increased steeply from 1980, i. e. from 62 % (1980) to about 90 % from 1996 onward. The proportion of current users in a given calendar year rose from 44 % (1980) to 49 % (1991-95) and dropped after the "pill crisis 1995". The percentage of current users who used high-estrogen-dose OCs dropped from 32 % (1980) to 5 % (1999). In contrast, the percentage of users of low-dose OCs of the 2nd generation steeply increased as was the percentage of users of the 3rd generation pills, however the latter dropped after 1995.The high acceptance of oral contraceptives despite many "pill crises" underlines the continuously high appreciation of their efficacy on the one hand, but underscores also the high responsibility of physicians and industry concerning surveillance or reduction of discussed side effects.

Research in psychooncology focuses primarily on the impact of cancer, less on psychosocial causes of cancer. Recent tendencies in clinical practice are shown.Original papers show that anxiety, depression, postmenopausal symptoms, fatigue, sexuell issues, relationship and family become important problem areas for the patients. Anxiety and depression are independent of the state of the disease but, instead, depend on the extension of treatment. For unmarried single women sexual issues become a problem earlier whereas the problem develops later for married women. Women with cervical carcinoma are more affected than others.There is a high need for psychosocial counselling which is not considered enough in the daily clinical practice. Psychosocial aftercare is, regardless to different focuses, the task of the entire team. Good precare is just as important as good aftercare to reduce anxiety, pain and increase well-being. Addressing information and support in a timely fashion is important in providing success to psychosocial aftercare.

In the last 100 years many different theories have tried to explain the symptoms and causes of urinary incontinence in the female. Urinary incontinence is a debilitating condition and not only leads to medical problems and costs, but is associated with embarrassment that can lead to isolation and loss of independence. Women with stress urinary incontinence can have both urethral support loss and decreased urethral function. Aging and delivery can lead to multiple damages which can be manifest either as loss of support with symptoms of prolaps or incontinence. This paper provides an overview of the functional anatomy of the structures responsible for controlling urinary continence under stress and discusses some of the theories on incontinence.

The aim of this paper was to describe the possible use of the software RecDate für documentation and Quality Management in Reproductive Medicine.RecDate was programmed using the data base program Filemaker Pro. The functions and potentials of RecDate were analyzed.RecDate enables the collection, documentation and evaluation of data from Reproductive Medicine and also functions as a hospital management tool.The present status of Reproductive Medicine can be described by the use of RecDate in IVF-clinics, which is important for consulting and treatment of couples, for the quality of public enlightenment and for optimizing the processes in daily routine.

In the future clinical trials will increasingly be conducted using "electronic data capture EDC" in place of documentation on paper. The utilization of computer systems and special software programs will make quality optimization possible while speeding up the documentation and data processing. In the publication the software system IOStudy Office and its modules are presented. The facilitation of the data capturing process (physician), data monitoring (monitor), and project managment are discussed in detail.

Data input in web-htm-forms with a browser is much more efficient in comparison with write in paper mask documents. The specification-compliant forms for data entry as htm-forms are downloaded from the homepage of the project manager by the participants of the study. The transformation of content of different formatted htm-forms is made by the program "security-based form converter (SFC)", which is located on a web server respectively a proxy server. From there the transformed data are returned the project manager via e-mail. Those incoming data are imported into databases by means of ODBC-data source. The data are pivoted from sequential format to table format. The data entry principle presented here is a client-server-structured, web based intranet program. For this purpose only standard software and relational databases with ODBC-interfaces are used; no further registered commercial programs are needed. General data protection is ensured by encrypted data transmission.

The paper reports on four patients with choriocarcinoma. In two of them, the choriocarcinoma was found after abortion, in one of them following termination of pregnancy, and in the last patient a hydatidiform mole was present. In all patients increased beta-HCG was found. One patient had lung metastasis at the time of diagnosis. In another patient, choriocarcinoma was suspected owing to ultrasonographic vaginal examination. According to the Bagshawe Score, 3 patients were low-risk and were subjected to methotrexate. One patient was medium-risk and received PEB chemotherapy. All four patients are regarded as cured.

There are few breast-conserving therapies (BCT) for centrally located breast cancer. The present paper describes a BCT for breast cancers in such a location, which permits conservation of the nipple-areola complex (NAC), provided this has not been infiltrated. After histological detection of the breast cancer by punch biopsy, a central segmental mastectomy and an axillary dissection are performed. An immediate reconstruction of the subareolar defect is carried out by means of a local flap technique, thus conserving the NAC.

Women with gynecologic cancer are confronted with difficult decisions regarding the therapeutic options. The objective of the present paper is to demonstrate the relationship between surgical procedures and the outcome on quality of life and to discuss the implications for patient management.Gynecologic patients were assessed in a prospective study with preoperative semistructured interviews and objective assessments (T1), interviews were repeated 4 and 12 months postoperatively (T2, T3).Women planned for hysterectomy with severe complaints indicate a better postoperative quality of life. Cancer patients, however, tend to feel more distressed about the surgical procedure if they could not be treated organ preserving or by reconstructive techniques. Medical interaction is dependent on the patient's anxiety level and mostly important for their quality of life before and after surgery.Psychosomatic research is not only necessary to understand the patient's needs before and after surgery but may also serve as an evaluation method of therapeutical options. By this methods we are able to anticipate the medical and psychological consequences of the therapeutic decisions. Future studies will systematically explore the alternating effect of surgical procedures on the patient's well-being.

Evidence-based medicine is the synthesis of internal evidence (experience) and best external evidence (literature) aiming to solve a particular clinical problem. This paper gives an overview on different tools to appraise rationales and results of diagnostic tests such as CA-125 monitoring in patients with ovarian cancer.

In the presented paper, obstetrical management after previous caesarian section was studied in a large patient collective at the University Department of Gynaecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of rupture of the uterus.From a total of 15,166 deliveries, 1,086 of the births had been preceded by one or more caesarian section. These 1,086 births formed the patient collective for the present study.Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. If there had been a previous caesarian section, the percentage shifted in favour of vaginal delivery. All patients with more than two previous caesarian sections were delivered by a primary caesarian section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for primary (11.5%) or secondary resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery.This retrospective study confirms the general recommendation of vaginal delivery following previous caesarian section as long as risks are minimized by a readiness to proceed with resectioning when signs of imminent rupture of the uterus arise.

The scientific and commercial use of the internet has caused a revolution in information technologies and has influenced medical communication and documentation. Web browsers are the becoming universal starting point for all kinds of client-server applications. Many commercial and medical systems--such as information reservation systems--are being shifted towards web-based systems. This paper describes new techniques. Security problems are the main topics for further developments in medical computing.

This article analyses, after introductory comments on the legal situation in the German Empire and the Weimar Republic, the legal basis for induced abortions during National Socialist rule in Germany. During this period the first legal definition for eugenically and medically indicated abortions was established. At the same time the prohibition of induced abortions outside these criteria was controlled more strictly and violations were punished more severely. This concerned abortions mainly for social reasons. The intention was to legalize abortion for those deemed "less worthy" while, at the same time, to minimise the number of abortions of those considered as "more valuable" to society. The main thrust of this policy was to increase the birth rate of "valuable" citizens. The second part of this paper focuses on eugenic and medical abortions at the University of Freiburg's Maternity Hospital.

Computer-based medical documentation so far proved advantageous especially through standardization of data entry and increased access speed. Additional benefits can be achieved through the implementation of integrated, cross-project documentation tools and their integration into the clinical work-flow, which allow data to be used for a wide variety of applications (e.g. quality management, clinical research, clinic management). The presence of incompatible documentation software often complicates the realization of these goals. Implementation of new documentation tools therefore should consider flexibility and multiple-use of data as primary design goals. In the presented paper requirements for flexible documentation tools are introduced. The Entity-Attribute-Value-Model is described as a possible means of implementation. Practical experiences made with a prototype application are reported.

This paper reports on a 56-year-old patient with a history of "testicular feminization syndrome" who was admitted to hospital because of a rapid gain in her abdominal girth (106 cm). A benign cyst was removed laparotomically which, histologically, was equivalent to a cystadenofibroma. Based on this case report, the clinical significance of testicular feminization syndrome and the necessity for gonadectomy due to the risk of growth of a possibly malignant tumor are discussed.

While rare cardiovascular risks of oral contraceptives (OCs) caused a lot of concern among OC-using women in the recent past, little attention has been paid in the public to the non-contraceptive benefits of OCs. Short, medium and long term non-contraceptive benefits have to be considered. The early Anglo-American cohort and case-control studies demonstrated a reduction of menstrual complaints, iron-deficiency anaemia, ectopic pregnancies, and a partly drastic reduction of some benign and malignant tumours such as endometrial and ovarian cancer. A risk reduction of rheumatoid arthritis is discussed controversially. The present paper gives an overview of the state of knowledge. For newer OCs with different composition, comparable studies are lacking. Therefore, a cohort study was initiated in Germany in April 1998 to investigate these associations as well for newer OCs, which is presented. The described non-contraceptive benefits should be considered in the benefit-risk assessment when prescribing OCs.

Venous thromboembolism (VTE) remains the leading cause of maternal death. Today, various risk factors and conditions are known to increase the risk for VTE associated with pregnancy. Having identified the individual risk of a pregnant women, appropriate preventive measures can be taken. If VTE occurs during pregnancy, an appropriate immediate diagnostic work-up is essential in order to avoid further complications. For deep vein thrombosis (DVT) the diagnostic tool of choice is color-coded duplex-sonography, for pulmonary embolism (PE) perfusion/ventilation lung scan can be used. Integrating a detailed individual and family history, the presence of thrombophilia or other risk factors, a risk stratification can be undertaken. These risk categories are defined in the present paper and the appropriate treatment measures are described. As oral anticoagulants cross the placenta and may cause embryopathy in any trimester, oral anticoagulants should be avoided throughout pregnancy. Therefore, heparin is the anti-coagulant of choice for pregnant women, with low molecular weight heparins (LMWH) having distinctive pharmacological advantages over unfractionated heparins. Besides a potential for bleeding, the main side effects of heparin include heparin-induced thrombocytopenia which prompts for platelet monitoring, especially in the first weeks of heparin treatment, and, secondly, heparin-induced osteoporosis, which is a potential sequel of long-term heparin administration. Even though there are abundant reports in the literature on the use of LMWH in pregnant women, that show that they are safe and effective, LMWH are not specifically licensed for the use in pregnancy.

For a variety of reasons, hospitals are developing a growing interest in changing their information systems to support patient processes in a more direct way. This means to actively deliver the tasks to be performed to the right persons at the right point in time with the necessary information and the application functions needed for performing these tasks. Process-oriented workflow technology is a very interesting candidate to achieve this goal. It offers components for the computer-based analysis, modeling, animation, coordination and monitoring of (hospital) processes. In this paper we discuss the perspectives offered by workflow-based, clinical information systems. We survey key features of today's business process modeling tools and of workflow management systems, and we show how they can be applied in the clinical domain. To illustrate the huge potential offered by workflow technology, we present results from the project "Using Workflow Management Systems for Clinical Applications". Within this project we thoroughly analyzed and redesigned core processes from the University's Women hospital and we proto-typically implemented a workflow-based application system for the support of processes from the division day clinic. Although our work shows that current workflow technology is still lacking some important features, in the long run, it may strongly influence information processing within hospitals.

This paper was intended to settle the question whether the so-called gentle sectio caesarea with a high skin incision as described by Cohen in 1972 [2] could be applied in combination with a sectio on the level of the classic Pfannenstiel's incision which would be more satisfying cosmetically. Furthermore a comparison was to be drawn between the postoperative condition of those patients on whom this surgical method had been performed and the condition following a classic Pfannenstiel's incision. Between January 1997 and July 1997 we compared the classic method of Pfannenstiel's incision with the variant of Cohen's method as described above in a prospective randomised study. On applying this surgical technique, the abdomen was opened according to Cohen's method using a surgical knife but for the skin, and the tissue layers underneath were opened blunt with two fingers. Following the extraction of the child only three sutures were made: Uterus, fascia and skin. Redon drainages were not inserted. We were able to show that this method of applying mainly blunt "incision" to sectio caesarea the tissue is at least equal to the sharp opening of the abdominal cavity. In some respects, such as the early postoperative mobilisation, it is, in fact, superior, because the blunt opening causes less bleeding and the reduction to three sutures only, deliberately leaving the two peritoneal membranes open, as well as leaving away the redon drainages, considerably increases the patients' postoperative well-being. It is for these reasons that we call for this method to become part of the routine procedures in caesarean sectio.

Implementing hospital information systems for an efficient application of electronic data processing requires the integration of previously introduced departmental systems, which traditionally have been designed only from the viewpoint of an isolated hospital department. Those efforts have to be accompanied by a parallel implementation of a hospital-wide network and the introduction of PC workstations on clinical wards and in outpatient clinics. In this paper currently ongoing efforts at the University Hospital of Münster are presented in order to illustrate how such integration efforts can improve communication and information retrieval in all clinical areas of a hospital.

After a brief introduction about virtual reality and model-building this paper describes the special technical and theoretical requirements of dynamic surgical simulation in contrast to traditional static systems. This is done by means of the simulator SUSILAP-G. With SUSILAP-G an example of an application in telemedicine is given.

"B-technique" was first developed for breast reduction. In the past there were some new information characterizing the "B-technique" as being a good method for some breast cancer patients undergoing conversation surgery as well. In this paper we report on a patient suffering from anisomastia; after augmentation mammaplasty the "B-technique" was used to put the nipple and areola in the right position. If the dislocation of the nipple is not extreme we considered the "B-technique" a favourable method to obtain a good aesthetic result.

The ethical problem of permissibility of sterilisation for eugenic reasons is being discussed since the end of the last century. For many years restriction and rejection were the predominant opinions. A bill passed July, 1933--"Gesetz zur Verhütung erbkranken Nachwuchses" ("Act of prevention of heredopathic progeny")--imposed juridical regulations to prevent offspring with inherited diseases in National Socialist's Germany. No major protests had been made against such compulsion put upon the medical profession. Papers dealing with questions of surgical techniques had been published in Zentralblatt für Gynäkologie predominantly in 1935 and 1936. The significance of the scientific analysis of mandatory sterilisations for so-called eugenic reasons performed in almost 400,000 women and men in Germany between 1933 and 1945 has only recently began to be recognised by the scientific community in the last decade addressing predominantly the regional impact of this jurisdiction.

This paper informs about the diagnostical accuracy of clinical examination and mammography at the women's Hospital of the Städtische Klinikum Zwickau from 1989 to 1992 when pathological changes of breasts are diagnosed. A total of 508 diagnostical biopsies was performed during this study period. The histological examination resulted in 276 benign breast lesions and in 232 breast cancers. In 432 cases there was a lump palpable in the breast that was noticed at first by more than 60% of women themselves. 288 (56.7%) correct and 220 (43.3%) false diagnoses were established following the clinical examination. This resulted in a sensitivity of 100% with a specificity of 20.3% and an overall accuracy of 56.7%. However, with the help of mammography 386 (76.6%) pathological changes of breasts were found to be correct. 118 mammograms proved to be false. Out of these 90 (17.8%) had a false-positive diagnosis and 28 (5.6%) a false-negative one. The overall accuracy of mammography was 76.6% (sensitivity 87.9%, specificity 67%).