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We describe a 62-year-old patient with a coincidental finding of a uterine lipoleiomyoma. The patient presented with vague abdominal complaints. Computed tomography showed a large lobulated mass, with a density consistent with fat, surrounding a normal uterus. Few cases have been described. We review the histologic and clinical features of this condition and theories regarding its origin.

Das SC-Phokomelie- oder Pseudothalidomid-Syndrom (Roberts-Syndrom) ist eine seltene autosomalrezessiv vererbte Krankheit, die sich klinisch mit einer Phokomelie, einer prä- und postnatalen Wachstumsretardierung mit kraniofazialen Dysmorphien und Missbildungen (z.B. Lippen-Kiefer-Gaumenspalte, Mikro[brachy]zephalie) manifestiert, zytogenetisch eventuell mit dem Phänomen des Zentromersplittings. Beobachtet werden ausserdem Nierenmissbildungen, Herzfehler, eine Klitoris- bzw. Penishyperplasie sowie beidseitige Korneatrübungen oder andere Augenanomalien. Geistige Retardierung ist bei überlebenden Patienten häufig.

Dank der enormen Forschungsanstrengungen und -erfolge in allen Bereichen der Krebsmedizin ist die Mortalitatsrate der an Krebs erkrankten Menschen seit den fruhen 1990er Jahren rucklaufig. Von der Grundlagenforschung bis hin zur strukturierten Nachsorge der Patienten konnten in den letzten Jahrzehnten grose Fortschritte erzielt werden. Zur Behandlung von Krebserkrankungen wurden im Laufe der Jahre verschiedene Medikamente erprobt und in den Markt eingefuhrt.

Cell scrapings from 552 consecutive women attending the colposcopy outpatient unit were examined by radioactive isotopic DNA hybridisation using the Dot-Blot technique, and by conventional Papanicolaou-smear cytology. In 315 out of these patients, punch biopsies were submitted for histological examination. HPV DNA-sequences were detected in 72% (n = 167) of 232 cytologically diagnosed CIN cases and in 77% (n = 97) out of 126 histological diagnoses of CIN. The proportion of HPV positive cases increased proportionally to the grade of CIN. The frequency of HPV type 6/11 decreased proportionally to the grade of the CIN, and HPV type 16/18 increased at the same time. The most frequent HPV type was 16/18 (26.3%), followed by the HPV types 31/33/35 (16.3%) and 6/11 (4.2%). Furthermore, HPV positivity was detected in 16.5% of patients with negative cytologic smears, in 21.7% of those with negative histology and in 8.9% of women with both negative histology and cytology. Histological and moreover cytological criteria of HPV infection decreased dramatically and proportionally inverse to the grade of the CIN. These changes were not followed entirely by HPV positivity. The discrepancy between HPV positivity (66.1%/67.6%) and morphological evidence of HPV infection (cytology 4.9%, histology 21.6%) was higher in CIN III than in lower grade CIN. Neither cytology nor histology is able to detect all HPV-related cervical lesions. Hybridisation techniques are helpful in the detection of latent HPV infections as well as of CIN lesions have been missed either by cytology or by histology or both. Thus both morphological methods are supplemented by HPV hybridisation.(ABSTRACT TRUNCATED AT 250 WORDS)

The increasing incidence of drug abuse in central Europe leads to a growing number of children with intrauterine drug exposure. During pregnancy various risks affect these children. Postnatally severe symptoms of withdrawal are observed frequently. The psychosocial development is endangered. Between 1986 and 1990 30 drug dependent women attended the obstetric department of the University Hospital Basel during pregnancy. The data of 21 children born to mothers drug dependent at birth were evaluated. 11 children were born in 1990. 12 mothers received Methadon, 10 were polydrug abusers. Positive serology was found for hepatitis in 18, for HIV-infection in 9 women. 6 babies were premature, 8 were small for gestational age. 20 newborns presented withdrawal symptoms which required a mean hospitalization time of 45 days. Tonic and/or clonic seizures were observed in 6 neonates. In 9 other children some symptoms were suspicious of seizures. EEG recordings were pathological in 10 of 12 infants. For the control of withdrawal symptoms 16 children received pharmacological treatment for a mean duration of 61 days. Neurodevelopmental examinations were performed in 14 children at an average age of 22 months. Neurological findings were pathological in 2 children. 3 had mild, 2 had severe mental retardation, 5 presented with behavioural disturbances. Our data are compared with those of the literature. Therapeutic proposals for children of drug dependent mothers are presented. The impact of methadon programs on the exposed children is discussed.

A rare case of a pregnancy of a 34-year old IV gravida/II para is reported, which ended in the 19 th week with the rupture of a rudimentary horn of the uterus bicornis unicollis. Histopathological examination showed a placenta accreta. Two years after this event spontaneous birth of a boy resulted without any pathological findings of the placenta. Basing on the literature, the significant roles played by ultrasonic investigation as well as by serum-AFP-screening are pointed out.

We present a patient in the 30th week of gestation with adnexal torsion, which was treated by laparotomy with oophorectomy. After 2 days, we had to perform a cesarean section because of bowel obstruction. We discuss the diagnosis and treatment of adnexal torsion in pregnancy and compare laparoscopic management with laparotomy. By reviewing the literature, we evaluate the conservative therapy by detorsion employing Doppler sonography.

Die Bedeutung der Kolposkopie ist mehr denn je umstritten. Obwohl heute die Kolposkopie in den angelsachsichen Landern bei der Abklarung einer interepithelialen Neoplasie nicht mehr wegzudenken ist, dauert der Streit uber die Bedeutung dieser Methode in der Bundesrepublik immer noch an. Auch in Osterreich und in der Schweiz hat die Kolposkopie einen festen Platz. Um aber die Kolposkopie bei der Abklarung der interepithelialen Neoplasie richtig anwenden zu konnen, mussen auch die Normalbefunde gekannt werden. Dies ist ebenfalls ein wichtiger Bestandteil, weswegen die Kolposkopie bei jeder Vorsorgeuntersuchung miteinbezogen werden sollte.

Unter konservativem ambulanten Operieren versteht man alle Behandlungen, welche in der sogenannten „one day surgery“ moglich sind. Meine Ausfuhrungen beziehen sich vor allen auf die Lasertherapie. Dabei konnen folgende Veranderungen therapiert werden (2): - Gutartige Veranderungen - Virale Infektionen, vor allem Condylomata acuminata - Intraepitheliale Neoplasien - Invasive Karzinome

Unter einem septischen Abort versteht man jedes Abortgeschehen, welches mit Fieber uber 38°C einhergeht. Diese Definition geht davon aus, das bei diesen Fallen mit der unvorhersehbaren Komplikation eines septischen Endotoxin-schockes gerechnet werden mus [3, 81.

Human papillomavirus (HPV) infections, such as condylomata acuminata, can be treated in numerous ways. A variety of drugs, e.g. podophyllin, podophyllotoxin, 5-fluorouracil and trichloroacetic acid, are available for their pharmacological management [5, 8]. Alternatively, these focal lesions can be removed surgically, using a scalpel, sharp curette, electrosurgery, cryosurgery or laser surgery. Recently, interferon has also been recommended for the treatment of HPV infections. Further research is required to establish whether or not this is merely an adjunctive form of treatment.

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.

Die Diskussion und das Vorlegen von Erfahrungsberichten im Arbeitskreis hat ergeben, das eine Fruherkennung des Endometriumcarcinoms mit geeigneten morphologischen Methoden grundsatzlich moglich ist.

Report on 114 terminations of pregnancy during the second and third trimester of pregnancy with a new prostaglandin E2 derivative "Sulprostone". In 84 cases legal therapeutic abortions were induced. In 30 women an abnormal pregnancy was terminated. "Sulprostone: is a prostaglandin with selective activity in the uterus. It can be administered parenterally or locally. 48 women received intravenous sulprostone, 35 patients had extraamniotic injections and 31 patients had extra-amniotic injections following an intramuscular injection for priming of the cervix the night before. In 103 women the pregnancy was terminated within the first 24 hours after the administration of sulprostone (90.3%). 8 patients (7.0 %) had a cervical dilatation over 2 cm. In 3 women no effect was noted. In 1 patient the prostaglandin application was stopped because of severe vomiting. The mean administration abortion interval was 12 hours and 54 minutes following extra amniotic application and 10 hours and 30 minutes with extra amniotic application and following intramuscular priming. In 5 patients the abortion was completed after the priming administration. More than 90% of the patient's required analgesia. There were 32.4% side effects of mild character. The results and the methods are described and compared to other methods.

Due to better care and better knowledge pregnancies in paraplegic patients nowadays have a good prognosis. We report on 16 deliveries in 13 paraplegic or tetraplegic patients. To minimise the danger of possible further damage it is important to know about the special problems associated with pregnancies in paraplegic mothers. It is particularly important to know about the elevated risk of premature labour and the risk of autonomic hyperreflexia in lesions above D7. To prevent urogenital infections, patients should try to keep the genital region clean and try to empty the bladder as completely as possible. Intermittent catheterisation might be necessary. One should try to prevent decubital ulcers, and therefore an eventual anaemia (below 80%) should be corrected by transfusions. The patients should be instructed how uterine contractions can be palpated manually because sometimes perception of contractions in other ways is not possible. Repeated examinations of the cervix also help to prevent premature birth. Hospitalisation of the mother two to three weeks before the expected date of birth is suggested. If the lesion is higher than D7, symptoms of autonomic hyperreflexia (bradycardia and rise of blood pressure with the risk of cerebral haemorrhagia) are almost always present when labour starts. To prevent this possibly life-threatening complication, early application of epidural anaesthesia is suggested. There is no contraindication to spontaneous delivery. Vacuum extraction or forceps are necessary more frequently. In the post-partal period, prophylaxis of decubital ulcers is important. Breast feeding is not influenced.

Zusammenfassung Die beiden letzten Stunden von 342 intrapartalen, technisch moglichst einwandfreien Kardiotokogrammen wurden manuell mit einfachen Hilfsmitteln (Stechzirkel, Schublehre) ausgewertet (Papiervorschub 2 cm/min, Hewlett-Packard); die Daten wurden auf Lochkarten (25/Fetus) ubertragen, abgelocht und auf einem IBM System 370/135 weiterverarbeitet. Registriert wurde die mittlere basale Frequenz pro Minute, die Bandbreite, die Oszillationsfrequenz (OF) sowie wesentliche Daten aller Dezellerationen und Akzelerationen.

The last 120 minutes of 394 intrapartum fetal heart rate (FHR) records of high technical quality were evaluated. Baseline FHR was estimated and oscillation frequency (OF) counted for each minute. There was a highly significant association between the baseline FHR and the number of oscillations/minute; an increase in baseline FHR of 10 beats/minute was associated with a fall of about one oscillation/minute. The highest mean OF (9.6 +/- 4.8 events/minute) was found in fetuses with an umbilical artery pH of between 7.20 and 7.25. The baseline FHR should be taken into account when assessing fetal condition.

Die beiden letzten Stunden von 342 intrapartalen, technisch einwandfreien Cardiotokogrammen (~ 41 000 CTG-Minuten) wurden manuell mit einfachen Hilfsmitteln (Stechzirkel, Schublehre) ausgewertet, die Daten auf Lochkarten ubertragen (25/Fetus) und elektronisch auf einem IBM-System 370/135 weiterverarbeitet. Registriert wurden die mittlere Frequenz pro Minute, die Bandbreite (Oszillationsamplitude), Oszillationsfrequenz sowie wesentliche Daten aller Dezelerationen und Akzelerationen. Die mittlere Oszillationsfrequenz der FHF von Feten mit einem pH uber 7,200 (N=253) betrug in den letzten 30 min 9,5±4,7 bei 4615 auswertbaren dezelerationsfreien CTG-Minuten; die 5. Perzentile lag bei 2, der Median bei 9 und die 95. Perzentile bei 18 Oszillationen pro Minute. Es fand sich eine statistisch hochsignifikante und klinisch relevante Abhangigkeit der Oszillationsfrequenz von der Oszillationsamplitude in dem Sinne, das Abnahme der Amplitude immer auch Ruckgang der Frequenz bedeutet. Die Anzahl der Oszillationen ist normal verteilt, wenn hypoxische und medikamentose Interferenzen eliminiert und die Oszillationsamplitude nicht zu weit gefast wird. Bei azidotischer Stoffwechsellage nimmt die Anzahl der Oszillationen bei konstant gehaltener Bandbreite um ca. 3 Ereignisse pro Minute ab. Dies last sich jedoch erst bei ausgepragter Azidamie (pHNA

In rat pancreatic islets the effects of diamide, which has been shown to decrease islet levels of reduced glutathione (GSH), and of exogenous GSH were investigated on cyclic AMP as increased by glucose, p-chloromercuribenzoate, and aminophylline. In addition the effect of diamide on islet ATP level, low K m and high K m phosphodiesterases was studied. Diamide (0.1 mM) inhibited the increase of cyclic AMP (cAMP) in response to glucose (16.7 mM), and p-chloromercuribenzoate (1 mM) in the presence of 5.6 mM glucose. No inhibitory effect of diamide could be demonstrated when cAMP was raised by 10 mM aminophylline in the presence of 5.6 mM glucose. The glucose (27.7 mM) stimulated increase of cAMP was further augmented by GSH (0.4 mM) whereas GSH in the presence of 5.6 mM glucose had no such effect. Diamide neither affected islet high K m nor low K m cAMP-phosphodiesterases. Diamide (0.1 mM) as used in this study did not affect islet AMP levels. A concentration dependent decrease of ATP was observed, however, with higher concentrations of diamide (0.25, 0.5 and 1.0 mM). It is suggested that the accumulation of islet cAMP in response to glucose and para-chloromercuribenzoate depends on the redox state of islet thiols. Since thiol oxidant diamide neither affected cAMP-phosphodiesterase activities nor inhibited aminophylline induced accumulation of cAMP in the presence of low glucose the possibility is raised that in pancreatic islets the formation of cAMP rather than its degradation depends on the redox state of islet thiols.

Treatment of intraepithelial neoplasias of the vulva (VIN) and the cervix (CIN) has undergone a transformation in recent years. Even a few years ago, patients with intraepithelial neoplasias were subjected to radical treatment in the majority of cases. With increasing knowledge of the biology of epithelial alterations, more conservative treatment procedures increased in importance. Today, there is no question that complete destruction of the lesion is adequate therapy. For this reason, locally destructive methods are increasing in significance despite weighty arguments against them.

A prospective, randomized, controlled study was carried out to investigate the dilating and softening effect on the cervix of prostaglandin F2-alpha gel administered intracervically and of prostaglandin E2 tablets administered orally. A total of 581 patients were included in the study: 149 received 2.5 mg prostaglandin F2-alpha in gel form intracervically, 150 received 1 mg prostaglandin E2 in tablet form orally, 138 were given placebo gel and 144 no medication at all. In the group given prostaglandin F2-alpha gel intracervically, success was achieved in 85.8% of patients and partial success in 8.8%. In the group given prostaglandin E2 tablets orally, the results were successful in 29.4% and partially successful in 40.6%. The incidence of side effects in the group given prostaglandin F2-alpha gel was rather high - 53%. The results show that prostaglandin can bring about a certain softening of the cervix, but side effects cannot be ruled out. Nevertheless, priming of the cervix is to be recommended in young primigravidas.To prevent complications with 1st-trimester abortions, it has been felt that use of a chemical method of dilatating the cervix would be preferable to the mechanical methods which have been used previously. A prospective, randomized, controlled experiment was done to test the effectiveness of PGs (prostaglandins) in inducing cervical dilatation. A total of 581 patients were used: 149 received 2.5 mg PGF2alpha intracervically in gel form, 150 received 1 mg PGF2 orally in tablet form, 138 were given placebo gel, and 144 received no medication. Results are tabulated. The intracervical gel was most successful in inducing cervical dilatation, achieving a success rate of over 85%. Oral PG tablets were successful in 40.6% of the cases. Side effects occurred only in the PG cases, and they occurred at a high incidence rate. Side effects were most prevalent with the intracervical gel. Very severe pain and heavy bleeding were the most disagreeable and frequent side effects. It is concluded PGs are effective in priming the cervix of young primigravidas. However, side effects cannot be ruled out.

There are few reports of primary malignant tumours of the pleura other than mesothelioma. Reports of squamous-cell carcinoma of the pleura are especially rare. Epidermoid carcinoma of the pleura may occur in connection with persistent empyema drained by a pleurocutaneous fistula or long-standing extrapleural pneumothorax without fistula.