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Identification of patients at low risk presenting to the emergency department with chest pain is a continuing challenge. We examined a cohort of low-risk women with negative cardiac injury markers, electrocardiogram with normal results, and clinical stability. We hypothesized that these patients can be safely and accurately managed in a chest pain unit (CPU), may not require predischarge cardiac testing, and have an excellent short-term prognosis. The primary end point was major cardiovascular events during index admission or follow-up. Mean age of the 403 women was 42 ± 4.3 years (30 to 50 years). No patient had a cardiovascular event in the CPU, and none of the 321 patients followed for 6 months had a late cardiovascular event. Most (211, 52%) did not receive predischarge cardiac testing. The remaining 192 patients (48%) had predischarge exercise treadmill test, stress imaging, or cardiac catheterization. Of those patients who underwent treadmill testing, almost 90% had no exercise-induced chest pain and approximately 50% had functional capacity 8 to 14 METs. In addition, 166 patients (41%) were discharged from the CPU after

The goal of our study was to evaluate two newly developed implant designs and their behavior in terms of subsidence in lumbar vertebral bodies under cyclic loading. The new implants were evaluated in two different configurations (two small prototypes vs. one large prototype with similar load-bearing area) in comparison to a conventional screw-based implant (MACS TL). A pool of 13 spines with a total of 65 vertebrae was used to establish five testing groups of similar bone mineral density (BMD) distribution with eight lumbar vertebrae each. In additional to BMD assessment via dual-energy X-ray absorptiometry, cancellous BMD and structural parameters were determined using a new generation in vivo 3D-pQCT. The specimens were loaded sinusoidally in force control at 1 Hz for 1000 cycles at three load levels (100, 200, and 400 N). A survival analysis using the number of cycles until failure (Cox regression with covariates) was applied to reveal differences between implant groups. All new prototype configurations except the large cylinder survived significantly longer than the control group. The number of cycles until failure was significantly correlated with the structural parameter Tb.Sp. and similarly with the cancellous BMD for three of five implants. In both large prototypes the cycle number until failure significantly correlated with the preoperative distance to the upper endplates. Although the direct relationship between bone structure or density and mechanical breakage behavior cannot be conclusively proven, all the prototypes adapted for poor bone structure performed better than the comparable conventional implant. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

For screening efforts to maximally reduce mortality in the general population, a large proportion of women need to utilize mammography routinely. To investigate utilization of mammography in a community setting, the authors used population-based data collected by the New Mexico Mammography Project for residents of the Albuquerque, New Mexico, metropolitan area for the period 1994-1997. The authors computed screening rates and the proportion of women who routinely use mammography. The utilization of mammography was low. Only 50% of the women aged 50-74 years were screened each year. Less than one third of women aged 40-49 years or 75 years and older were screened annually. The percentage of women who routinely used mammography on an annual or biennial basis was low in all age groups, especially among Hispanics and American Indians. Women aged 50-74 years had the highest percentage of routine annual mammography use, ranging from 30% in non-Hispanic Whites to 20% in Hispanics. Current utilization of mammography in community-based screening efforts is unlikely to achieve a potential 30% reduction in breast cancer mortality. Interventions are needed to increase the routine use of mammography.

Background: Interval breast cancer is defined as a cancer that is detected within 12 months after a negative mammogram. The failure of mammography to detect breast cancer depends on testing procedures, radiologist interpretation, patient characteristics, and tumor properties. Although errors by radiologists explain some interval cancers, another explanation is that the tumor is rapidly growing and was too small to be detected on the last mammogram. To determine whether markers of tumor growth rate are associated with risk of an interval cancer, we conducted a population-based study with the use of data collected statewide by the New Mexico Mammography Project. Methods: Among women who received a mammographic examination from 1991 throughout 1993, we ascertained records of all patients with breast cancer diagnosed within 12 months of a negative screening mammographic examination (interval cancers) and corresponding tumor samples, when available. We selected an age-and ethnicity-matched comparison group of control patients with screen-detected breast cancers diagnosed during the same period. In tumor samples, p53, bcl-2, and Ki-67 were examined immunologically and the apoptotic index was assessed histologically. We used logistic regression to determine whether interval cancers were associated with selected demographic, radiologic, and biologic characteristics. Results: It is more likely that mammography did not detect tumors with a high proportion of proliferating cells (>20%) than tumors with a low proportion of proliferating cells (

Background Bioelectrical impedance analysis (BIA) can potentially be used to estimate body composition in large populations studied at multiple sites. However, it is not clear whether age-specific BIA equations are necessary for accurate application of BIA to research on elderly subjects. Methods We compared a published equation designed to predict fat-free mass (FFM) that had been derived in a young healthy population (mean age 27 y; mean BMI 23.9 kg/m2), with equations that we developed for the elderly by using data from 455 participants in the Framingham Heart Study (78 Y; 27.3 kg/m2), using dual-energy x-ray absorptiometry (DXA) as a reference technique. The BIA equations were then compared in an independent sample of 283 participants in the New Mexico Aging Process Study (76 y, 25.5 kg/m2), who also underwent BIA and DXA. Results When the young-population equation was applied to Framingham, it caused an overestimation of FFM in heavier subjects that was eliminated by use of the age-specific equation. However, when the two equations were tested in the New Mexico population, the published equation gave estimates of FFM that were closer to DXA than the Framingham equations did. Conclusions The accuracy of a BIA equation depends on the body composition of the population of the population and the validation method rather than on age per se. Application of BIA to elderly populations requires uniform validation procedures in the actual study population, rather than reliance on age-specific equations.

BACKGROUND There is little information for age differences in body composition in elderly people > 65 years of age, especially for those > 80 years. As the proportion of people older than 65 years is expected to nearly double during the next few decades, this information is needed. METHODS Age differences in body composition and anthropometry were examined in 316 men and women aged 60 to 95 years. Multiple components of body composition were quantified using dual energy X-ray absorptiometry and isotope dilution methods, and expressed in molecular and cellular models. Analysis of variance was used to test for differences between age groups 60 to 70, 71 to 80, and > 80 years in each sex. Body composition components were regressed on age, controlling for knee height, fat-free mass, or total body fat. Age-adjusted correlations were calculated with anthropometric variables. RESULTS Fat-free mass (FFM), body cell mass (BCM), and appendicular skeletal muscle (ASM) decreased with age in both sexes. ASM decreased relative to FFM in both the men and the women, while BCM decreased relative to FFM in the women only. Total fat mass and percent body fat decreased with age in the women, but not in the men. Body fat distribution did not appear to change with age. Anthropometric indices, muscle area and waist/hip ratio, had low correlations with muscle mass and fat distribution. CONCLUSIONS "Sarcopenia," or muscle loss, continues to occur into old age, and may have significant impacts on physical function and health status. New anthropometric techniques are needed for assessing muscle loss with age.

Background: We examine benign breast biopsy diagnoses as reported by community pathologists in New Mexico and investigate associations with future breast cancer development. Methods: Using data collected between 1992 and 2000 by the New Mexico Mammography Project and cancer data through 2003 from the New Mexico Tumor Registry, we calculated breast cancer rates following 14,602 benign breast biopsies for women ages 30 to 89 years. For comparison, we also calculated the breast cancer rate following 215,283 normal screening mammograms. Hazard ratios (HR) are presented. Results: We identified 480 subsequent breast cancer diagnoses among 14,602 women with benign breast biopsies and 4,402 breast cancer diagnoses among 215,283 women with mammograms assigned a “negative” or “benign finding” assessment. Histologic diagnoses in absence of atypia had an age-adjusted HR of 1.95 [95% confidence interval (95% CI), 1.77-2.15]. Among low-risk histologic diagnoses, the strongest associations with subsequent breast cancer development included adenosis, apocrine metaplasia, calcifications, and ductal hyperplasia. Fibroadenoma, inflammation, and cysts did not exhibit an association with breast cancer development. Women with low-risk diagnoses and breast tissue characterized as fatty or with scattered densities had a HR of 2.09 (95% CI, 1.68-2.60), whereas women with low-risk histologic diagnoses and dense breasts had a HR of 3.36 (95% CI, 2.83-3.99). Conclusions: The observed breast cancer occurrence contributes to evidence of increased risk following benign biopsy. The risk associated with histologic diagnoses in absence of atypia was twice the risk experienced by women with normal mammogram evaluations and may be modified by breast density. (Cancer Epidemiol Biomarkers Prev 2007;16(3):467–72)

The impact of various medical and demographic factors on the quality of life (QoL) of breast cancer patients has been discussed controversially. We investigated the influence of six different factors on long-term QoL and body image of women with primary breast cancer.Two-hundred and seventy-four breast cancer patients were administered the QoL questionnaire following a mean interval of 4.2 years after primary diagnosis. All women had been primarily treated for stage I to III breast cancer without evidence of distant metastases. QoL was evaluated by using the QLQ-C30 questionnaire Version 2.0. Supplementary scales included body image, satisfaction with surgical treatment, cosmetic result and fear of recurrence. We analyzed the impact of tumor stage, surgical treatment, adjuvant radiotherapy, adjuvant cytotoxic therapy, age and length of follow-up period on the examined outcome parameters.At the time of the follow-up examination, patients showed minor impairment of QoL (mean 67.8) and body image (mean 24.8), but more fear of recurrence (mean 60.7). None of the studied factors had a significant impact on overall QoL (P0.05) according to the QLQ-C30 questionnaire. In contrast, with the exception of the factors 'cytotoxic therapy' and 'radiotherapy' all investigated variables influenced at least one of the additional psychological scales (P0.05). The primary surgical treatment modality had the strongest impact and affected all four scales. Patients treated with breast conservation reported a more favorable body image, compared to those treated with mastectomy (17.2 versus 37.5, P0.01), more satisfaction with surgical treatment (4.0 versus 10.7, P = 0.01), rated a better cosmetic result (75.5 versus 57.1, P0.01), but presented more fear of recurrence (63.9 versus 55.3, P = 0.04).Current QoL questionnaires do not sufficiently cover all relevant aspects of QoL, but might be complemented by breast cancer specific aspects such as body image and fear.

In the last 10 years about 130 women with a drug addiction and more than 100 HIV-positive pregnant women were treated at the 1. University Hospital of Obstetrics and Gynaecology in Munich. Besides a specialized medical treatment both groups required intensive psychosocial care. HIV-infected people are still isolated and suffer from the social stigmata. Their essential needs for sexuality and children of their own are often ignored or even condemned because of irrational fears about HIV, which continue despite rapid medical improvements. The life-expectancy for example has increased since the inauguration of protease inhibitors. Vertical transmission of HIV is below 2% through medical treatment in pregnancy, elective cesarean section and renunciation of breastfeeding. Drug addicted pregnant women are given the opportunity to change their life in order to care for their children appropriately. The basis for this is a substitution with levomethadone and elimination of the use of other drugs. The addicted women often can reduce the dosage of levomethadone during the course of their pregnancy and sometimes can cease totally. Normally they are highly motivated and thus can ease the withdrawal symptoms of their newborns following delivery. By establishing a reliable social net during pregnancy mothers learn to recognize the demands of their children after birth and thus emotional and cognitive deficits can be prevented.

An elevated serum concentration of the metabolite, homocysteine (Hcys): 1) can indicate folate or vitamin B12 deficiency, 2) is an independent risk factor for vascular disease. The metabolite, methylmalonic acid (MMA), is elevated in deficiency of vitamin B12, but not folate. The purpose of this study was to determine the effect of self-selected vitamin supplementation and other variables on serum Hcys and MMA concentrations in elderly men and women.Serum concentrations of Hcys, MMA, folate and vitamin B12 were measured for elderly volunteers, age 68-96 years, and compared for those consuming (26 men, 25 women) and not consuming (24 men, 25 women) self-selected vitamin supplements.Compared with the nonsupplemented group, the supplemented group had lower mean serum MMA (208 +/- 162 vs. 241 +/- 98 nmol/L [+/- SD]) and Hcys (9.5 +/- 2.6 vs. 11.2 +/- 2.7 mumol/L); and higher serum vitamin B12 (391 +/- 174 vs 292 +/- 107 pmol/L), and serum folate (46 +/- 15 vs. 24 +/- 10 nmol/L) p0.05. Among all 100 subjects, the prevalence of serum vitamin B12221 pmol/L (300 pg/mL) was 18; MMA271 nmol/L, 16; Hcys16.2 mumol/L, 3; folate5.0 nmol/L, none. Based on serum vitamin B12221 nmol/L with elevated serum MMA, vitamin B12 deficiency was probable in seven subjects, of whom two were supplemented. All three subjects with elevated serum Hcys had elevated serum MMA as well, suggesting vitamin B12 deficiency or renal insufficiency. A stepwise linear regression model for serum Hcys explained 61.7% of the variance, and included (in order) serum creatinine, folate, vitamin B12, albumin, age and body mass index (BMI). A model with serum MMA replacing serum vitamin B12 explained 64.1% of the variance in serum Hcys. Folate did not enter the model for supplemented subjects, supporting a "threshold effect": serum Hcys was inversely related to serum folate at lower serum folate (nonsupplemented subjects), but at higher serum folate (supplemented subjects), the relationship was flat. In supplemented subjects, serum Hcys was still related to vitamin B12 status, confirming that tissue deficiency of the vitamin was present.Results showed potential usefulness of serum MMA and Hcys in identifying subclinical or tissue deficiency of vitamin B12. Clinicians should be aware of the risk of vitamin B12 deficiency in older people and of current screening algorithms using serum metabolites. These elderly volunteers had generally good folate status; nevertheless, some subjects seemed likely to benefit from an improvement in folate status that would reduce their serum Hcys within the normal range. The role of serum creatinine in the normal range in predicting serum Hcys, a vascular disease risk factor, remains unexplained.

Course of Grief Response, influencing Factors, Satisfaction with treatment, Need for Psychotherapeutic Support: The emotional response to a late miscarriage or a stillbirth was examined retrospectively in a systematic study involving 51 patients. The women had lost a child either by stillbirth (beyond the 20th week of gestation) or shortly after delivery. We assessed the long-term course of possible determinants of grief, a complicated grief response, as well as the patients' satisfaction with the treatment and their need for further psychotherapeutic support. The mourning response was complicated by a depressive reaction in 22%. Major risk factors were individual disposition, lack of partner and professional support. The findings reveal that the course of the grief response is positively influenced by: 1. open discussion (thematisation) with the skilled personnel and the patients' families, 2. direct or indirect contact with the deceased child (concretisation) and 3. the patients concerned being extensively informed as to place and circumstances of the funeral (whereabouts of the child).

Associations of fat and muscle masses with bone mineral status were studied in 301 men and women aged > or = 65 y. Bone mineral and soft tissue composition were estimated by using dual-energy X-ray absorptiometry. Univariate correlations suggested that muscle is associated more closely than fat with bone mineral content (BMC) as well as with bone mineral density (BMD) in men. In women, however, correlations of BMC with muscle were only slightly greater than those with fat and correlations with BMD were consistently greater with fat than with muscle. This suggests that correlations of BMC with muscle are influenced by bone and body size, especially in women. A multiple-regression model was developed that adjusts BMC for bone area, knee height, age, and the independent effects of fat and muscle. In men, muscle remained more closely associated with adjusted BMC than with fat. In women, fat mass was associated significantly with BMC but muscle mass was not. The exception was for women taking estrogen, in whom neither fat nor muscle was associated significantly with adjusted BMC. This study suggests that body fatness may be more important than muscle in maintaining bone mineral in elderly women not taking estrogen.

Only recently a stillbirth has been recognized as a major loss for the majority of women. Based on psychotherapeutic experience and clinical investigations, symptoms and risk factors of normal and pathological courses of grief are delineated and illustrated by a case vignette. Risk factors for complicated grief refer to quality of inpatient care, partner support, previous depression, anxiety or unresolved strain. Recommendations for inpatient care include validating the loss, making it real, enabling the bereaved parents to make informed decisions. Ambulatory after care should provide for monitoring and supporting the grief process.

In our opinion German gynaecology has failed to adequately face what came to pass during the Nazi period. This can be proved objectively, for there is no evidence that, after 1945, gynaecology had in any way cared to take notice--either thermatically or medically--of the thousands of victims of inhuman practices such as forced termination of pregnancy, compulsory sterilisation and the like. During the past 50 years recollections of enforced sterilisations, compulsory abortions, deliberate and hence criminal negligence and problematic approaches in research and teaching were almost completely banished from the area of conscious awareness and largely suppressed or silently ignored. Most of the medical directors of Departments of Gynaecology of German universities shared this view whenever they were questioned on the connections between gynaecology and Nazism. Now that two generations have passed it seems possible to examine and explore with less guilt feelings and shame the immensely fateful rôle of gynaecology in that context. Accent should be on the fate of the victims of that period. To bring back these events to memory, however, does not permit to conceal the part played by the physicians committing of these inhuman Nazi crimes. Data collected from a psychosomatically oriented examination of victims exemplify that to concretely recall gynaecology during Nazism a1-so offers a chance in several respects. One of the possibilities in this context is to signal "late apology" and regret to patients who had been victims, in one's own area of work, after one has psychically worked over their fate. Besides, a gynaecological-psychosomatic expertise will help e.g. that compulsorily sterilised women are granted financial aid that has at long last become a legal possibility and can be applied for since 1980. However, the relevant patient records do show very clearly that the inhuman practice of gynaecology during the so-called "Third Reich" was not only a collective problem but equally due to a failure of the individual conscience of numerous gynaecologists. Working over this complex may enhance our own sensitivity for psychosomatic and ethic problems and counteract any likelihood of a recurrence of an inhuman gynaecology.

Several more recent research results in psychosomatic obstetrics and gynecology will be presented, and directions for the practice will be given. In conclusion, it will be discussed how, for the realization of psychosomatic concepts, 'old-fashioned thinking' with biased, monocausal, scientific approaches is unproductive. This concerns, in particular, university gynecological hospitals where psychosomatic thinking is only very hesitantly accepted. The goal is, therefore, to promote a new thinking process, which incorporates an increased consideration of reference points like sensibility, flexibility and creativity.

Nowadays, in vitro fertilisation can be judged as a relatively successful treatment in special cases of sterility. Success cannot be defined only by induction of pregnancy, but must also be taken into consideration the couple's and the "IVF-children's" personal situation. The main problem of IVF is the high multiple rate of nearly 20%, resulting in a higher frequency of preterm deliveries. This leads to higher perinatal mortality and more longterm deficiencies in these children. The women's attitude during pregnancy can be considered to be responsible. From a psychosomatic point of view (the husband's presence during delivery, breast feeding etc.) there are favourable preconditions for the "birth of the family." In most cases, the couples give a contented or good view of their partnership (self-assessment). Nearly 5% of them seem to be "disappointed" after the birth of the baby. The method of IVF is positively assessed from an overall point of view. But only half of the women do not keep this special method of procreation secret.

This study examined the association between dietary supplementation with vitamin A and biochemical symptoms of toxicity in 116 healthy elderly volunteers (47 male, 69 female), aged 64-88 y. Plasma retinol and retinyl ester concentrations, seven liver-function tests, and dietary and supplemental vitamin A intakes were measured annually for 5 y. Supplemental intake range was 0-47,000 IU/d; dietary intake range was 2528-23,032 IU/d. Fasting retinol and retinyl ester concentrations were determined by HPLC and dietary intake was assessed by a 3-d food record. Supplemental vitamin A intake was highly correlated with retinyl ester concentrations (r = 0.74, P = 0.0001). Retinyl esters ranges from 3.4% to 10.2% of retinol concentrations. Retinyl ester concentrations did not increase over time, regardless of supplement amount. The association of retinyl esters and liver-function tests was significant only for aspartate aminotransferase activity in females (r = 0.47, P = 0.0001). The supplementation amount in this study was not associated with vitamin A toxicity.

It is well known that tendon or muscle interposition can cause fractures to be irreducible by closed means. A rare tendon interposition of extensor carpi ulnaris occurred in an 11-year-old boy. The isolated displaced distal ulnar physeal injury was the result of a motor vehicle accident. Attempts to perform a closed reduction failed. At operation, an interposed extensor carpi ulnaris tendon was found. After repositioning the tendon, a near anatomic reduction was easily accomplished. Only two cases seem to have been reported in the literature on the need for open reduction of distal ulnar physeal injury, none with an interposed tendon. Interposed extensor carpi ulnaris tendon should be considered as a cause of irreducible displaced distal ulna epiphyseal fracture.

During an in vitro fertilization (IVF) program 122 inseminated eggs showing polar body extrusion, but neither formation of pronuclei nor cell cleavage were analysed cytogenetically. Nine of these eggs showed prematurely condensed sperm chromosomes of the G1-phase (G1-PCC) besides the haploid set of maternal metaphase II chromosomes. This phenomenon can be explained by the permanent arrest of the oocytes at metaphase II after sperm penetration and hence the continuing presence of cytoplasmic chromosome condensing factors which lead to the induction of PCC in the sperm nucleus. The overall frequency of this aberrant type of fertilization was calculated to be in the order of 3-4% of all in vitro fertilized eggs.

Delivery in a hospital on an outpatient basis is increasingly accepted in obstetrics. In West Berlin about 15% of the mothers consider this as desirable, and about 10% actually utilize it. Delivery at home, which is associated with safety hazards, is getting less frequent. Since the problem of disturbed adaptation of the infant can be quite difficult, the method of choice is the easily manageable noninvasive monitoring of heart and respiratory frequency of the newborn during the first hour after birth. This can help to detect latent disturbances of adaptation and premature discharge of the infant from hospital is avoided. The following aspects must be considered: 1. Monitoring is noninvasive and does not exercise stress on the infant. 2. Mother and child are not separated during the monitoring. Hence, the early mother-child relationship is not disturbed. 3. The obstetrician can assess the state of adaptation of the newborn more clearly with the help of the cardiorespiratory diagram. This makes it easier for him to decide whether a child may be released or ought to stay in hospital. 4. If the paediatrician is consulted, he has at his command useful data on a child he does not know with the exception of a few anamnestic data and the actual examination findings.

Chromosomal abnormalities and abnormal embryonic development have been observed after human in vitro fertilisation (IVF). Such investigations are not permitted according to the ethical guidelines approved by the IVF team in Berlin ("Berliner Modell"). However, the chromosomal status was studied in oocytes which remained unfertilised in a human IVF programme. In 50 fertilisation attempts the chromosomes of 62 oocytes could be analysed. 45 of the oocytes were in the process of meiotic maturation. One of these showed abnormalities in the first meiotic division and seven during the second meiotic division. After fertilisation in addition to normal embryos, all of which were transferred to the mother, three embryos were triploid and six oocytes were fragmented. The results prove that in human IVF chromosome abnormalities can occur in oocytes already before fertilisation. The importance of the results for later stages of embryonic development is discussed.

This paper goes into the question as to how greatly mother and father desire an individualised kind of delivery, how this wish is realised, and how it is valued many years later. The basic demand was a safe delivery-safe for both mother and child. For the purpose of analysis and study, 170 women were asked to register their opinion before being admitted to the labour ward, on the following points: for example, presence of the partner, free mobility during the first stage of labour, avoidance of analgesics, positioning the baby on the mother's belly, use of the obstetric chair, rooming-in, breast feeding, etc. Changes in the mother's behaviour during birth, as well as the interaction between mother, child and partner were observed. During the puerperium the delivery was critically assessed by the mother, and her ideas regarding delivery at a future time were recorded. It is possible to show that under the conditions of a safe, monitored birth (uncorrected perinatal mortality 1980-1983 0.71%) the individual wishes of the patients can be met. All mothers whose partners had been present during delivery, assessed this fact positively. Likewise, 100% of the mothers whose baby had been positioned on their belly after birth, considered this to be pleasant. 77% of them actively caressed the newborn in this position. 68% of the mothers talked to the child within the first 15 minutes. 86% kept the newborn for more than an hour in their bed. Of the fathers present during delivery, 55% caressed the newborn, and 50% talked to it within the first 15 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Nine pregnant women with the AIDS problem were under treatment and care at the Department of Gynaecology of the University of Berlin at Charlottenburg during 1985. Of these, seven had HTLV-III antibodies only, whereas one woman showed additional clinical signs such as lymphoadenopathy and opportunistic infections; another woman developed exanthemas during pregnancy that pointed to a possible manifestation of AIDS. The increasing incidence in our clinic of pregnant women infected with or actually suffering from AIDS is due to the fact that for several years we have been conducting heroin withdrawal programmes in pregnant women. It must be born in mind, however, that generally more and more women outside the high-risk groups covered by anamnesis are being infected with HTLV-III. Screening tests for HTLV-III can help to clarify matters and make it possible to care adequately for the patient and to guarantee the obstetric team an appropriate management of the risk of infection. However, it must be considered as a minimum demand to be made on the obstetrician to conduct tests for HTLV-III antibodies in women of the high-risk groups (heroin addicts, prostitutes, blood transfusion recipients, fathers at risk). Based on update knowledge, the authors supply pointers to a more realistic information of pregnant women. Suggestions are advanced in respect of care during pregnancy, childbirth and puerperium.

Developmental arrest of 18 ova (about 5%) of 362 fertilized oocytes showing formation of two pronuclei was observed after in-vitro fertilization. In 7 ova the pronuclei were still visible 40 hrs after insemination. Five ova were degenerated after formation of the pronuclei. Cytological analysis of the ova revealed that the arrest of development had occurred at different stages of the cell cycle (interphase to metaphase of the first mitotic division) with one ovum being characterized by a tetraploid chromosome set. Asynchronous development of the pronuclei, which is obviously a cause of early developmental arrest, was observed in 4 ova. According to our observations we would rather transfer fertilized oocytes after cell cleavage (in the 2- to 6-cell stage) than in the pronuclei stage.

The following study reports an application to primae gravidae of two different psychological treatments aiming at reducing the fear of childbearing and facilitating the delivery. The treatments under comparison were systematic desensitization and modification of self instruction, a more cognitive approach. The effects of the two treatments proved to be identical; nevertheless there were significant differences between the results of the women who underwent treatment and those of the control group. Moreover, in our study a certain number of socioeconomic factors turned out to be correlated with the treatment effects.

Tissue samples were taken from a 20-week old foetus in a mother with positive LAV/HTLV-III reaction without clinical or immunological signs of AIDS. These samples were used for cocultivation of LAV/HTLV-III. This resulted in inducing in MT-2 cells a cytopathic effect characteristic for LAV/HTLV-III infections, induced by thymus, spleen, lungs and brain tissue of the foetus after cocultivation with umbilical cord lymphocytes; in H-9 and MT-2 cells this led to the expression and release of antigens reacting with LAV/HTLV-III-specific anti-bodies. This observation shows that intrauterine infection of the foetus must have occurred already before the 20th week of gestation; the same target cells are involved via uterine transmission as via postnatal infection, i.e. cells of the lymphatic system and of the CNS.

We discuss the late "wish for pregnancy" (involving women over 45 years of age). Late hopes for in vitro fertilization occur, encouraged by "solutions" that are deceptive and to our experience distract from inner conflicts. We consider the problems of idiopathic infertility, a diagnosis that is frequently accepted as final without exploration of the psychological background. Finally, we discuss secondary sexual dysfunctions, caused by a very technical approach to infertility treatment. We conclude with a demand for critical discussion of neuralgic problems in modern reproductive medicine (e.g., manipulation of embryonic structures and breaking up of family structures).