Biomedical subjects
Publications and source records attributed to E Bernoth.
The vaginal operation of the Stein-Leventhal syndrome is presented. The procedure is described. In comparison to the abdominal operation, the new technique has the following advantages: shorter duration of the operation, no scar due to laparotomy, smaller peritoneal wound, and less severe trauma.
The histological results of 242 testicular biopsies in the period from 1974 to 1983 were evaluated with special consideration of the Leydig cells. Normal spermatogenesis was found in 9.5% of cases, hypospermatogenesis with and without maturation arrest in 76.4%, also Sertoli-cell-only and Klinefelter's syndrome in 11.6% and 2.5% respectively. Frequently an increase as well as a decrease of Leydig cells were observed in cases with pathological findings in these biopsies. In patients with Klinefelter's syndrome only an increase of Leydig cells could be seen. Ultrastructural investigations have shown that there were degenerative alterations of nucleus and cytoplasm in the Leydig cells of pathological biopsies, which could not be seen with light microscopy. In one patient with Klinefelter's syndrome needle-like crystalloid inclusions of unknown genesis were found in cytoplasm.
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The principal different readings of transplantation of human ova are explained: embryo transfer, artificial embryonation, extracorporal breeding and oocyte transfer. Our procedure of egg transfer is reported by means of 19 operations, consisting of implantation of preovulatory oocytes into the uterine tubes opened by microsurgery. One pregnancy only could be observed, but it was terminated by early abortion.
Using a special chamber, the authors investigated the penetration capacity of spermatozoa of 120 sterile couples in both simple and crossed mucus penetration tests. Moreover, the glycolytic activity and the oxygen consumption of the ejaculates were biochemically determined in an artificial cervical mucus medium. A negative spermatozoan penetration was found to be associated with a markedly reduced aerobic glycolytic activity. It was for low-motility spermatozoa that no penetration was observed in cervical mucus, if the aerobic glycolysis was diminished, but the respiratory activity enhanced. Comparative investigations into the penetration capacity of spermatozoa in an artificial cervical mucus medium permit the detection of causes of male sterility, which exhibit metabolic regulation disturbances of spermatozoa.
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Transvaginal surgery for Stein-Leventhal syndrome is introduced in this paper. The following advantages are claimed for the new approach, as compared to abdominal surgery: less time required for surgical intervention, no laparotomic scar, smaller peritoneal wound, less traumatisation. The surgeon in command of vaginal surgery will find the new approach more convenient than the abdominal route.
Male infertility is common. It usually is attributable to impaired maturation of germinal cells. The causes are related to the following factors: 1. Defective development of the gonadal ridge; 2. Abnormality of chromosomes; 3. Disorders in pituitary function; 4. Exogenous effects; 5. Unknown aetiology. -- Differentiation is difficult between those causes which often cannot be discovered at all. Therefore, assessment of male infertility is undertaken with reference to findings obtained from seminal, histological, immunological, cytogenetic, and hormonal tests as well as from electron microscopy.
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An overlook is given about the theory of penetrating tests. The assay of tests depends from some biological factors concerning sperms, spermplasma and the cervix mucus itself. The penetrating tests are important in functional disorders in the area of cervixsperm. In negative results hormonal defects and immunological factors have to be considered.
The causes of male infertility generally fall into three categories: pretesticular, testicular and posttesticular causes. The pretesticular causes are extragonadal endocrine disorders, such as those originating in the pituitary or the adrenals, which have an adverse effect on spermatogenesis. The testicular causes of infertility are conditions in which the primary defects reside in the testes. The posttesticular causes of infertility consist mainly of obstructions of the ducts leading away from the testes. Testicular biopsy is an important method in the diagnosis and management of male infertility.
The intrauterine pressure was determined by means of endoradiosonde in 42 pregnant women before induced abortion. It was measured the tonus and after stimulation with oxytocin the liminal value the basic tonus and the highest increase of pressure. The values of pressure were higher after artificial rupture of the amnion than before. Telemetering of intrauterine pressure is an advantageous method.
138 patients were referred to us to prenatal diagnosis of genetic defects. Only in 120 patients the diagnostic procedures could also be carried out. In 75% the amniocentesis was performed to establish the amnion cell culture and in 22.5% for analysis of alphafetoprotein and for performance of fetography. In 4.2% a genetic indication for interruption was found by the prenatal diagnosis. Among the 61 terminated pregnancies a premature delivery occurred in 13.1%. The operating frequency of delivery was 16.2% and the perinatal mortality was 1.6%.
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68 patients were transfered to the prenatal diagnosis. Both the alpa-fetorotein-estimation and the fetography or amniography were performed in 13 patients. The indication for fetography is the exclusion of neural tube defects and other serious visible defects. The amniography can especially carried out in the prenatal diagnosis of defects of intestinal tract. A program is proposed to the prenatal detection of neural tube defects: 1. Examination of all of the pregnacies with ultra sonic B scan. 2. At suspicions ultra sonic B scan and after birth of a child with neural tube defect alpha-fetoproteinestimation at the 16th week of pregnancy and fetography at the 24th week of pregnancy.
The prenatal detection of genetic defects can make concrete predictions on definite diseases that are to be expected. In the indication catalogue of the prenatal diagnosis from the amniotic fluid the chromosomal anomalies are predominant. The basis and the potential consequences of the prenatal diagnosis are surgical treatments and highly differentiated methods which may have consequences on the fetus and on the pregnant woman. Therefore the structure of a prenatal diagnostics centre must to a great extent observe the "Nihil nocere". The most important functions in the prenatal diagnostics are incumbent on the surgical gynaecologist. His duties are the indication and the carrying-out of the surgical treatments and measures for the prenatal diagnostics under consideration of the risks existing. The gynaecologist has either further to care for the pregnancy as a risk pregnancy or at corresponding indication to interrupt it even after the 12th week of pregnancy. On these grounds it is recommended to build up a prenatal diagnostic centre in a gynaecological hospital.
A report is given on an infection of intrauterine gas gangrene of stage 2 according to Dieminger (Tumpania uteri) in the 37th week of pregnancy which turned out well. The clinical progress of gas gangrene is discussed. The abstention from a caesarian section by reason of indication of the child with suspicion of a severe intrauterine infection, the vaginal delivery which was forced subsequently, the prevailingly prophylactic administration of antibiotics, and the largely initiated infusion and transfusion therapy have in a high degree determined the positive end of the disease. The intensive observation of the woman in labor, who at first had only been clinically conspicuous, led to an early recognition of toxic symptoms, so that an aimed intensive therapy could be carried out.
It is reported about an organizational plan for more intensity in the field of medical care and research of sterility and infertility. Diagnosis and therapy of sterility should be carried out within a high specialised centre. General practitioner and gynecologist in general and clinical practice of the territory have to accomplish important problems in prophylaxis and metaphylaxis of sterility and infertility.