Biomedical subjects
Publications and source records attributed to W Böhm.
A case with a hyperkeratotic form of porokeratosis Mibelli is reported. The clinical characteristics were a nonfamilial occurrence, hyperkeratotic verrucous plaques with an erythema and a segmental distribution. The histopathology showed cornoid lamellae and additional atypical findings. By electron microscopic study Civatte bodies and other degenerated epidermal cells were clarified.
The tumor of lutein cells of the ovary during pregnancy was first described by Sternberg (1963) as "luteoma of pregnancy". Up to 1973/74 66 cases were published. This benign tumor occurring only during pregnancy probably arises under stimulation of chorionic gonadotropin and may cause a virilization of the mother and female infant. After birth the ovarian tumors regress spontaneouly. Lutein cell tumors are usally discovered incidentally at laparotomy (cesarean section) in late pregnancy and require no radical surgical treatment. The feature of these tumors and some related questions are discussed on the basis of on own observation being, to our knowledge, the first case of this type in Central Europe.
Own experiences on IUD-complications especially irregular bleedings and infections underline that modern plastic intrauterine devices are second-rate contraceptives. Compared to hormonal contraceptive drugs intrauterine devices have a higher pregnancy risk and increased rates of infections. Therefore the IUD is in our opinion not suited primary contraceptive method used without indication. Because of the relatively often occurring ascendant genital infections the application of intrauterine devices should not be carried out in nulliparae.
Endometrium was investigated histologically in 55 fertile women and by electron-microscope in 6 women under the influence of Deposiston (Jenapharm), a sequential contraceptive containing a long acting oestrogen--ethinyloestradiolsulfonate. The drug was administered orally in 1 mg doses on the 5., 12. and 19. day of each cycle. To achieve proper withdrawal bleeding a single oral dose of 10 mg norethisteronacetate was given on the 26. day of the cycle. Whereas Sequenz- Ovosiston (Jenapharm), a "classical" sequential preparation causes only insignificant variations from the physiological endometrium of fertile women, Deposiston developes irregularly proliferated patterns in more than 50% of the patients, due to differences of the elimination rate of ethinyloestradiolsulfonate. The degree of proliferation covers a wide range from a slightly proliferated endometrium to changes similar to hyperplasia of the endometrium with cystically enlarged glands. The secretory transformation takes place 2 or 3 days following the progestogen application. In 2 of the cases a secretory pattern could be found several days before the intake of the progestogen. This indicates break-through-ovulations.
The authors report their results on the treatment of progressive endometrial carcinomas of cases not suitable for conventional therapy by means of long term progestogen application in high doses. It is demonstrated the effectiveness of this method of treatment if the progestogen is given in necessary doses without stopping the application. An additional short term treatment in low doses in all cases of operated endometrial carcinomas is assesed not to be useful.
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The term, 'proliferation dosage' of an estrogen is defined differently in the gynecologic literature. In this article the authors were concerned critically with the methods of its determination. They came to the conclusion that under standardized conditions sufficiently sure and reproducible results can be received in postmenopausal women. 7 short acting and 3 long acting estrogens, some of which are clinically unknown substances, were examined using the following definition of proliferation dosage: 'Proliferation dosage is the amount of an estrogen which induces the signs of the late proliferation phase after being administered daily in the course of 10 to 14 days to postmenopausal women with atrophic endometrium.' In order to investigate the proliferating properties of 3 depot estrogens a modified test procedure was performed, derived from animal experiments' results and the planned clinical mode of application.
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The ultrastructure of endometrium was investigated after oral application of 1 or 3 mg of the new depot oestrogen etinyloestradiolsulfonate by means of long time observation with biopsies on postmenopause women. Details of this experimental proliferation was described. The highest functional activity in the endometrial gland and stromal cells was found 3 weeks after intake. There was no difference between ultrastructure following exogenous and endogenous oestrogen action. Degenerative changes within mitochondria were observed earlier than the regression in light microscopical picture.
Anomalies of vessels of the umbilical cord (especially the aplasia of one arteria) are besides abnormal placental implantations and pathological alterations of the placental tissue itself of particular importance for the perinatal mortality. In 3 out of 11 cases of perinatal death of the University Clinic of Jena of the years 1971 and 1972 there had been found 3 times anomalies of vessels of the umbilical cord. Each of these 3 cases showed severe malformations. This emphasizes the necessity of checking the presence of the 3 vessels on the cross-section of the umbilical cord in every case of inspecting secundinae.
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The present state of classification, diagnostics and therapy of preinvasive and early stages of cervical carcinoma has been demonstrated by means of literature and own experiences. In order to avoid damages caused by treatment the necessity of differenciated therapy is proved. A clear classification and the subtil histological investigation performed by a pathologist experienced in gynecological histology has to be regarded as an indispensible precondition in this neccessary differentiated treatment in early cases of cervical cancer.
From 19 with Heparin treated patients by suspicion of intrauterine retardation 12 patients were investigated relative to the physiology of coagulation. The placentae were investigated morphologically. The treatment with Heparin was without danger. A certain effect of the efficiency by the treatment with Heparin we couldnt establish. The theoretical introductions relative to the efficacy of Heparin entitled the further application of this drug. We can hope, that a better selection of patients with intrauterine retardation by help of ultrasound and other methods (sequenzszintigraphy with In113m and electronmicroscopical procedures) are able to establish the favourable impression by the clinical use of Heparin.
Ethinylestradiol sulfonate is a newly developed orally effective derivate of ethinylestradiol with depot properties produced by "Jenapharm"-GDR. This depot estrogen has been proved for its usefullness in treating menopausal syndrom. A modified Kupperman-index had been used to check the therapeutic results. The effects concerning the endometrium were examined in postmenopausal women that atrophic character of endometrium had been ensured before. Ethinylestradiol sulfonate was applicated in the following dosages: 0,015 mg/day; 0,25 mg/week; 0,5 mg/week; 1,0 mg/week; 3 mg/month. The treatment with 0,25 mg/week over a period of 4 up to 6 weeks proved to be possible and effective if we take into account the endometrial reaction and the danger of bleeding. After the removal of the uterus higher dosages can be given. Up to a dose of 1 mg/week there were not to be seen subjective side effects. Ethinylestradiol sulfonate was compared with other oral estrogens.
The epidermis thins in response to short-term contact with urea, and the results of extensive enzymological and autoradiographical studies suggest that urea acts on processes involved in epidermal proliferation. After long-term exposure of skin to urea, lasting more than 2, 4, or 6 weeks, no further thinning occurs, and there is no tendency for atrophy to develop during this period. This assertion is made on the basis of biometrical, autoradiographical, and cytophotometrical data. It is likely, however that a reduced number of cells synthesizing DNA is not the only change in normal epidermal proliferation leading to the peidermal thinning that was measured. The urea could also alter factors regulating either cell entry into DNA synthesis or the synthetic process itself, or both. These findings clearly are of significance not only in industrial medicine but also in the use of urea in topical dermatological therapy.
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Over the last 1 1/2 years diagnostic laparoscopy has been performed in 135 cases and laparoscopic tubal cauterization carried out in 15 patients. Indications and the diagnostic Value of the gynecological laparoscopy are discussed. In agreement with other authors, laparoscopy is found to have a definite place for the diagnosis of the following gynecological disorders and complaints: 1. Examination of fallopian tubes in cases of infertility, diagnosis of malformations of the genital organs and of grave functional disorders of the ovaries; 2. Possible ectopic pregnancy; 3. Differential diagnosis of pelvic mass; 4. Evaluation of chronic pelvic pain; 5. Differential diagnosis of acute diseases of pelvic and lower abdominal organs. Histological examinations of coagulated human fallopian tubes yielded information on the mechanism of action of this modern method of sterilization.
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