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Biomedical subjects

D Mühlenstedt

Publications and source records attributed to D Mühlenstedt.

At least 19 recordsLinked to original sources

[Duration of desire for a child, contraceptive behavior and rate of previous infertility treatment. An epidemiologic study of 750 consecutive patients in labor at the Oldenburg Gynecologic Clinic using a structured interview].

In order to gain current information, on how long a healthy couple desiring a child has to wait until conception, on previous contraceptive behaviour and prior infertility treatment, 750 women were interviewed within 7 days after delivery between January and November, 1989, using a standardised questionnaire. This sample represents one third of all patients, who delivered a child in an Oldenburg hospital during the time period covered. 544 women had desired a pregnancy, an additional 206 women had not directly planned a pregnancy, and 73 of these had taken no precautions against conception, since they were willing to accept a pregnancy if it should occur. 133 women called their pregnancy an "accident", which in 87 couples occurred despite some kind of contraceptive procedure. The absolute number of contraceptive failures was highest for timed intercourse (n = 38) and users of oral contraceptives (n = 32). Couples without a history of infertility treatment had to wait for an average period of 3.4 months before a conception occurred (95% confidence limits: 3.1-3.8 months). The mean age of the women in this group was 28.1 +/- 0.2 years, whereas on an average their male partners were 30.9 +/- 0.2 years of age. The likelihood to achieve pregnancy within the first 4 months of trying, varied between 13 and 15% per month. After 6 months of waiting, the pregnancy rate per cycle was reduced to 6%, whereas, after one year, the likelihood for conception was only 1%. Half of all couples desiring a pregnancy achieved this within 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Adjuvant chemotherapy in primary radically operated ovarian cancer].

There are no conclusive studies on the value of adjuvant chemotherapy in radical resected ovarian carcinoma. General reflections including parameters, toxicity and formation of a secondary tumor suggest forgoing adjuvant therapy of stages Ia to IIa. The survival rate of all other stages is below 50%. A therapy would seem necessary. Only general recommendations can be made due to lack of conclusive trials.

Antineoplastic Agents↗

[Gynecological and endocrinological studies of thalidomide-damaged girls].

Gynaecological examinations were done for the first time in 32 girls, between age 13 and age 18 damaged by thalidomide. 11 of the girls had primary amenorrhoea at the time of examination. 9 of these cases showed genital malformations. 7 cases showed aplasia of the uterus. A rudimentary uterus and a hypo-plastic uterus were found in one patient each. In 8 girls these changes were combined with abnormalities of the vagina, 3 cases had vaginal aplasia. 4 cases had a blind vaginal sac. 1 case had a urogenital sinus. Two patients had primary amenorrhoea without genital malformations. In the girls who had started menstrual periods none of the 21 cases showed genital malformations. Supplementary endocrinological investigations were done to answer the question whether functional disturbances were caused by thalidomide in addition to organic changes. The development of puberty can be diagnosed from secondary sexual markers. Our patients had almost all advanced puberty with more mammary development than pubic development. The menarche between age 11 and age 16 showed no deviation from the normal in our patients. 11 girls had regular cycles. The hormonal vaginal cytology in 28 patients showed no sign of deficient estrogen. Neuro-endocrine maturation is responsible for the development of puberty. The basal secretions of FSH and LH increase. The dynamic functional test with LHRH shows the LH reserve of the pituitary which rises in a typical pattern. 14 patients had a LHRH test and nine of these showed a mature LH reserve corresponding to the index R2.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗

[Case report on the administration of diuretics during pregnancy].

Diuretics potentiate existing hypovolaemia and hämoconcentration in patients suffering from toxemia of pregnancy. This effect also applies to the fetus. A case is presented of an intrauterine spontaneous thrombosis in the inferior vena cava and its tributaries in a fetus with resulting perinatal death during long-term diuretic therapy because of edema in the mother in the third trimester. Basing on this example, the present state of assessment and necessity of treatment of the symptom "edema" in late pregnancy is discussed, with the conclusion that administration of diuretics, if it becomes necessary in a life-threatening state of the pregnant mother (pulmonary edema or oliguria in pre-eclampsia or eclampsia) is indicated only with monitoring of the hematocrit and central venous pressure.

Adult↗

[Familial endocrine adenomatosis (author's transl)].

The combination of pituitary and thyroid gland adenomatosis is reported in four family members of two generations. This finding of dominant inheritance is discussed with special reference to multiple familial adenomatosis, also known as Wermer's syndrome. The endocrine status including dynamic function tests is presented. It is our intention to point out that in cases of monoglandular adenomatosis clinical attention should be directed not only to anterior pituitary and thyroid gland but also to their possible incidence with tumours of the parathyroid gland and the islet cell organ.

Adenoma, Islet Cell↗

[Gonadoblastoma and overgrowing dysgerminoma in Turner mosaicism [45, XO/46, Xi (Xq)] (author's transl)].

It is well established that the Y-chromosome is associated with germ cell tumor development. There is a considerable tumour risk in XY- and XY/XO-gonadal dysgenesis. In the absence of Y-chromosome germ cell tumours are extremely rare. The history of a patient with 45 XO/46 Xi (Xq)-karyotype is presented, who had a gonadoblastoma with overgrowing dysgerminoma. According to basal body temperature recordings, this patient ovulated up to the age of 22 years. After this cyclical ovarian function was exhausted; histologically no primordial follicles could be detected. Gonadotropin as well as prolactin binding sites in the tumours could not be demonstrated, suggesting hormone independency and complete malignant transformation of the tumor. In general the clinician should be aware of a possible germ cell tumour development in the absence of a Y-chromosome. However as far as the clinical management of patients with dysgenetic gonads is concerned, prophylactic gonadectomy is only indicated in the presence of a Y-chromosome.

Adult↗

Sexual differentiation of the hypothalamus in gonadal agenesis and testicular feminization.

Cyclical hypothalamic function was investigated in three patients with an XY karyotype and female external genitalia; in one of them we diagnosed gonadal agenesis, and in the other two testicular feminization. We studied the effect of estradiol and progesterone on gonadotropin release. The patient with gonadal agenesis had cyclical hypothalamic function, but this cyclical function was suppressed in the patients with testicular feminization in whom no LH secretion could be provoked by steroid stimulation. These observations support the concept that hypothalamic sexual differentiation is due to testosterone (which is locally converted to estradiol in the hypothalamus).

Androgen-Insensitivity Syndrome↗

[Pregnancy and delivery combined with hereditory angioneurotic edema (author's transl)].

Two deliveries in a patient combined with hereditory angioneurotic edema are reported. Although even the smallest trauma can lead to life threatening edema the tendency to edema is reduced during pregnancy. Neither in the vagina nor the vulva the deliveries caused edema. The episiotomy did not cause a concomitant edema of the vulva, despite the predilection of the external genital organs for edema. It is possible that a correlation between the gonadotrophin level and the tendency to edema exists in hereditory angioneurotic edema.

Adult↗

[The influence of highly purified hCG on the immunocompetence of human lymphocytes and DNA repair system].

PHA-stimulation of human T-lymphocytes, a parameter of cellular immunocompetence, can be suppressed by highly purified human chorionic gonadotropin (hCG) in a dose-dependent manner. This was shown spectrophotometrically and by the mitosis index. Our results are in agreement with H3-thymidine incorporation studies. We further investigated the DNA repair system in UV-light- and hCG-explsed lymphocytes. It could be shown that DNA repair-replication is disturbed by hCG. Such repair disturbances may cause reduced H3-thymidine incorporation in PHA-stimulated and hCG-treated lymphocytes. It is probably on this molecular level that hCG influences the immunocompetence of human lymphocytes.

Antibodies↗

[Tumour regression in pituitary adenoma by bromocriptin (author's transl)].

A 35 year old patient with longstanding amenorrhea-galactorrhea due to a pituitary macroadenoma has been observed for a period of more than 2 years. During this time tumour expansion was radiologically evident. A full term pregnancy was responsible for most of the tumour growth. Following postpartum period Bromocriptin treatment led to considerable regression of the adenoma. Recalcification of sella structures and an involuted sella volume was radiologically evident. With reference to the experimental investigations of Lloyd (1975) and following the suggestions of L'Hermite (1977) and Vaidya (1977) this tumour regression is interpreted as being due to the antimitotic effect of Bromocriptin via inhibition of c-AMP and DNA.

Adenoma↗