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Postmenopausal bleeding is associated with a relatively high incidence of malignancy. The lowest incidence reported in the literature was observed among Jewish women in Jerusalem, more than 21 years ago (1). A similar survey of Jewish women admitted to our Department for postmenopausal bleeding during 1962-74 is presented. Fifty-five of 397 cases (13.8%) of postmenopausal bleeding were due to malignancy. There were 34 women with endometrial carcinoma, 11 with cervical carcinoma, five with ovarian carcinoma, four with uterine sarcoma and one with vaginal sarcoma. In 86% of cases, benign pathological states were found, 42.8% being associated with atrophic endometrium. An active endometrium was found in 56 patients (14%), and in two of them the endometrium was secretory. Estrogen therapy was not an important causative factor in these cases. The low incidence of malignancy seems to be due to the fact that cervical carcinoma is less common among Jewish women. Nevertheless, 20% of the malignant tumors in this series were invasive epidermoid carcinomas of the cervix. The need for a cytologic screening program in this country must therefore be reevaluated.

Names of women eligible to be screened for cervical cancer are taken from the national population registry and the women are invited by a personal letter. The data, from these mass screenings are analysed and stored at the screening registry. To reduced the costs of the system and to increase the yield of preinvasive lesions the idea of selective screening was considered. Tt was decided that if people were selected according to their risk factors, as recorded in the national population registry, the screening would be ineffective as many cases of invasive cancer were found in the low risk groups. High risk factors were determined from anamnestic data on systems and from previous cytological diagnoses. The proportion of women with symptoms of bleeding or the class II-V smears without positive histological results constituted fewer than 10% of the participants, but 20% and 40% respectively of invasive carcinomas were found in these groups during the subsequent follow-up period. Thus it is suggested that selective screening apart from that based on age has a limited application and should be restricted mainly to the interval between the organised screenings, which in Finland is five years.

Proceeding from the results obtained by the analysis of laparotomies performed in the year 1972 and 1973 in all gynaecological and surgical hospital departments of the city Brno, the authors conclude, that the most cases of pathological haemorrhages of corpus luteum or Graaf's follicul --82,8 per cent -- were not received and operated at the gynaecological clinics, but at the surgical departments. The paper is analysing how much this fact can be caused by diagnostic mistakes. That disparity is apparently also able to impress the common false presumption in the gynaecology, that those haemorrhages are constituting only a very rare and curious case.

Out of 11315 childbirths under review, 109 women (0.96%) with state after secio caesarea were delivered of a child in the period from 1970 to 1978. In 63.3% of the cases it was possible to achieve a vaginal birth. With 450 caesarean sections, 2 cases of the mother mortality occurred. -- A comparison between the sectio and the re-sectio indications does not show any difference. -- Uterus rupture was noticed in 2 cases. -- In a comparative study, general palpating of the uterus is contrasted with a conservative behaviour involving haemorrhage, blood-pressure, and pulse controls. -- As a result, manual re-palpating is again recommended, however, should not be forced. In certain individual cases a conservative behaviour is also justified.

The endometrial response to oral, cyclic conjugated equine estrogens with and without the randomized addition of medroxyprogesterone acetate was evaluated in 95 postmenopausal women with respect to morphology and bleeding patterns. At 1 year, therapy with 0.625 mg conjugated equine estrogens or 1.25 mg conjugated equine estrogens for 25 days of a 30-day cycle and 5 mg medroxyprogesterone acetate added to the last 11 days of the conjugated equine estrogens cycle was associated with hyperplasia in 0 and 10% of the patients, respectively (P = not significant). Hyperplasia developed in 30 and 57% of the patients who received the above conjugated equine estrogens and placebo regimens, respectively. Irregular, breakthrough bleeding occurred in 14% of the conjugated equine estrogens/medroxyprogesterone acetate users and in 54% of the conjugated equine estrogens/placebo users. The results of this study indicate that 1 year of therapy with 0.625 mg conjugated equine estrogens and 5 mg medroxyprogesterone acetate provided the most satisfactory endometrial protection against hyperplasia and was associated with relatively low rates of breakthrough bleeding.

This study aims to compare the risk of anemia by iron deficiency in mothers and infants of twin and single pregnancy. It concerned 33 couples of twins and 31 control, all 97 being term newborns. At birth, ferritinemia is significantly lower in twins, and reticulocytes count is significantly higher; their mothers have a significantly lower hemoglobin level and higher reticulocytes percentage and count. At 3 and 6 months, hemoglobin level and mean corpuscular hemoglobin are significantly lower in twins, as at 6 months ferritinemia is significantly lower in twins. Iron stocks constituted in utero are significantly lower in twin pregnancy, and this study support the early preventive iron treatment in twins.