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Two cases of rare pelvic masses of obscure origin are presented. The first was a giant pyometra, simulating an ovarian cyst, detected accidentally 13 years after conisation. The second was hematoma of lower parts of rectus muscles, also detected accidentally. The woman had a history of long-lasting anticoagulation, but couldn't remember any trauma. The difficulties of differential diagnosis are discussed.

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A case of life-threatening postpartum haemorrhage after Caesarean section is reported. The bleeding could finally be stopped by transcatheter embolisation of the internal iliac arteries. Our case and literature concerning management of obstetric haemorrhage by transcatheter embolisation reveals this method to be highly effective, but only slightly invasive and rarely associated with (usually minor) complications. The method is considered to be superior to arterial ligation.

A study of the clinical course of severe pre-eclamptic toxemias shows that, in case of antihypertensive therapy, it is usually necessary to terminate the pregnancy in cases of foetal maldevelopment, in cases with foetal indication (if no intrauterine death of the foetus takes place), whereas if there is no maldevelopment it is usually a maternal indication that enforces before-term termination of pregnancy. In case of foetal maldevelopment, a drop in HPL and oestriol values was seen. This suggests that the foetal condition deteriorates under antihypertensive treatment. For the foetus, which is deficiently supplied by the placenta, pre-eclamptic toxaemia is a regulatory mechanism of circulation that enhances blood supply of the placenta, since the peripheral resistance in the placental circulation, which is free from vascular nerves, is lower than in the nerve-supplied circulation of the body, on which a hypertensive substance can act. The assumption that such a compensatory mechanism exists is supported by a number of clinical observations. This regulation, which is necessary for the development and perhaps also for the survival of the foetus, is disturbed by the antihypertensive therapy, which explains the deterioration in the condition of the foetus.

The ability to produce a large increase in plasma volume is one of the hallmarks of a successful pregnancy. Data from Garn et al. (5), Knottnerus et al. (14) and Murphy et al. (15) have shown, that hemoglobin levels above 13 g/dl or hematocrit 38% before admittance to hospital are associated with a high incidence of IUGR (intrauterine growth retardation), gestational hypertension and with a greater perinatal mortality. Patients with an elevated viscosity and hematocrit have increased perinatal risks. In these cases the hemodilution with hydroxy- ethylstarch (HES) improves the blood flow and decreases the incidence of dysmature babies and pregnancy complications. The effect of HES on certain coagulation assays seems qualitatively similar to those of Dextran. In a prospective trial we evaluated the effect of HES in the incidence of thrombosis after cesarean section and we found a 5.9% incidence of thrombosis in patients treated with 6% HES 0.62 compared with a 7.8% incidence in heparin treated patients. Treatment with 1500 ml 6% HES 0.62 before and after cesarean section is similarly effective in preventing deep vein thrombosis as heparin prophylaxis.

In an open-label, multicentric randomized trial the efficacy and tolerability of Estraderm TTS, a 17 beta-estradiol, and Premarin, consisting of conjugated estrogens, were compared in the treatment of the climacteric syndrome. 84 patients with manifest menopausal complaints were randomized into two groups of 42 women each. The duration of treatment was 11 weeks or 3 cycles, each with 3 weeks of estrogen treatment followed by a therapy-free week. Therapeutic efficacy was assessed with a questionnaire recording frequency and intensity of hot flushes and of sweating episodes during the night, changes in psychic well-being, frequency of micturition and dryness of the vagina. Systemic and local tolerability was also evaluated. Both substances proved almost equivalent in the treatment of menopausal complaints, although Estraderm TTS was markedly superior in suppressing vasomotor symptoms.

How well do clinical examination, laboratory testing and imaging techniques predict the malignant or benign characteristics of an adnexal tumor before surgery? 60 patients underwent an extensive preoperative work-up including serum levels of gonadotropins, adrenal and ovarian steroids, oncofetal and placental antigens and CA 125. Sensitivity and specificity of laboratory criteria, including CA 125, compared unfavorably with others and are of no use in early diagnosis of ovarian malignancies. The differential diagnosis of adnexal tumors is primarily a matter of PV examination and ultrasound.

After a long period of 15 years, the SGGG recognized the Gynäkologisch-geburtshilfliche Rundschau once again as their official organ. Herewith a sign is given for a more intense cooperation with the Austrian Society for Gynecology and Obstetrics. Eventually, the possibility that the Bavarian Society of Gynecology and Obstetrics will also join might be achieved. In a time of rapid developments in the field of print media, publishers and editors are now facing new and upcoming challenges. The concept of our journal will be adapted to the modern requirements of our readership. Besides the traditional original papers, important with regard to the impact factor, other topics will be published, e.g., medicine and law, management and health care, and congress reports. As recently introduced, articles in German as well as in English are welcome.

In a prospective open-label multicenter trial, safety, tolerance, cycle control and changes in lipid metabolism before and during intake of a low-dose hormonal contraceptive (gestodene 75 mcg + ethinylestradiol 30 mcg) have been investigated under normal conditions of a general or gynecology practice (232 testing physicians, 1321 women). The atherogenic index remained almost unchanged over six cycles observed (3.3 before drug intake vs. 3.28 after drug intake, cycle 6). HDL cholesterol levels increased significantly in the period between prestudy and cycle 6 (+4.4%, p < 0.0001). A very good cycle control was demonstrated, and reliable contraception was achieved, combined with excellent general tolerance. The preparation conclusively suits very well for oral hormonal contraception.

The colour doppler signals of the female breast showed significant differences between malignant and benign breast lesions according to the criteria defined as follows: Pattern of vessels in the tumour area Amount of vessels compared with the contralateral side Speed maximum of a tumour-supplying arteria in comparison with the contralateral side. We were able to characterise the above in 13 of 14 malignancies. 10 of 10 benign lesion were identified correctly. In European literature, with the exception of one study, a similarly high sensitivity concerning the diagnosis of malignant breast tumours was reported. As our results show the extreme politary of malignancy and benign lesion, we are publishing them in order to draw attention this method as early as possible.

Transvaginal sonography has been developed as an useful tool to recognize and define structural defects in the first trimester fetus. Fetal cystic hygromas as an manifestation of malformation of the lymphatic system are often the only sign of an severe fetal anomaly. In 70-80% of cases cystic hygroma is associated with a Turner-Syndrome (45,XO). We report a case in which transvaginal sonography has been the only instrumental in the prenatal diagnosis of a nuchal cystic hygroma. Based on this sonographic finding the pregnancy has been terminated. We point to the value of early and subtle ultrasound examination as an excellent method in finding hints for chromosome abnormalities.

The authors report on two new cases of sebaceous glands in the uterine cervix. This extremely rare histological observation was found on biopsy specimens of the uterine cervix because of unclear colposcopic findings and of recurrent CIN II. The etiology of this entity is discussed including a brief review of the medical literature.

The vaginal microflora of a healthy asymptomatic woman is part of a dynamic ecosystem which is easily disturbed by known and unknown factors. The normal vaginal microflora consists of a broad spectrum of aerobic and anaerobic germs. The anaerobic microaerophilic Doederlin's bacillus (lactobacillus) plays a major role in the microflora, but is only one of the many factors controlling and tuning a well-balanced ecosystem. Although our understanding is still insufficient, basic knowledge of the ecosystem and new results lead to a successful therapeutic approach.

The postnatal treatment with anti-D immunoglobulin to prevent rhesus sensitization is successful in about 90% of all rhesus-negative mothers at risk. Failures derive mostly from large fetomaternal hemorrhages during the last months of pregnancy. Studies from Canada, Great Britain and Sweden have shown that the injection of an additional dosage of anti-D during the 28th to 34th week of pregnancy results in a further 90% reduction of the failure rate. Although there is only a limited number of cases of hemolytic diseases in the newborn, the cost-effect ratio of this prophylactic treatment calculated for the Federal Republic of Germany shows not only a medical but also an economic benefit.

Thanatophoric dwarfism is a rare malformation, occurring in less than 1:10,000 pregnancies. It can be discovered by standard ultrasound examination, but other skeletal dysplasias such as achondroplasia, achondrogenesis and polydactyly syndromes must be taken into consideration. Sonographic findings are polyhydramnia, narrow chest, symmetric tetramicromelia and macrocephaly. Macrocephaly might cause a problem for vaginal delivery. The narrow chest with secondary lung hypoplasia determines the infaust prognosis.

In a retrospective study, the complications of vesical drainage after gynaecological surgery in 2362 cases was analysed. The suprapubical catheter was found to cause less urinary tract infection than the dwelling transurethral catheter. Less intermittent recatheterisation, owing to vesical emptying disorders, was needed after suprapubical catheter. Due to frequent obstruction, the suprapubical catheter had to be removed earlier in some cases. In this study urinary tract infection was more frequently observed after vaginal hysterectomy than abdominal. Regarding the incidence of microorganisms in the urine, we found, that after Caesarean section Staph. epidermidis occurred more frequently, whereas E. coli prevailed in most of the other cases.

This retrospective study covers a period of 10 years (1977-1986) during which a vaginal hysterectomy with or without colporrhaphy was carried out in 431 women. In 317 patients the skin at the end of the vaginal stump was closed primarily, whereas it was left open in 114 patients. Comparing both groups less morbidity-, secretion-, infection- and bleeding-rates can be found in the group with primary closure of the vaginal stump. The healing of the operative wound is much better when closed primarily. Fear of entrapped secretions or formation of abscess or hematoma is not justified.

Forty-one histologically verified endometrial carcinomas were examined to reveal relationship, if any, between cytoplasmic receptor content and tumour differentiation, cytologic diagnosis and mean nuclear surface area. The latter in itself was found to be a reliable prognostic sign of the estrogen receptor positivity of the tumour.

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