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The side-effects of "artificial ascites" induced with Dextran 60 (Makrodex 6%) as a mean of preventing adhesions were investigated in 47 patients (treatment group: 32 patients; control group: 15 patients) in whom microsurgery had been performed for infertility with adhesiolysis. On the day of surgery and the following four days 300 to 500 ml of Makrodex was instilled via an intraperitoneal catheter (7.5 ml/kg body weight on day of surgery; 5 ml/kg body weight on days 2 to 5). In addition, the patients received, on the day of surgery, single doses of 450 IU of hyaluronidase (Kinetin), 500,000 KIU of aprotinine (Trasylol) and 1 g of hydrocortisone acetate instilled intraperitoneally. In the group treated with Dextran, there was a significantly higher number of patients who felt unwell and had abdominal complaints and dyspnea. In six cases in the Dextran group a vulval edema was seen, and in 2 cases a thigh edema. A significant weight increase and elevation of central venous pressure occurred for the duration of the "artificial ascites" in this group. There were a few cases of bradycardia with frequencies of under 50 beats per minute. On the fifth p.o. day 75% of the patients in the Dextran group had a pleural effusion. Such changes were not observed in the control group. In view of these side-effects and the fact that it is still not proven that Dextran effectively prevents adhesions we no longer carry out this form of adhesion prophylaxis.

From 1917 to 1979, the maternal mortality in the Rheinische Landesfrauenklinik Wuppertal has been investigated on the basis of 136084 live births. From 1917 to 1921, it was 10.1% and decreased to 0.16% in the period from 1973 to 1979. The maternal mortality in association with caesarean section, which was 11.8% in the period from 1917 to 1921 with a frequency of caesarean sections of 2.5%, decreased to zero since 1973 with a frequency of 6.3%. A caesarean section preceded more than 50% of the deaths since 1962. Most of the decreased (24.4%) were in the group of 30-34 years of age and 48.3% aged more than 30 years. 51.5% were primiparas and 14.6% of the women were at least para 4's. From 1917 to 1936, infection was the main cause of maternal mortality with 39.6%; from 1957 to 1966, however, thrombo-embolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anaesthetic deaths. During all the examined periods, non-specific reasons of maternal mortality were an important factor with more than 30%.

The present paper describes a test center which permits urodynamics tests with the patient in various positions, such as lithotomy position (A), supine position with outstretched legs (B) and, by continuously raising the patient, upright position (C). The results of a comparative investigation show the influence of these different examination positions on urodynamic parameters, in particular the functional length of the urethra and maximum urethra closing pressure at rest. Urodynamic tests on 40 patients with urinary incontinence showed that there is a significant increase in the functional length of the urethra when the patient is in lithotomy position (A) as compared to lying with outstretched legs (B), and that it is once again significantly reduced when the patient is raised to upright position. Maximum urethra closing pressure at rest drops significantly when the patient is repositioned from lithotomy (A) to supine (B) position, and once again rises significantly when she is raised to the upright (C) as compared to the supine (B) position. In the light of the changes described, which cause major changes in the form of the urethra pressure profile, it makes sense to perform urodynamic measurements in at least two different positions. The authors recommend the supine position with outstretched legs (B), as it appears more physiological than the lithotomy position (A), and measurement in the upright position (C). The importance of positioning with regard to the diagnostic information value in determining the cause of urinary incontinence is discussed.

Endometrium morphology has been analysed by means of light microscopy, scanning and transmission microscopy in patients before and during treatment with a norgestimate containing low dose combined pill (Cilest). Endometrium biopsies were taken after 1 (N = 3), 2 (N = 3), 3 (N = 7), 5 (N = 1) and 6 (N = 4) OC cycles. Light microscopy of the endometrium obtained during the OC-free pretreatment cycles shows a regular secretory transformed endometrium. During the first OC cycles of Cilest treatment slight growth retardation of endometrial glands was observed. Endometrium after 3 to 6 OC cycles showed an increasing delay of the growth of endometrial glands in terms of an abortive secretion. Morphometric studies revealed a retardation of the development of endometrial glands and an "arrest of secretion". The degree of proliferation varied slightly; a general delay between the date of the menstrual cycle and endometrial dating was evident. Using scanning electron microscopy the endometrium presented mostly a regular surface corresponding to the midcycle or a late proliferative phase up to the early secretory phase. Infiltrative dysplasia or inflammatory changes as well as local proliferations could not be detected. In transmission electron microscopy with semi-thin and ultrathin slices, stroma, structure of glands and surface appeared to be normal. Furthermore, no time delay between the endometrium and the day of menstrual cycle was observed. During treatment with a norgestimate containing low dose combined pill, only slight changes of the endometrium in terms of a growth retardation of endometrial glands were seen in the first 6 treatment cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

During labor the maternal cardiogram was traced through the dead fetus. The technical prerequisites for this phenomenon are described. The concomitant intra-uterine tracings of the contractions showed decelerations during the contractions in the maternal cardiogram obtained from the dead fetus. Similar observations have been described by other authors. The etiology of maternal cardiographic decelerations during the contractions is discussed. Decelerations in the maternal cardiogram traced from the dead fetus during labor may result in misinterpretations which lead to inappropriate obstetric management.

Two cases of carcinomatous meningeosis are reported. One occurred during cis-platinum combination treatment (PAC-scheme) for advanced ovarian carcinoma and one during the same treatment for a carcinoma of the cervix. Both patients showed no neurological problems prior to chemotherapy. The central nervous symptoms developed rapidly following the administration of small doses of cis-platinum (total dose 160 or 300 mg) and could not be controlled. In one case tumour cells were found in the cerebral spinal fluid. The cause of death could have been an unusually toxic reaction to cis-platinum. A thorough neurological examination prior and during chemotherapy with cis-platinum is necessary in order to recognize toxic side effects of the drug as soon as possible.

The side-effects of "artificial ascites" induced with Dextran 60 (Makrodex 6%) as a mean of preventing adhesions were investigated in 47 patients (treatment group: 32 patients; control group: 15 patients) in whom microsurgery had been performed for infertility with adhesiolysis. On the day of surgery and the following four days 300 to 500 ml of Makrodex was instilled via an intraperitoneal catheter (7.5 ml/kg body weight on day of surgery; 5 ml/kg body weight on days 2 to 5). In addition, the patients received, on the day of surgery, single doses of 450 IU of hyaluronidase (Kinetin), 500,000 KIU of aprotinine (Trasylol) and 1 g of hydrocortisone acetate instilled intraperitoneally. In the group treated with Dextran, there was a significantly higher number of patients who felt unwell and had abdominal complaints and dyspnea. In six cases in the Dextran group a vulval edema was seen, and in 2 cases a thigh edema. A significant weight increase and elevation of central venous pressure occurred for the duration of the "artificial ascites" in this group. There were a few cases of bradycardia with frequencies of under 50 beats per minute. On the fifth p.o. day 75% of the patients in the Dextran group had a pleural effusion. Such changes were not observed in the control group. In view of these side-effects and the fact that it is still not proven that Dextran effectively prevents adhesions we no longer carry out this form of adhesion prophylaxis.

In a preliminary study the new "Histocan"-needle was tested in respect of its diagnostic value in patients with palpatory findings suspicious for recurrent cancer in the pelvis and in patients with breast tumours. Initially there were some difficulties in handling the biopsy needle. Furthermore we saw some haematomas after breast biopsy, which could be avoided, however, by compression of the biopsy wound. From the morphological point of view the fine structures of tissue specimen were without the gross needle-conditioned artifacts and in some respect could be interpreted better than in Silverman-biopsies. Statistical data can only be given after finishing our cooperative studies.

During labor the maternal cardiogram was traced through the dead fetus. The technical prerequisites for this phenomenon are described. The concomitant intra-uterine tracings of the contractions showed decelerations during the contractions in the maternal cardiogram obtained from the dead fetus. Similar observations have been described by other authors. The etiology of maternal cardiographic decelerations during the contractions is discussed. Decelerations in the maternal cardiogram traced from the dead fetus during labor may result in misinterpretations which lead to inappropriate obstetric management.

From 1917 to 1979, the maternal mortality in the Rheinische Landesfrauenklinik Wuppertal has been investigated on the basis of 136084 live births. From 1917 to 1921, it was 10.1% and decreased to 0.16% in the period from 1973 to 1979. The maternal mortality in association with caesarean section, which was 11.8% in the period from 1917 to 1921 with a frequency of caesarean sections of 2.5%, decreased to zero since 1973 with a frequency of 6.3%. A caesarean section preceded more than 50% of the deaths since 1962. Most of the decreased (24.4%) were in the group of 30-34 years of age and 48.3% aged more than 30 years. 51.5% were primiparas and 14.6% of the women were at least para 4's. From 1917 to 1936, infection was the main cause of maternal mortality with 39.6%; from 1957 to 1966, however, thrombo-embolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anaesthetic deaths. During all the examined periods, non-specific reasons of maternal mortality were an important factor with more than 30%.

Two cases of carcinomatous meningeosis are reported. One occurred during cis-platinum combination treatment (PAC-scheme) for advanced ovarian carcinoma and one during the same treatment for a carcinoma of the cervix. Both patients showed no neurological problems prior to chemotherapy. The central nervous symptoms developed rapidly following the administration of small doses of cis-platinum (total dose 160 or 300 mg) and could not be controlled. In one case tumour cells were found in the cerebral spinal fluid. The cause of death could have been an unusually toxic reaction to cis-platinum. A thorough neurological examination prior and during chemotherapy with cis-platinum is necessary in order to recognize toxic side effects of the drug as soon as possible.