Biomedical subjects
Publications and source records attributed to H Kyank.
Shoulder dystocia is an uncommon complication of delivery with a high neonatal morbidity rate. This review describes the use of the most important shoulder dystocia maneuvers and underlines the demand to perform a written description of all details of the management during delivery.
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It was the aim of this paper to report on new estimations from the literature suggesting that vessel endothelial cell injury may be a very pathologic process in preeclamptic women. These reports relate to structural vessel endothelial cell damages in and outside of the placenta bed and in other body sides. Furthermore there are indirect estimations that indicate elevated plasma fibronectin concentration before preeclamptic symptoms becomes apparent, the activation of the coagulation cascade by damaged endothelium, the known reduced prostacyclin synthesis, an increased mitogenic activity and the occurrence of anti-endothelial cell antibodies in preeclamptic women, an increased number of circulating desquamated vessel endothelial cells in peripheral blood in patients with preeclampsia and an increased cytotoxic activity of preeclamptic serum against umbilical vein endothelial cells. These findings will be discussed.
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Corresponding to the newer literature and based on good own experiences lasting for four decades magnesium sulfate is put out as anticonvulsive drug of first choice in cases of severe preeclampsia and eclampsia. Especially the dosage is explained in connection with the classic schemes of Pritchard and Zuspan, in which a high concentration of magnesium in serum situated in therapeutic range is aspired to without additional sedatives. As standard dose initially 4 g MgSO4, followed by 2 g/h intravenously (in severe cases in the first hours 3 g/h) for continuing serum level applied by infusion pump are recommended. Dihydralazine as most used drug shall be applied by a second pump. Besides some newer results about the effects of magnesium sulfate on mother and child are mentioned.
It is reported on 68 Latzko-grafts in vesicovaginal fistulae. In 63 cases (92.6%) the closure was successful in the first session; 4 of the 5 failures were corrected with the same technique in the second session. The method is technically simple and little stressing for the patient. It is to be recommended particularly for the treatment of the typical posthysterectomy fistula. The shortening of the vaginal canal is insignificant also in young women.
Report about the metabolism of estrogens in the postmenopausal period and the hormone replacement therapy. The indications and contraindications for the estrogen- and estrogen-progesterone-therapy were discussed. Osteoporosis in the aging women constitutes a major public health and socio-economic importance than the climacteric syndrome.
The fundamental histological findings about endometrial and ovarian changes during the menstrual cycle by Robert Schröder (1884-1959) are passed in review and some actual conceptions of the regulation of the ovarian cycle are cited. In addition, general findings of molecular processes during gonadotropin actions in follicular cells are described, e.g. activation and desensitization of adenylyl cyclase, the role of 3',5'-adenosinmonophosphate and down-regulation of gonadotropin receptors. In general, the progress in cycle research since the work of R. Schröder was done consists in the transition from the histological description of endometrial changes to recognition of intracellular events which have to be considered by gynaecologists.
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The pros and cons of incidental appendectomy on the occasion of gynecological laparotomies are discussed. It is possible to prevent the well known morbidity and mortality of appendicitis later on by removing the appendix. The rate of complications is elevated only insignificantly. Incidental appendectomy is proposed under special preconditions.
Particle electrophoresis has been used to investigate particles obtained from amniotic fluid. These particles are defined mainly as unilamellar and multilamellar liposomes by electron microscopy. A total of 172 samples of amniotic fluids from 132 pregnancies were included in this study. The electrophoretic results were compared to the total phospholipids and to neonatal outcomes in 42 cases. At least two kinds of particles from amniotic fluids with different electrophoretic mobilities (EPM) are evident. With a ratio of F greater than 1.0, the presence of electrophoretically faster particles was found to be associated with apparent fetal lung maturity. On the other hand when the ratio was F less than 1.0, this seems to indicate an immature fetal lung. Seventy-seven per cent of F values correspond to the total phospholipid content P regarding the prediction of fetal pulmonary maturity resp. immaturity. The correct prediction of fetal lung maturity was demonstrated in 42 patients delivered within 48 hours of amniotic fluid sampling. In 28 cases with a mature F value (greater than 1.0) the correct prediction of respiratory distress syndrome (RDS) was 100 per cent. Eight out of 14 patients with immature F values (less than 1.0) developed RDS. The F values were found to increase as pregnancy progressed. The electrophoretically differentiated amniotic fluid particles behave differently at low pH. Selection and electrophoretic measurement of particles were made in a subjective manner. This preliminary investigation suggests that the results correspond to those obtained by objective cell electrophoretic measurements.
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Brief reference is made to classification of gestoses. For purposes of research, classification should be restricted to cases of "pregnancy-induced hypertension" which are, more or less, identical with cases of pre-eclampsia. Grouping by pathogenesis, as established by the two American Committees, is considered to be suitable for proper coverage of all cases of gestoses, say, for statistical records.
Pituitary stimulation tests with arginine, gonadotropin-releasing hormone (GRH) and thyrotropin-releasing hormone (TRH) were performed in five 45, XO patients with Turner's syndrome. Their ages ranged from 12--17 years. Serum levels of LH, FSH, PRL, HGH, and TSH were measured by RIA. The hypothalamo-pituitary system appeared normal in the patients with Turner's syndrome.
Results obtained in the treatment of cervical carcinoma at the Gynaecological Hospital of Rostock University, between 1959 and 1972, are reported and compared with the figures given in the Annual Report. The results obtained in Rostock were found to be in key with that international standard. Surgical and radiological therapies yielded somewhat identical results, when applied under optimum conditions to the operable stages I and II.
Sixty-three intra-uterine transfusions were applied to 44 foetuses with foetohaemolytic disease, in Rostock, between 1967 and 1976. Patients were selected for treatment by means of stepwise prenatal diagnosis. Details of that selection are described together with the technique of intra-uterine transfusion, with reference being made also to risks and complications. The survival rate of children, following intra-uterine transfusion, accounted for 41 per cent. The survival rate of non-hydropic foetuses was 76 per cent and thus much beyond that of hydropic foetuses of whom only 19 per cent survived. While the incidence of severe foetohaemolytic disease due to blood-group incompatibility is on a declining trend, intra-uterine foetal transfusion should be maintained as a possible therapy for certain cases.