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We are reporting on postoperative pain treatment using epidural analgesia in 1,822 patients, performed between 1995 to 2000, following continuous epidural anaesthesia combined with general anaesthesia for operations in various specialized areas (general or visceral surgery, vascular and thoraxic surgery, gynaecology, urology and orthopaedics). A total of 1,727 of these postoperative epidurals were included in a detailed evaluation. The postoperative epidural analgesia consisted of a continuous application of 0.25% bupivacain or 0.2% ropivacain. These local anaesthetics were administered epidurally in an hourly perfusion rate of 7.5 ml. We found "good" pain relief through continuous epidural administering of the local anaesthetics in 1,292 patients (74.8%). "Moderate" pain relief was achieved in 392 patients (22.7%). Sufentanil had to be epidurally administered in addition to local anaesthetics in 262 patients (15.2%) in the wake-up room. The sufentanil doses lay between 5 and a maximum 10 micrograms per hour. An additional epidural application of morphine-boli in a dose of 3 mg every 8-12 hours was necessary in 384 patients (22.2%) in the surgical wake-up stations. In 392 patients (22.7%), the additional systemic administering of antipyretic analgesics such as metamizol or paracetamol or spasmolytica was sufficient. In 43 cases (2.5%), sufficient pain relief could not be achieved with epidural analgesia even with additive applications of systemic functioning pharmaceuticals, so that the postoperative pain therapy had to be completely switched to a PCA. The lying time of the epidural catheter was 2-5 days. It was shortest with the gynaecological patients and longest with patients from general, visceral, thoraxic and vascular surgery areas. An important factor for a sufficient epidural analgesia is the exact epidural positioning of the catheter tip in the area of the spinal cord segments, which are affected by the operation. This reveals the required puncture height. The following side-effects resulting from the epidural analgesia were found: blood pressure loss of more than 20% of the starting value (21%), temporary bladder voiding disorders (8%), temporary sensory disorders of the lower extremities (6.5%), seldom nausea (2.4%) and post-puncture headaches (1.2%). The most important prerequisites for successful postoperative epidural analgesia and thus for increased patient satisfaction are correct selection of the insertion height in relation to the planned operation, constantly available medical pain service, the inclusion of trained care personnel and unequivocal written instructions.

Objective: The use of latissimus-dorsi-flap with postoperative radiotherapy is method of choice in primary reconstruction of breast cancer. The efforts of radiotherapy on flap healing, cosmetic results and formation of edema in the arm were studied in 30 patients., Materials and Methods: 30 patients were followed in three to six months intervals clinically and sonographically (ATL-Ultramark 9, HDI)., Results: The most frequent symptom was a moderate edema. No healing problems or interference with cosmetic results were observed. Blood flow in the thoraco-dorsal vessels showed unchanged pre- and postoperatively., Conclusions: The complains might be the consequence of the combination of surgical dissection of the axilla, radiotherapy and possible additional factors such as trauma and overstress for example. Cosmetic result and healing seems to be impaired by 50 to 60 gy.

Objective: The purpose of this study was to evaluate whether the use of one singleton and safe surgical procedure could be replaced by modified procedures adapted to the individual pathology without increase of complications rates., Material and Methods: 225 consecutive reduction mammaplasties were evaluated retrospectively, comparing the inferior central pedicle (n = 89) to the superior central pedicle (n = 12), the superior medial pedicle (n = 13), the central gland pedicle (n = 17) and the free areola nipple transplantation (n = 34). We checked for surgical and aesthetic complications of different techniques and satisfaction of the patients by questionnaire and personal interview., Results: There was no difference in the incidence of different complications, satisfaction of the patients was comparable. The most frequent perioperative complication was hematoma formation, long-term problems were scar formations., Conclusions: As different techniques of reduction mammaplasties are mainly variations of surgical procedures it seems to be possible to adapt the procedure to the individual situation. With thorough indication and technique this approach does not increase complication rates.

The answer is affirmative to the question whether mammary diseases should be treated by the gynaecologist. An attempt is made to substantiate this view by making reference to essential aspects relating to diagnosis and therapy of mammary diseases. Examination of the female breast is part of gynaecological routine diagnosis. Women with mammary complaints usually apply first to their gynaecologist. The female breast, after all is one of the reproductive organs exposed to endocrine effects, just as the genital organs are. Methods of endocrinological therapy have gained growing importance for both benign mammary diseases and mammary carcinoma.

Reported are 304 patients with whom programmed childbirths were introduced, between 1976 and 1978. A control group was made up of 100 women in labour who had been hospitalised for spontaneous onset of labour but then given slow drip oxytocin infusions for secondary uterine inertia. The parameters tested (time of labour, FHF behaviour, pH of umbilical artery, Apgar score, weight, length, and perinatal mortality) did not reveal any aggravated risk to mother and child. Programmed childbirth may be recommended as another important preventive step towards lower infantile morbidity.

There were 37 cases of prolapse of the umbilical cord among 16 177 deliveries (incidence of 0,2%). Therapy is firstly knee-chest positioning of the mother, control of fetal heart rate and acute tokolysis, secondly rapid delivery. The perinatal mortality of prolapsed cord was 13,5 per cent. Various methods of delivery are analysed.

Experience obtained from 115 childbirths with catheterisation for epidural analgesia is reported in this paper. Reduction of labour pain was optimum with all patients.--The rate of CTG alterations and acidosis of foetal blood was not beyond that recordable from normal deliveries. The rate of vaginal surgery was increased to 14.8 per cent due to one patient in whom expulsion was delayed and the expulsion period thus prolonged.

50 women, observed after mastectomy in the oncology dispensaire Wismar, were submitted to a detailed medical exploration and the treatment with the "Freiburger Persönlichkeitsinventar" (FPI). We can say, that hitherto existing forms of psychological treatment of the patients with breast cancer are not sufficient and a change of treatment of these patients is suggested.

Reported in this paper are 359 abortion patients and 550 women with normal pregnancy from whom serum PZ (pregnancy zone protein), SP3, PAG, was determined, between 1974 and 1979. Serum PZ failed to enable any safe prognostic assessment of endangerment to early pregnancy. Evaluable diagnostic information was found to be not obtainable before the tenth week of pregnancy. Any drop of data below the critical limit of 200 mg/l must be taken to indicate with high probability that pregnancy is no longer intact.

In 114 cases material of spontaneous abortion was examined histologically. Analysis allows a partial diagnosis of causes in spontaneous abortion and in trophoblastic tumours.

Investigations of maternal blood concentration of IgA, IgG and IgM are described in normal and disturbed pregnancy. The estimations of factors of humoral immunity have no high value in diagnosis of disturbed pregnancy.

In breech presentation near term the prophylactic external cephalic version using tocolytic drugs represents a modern practice. This method needs a critical valuation. Report about 23 external versions with assistance of tocolytic drugs and insufflation anesthesia. In 17 cases the version was successful. In addition to the 3 unsuccessful attempts 3 complications appeared: twice a partial ablatio placentae and once a prolapse of the arm and umbilical cord on intact amniotic sac.

Carcinoembryonic antigen (CEA) was assayed by radio immunoassay in serum of 87 patients with breast cancer and 85 patients with benign breast tumors from 1983 to 1986. The sensitivity of 43%, the specificity of 89%, the predictive values in regard to a positive assay result of 75% and in regard to a negative assay result of 67% was determined in consideration of a changed prevalence. It is referred to the importance of the estimation of CEA in the individual diagnosis, monitoring and follow up of patients with breast cancer. It is claimed the follow up for the premature recording of a recurrency the aid of CEA-estimation in always the same technical variant at the same patient.

Reported in this paper are 128 tocometrically controlled oxytocin infusions, using the Cardiff system. The oxytocic intervals were clearly shorter in comparison to conventional oxytocin drip infusion. However, more deliveries had to be completed surgically for foetal emergency situations, which, probably, was attributable to excessive rapid increase in oxytocin infusion rate due to the instruments used.