Die Operation nach Vecchietti zur Bildung einer Neovagina: Technik und Ergebnisse

We performed Vecchietti's operation in 10 patients with absence of the vagina (8 Rokitansky-Küster-syndrome, 1 testicular feminization, 1 occlusion of the vagina after radiotherapy). There were no intra- or postoperative complications; on discharge the neovagina was patent for 2 fingers in all cases. On follow-up examinations 2 to 20 months postoperatively the neovagina was no longer patent in the patient after radiotherapy, all other patients had neovaginas with a length ranging from 5 to 9 cm and reported satisfactory coitus without dyspareunia. According to our experience the conditions for successful surgical formation of a neovagina are: good psychosocial adjustment, some preoperative sexual experience, higher age, preoperative counselling, and longterm follow-up.

Zur Klinik und Therapie von Wadenkrämpfen in der Schwangerschaft

Of 8204 gravidae, 486 (5,9%) complained at least once of muscle cramps during pregnancy. Muscle cramps were noticed most often in the second half of pregnancy. Gravidae with muscle cramps were on the average older and of higher parity; there was no relationship between muscle cramps and complications during pregnancy or unfavorable fetal outcome. In an uncontrolled therapeutic trial 21 women with muscle cramps received 1,8 g monomagnesium-aspartate twice daily per mouth for 4 weeks. 21 women with muscle cramps had no therapy. 4 weeks after the initiation of magnesium therapy 19/21 women were free of symptoms, compared to only 7/21 patients in the control group. Muscle cramps during pregnancy do not have to be considered a risk factor; they can be significantly improved by the administration of oral magnesium.

Nachweis und klinische Bedeutung von freizirkulierenden IgG-Immunkomplexen bei EPH-Gestose

With enzyme linked immunosorbent assays, using a solid phase Clq method, we determined free circulating immunocomplexes (CIC) in the serum of 47 pregnant women. In 30 normal pregnant women without EPH gestosis no CIC could be found. 3 normal pregnant women showed temporary CIC after viral infections. In 7 women with slight gestosis no traceable CIC concentrations were present. All 7 patients with medium or severe gestosis had clearly positive CIC levels simultaneous with hypertension and during the further course of the pregnancy. Hospitalisation and antihypertensive therapy had to be carried out because of increasing symptoms of gestosis. Thus only in medium and severe gestoses clearly demonstrable CIC concentrations could be measured. The presence of free circulating CIC might be a prognostically unfavourable indication for the further course of an EPH gestosis.

Updated recommendations on ultrasonography in urogynecology

Ultrasound is a supplementary, indispensable diagnostic procedure in urogynecology; perineal, introital, and endoanal ultrasound are the most recommended techniques. The position and mobility of the bladder neck can be demonstrated. In patients undergoing diagnostic work-up for urge symptoms, ultrasound occasionally demonstrates urethral diverticula, leiomyomas, and cysts in the vaginal wall. These findings will lead to further diagnostic assessment. The same applies to the demonstration of bladder diverticula, foreign bodies in the bladder, and bullous edema. With endoanal ultrasound, different parts of the sphincter ani muscle can be evaluated. Recommendations for the standardized use of urogenital ultrasound are given.

Prevalence of female sexual dysfunction in gynecologic and urogynecologic patients according to the international consensus classification

OBJECTIVES

To evaluate the prevalence of female sexual dysfunction (FSD) in an outpatient gynecologic and urogynecologic clinic using the current International Consensus Classification.

METHODS

One hundred fifty-nine patients were asked to answer an anonymous survey about FSD. Patients in the gynecologic (group 1) and urogynecologic (group 2) clinics were compared.

RESULTS

The mean age in group 1 was 37.8 years (range 20 to 76) and in group 2 was 55.7 years (range 18 to 82). The prevalence of FSD was 50% in group 1 and 48% in group 2; 86% of group 1 and 66% of group 2 patients had been sexually active within the past 2 years. The differences found in FSD according to the consensus panel classification achieved no significance. Of the 159 patients, 96% were not embarrassed by filling out this questionnaire about their sexual function.

CONCLUSIONS

No statistically significant difference in FSD was found between the younger and older patients seeking help in a gynecologic or urogynecologic outpatient clinic. Because of the high incidence of FSD, we recommend integrating the inquiry about female sexual health concerns into routine gynecologic care. The simple survey based on the International Consensus Conference Classification of FSD gives reliable results, and this systematic framework facilitates methodologic examination.

The role of intraoperative quick PTH measurements in primary hyperparathyroidism

BACKGROUND

In patients with primary hyperparathyroidism (PHPT), circulating concentrations of intact parathyroid hormone (PTH), decline dramatically within minutes following surgical excision of hyperfunctioning parathyroid tissue. The magnitude of this decay correlates with the completeness of resection of hyperfunctioning parathyroid tissue and can be monitored during the operation.

METHOD

Intraoperative Quick PTH (QPTH) monitoring and pitfalls of more than 350 patients, who were operated because of primary hyperparathyroidism are analyzed. Special attention is given to correct baseline values and interpretation of QPTH values.

RESULTS

QPTH monitoring is able to distinguish reliably between single and multiple gland disease and is an indispensable prerequisite for any form of limited parathyroid exploration. Experience with QPTH monitoring is necessary to achieve the excellent results known from bilateral neck exploration.

CONCLUSION

Applying correct baseline values and cautious interpretation of QPTH values results in excellent results. Nevertheless more data must be collected to allow reliable interpretation of QPTH monitoring in all patients with PHPT.

The Austrian tension-free vaginal tape registry

In Austria a central registry for all TVT operations has been established in which more than 800 cases have so far been registered. The registry contains information on pertinent data on the operated patients and intra- and postoperative outcomes of the TVT surgery. No serious complications and no mortality have been registered until now.

The relevance of angiogenesis in benign and malignant epithelial tumors of the ovary: a quantitative histologic study

The ability of a tumor to grow and eventually to infiltrate adjacent tissues requires a sufficient blood supply. Many malignant neoplasms have been shown to induce neovascularization. We asked whether it is possible to characterize ovarian epithelial tumors on the basis of vascularization and whether vascularization can be used to differentiate between benign and malignant neoplasms. We examined 14 cases of benign cystadenomas and 18 carcinomas. The microvessels were identified by immunohistochemical staining of endothelial cells for factor VIII. They were counted within the most vascular area of a tumor (neovascular "hot spot") on a x 100 and a x 400 field. Mean vessel counts were 51.64 [standard error of the mean (SEM), 5.7] in the benign cystadenomas and 131.05 (SEM, 6.7) in the group of carcinomas at a x 100 magnification. The mean microvessel counts per x 400 field were 14.4 (SEM, 1.9) in the benign and 33.7 (SEM, 3.45) in the malignant tumors investigated. These differences were significant (t test for independent samples, P < 0.001). Since our study shows significantly fewer small blood vessels in the benign cystadenomas than in the malignant tumors, the histologically determinable vascular density may be the basis for imaging blood flow by means of color ultrasound.

Nucleolar organizer regions as markers of endometrial proliferation: a study of normal, hyperplastic, and neoplastic tissue

Nucleolar organizer regions (NORs) are loops of DNA that transcribe to ribosomal RNA. They can be visualized as intranuclear black dots by histochemical staining with a colloid silver solution. We applied this method to 78 sections of endometrial tissue obtained either from curettage or from hysterectomy specimens. The histological diagnoses were as follows: normal proliferative (N = 9) or secretory (N = 5) endometrium, simple hyperplasia (N = 10), complex hyperplasia (N = 18), atypical hyperplasia (N = 8), and adenocarcinoma (N = 28). Mean silver-stained NOR (AgNOR) counts per cell were 3.2 (standard error of the mean [SEM], 0.2) in normal proliferative and 2.7 (SEM, 0.2) in normal secretory epithelium, and increased to 4.1 (SEM, 0.3) in simple hyperplasia, to 5.4 (SEM, 0.4) in complex hyperplasia, to 8.1 (SEM, 0.7) in atypical hyperplasia, and finally to 10.0 (SEM, 0.5) in endometrial carcinoma. The differences were significant (one-factor analysis of variance [ANOVA], P < .001). A slight increase but no significant difference was seen between the mean AgNOR counts in endometrial carcinomas of different histological grades. Our study suggests that AgNOR counts are reliable markers of endometrial proliferation and allow a clear distinction between benign, premalignant, and malignant epithelial changes. Our AgNOR findings in endometrial hyperplasia support the concept of various degrees of hyperplasia that can be differentiated on morphological grounds.

Localization of blood vessels and qualitative assessment of blood flow in ovarian tumors

OBJECTIVE

To study the localization of blood vessels within a tumor and the shape of the flow curve as a method of assessing ovarian neoplasms.

METHODS

We studied 39 patients with malignant tumors and 63 patients with benign ovarian tumors by means of vaginal color Doppler ultrasound, noting the localization of blood vessels in the tumors, the shape of the flow curve, and peripheral resistance.

RESULTS

Blood vessels could be visualized in 95% of the malignant tumors and in 70% of the benign tumors. Blood vessels tended to be localized centrally (65 versus 5%) in malignant tumors and peripherally in benign tumors (65 versus 0%). A diastolic notch was seen in 89% of the benign tumors, but in none of the malignant tumors. The mean resistance index (RI) +/- standard deviation was 0.48 +/- 0.19 in malignant and 0.69 +/- 0.09 in benign tumors (P < .05). The corresponding values for the pulsatility index (PI) were 0.56 +/- 0.13 and 1.06 +/- 0.07, respectively (P < .01).

CONCLUSIONS

Low RI and PI values are general indicators of tumor growth. The localization of blood vessels within an ovarian tumor and the presence or absence of a diastolic notch are the most useful variables in the evaluation of ovarian tumors.

[The birthing stool--an obstetrical risk?]

During 1992, 140 women out of a total of 1122 used the delivery chair at the department for obstetrics and gynaecology at the LKH Mödling. We compared them to a control group in the supine position. In order to evaluate the safety of deliveries on the delivery chair, we studied the duration of the stages of labour, rate and degree of soft tissue injuries, maternal blood loss, fetal outcome and complications in the puerperium. The use of the delivery chair showed no increased risk to either the mother or the fetus and therefore represents an appropriate alternative to the traditional supine position for delivery.

[HELLP syndrome in routine obstetrical care. Three case reports]

In recent years the syndrome of hemolysis, elevated liver enzymes and low platelets (H-ELLP) has attracted increasing interest in obstetrics as a serious complication of pregnancy, either alone or in combination with the classical symptoms of EPH-gestosis or eclampsia. In 1993, we observed 3 cases of severe HELLP syndrome in a total of 1126 deliveries. We present the clinical characteristics and the laboratory findings in these cases. A common symptom was general malaise and upper abdominal discomfort or pain. All patients were delivered by cesarean section of healthy infants. We conclude that it is no longer sufficient to emphasize edema, proteinuria and hypertension, but that the signs and symptoms of the HELLP syndrome present a new and increasingly important challenge in obstetric practice.

[Abdominal colposuspension--the gold standard in incontinence therapy?]

Abdominal colposuspension has become the operation of choice in moderate and severe urinary incontinence in the female. The operation involves an elevation of the bladder neck and approximation to the back of the symphysis pubis, resulting in an improved pressure transmission to the proximal urethra. These operative techniques have become standardised, while the various modifications differ in the exact location of the sutures in the vaginal fascia and connective tissue in the small pelvis. Most commonly, the sutures are placed lateral of the bladder neck and passed through the ileo-pectineal ligament (Cooper ligament). Even in unfavourable cases, success-rate lies between 70% and 90%.