Vulva- und Vaginalkarzinom

Ohne Zusammenfassung     

Begrüßung

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Osteodensitometrie

Osteodensitometrie ist inzwischen eine allgemein anerkannte Methode zur Beurteilung des Frakturrisikos und klinisch unerl?sslich im Rahmen einer Osteoporosediagnostik. Die radiologischen Verfahren wie die duale R?ntgenabsorptiometrie (DXA) und quantitative Computertomographie (QCT) sind Ultraschallverfahren wie der quantitativen Ultrasonometrie und -graphie (QUS) in Bezug auf die Frakturpr?diktion ebenbürtig. Entscheidend dabei ist, diskrepante bzw. konkordante Werte für die Patientin im Sinne der Fragestellung richtig zu interpretieren. Diskrepanzen zwischen zwei Messungen bei der gleichen Patientin k?nnen durch Fehlinterpretation der Messwerte verschiedener Methoden entstehen, die durch die Variabilit?t der Anteile von Compacta und Spongiosa im menschlichen Skelett an unterschiedlichen Messstellen und den unterschiedlichen Einflüssen von Messtechnologie und Biologie bedingt sind.     

Kardiotokographie

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Kardiopulmonale Funktionsst?rungen im Alter

Die Arbeit fasst die wesentlichen kardiopulmonalen Risiken im Alter knapp zusammen und gibt einen überblick über die therapeutischen M?glichkeiten bei Herzinsuffizienz, chronischem Cor pulmonale, koronarer Herzkrankheit, Herzrhythmusst?rungen sowie pulmonal-respiratorischen Erkrankungen und arterieller Hypertonie.     

Krankenheimtransport bei gynäkologischen Problemen und Schwangerschaftskomplikationen auf Reisen

The German Automobile Club (ADAC) offers car and health insurance for domestic and foreign travel and is thus confronted with a myriad of cases within Germany and abroad involving gynecology and obstetrics. Many of these acute problems arising during vacation or travel entail a hospital stay abroad or sometimes rather expensive transfer back to Germany for inpatient treatment. Depending on the severity of the illness and the clinical picture, complex problems often appear during transport, which require application of all medical possibilities extending even to intensive emergency care. Rapid return home is always aspired in cases of less than adequate treatment. When, however, the quality of care meets German standards, the risks involved for the patients during transportation should be weighed carefully. Many of the problems occurring during travel can already be solved and minimized by the local gynecologist.     

Quantitative Analyse des Kardiotokogramms während der Schwangerschaft

Recording the heart rate of the fetus in the surveillance of at risk pregnancies belongs to the standard diagnostic repertoire when the fetus is endangered. The contraction stress test is of particular importance as this is the only method of determining the hemodynamic reserve at the uterus in the case of retarded intrauterine growth. The pathophysiological relationship has been verified in animal studies and by observations in humans. In the case of restricted growth, the basal heart rate of the fetus is more often significantly increased, the amplitude of oscillation more often restricted and deceleration demonstrable. These parameters can be quantitatively scored visually.     

Subclinical chorioamnionitis as an etiologic factor in preterm deliveries.

OBJECTIVE: This study was performed to determine the possible relationship between histologic chorioamnionitis and genital tract cultures and their contribution to preterm delivery. METHODS: The study group consisted of 45 preterm and 37 term pregnancies. Cervico-vaginal cultures were obtained from all patients at admission and placentas were histopathologically evaluated and graded for inflammation of the chorial plate, amniochorionic membrane, umbilical cord and villi. Inflammation scores and presence of pathogenic bacteria were compared between the preterm and term patients. RESULTS: Severe chorionic plate inflammation was present in 35.5% of 45 preterm deliveries as compared to 5.4% of 37 term deliveries. Amniochorionic-decidual inflammation was not present in 14 of the term deliveries (38%), mild (Grade 1--2) in 20 (54%) and severe (Grade 3--4) in 3 (8%) as compared to 14 (31%), 17 (38%), and 14 (31%) in the preterm group, respectively (P<0.05). Pathogenic bacteria were isolated from the lower genital tracts of all patients who had severe chorionic plate (CP) and/or chorioamnionic (CA) inflammation while this was true only in 37.5% of the patients with no or only mild chorionic plate inflammation (P<0.001 for CP, P<0.01 for CA). CONCLUSION: Our results show that pathogenic bacterial colonisation of the cervicovaginal region is closely associated with placental inflammation, preterm labor and cervico-vaginal cultures which may be useful in determining the pregnancies at risk for preterm labor.     

Evaluation of a fetus at risk for dihydropteridine reductase deficiency by direct mutation analysis using denaturing gradient gel electrophoresis.

Dihydropteridine reductase (DHPR) is an enzyme involved in the recycling of tetrahydrobiopterin (BH(4)), which is an obligate co-factor of the aromatic amino acid hydroxylases. DHPR deficiency is a rare, autosomal recessive disorder caused by mutations in the QDPR gene. DHPR-deficient patients are diagnosed by a lack of response to a low phenylalanine diet and by severe neurological symptoms. Final diagnosis is made by measurements of neurotransmitters and pterin metabolites in cerebrospinal fluid (CSF) and urine, in addition to DHPR enzyme activity, which can be assessed in whole red blood cells. Treatment of DHPR deficiency can be difficult and the outcome is not always satisfying, even if all treatment strategies are followed. Therefore prenatal diagnosis is of great importance in affected families. Prenatal diagnosis is possible by measuring DHPR activity in different cell types but this is time consuming. More than 25 different mutations have to date been identified in the QDPR gene and direct identification of a mutation in a fetus would be easy and rapid. We have developed a method based on denaturing gradient gel electrophoresis (DGGE) for the analysis of the QDPR gene. The method is useful for rapid and simultaneous scanning of all exons and flanking intronic sequences of the QDPR gene. We describe the first prenatal diagnosis conducted using this method.