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Several complications of pregnancy have been reported to be associated with alterations of serotonin (5-HT). This study describes the changes in 5-HT metabolism in patients with preeclampsia. Our examination findings should explain if there are elevated 5-HT and 5-HIAA concentrations in urine and serum of women with preeclampsia. On the other hand it should be proved if the observed chances are due to a decreased kidney function and if there is an important prognostic factor to detect asymptomatic preeclamptic patients. 5-HT and its main metabolite 5-hydroxy-indol-acetic acid (5-HIAA) was evaluated in serum and urine of 24 pregnant women with preeclampsia and of 27 pregnant women without preeclampsia in the last month of pregnancy, within 24 hours after delivery and at the fourth day post partum. Besides 5-HIAA was ascertained in 24-h urine from the 24th week of pregnancy until after delivery. 5-HIAA excretion increased continuously during pregnancy independently of whether the patients developed preeclampsia. A significant less increase and lower concentration of 5-HIAA pre and post partum were observed in preeclamptic patients when compared to non-preeclamptic patients. We noticed a remarkably lower 5-HIAA excretion and a higher concentration of 5-HT in women with preeclampsia. Preeclamptic patients demonstrate a lower decrease of 5-HIAA and a significantly greater increase of 5-HT than women without preeclampsia. These results could be explained by a decreased metabolism of 5-HT due to the placental MAO. The changes observed in our study are not due to a decreased kidney function because creatinine concentrations in women with and without preeclampsia were comparable. Our results indicate that 5-HIAA-/creatinine ratio might be an important prognostic factor.

Several complications of pregnancy have been reported to be associated with alterations of serotonin (5-hydroxytryptamine; 5-HT) metabolism. Reported data regarding changes of 5-HT metabolism in pregnancy are partially contradictory. The presented study tries to describe pregnancy-associated changes in 5-HT metabolism. Urine and blood samples were taken from 20 pregnant women 4 weeks before, within 24 hours and on the 4th day following delivery. 17 non-pregnant age-matched women served as controls. 5-HT and its main metabolite 5-hydroxyindoleacetic acid (5-HIAA) were analysed. We observed a continuously increasing production and excretion of unbound 5-HT and 5-HIAA during pregnancy. Four days after delivery 5-HT production returned to baseline levels, while excretion remained elevated. 5-HIAA excretion increased in pregnancy and return to baseline levels on the day following delivery. Increased 5-HT metabolism and excretion results in a decreased 5-HT serum concentration despite increased 5-HT production during pregnancy. Our results help to understand the contradictory observations of elevated 5-HT production on the one hand and decreased 5-HT activity during pregnancy on the other.

The necessity for an integrated psychological care is proven by the example of the Psychological Ambulance in the University of Freiburg Women's Hospital. In 1993 387 out- or inpatients contacted the psychologist, mainly out of their own initiative. 819 consultations, each lasting for at least 45 minutes, were registered. Parameters influencing acceptance and implementation were as follows: formal qualification as well as medical and psychological competence of the staff; cooperation with the hospital physicians and other institutions providing psychosocial care. We found that further important is the integration within the hospital facilitated by the consultation-model plus the longterm perspective of the ambulance and its staff. Additional promotion of acceptance was generated by the informal recommendations among patients.

Techniques of assisted fertilization are usually preceded by ovarian stimulation therapies. This implies the risk of development of an ovarian hyperstimulation syndrome (OHS). With this article, clinical relevance, possible pathogenetic mechanisms, diagnosis, therapy and prevention of OHS are discussed. In addition, three patients with severe OHS are presented. Valid parameters for OHS risk assessment are peripheral E2 values as well as number and diameter of follicles. Until now, the mechanisms which lead to severe OHS are unknown, but hCG seems to trigger the development of symptoms, as OHS very rarely occurs without prior hCG application. Symptoms of severe OHS comprise ovarian enlargement, fluid- and electrolyte imbalance, third space fluid accumulation, haemoconcentration and hypercoagulation. Only symptomatic therapy is available. The significance of vascular mediators for the development of OHS is discussed.

In 129 patients with ovarian tumours, a preoperative examination by transvaginal colour Doppler sonography (ATL UM9 HDI) was performed. 45 were malignant and 84 benign. 46 patients were premenopausal and 83 postmenopausal. All tumour vessels were analysed by spectrum analysis. The number of tumour vessels and the lowest resistance index (RImin) and pulsatility index (PImin) of all vessels were evaluated as diagnostic criteria of the neovascularisation. Up to 19 vessels were found in 115 (89%) tumours. In benign lesions, the number of vessels was significantly lower than in malignancies (median 3 versus 9, p < 0.0001). The RImin and PImin values between benign and malignant tumours were also significantly different, independent of the menopausal status. In postmenopausal patients, the median RImin in 42 benign tumours was 0.62 (0.26-1.0) and in 41 malignancies 0.40 (0.22-0.66). The median PImin was 0.98 (0.31-5.84) in benign tumours and 0.53 (0.25-1.22) in malignant tumours. However, due to the overlapping range between benign and malignant tumours, these parameters do not allow an accurate differentiation. With a cut off value for RImin = 0.5 and PImin = 0.7, the sensitivity is 85% or 82.5% respectively. The specificity for RImin and PImin is 77%, and the diagnostic accuracy is 84% and 80% respectively. The correlation coefficient between RImin and PImin is 0.99 in benign and malignant tumours and both indices are adequate. The calculation of the RI is more easily available and should be preferred as a diagnostic parameter.

Doppler blood flow measurements allow differentiation of malignant lesions, that are characterised by an abnormal vascularity. The accuracy of this method is limited due to the physiological flow variation in normal breast parenchyma and in tumours. Magnetic resonance imaging in combination with contrast agents can also be used for flow assessment by measurement of the dynamic contrast enhancement. Recently, a new echo contrast agent (Levovist) has been developed, which survives pulmonary transit and increases the Doppler signal intensity after intravenous injection. Fourteen malignancies with low vascularity were selected for the study. Twenty-two seconds after injection of contrast agent, the Doppler signal intensity increased dramatically. This demonstrates, that echo contrast agents might improve the diagnosis of breast lesions in case of non-conclusive Doppler findings.

Fortunately, coincidence of pregnancy associated with malignant neoplasm is rare. As reported in the literature, incidence is 1.5-10: 10,000 pregnancies. The study presented reports data on the incidence and outcome of 16-35 years old female patients suffering from malignant neoplasms. Patients, who were treated in Freiburg 1980-1989, were considered for evaluation. We analysed the impact of pregnancy on the outcome of these patients by stratifying patients for the time of diagnosis (before, during, or after a pregnancy). 247 patients were included. 118 patients developed a neoplasia after a successful pregnancy. In 24 patients, neoplasia was diagnosed during pregnancy, and 28 patients became pregnant after diagnosis and therapy for a malignancy. Further 77 patients without pregnancy, but in whom neoplasia diagnosed at the age of 16-35 years were included. Cancer of the cervix uteri, breast cancer, ovarian cancer, and malignant lymphomas were the most frequent neoplasias diagnosed in young women. In an analysis stratified for stage of disease, we found no significant difference between 3- and 5-years survival of patients with pregnancies before, during, or after diagnosis and treatment of neoplasia. Due to the inhomogeneity of the subgroups analysed, the question, whether pregnancy has any impact on the outcome of neoplasm could not be conclusively answered. The necessity for the establishment of national and international registries collecting sufficient data about incidence and outcome of patients with pregnancies associated with malignant neoplasms is emphasised.

An increasing percentage of patients with uterine leiomyomas was observed in the Department of Obstetrics, University of Freiburg, on comparing the years 1970-79 (0.25%) and 1980-89 (0.64%). While first trimester bleeding, pain and premature labour, being typical obstetrical complications, were encountered in a comparable frequency, atonic bleeding was observed more often during the nineteen-eighties. Pain and premature labour were often present, if the leiomyomas were large, irrespective of both their number or localization. Atonic bleeding was observed more frequently, if large leiomyomas were present. A correlation between the presence of uterine leiomyomas and placental deficiency, premature birth, and EPH gestosis seems uncertain. The total complication rate among all pregnant patients with uterine leiomyomas was 65% from 1980-89. The Caesarean section rate among patients with uterine leiomyomas increased during the evaluated time span, and reached 51% during the 1980's, as compared to a general frequency of Caesarean sections of 19% during the latter time period; this increase in frequency seems to be rather in keeping with a generally increasing Caesarean section rate as opposed to a changing indication for surgery in patients with myomas. The myomas themselves caused Caesarean sections in 50% of cases, while in the remaining 50% of patients, Caesarean sections were performed for general obstetrical reasons. The probability to be delivered by Caesarean section was especially high amongst patients with multiple myomas or with an isthmic myoma. Our study supports a conservative approach in the case of pregnancy and uterine leiomyomas.

There is a low incidence of pregnancy associated with malignancy. We performed a retrospective analysis of patients of 16 to 35 years of age with malignancies, who had given birth to children in Freiburg 1980-1989. 170 patients were included. 118 patients became pregnant before a malignancy was diagnosed. Malignancy was diagnosed during pregnancy in 24 patients, and 28 patients became pregnant after diagnosis of and therapy for neoplasm. The frequency of preterm delivery, growth retardation and performance of Caesarean section was markedly increased only in patients with concurrent pregnancy and malignancy. 59 children were born after their mother had been treated for a malignancy. Treatment was started during pregnancy in 19 cases. 40 children were born to mothers who became pregnant after treatment. Malformations and abnormalities with respect to the development of the children were observed in similar frequency in both groups and occurred more frequently compared to the group of children, who were born before the treatment of the mother. These results were supported by an analysis of 16 siblings. We conclude, that there is a demand for national and international registries for all pregnancies associated with malignancies. Long-time observation of the children born to mothers, who had been treated for malignancy are necessary.

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

Explored by structured dialogue, miscarriage meant for 31 women, a psychosocial stress but not a medical stress. They tried to convince themselves of the non-normative event via subjective causal attributions to obtain cognitive control. Social support, especially by the partner, minimising the importance of the miscarriage, and social comparisons were the main modes of coping with their problem. Doctors and nurses significantly undervalued the degree of psychosocial stress, which resulted in negative consequences in the doctor-patient-relationship.

A case of pseudovaginal perineoscrotal hypospadia (PPSH) is presented. This autosomal recessive disorder, also termed incomplete male pseudohermaphroditism type 2, is mostly caused by a deficiency of 5 alpha-reductase, which controls the conversion of testosterone to 5 alpha-dihydrotestosterone. In genital skin fibroblasts, the activity of the 5 alpha-reductase was strongly reduced, compared with a normal male. The 5 alpha-reductase activity in nongenital skin fibroblasts, however, was in the range of the normal male control. For complete diagnostic evaluation of PPSH 5 alpha-reductase activity it should be determined simultaneously in genital and non genital skin fibroblasts. The conversion of T to DHT in genital skin fibroblasts of a patient with testicular feminisation (Tfm) was found to be of the same order of magnitude as in PPSH. This suggests, that the expression of 5 alpha-reductase is androgen-dependent.

In four cases of one twin pregnancy and three triplet pregnancies, efforts were made to prolong the pregnancy after the death of one foetus between 15th and 26th weeks of gestation. Two patients had a history of spontaneous abortion, three patients had undergone infertility treatment. In a further three cases the membranes ruptured prematurely in association with severe disturbance of the vaginal flora. Treatment consisted of rest in bed, sedation, and administration of magnesium and antibiotics. Neither cervical cerclage nor general IV tocolysis were performed. Although the pregnancies could be prolonged for 4, 22, 28, and 76 days, they all terminated before the 27th week, mainly due to ascending infection. Of the 11 children, two survived with no morbidity, two children (B and C of the third triplet pregnancy), died 2 and 19 days after delivery, respectively, and seven were stillborn. A comparison with prolongations of twelve twin and four triplet pregnancies reported in the literature, reveals the various concepts for treatment. After infection has been ruled out and the parents have been fully informed, efforts could be made to prolong the multiple pregnancy after the death of one foetus until the surviving child is viable. This requires intensive supervision.

We describe two cases of autoimmune polyendocrinopathy syndrome as a cause of primary ovarian failure. Antibodies against various endocrine organs cause pluriglandular insufficiency, in most cases hypoparathyroidism. Addison's disease, and primary ovarian insufficiency. In these patients, careful examination of all endocrine organs is necessary in order to provide an adequate hormone replacement.

Since 1 October 1990, German legislation requires compulsory counselling of an infertile couple before artificial insemination on the medical and psychosocial aspects, by a doctor not performing the treatment. A prerequisite of successful counselling, which enables the couple to take a decision and helps coping with the psychosocial stress of sterility and its consequences, is, in addition to the intrinsic motivation of the couple, also the empathy and the discussion with the doctor. Subject for counselling should be the burdens of therapy, effects of the sterility upon sexuality, partnership, and communication, motivations for wanting a child and the functions of the child for both partners individually and as a partnership. As a prophylactic measure against the development of a neurotic desire for a child and a fixation upon sterility therapy, alternative resolving strategies for therapy failure should be discussed and developed.

Hormonal contraception with a combination of a GnRH-agonist (Buserelin) and progesterone was achieved in 47 high risk patients in 547 cycles. In these patients, oral contraceptives were contraindicated because of severe cardiovascular diseases, thromboembolic complications, benign liver tumours, advanced diabetes, terminal kidney insufficiency and severe migraine. Buserelin was administered intranasally in one daily dose of 300-400 micrograms from the 1st day to the 21st day, one dose of 100 mg of Progesterone was given intravaginally daily from the 12th day to the 21st day. Under these conditions, average E2 concentrations were found in the range of 50-60 pg/ml. The discontinuation of progesterone replacement resulted in withdrawal bleeding. Cycle control was acceptable. In 4 cases, this contraceptive regimen had to be discontinued because of side effects or paradox reactions. One patient conceived. In conclusion, GnRH-analogues in a moderate dose can be used to inhibit ovulation without inhibiting follicular maturation and adequate oestrogen production. This costly regimen of contraception requires strict indication and careful monitoring.

This paper reports on four pregnancies with maternal liver tumors induced by oral contraceptives. No increase in size and no rupture of these liver lesions were observed during the gestational and postpartum period. The toxic potentials of orally active sex steroids and the role of natural sex steroids are discussed. Criteria for differential diagnosis and practical suggestions are presented.

The widening effect of Sulproston 500 microgram IM on the cervix uteri was investigated in a double-blind study conducted in 50 non-pregnant volunteers. In women in the postmenopausal stage who had been given Sulproston, resistance-free widening of the cervix with Hegar's rods was H 8.33 +/- 0.87. Easy passage of the cervix uteri and of the internal os uteri was achieved with Hegar 8.22 +/- 0.66 in the first half of the cycle and with Hegar 8.35 +/- 3.06 in the second half of the cycle. In all three groups, the size of the rods was significantly smaller following intramuscular application of physiological saline solution. The widening effect of PGE2 or PGE2 derivatives on the cervix, which has been known for quite some time in patients with pregnant uterus, applies in equal measure to the non-pregnant cyclic uterus and to the postmenopausal uterus.

Five severe cases of intra-abdominal gynaecological haemorrhage (four haemorrhages from corpora lutea haemorrhagica and one haemorrhage of the endometritis genitalis externa) are described in relation to prolonged marcumar therapy. The problem of contraception in patients under marcumar therapy is highlighted and the possibility is discussed of prevention of ovulation and cardio-vascularly neutral treatment, to achieve contraception as well as avoidance of haemorrhage at ovulation with the Gn-RH analogue Buserelin.

In 18 cycles of 16 patients the morphological changes following stimulation by human gonadotrophin were followed by ultra-sonography and radio-immunoassays of 17 beta-estradiol and progesterone (HMG). In 9 of 18 cycles hyperstimulation with more than 3 follicles on the day of chorionic gonadotrophin administration were found. When the human menopausal gonadotrophin treatment (HCG) results in the maturation of more than 10 follicles per ovary the estradiol level reaches more than 2000 pg/ml. In 4 of 8 cycles the administration of HCG triggered the hyperstimulation syndrome. In 5 of 18 cycles pregnancy was induced after a follicle of at least 17 mm diameter was found independant of the number and size of concommitant follicles. Because of the high incidence of HMG hyperstimulation ultra-sonographic prediction of a multiple pregnancy is of no practical value. In 6 of 10 treated cycles without success the deformation or unclear margins of the predominant follicle suggested an insufficient stimulation with HMG. For the monitoring of follicular maturation ultrasonography is superior to estradiol determination since only a large number of follicles showed correlation to elevated estradiol levels.

Three patients with nonpuerperal mastitis are presented. The inflammation was supposedly related to hormonal stimulation of the breast. One patient suffered from hyperplasia of the breast, the second patient exhibited a rapidly growing fibroadenoma, a third patient developed a recurrent purulent mastitis on the basis of galactorrhea. All patients improved after exclusive administration of bromocriptine without the addition of antibiotics.

The results of 98 therapeutic abortions in the first and second trimester of pregnancy using F prostaglandins are reported. The prostaglandins were eigher administered by fractionated extra-aminotic PGF2 alpha, intramuscular 15-methyl PGF2 alpha or extra-amniotic or intracervical single shot 15-methyl PGF2 alpha. The induction abortion time of 13 hours and 15minutes for the single shot and 14 hours and 28 minutes for the intramuscular administratic with the prostaglandin derivatives is shorter than with natural prostaglandins which showed a mean induction to abortion time of 19 hours and 30 minutes. The blood loss was low in all groups at approximately 75 mls. Side effects are least with the single shot method (11%). Two patients had nausea, two patients had vomiting, three patients had flush or lower abdominal cramps. The intramuscular administration showed the highest frequency of side effects (80%). In the first trimester the single shot method always leads to sufficient cervical dilatation although the abortion rate was low at 59%. During the second trimester a high abortion rate is found. Therefore this method can be recommended for therapeutic abortions.

Hyperandrogenemia is associated with relatively high LDL- and low HDL-cholesterol levels, increasing the risk of the development of arteriosclerotic disease. In three women suffering from androgen producing ovarian tumors, this observation could be confirmed. After surgical removal of the ovaries, lipoprotein profiles returned to normal. In contrast, androgens did not affect lipoproteins in two testicular feminized individuals. Despite elevated testosterone levels, the lipoprotein profiles were absolutely normal. This observation indicates that the affects on the lipoprotein profile is receptor mediated.

The sonographic equivalent of the morphological changes of the ovaries in the physiologic menstrual cycle is the periodic evidence of cystic or solid ovarian structures. The selection of the follicle destined for ovulation occurs from a number of many small antral follicles. The initial polymicro follicular reaction the timing of selection differentiates the follicular phase in the selection and in the maturation phase. The selection phase is the limiting temporal part of the cycle. The maturation occurs usually in a unifollicular manner. The daily growth of the dominant follicle (maturation rate) is in most cases not constant. Usually an intraindividual or inter-individual variability of the maturation rate of a mean 2.5 mm per day is present. Preovulatory a non significant delay in the maturation occurs. The sonographic prediction of ovulation is indirect and determined by the timing of selection, the size of the selected follicle, the maturation rate and the size of the preovulatory follicle. The diameter of the dominant preovulatory follicle is 23.1 +/- 2.8 mm. In individual cases solid structures in the preovulatory follicle are recognized which probably correspond to the cumulus oophorus. The corpus luteum structure is significantly larger than the preovulatory follicle with a size of 28.1 +/- 6.7 mm. Corpus luteum cysts can persist until the maturation phase of the next menstrual cycle. The shift from corpus luteum to dominant follicle of the next menstrual cycle can occur alternating between ovaries or homolaterally .

In 13 patients with abortion in the second to fourth months of pregnancy the variation in oestrogen levels in the plasma was determined before and after abrasion of the abortus, using the radioimmunoassay method, and correlated with the results of histological examination of the abraded parts. Seven women without endometritis revealed high oestrogen concentrations before and after the abrasion (mean (1734 pg/ml or 397 pg/ml, respectively). On the fifth day after abrasion the levels corresponded with those of the proliferation phase of the normal menstrual cycle (mean 115 pg/ml). In six women with histologically established endometritis low oestrogen levels were found before and after the abrasion, the mean values being 101 pg/ml and 36 pg/ml, respectively. On the fifth day the values continued to remain low (average 25 pg/ml). The difference in oestrogen concentrations of both groups was significant and correlated well with the results of histological examination of the abraded parts.

Oestriol profile represents a functional parameter of the foetal placental unit. Basing on the fact that maternal cortisol regulates oestriol production via a negative feedback action on foetal hypothalamus, relative low serum oestriol concentrations in the morning are compared with increasing oestriol concentrations in the evening, spaced out at short-time intervals, pointing to a dynamic oestriol production of the foetal placental unit. The mean oestriol concentration in the morning and maximum peak values in the evening were determined as criteria of the oestriol profile. In normal pregnancies (n = 74) the oestriol concentration in the morning increases from an average value of 8.0 ng/ml in the 32nd/33rd week to 11.6 ng/ml in the 40th/41st week of gestation. During the same period the peak values in the evening rise from 8.8 to 15.9 ng/ml. The mean cortisol concentrations in normal pregnancies (n = 49) from 32nd to 41st week are in the range of 333 +/- 88 ng/ml in the morning and 205 +/- 66 ng/ml in the evening. There is no significant difference between individual weeks. The predictive value of the oestriol profile was assessed regarding the foetal outcome of 55 high-risk pregnancies. 32 newborn infants exhibited intrauterine growth retardation with birth weights below the 10th and 5th percentile, respectively. In this group 6 patients exhibited low oestriol values in the morning, whereas 12 demonstrated a pathological profile in the evening. In 11 of 12 high-risk pregnancies exhibiting pathological oestriol profile growth, retardation of the newborn was found to be below the 5th percentile. Cortisol concentrations do not significantly differ between normal and high-risk pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of Rothmund-Thomson syndrome of a 24-year old woman with primary amenorrhoea is presented. This autosomal recessive disorder is characterised by atrophy, hyperpigmentation and teleangiectasiae of the skin, furthermore by juvenile cataracts and congenital bone defects as saddle nose. Endocrinologic and morphologic parameters suggest a resistant ovary syndrome as cause of this hypergonadotropic hypogonadism.

The treatment of infertile women by gonadotropins is more effective in hypogonadotropic than in normogonadotropic ovarian insufficiency. In order to induce a hypogonadotropic state the luteinizing hormone-releasing hormone analog (LHRHA) buserelin was administered in eight cycles of four infertile patients suffering from luteal phase defect. Buserelin was infused subcutaneously in a dosage of 400 micrograms/d for 26-44 days using a portable external osmotic minipump system. Following suppression of estradiol-17 beta below 35 pg/ml within 11 +/- 5 days, gonadotropins were injected intramuscularly to stimulate ovarian function. In all cycles treated, ovulation and formation of a functional corpus luteum were observed without signs of premature luteinization. Whereas constant administration of LHRHA by a slow release system seems very useful for long-term reversible suppression of follicular maturation, further studies should evaluate the clinical usefulness of combined LHRHA/gonadotropin treatment in cases of infertility.

26 patients suffering from delayed labour at term were treated with Prostaglandine E2 (PGE2). The compound was administered i.v. in a dosage of 0,5-1,0 microgram/min. Delivery was completed in 20 patients approximately 5 hours after starting the PGE2-infusion. In 6 patients delivery had to be performed by caesarean section, 4 times because of maternal and 2 times of fetal indications. In none of the cases uterine hypertension was recorded. The rate of side effects was negligible.

The concentrations of prostaglandin F-equivalents were measured in peripheral plasma during labour at a cervical dilatation of 5 cm and at complete dilatation. After purification, extraction and chromatography the PGF-equivalents were measured radioimmunologically. The intraassay variation was 1.5%, the interassay variation 3.5%. The specificity for PGF was 96-98%. Logit/log transformation of the standardcurve yielded a sensitivity of the assay of 120 pg. At cervical dilatation of 5 cm PGF-equivalents varied between 1300 and 3200 pg/ml plasma. At complete dilatation values changed between 1200 and 5400 pg/ml. These fluctuations correlate timedepending to the uterine contractions recorded and may be interpreted as a result of uterine PGF-release.

The present study compares the negative feed back action of cortisol and cortison on oestriol production in late human pregnancy. 10 women from the 38th to 40th week of gestation volunteered in this study. All had uncomplicated courses of pregnancy and delivered healthy babies at term. 5 patients received a continuous infusion of 100 mg Cortisol from 10 a.m. to 12 a.m. To the other 5 patients 100 mg Cortison were infused during the same period. Blood specimens (5 ml) were drawn in 60 and 30 minutes intervals from 8 a.m. to 5 p.m. Plasma levels of unconjugated oestriol were measured by radioimmunoassay. The suppression of oestriol levels was nearly identical in both groups: After Cortisol oestriol concentrations decreased from 17.1 +/- 9.1 ng/ml to 6.0 +/- 1.2 ng/ml (p less than 0.001) and after Cortison from 15.5 +/- 5.8 ng/ml to 5.9 +/- 1.8 ng/ml (p less than 0.001), respectively. According to these results the placental metabolism of maternal cortisol to cortison does not impair the negative feed back action of this hormone on the foetal hypothalamus-hypophysis-system.

The present study investigates the significance of a circadian changing sensitivity on the feed back action of cortisol for the foetal hypothalamic hypophyseal system. 9 patients with uncomplicated courses of pregnancy in the 37th to 40th week volunteered in this study. All of them delivered healthy babies at term. 5 patients received a continuous infusion of 0.25 mg ACTH1-24 (Synacthen) in the morning from 10 a.m. to 4 p.m. (group I). To 4 patients an analogous ACTH infusion was applied in the evening from 8 p.m. to 2 a.m. (group II). Blood specimens (5 ml) were drawn from 8 a.m. to 5 p.m. in group I and from 5 p.m. to 3 a.m. in group II in 60 and 30 minutes intervals, respectively. Free plasma oestriol was measured by radioimmunoassay, total plasma cortisol by the protein binding method. In group I cortisol increased from 294.3 +/- 52.9 ng/ml to 774.5 +/- 170 ng/ml, whereas oestriol decreased from 13.1 +/- 6.1 ng/ml to 6.8 +/- 2.1 ng/ml (p less than 0.001). In group II cortisol rose from 267.5 +/- 76.2 ng/ml to 1010 +/- 284 ng/ml, whereas oestriol levels were suppressed from 21.7 +/- 10.5 ng/ml to 10.8 +/- 3.2 ng/ml (p less than 0.001). Two hours after starting ACTH infusion rising cortisol and falling oestriol concentrations were negatively correlated (r = -0.9657, p less than 0.001 in the morning; r = -0.9119, p less than 0.001 in the evening). Plasma oestriol levels were in the evening suppressed on an average of 10.9 ng/ml and exceeded the oestriol decrease in the morning (6.3 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

The paper reports on intravenous and intrauterine application of Prostaglandin F2alpha and its 15-methyl derivative for the treatment of severe uterine bleedings in obsteterics and gynaecology. The effectiveness of the compounds is demonstrated.

In the clinical study reported here, the relationship between the behavior of the serum lipids and the concentration of placental lactogen (HPL) was investigated in 107 gravidae in the last trimester. Among the patients examined there were 99 single pregnancies and eight multiple pregnancies--2x twins, 3x triplets, and 3x quadruplets. In these examinations, a significant positive correlation (p less than 0.01) was found between the HPL concentrations and the triglyceride values. Increases in HPL concentrations were associated with increasing total cholesterol and LDL cholesterol values. There was no relation to HPL values in the HDL and VLDL fraction of the cholesterol. Nor was there any relation between estrogen secretion in urine, which was measured in 42 patients, and plasma lipid concentrations. Extreme HPL values in multiple pregnancies, of more than 9 micrograms/ml, were associated with triglyceride concentrations of 383 +/- 37 mg/dl. Total cholesterol in these patients reached values of 294 +/- 19 mg/dl. These values returned to normal on the third day post partum. The mean HDL: total cholesterol ratio was 0.245 +/- 0.065 and was thus clearly above the pathognomonic limit of 0.150. The findings obtained in this study are indicative of the pronounced lipolytic potency of HPL.