Biomedical subjects
Publications and source records attributed to E J Hickl.
Two patients suffering from pelveoperitonitis had ascites and elevated CA 12-5 serum level mimicking epithelial ovarian cancer. Both were treated successfully with antibiotics, after laparoscopic confirmation.
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Diagnosis of premature rupture of membranes (PROM) usually leads to severe clinical consequences. Diagnostic tests for confirmation of suspected rupture of membranes are either unreliable or can adversely affect the pregnancy. Foetal fibronectin is synthesised by the foetoplacental membranes especially in the anchoring villus. Its concentration in the amniotic fluid is 5-10 times greater, than in the maternal plasma. An immunoassay has recently been developed, which detects fibronectin in vaginal secretions using monoclonal antibodies, thereby establishing the presence of amniotic fluid in the vagina. Vaginal specimens were collected from 133 pregnancies. 34 of 35 patients with clearly visible amniotic fluid in the vagina had a positive test result (97.1%), whereas the majority of the control group without any signs of ruptured membranes had negative test results (96.5%). 39 of 41 women with positive test results delivered within 48 hours (95%). A positive test result thus helps to confirm the diagnosis of PROM especially in equivocal cases or may indicate forthcoming labour.
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There is hardly any other disease where differences of opinion are so dramatic as they are in AIDS. Safely established epidemiologic data are interpreted most controversially and heatedly discussed. Gynaecology and obstetrics are no exception; here, too, scientific discussion is marred by emotional overtones. The article attempts to survey update information and to sum up epidemiologic knowledge while trying to strike a balance. Since even the nomenclature is not always clear or uniform, the most important definitions and abbreviations are listed. Special attention is focussed on the problems of the incubation time (3 months to more than 19 years), where in contrast to other diseases it is not the time of manifestation but the final stage of the disease that counts. That an infection may even be transmitted via intact mucosa is a newly established fact. Routes of infection can also be--besides those already known--saliva, gynaecological (vaginal and rectal) specula and possibly a direct iatrogenic infection. At the time of writing (1 January 1989) 82,500 manifest AIDS patients have been recorded in the U.S.A., 46,000 of whom died. There are about 500,000 patients with prestage signs and about 1 to 1.5 million carriers of the virus. Statistics for the Federal Republic of Germany on 31 January 1989 are: 2885 AIDS patients; about 30,000 serum-positive cases; estimated number of virus carriers: ca. 100,000 including about 10,000 women who are capable of bearing children. Switzerland: 702 AIDS patients, about 30,000 virus carriers. Austria: 243 AIDS cases. Figures for other European countries are also stated. The sequence of risk groups is graded. The article also describes the paths of transmittance in their correlation to the individual risk groups. No effective antiviral treatment is at present in sight. Medium-term prognosis for the FRG leads us to expect about 10,000 AIDS cases by the beginning of 1992 (cumulative figure; about half of these patients will have died by that time). The problem of the incidence of mother-to-child transmittance during pregnancy has not yet been clarified. According to latest results the probable quota of infected children is about 40%. Pregnancy care must include the offer of HIV testing; this is in fact mandatory, especially in women with enhanced risk of infection. If the doctor omits this information, he is liable to be sued for damages. Even in late pregnancy stages, testing is still meaningful (vaccination recommendations, newborn and infant care). Special precautionary measures are recommended for parturition. There is as yet no proof of the effectiveness of primary Caesarean section.(ABSTRACT TRUNCATED AT 400 WORDS)
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500 cases of carcinoma of the female breast were analysed in connection with the problem whether there is any involvement of the mamilla in this disease. The mamilla was found to be involved in 98 cases (19.6%), the incidence rate of this involved increasing with advancing age. A comparison of the types of carcinoma showed that the largest group (44%) was represented by the solid carcinomas. The percentage of carcinoma distribution was approximately the same as the share of mamilla involvement, with the exception of adenoid carcinoma. Only 12% of the mamillae were involved with a tumour diameter of less than 3 cm, whereas in the case of larger carcinomas the percentage was 30%. The distance between tumour and mamilla is also important. If the mamilla was affected, the homolateral axilla was also affected in 54% of the cases, but this figure dropped to 27% if the mamilla had remained free. This leads to the conclusion that while a conservative, non-radical surgical treatment is fundamentally possible, the selection and the formation given to the patients must be done with great care. The problem of multicentricity remains. Long-term comparisons have not been made so far.
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Epidural analgesia does not only produce relief of pain in childbirth; in many cases it also has therapeutic effects and prevents foetal injury. The adoption of epidural analgesia as a safe routine method for the relief of labour pain is subject to certain conditions: the indications and contra-indications must be carefully assessed; equipment and obstetric anaesthetic service must be adequate; potential complications following epidural analgesia must be considered; the patient should he told that epidural analgesia is going to be used and her consent should be obtained. Shared responsibility and close co-operation between obstetrician and anaesthetist provide the best conditions for the success of epidural analgesia.
15(S)-15-Methyl-Prostaglandin F2alpha was applied intramuscular to end 27 intact pregnancies mainly in the second trimenon and to induce abortion in 5 cases of disturbed pregnancy. The results showed a similar success of 90 percent in the cases of interruptions compared with the natural prostaglandins applied either extra- or intraamniotic; in the mean induction-abortion-interval of 16 hours the 15(S)-15-Methyl-Prostaglandin F2alpha is better than natural prostaglandins. It is much simpler to apply, the dosage is less. The initial dose is 250 mcg intramuscular, further doses depend on the success achieved, the effect on the bowel activity may be used as indicator. The intramuscular method avoids complications connected with the intraamniotic application, infections of the intracervical catheter lying for a long time and the severe side effects of the intravenous application. In cases of missed abortion and hydatidiform moles, where the use of natural prostaglandins is problematic, the use of 15(S)-15-Methyl-Prostaglandin F2alpha is a progress in this form of therapy.
An automated method for determining total estrogen in 24-hour urine was reported. The "estrogen-creatinine quotient" was computed in order to make the results of collective errors as independent as possible. This numerical value also makes possible comparative studies of 24-hour urine and morning urine (6:00 a.m.) as well as of urine specimens taken every two hours between 6:00 a.m. and 6:00 p.m. A total of 1000 analyses were made in 110 pregnant women; in addition, 82 daily profiles were studied. A high correlation was found between the E/C from 24-hour urine and from morning urine. In approximately two thirds of the cases, the deviation between morning urine and 24-hour urine did not exceed 10%. In the daily profiles, however, a wide variation in the daily rhythmn of some patients could be observed. According to our results, the determination of E/C in morning urine is well suited as a screening method for quick detection of estrogen elimination, particularly in high risk pregnancies.
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