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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.

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.

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.

Malignant tumors are a difficult problem in obstetrics, both in pregnancy but also after an successful therapy, especially, if the patient wishes to be pregnant. However, there are borderline cases of medical and ethical regions. In the present paper the case of a young women (21 years old) with HCC is described. In the age of 16 years a solid hepatocellular carcinoma was found and treated by partial resection of the right lobus hepaticus. Anamnestically a blood exchange transfusion caused by a neonatal Rh-incompatibility and a hepatitis B in the age of 11 months are known. 3 and 6 years after the treatment, she was successfully pregnant and is today mother of 2 children.

In this paper, morphological abnormalities of spermatozoa in the seminal fluid smear are described. An advantageous classification seems to be recommended: disturbances of the head, the cap, the midpiece, and the tail. The knowledge of intratesticular spermatogenetic processes and their disorders in certain phases of sensitivity enables the description of the disturbances of the spermium itself and beyond a systematical classification of pathological spermatozoon formation in relation to the kind or to the period of their origin. We recommend this method of sterility diagnosis as a alternative method to the testicular biopsy, because the last investigation is loading the patient.

In the present paper we will report on a pregnancy following a Gamete Intra Fallopian Transfer (GIFT). This is a 26 years old female, treated in our sterility dispensaire for a secondary sterility since 1982. All basic hormone levels were normal. The andrological examination of her husband showed an oligozoospermia stage 2. A following hormone treatment was unsuccessful. Stimulation, monitoring and laparoscopy are demonstrated.

Described in this paper is a patient, aged eleven years and eight months, with micropenis, dorsal prepuce, and rugous, partially bifid scrotum. FSH and LH values below normal were obtained from hormonal investigation. LH-RH stimulation was followed by retarded FSH response of moderate intensity, while the LH profile was moderately strong. Cytogenetic tests revealed the presence of 25 per cent of female sex chromatin. The karyotype was 46 XX. The patient did not have internal female genital organs, and his gonads were of testicular appearance. Histologically, both testicles exhibited tubules with primitive germinal cells and Sertoli cells. An inconspicuous number of Leydig cells was recorded from the interstitium.

Described in this paper is a new penetration chamber in which to test the penetration capacity of spermatozoa in cervical mucus. The technique has proved to be highly suitable for penetration testing practice and is likely to provide valuable information for diagnosis.

Described in this paper is a large urinary fistula which developed 38 years after Wertheim's radical hysterectomy and percutaneous irradiation. The patient's condition was improved by supravesical urine discharge through anastomosis between ureter and sigma. Discussed are conditions required for adequate uretero-sigmoidostomy. Good therapeutic results may justify, in certain cases, uretero-sigma anastomosis, despite a history of irradiation and poor general condition.

Stress incontinence of women is a widespread and sophisticated problem. Its incidence is between five and 20 per cent in medium and advanced age. In the last two years, 34 patients received treatment modified after the sling operation which had been inaugurated by Stoeckel and Kraatz. This surgical approach had been reserved for severe forms and recurrences of urinary incontinence. The surgical technique is described in this paper. Surgical action action had been preceded by complex gynaecological, neurological, and urological examinations. Sixteen patients have been without complaint for more than a year and six for more than half a year. The remaining twelve are continent, too, but require further observation. Postoperative urodynamic checks revealed proper function of the lower urinary tract.

Reported in this paper are the first two pregnancies and childbirths in the GDR following kidney transplantations. The point is made that pregnancy following kidney transplantation should remain to be a rare exception, though the courses were favourable in both cases described. Reference is made to most suitable forms of anticonception.

Some parameters about the metabolism of androgens in men and women taken from other papers have been compiled in five tables. Most of the female figures are completed by estimations for pregnant women. The transport proteins for androgens in plasma are also regarded.

Reported in this paper are two patients on whom gestational herpes was diagnosed by clinical examination as well as by optico-immunofluorescent checks. Direct immunofluorescence technique has now enabled diagnosis with higher accuracy of gestational herpes, a dermatosis specific of pregnancy, with diagnosis proper being preceded by identification of C3 and C5 complement fixation. In both cases, symptoms had appeared in the second trimester. They had started from the umbilical region and then affected the entire trunk and extremities. In one of the patients, symptoms disappeared immediately after delivery, while exacerbation was recordable from the second in the puerperium. The pathological process was controlled in either case by topical application of corticosteroids. The symptoms of these cases, diagnosed by optico-immunofluorescent methods, are compared with clinical reports about gestational herpes cases in earlier literature.

Reported in this paper are findings recorded from a male infant who died eight days from birth, after an attempt of pregnancy termination had failed earlier. Included in these findings were malformation of the vertebral column and bony thorax as well as dorsal meningomyelocele. Intra-uterine manipulation in early pregnancy does not necessarily lead to injury of the foetus and to abortion. Hence, intra-uterine foetal damage should be ruled out by methods of prenatal diagnosis in all cases of continued pregnancy.

Gynaecological complaints quite often are consequences of earlier appendectomy. On the other, appendectomy is often performed to cope with complaints resulting from unidentified gynaecological problems. The author's own relevant experience is reported in this paper, with particular reference being made to laparoscopic findings. Also discussed is the problem of appendectomy in conjunction with gynaecological operations.

Proof of the data are characterized and recommended, which have been executed at the data of the newborns. Both definitions of the percentiles used in the similar measurements are compared with their advantages and disadvantages. The exactness of the results contained in the 1st and 2nd paper is presented in a table.

This paper deals with three cases of osteogenesis imperfecta and pregnancy. The significance of this disease with regard to genetic advice, pregnancy and delivery is discussed considering the classification of Sillence.

Discussed in this paper is the psychic situation of sterile couples who resort to artificial insemination, using donor semen (ADI). --Careful psychodiagnostic checking prior to ADI seems to be essential to forestalling psychic problems. ADI treatment should be applied solely to really sterile couples of stable psychic status and with good communication between the two partners. A method of psychological preparation for ADI is described. Psychodiagnostic examinations should be followed by specific gynaecological checks. Such approach will yield at least two advantages: 1. Gynaecological examination will not be necessary, if contra-indications are concluded from psychological checking 2. Early psychological assessment of sterile couples will become possible. Favourable psychic development of both couples and children born as a result of ADI will be an additional advantage of high probability.

Described in this paper is a case of an incomplete form of testicular feminisation associated with asymmetrically impaired sensitivity to androgens. More strongly pronounced hair coverage was recordable from the entire left half of body and face. The breast was underdeveloped on the right. The genesis of the above deviations is discussed.

Except of adoption the heterologous insemination has for some years in the GDR been a part of the therapeutic possibilities of a couple's androgen sterility. However, there is no uniform conception on practical proceeding, juridical problems, selection of sperm donors and documentation of data. This paper describes the practical proceeding at the women's hospital of Berlin's Humboldt University (Charité). It contains, among other things, an indication list, regulations for medical examination, instruction and juridical securing of both the donor and the married couple. Documentation of data under special regard of professional discretion is also dealt with.

The paper reports on a newborn developing a scalp abscess 10 days after birth due to fetal monitoring with scalp electrodes. B-streptococci were isolated from purulent material after surgical intervention. The recovery was uneventful after therapy with appropriate antibiotics and removal of the pus (incision). In a short review of literature the authors discuss some of the aspects of infections arising in connection with use of scalp electrodes for fetal monitoring.

Described in this paper is a case of tubal pregnancy on the right side following removal of the right uterine cornu. The oviduct left on the right had no contact with the uterine cornu. The presence of corpus luteum in the right ovary produced evidence to the effect that the pregnancy had been caused by spermatozoa which had migrated through the left tube and the abdominal cavity.

This paper explains the momentary situation of diseasediagnostic with ultrasonic (B-scan). Possibilities and limits of this methods are shown. Some rare symptoms fetal-disease are explained and we discuss the possibility, to recognize diseases of skeleton and central nervous system better than before.

The results obtained from penetration testing of cervical mucus of 60 sterile couples are reported in this paper. Also, the presence of spermatozoal antibodies in the serum of both the female and male probands was detected by means of the immunofluorescence method. --Neither in the females nor males was any relationship detectable between the occurrence of spermatozoal antibodies and the results of penetration testing. Yet, spermatozoal antibodies were found to occur much more often in probands with sterility of unelucidated origin.

In the present paper the conditions of separation of cryopreserved spermatozoa from seminal plasma were varied. The optimum seems to be at 300 g and 5 to 7 min of centrifugation. The effect of separation was approximately estimated by means of determination of concentration, motility, morphology, and supravital staining of spermatozoa. The concentration of seminal plasma was reduced to less than one per cent (use of a radioactive marker). After the separation the activity of free acrosin reached 64 p.c. of the total acrosin. The process of cryopreservation and separation reduced the ouabain-sensitive netto-uptake of K+ of spermatozoa by nearly 50 p.c.

An analysis is presented in this paper of 525 stillbirths, related to 54,342 births, in the region of Suhl, between 1970 and 1977. The above number of stillbirths was subdivided by main groups of diagnosis and analysed by various parameters. Stillbirth rates were found to be somewhat increased with mothers aged 30 years and above, with the third child and more of one and the same mother, as well as with birth weights below 2,500 g. Stillbirths classified "avoidable" by competent district and regional commissions are critically appraised for their underlying causes. The following conclusions were drawn from the findings and established as demands: Intensification of general and specialised attention to pregnant women, early detection of retardation in embryonic development, high-accuracy control of labour and early detection of any risk to the "intra-uterine patient", early and properly indicated use of intrapartum surgery, and improvement in density of the network of obstetric control methods to include also smaller maternal centers as of 800 childbirths per annum.

Reported in this paper is the authors' experience from 81 dura-sling operations in which human dura had been used. The procedures for dura collection and preservation are described in some detail. Treatment was rendered to 61 patients with primary incontinence and 20 patients with recurrent incontinence. The recurrence rate was 6.2 per cent, between one and five years from surgery.--Cases of severe stress incontinence were treated by dura-sling operation, preceded by careful presurgical diagnosis on the basis of both urethrocystotonometry and lateral urethrocystography. The method was found to be adequate.

Reported in this paper is a rare urogenital malformation in a patient, 17 years of age. Extensive presurgical diagnosis of cele and cysts formation in the minor pelvis, with the right parts of vagina and ureter of a doubled urine-excreting system being involved, was confirmed by surgical therapy in two sessions. This hydronephrotic ureter, with its normal ostium located in the urinary bladder, was found to communicate with the right cervix of a double-bicorn uterus. Excess pressure in the cavities caused fluid to empty splashingly from the right vagina into the left which was in normal condition. The effects of such combination of malformations on individual life are discussed.

Reported in this paper are cytogenetic findings obtained from 19 cases of translocation in gynaecological and obstetric patients which had been recorded from 1,055 chromosomal analyses. The translocations are defined in some detail. Twelve of them were of the Robertson type and three unbalanced, while the origin of one "de novo" 4p+ translocation was not elucidated. The breaks in reciprocally balanced translocations were related to various chromosomal sections, but A chromosomes were involved in four cases. The relevance of cytogenetic studies into gynaecologico-obstetric patients is discussed with reference to the above findings.

Peculiarities of the postoperative phase of gynaecological and puerperal patients with increased risk of bleeding and thrombo-embolism are reported in this paper. Fulminant outbreak, under such circumstances, of pulmonary embolism calls for immediate decision and no-delay action on the basis of a thoroughly defined therapeutic concept. Acute fibrinolysis and thrombectomy together with complementary therapy are described as high-risk but effective possible therapy.

Reported in this paper is treatment of two African women for fistulae and incontinence. Findings recorded from one of them included total defect of the urethra and anterior wall of the rectum, including anus, as well as two vesicovaginal fistulae. Four operations were performed on her within 16 months, with sigmoid preternatural anus, hysterectomy, and restoration of vesical integrity being the only possible ways to remedy. Attempts for restoration of the urethra failed. Her absolute urinary incontinence was improved to stress-dependent incontinence. - A large vesicocervical-vaginal fistula was recorded from the other patient on whom combined abdominovaginal hysterectomy and fistuloplasty as well as dura-sling operation were performed in three sessions, in the course of nine months. These were supplemented with an operation to lengthen the urethra. The two former approaches were successful in removing absolute incontinence, while the patient's functional urinary incontinence was cured by the two latter approaches. Some considerations of principle are derived from the two cases with regard to choice of methods and actual treatment.