Biomedical subjects
Publications and source records attributed to H Hepp.
Gamete intrafallopian transfer has been performed since April 1985 in our hospital. In patients with a long history of infertility despite proved tubal patency, the follicles present at laparoscopy are aspirated. The oocytes thus obtained are introduced together with the prepared sperm via a special catheter directly into the ampulla. We would like to report on the first pregnancy for which we used this technique.
Antithyroid drugs can pass the placenta, in contrast to thyroid hormones. Therefore, their application in pregnancy carries the potential risks of teratogenic effects and foetal hypothyroidism. The actual danger to the foetus, however, is controversial. The history of a hyperthyroid patient treated with carbimazole and referred for termination of pregnancy in the 8th week of gestation gave rise to review the literature in order to elucidate the foetal risks. Data of 278 pregnant women treated with imidazole derivatives (group I) and 192 women, who received thiouracil derivatives (group II) during pregnancy, were found in the literature. The rates of foetal malformations and foetal goitre in group I were 3.6% and 3.2%, respectively. In group II the corresponding rates were 3.6% for foetal malformation and 7.8% for foetal goitre. From these figures we conclude that antithyroid therapy in pregnancy does not warrant termination of pregnancy for foetal reasons if there is meticulous control of maternal thyroid metabolism.
As far as the Federal Republic of Germany is concerned, the legal basis of "foetal" indication is, under the aspects of legal philosophy, exclusively directed at the question whether continuation or termination of pregnancy can be expected of, or tolerated by, the pregnant mother. This creates both for the parents and for the physician who is expected to become active or to remain inactive, a particularly tragic conflict arising from the confrontation with the child, which is either certain to be, or suspected of being, seriously diseased, handicapped or deformed or teratoid; this is, so to say, a second dimension of the indication for induced abortion. The conflict situation between the doctor, the patient and the child is analysed in this article on the basis of consultation talks; in such discussions, the doctor is unable to pass any verdict on the value of diseased human life, using medical categories of thinking. The article points out the necessity of acquiring a firm mental hold on the possibilities of prenatal diagnosis and the foetal indication for termination of pregnancy; in this connection, the article explains which of the relevant diseases can be diagnosed by the intrauterine route, with particular emphasis on the rapid development of improved methods of diagnosis which are likely to evolve in the foreseeable future.
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Between October 1978 and December 1980 165 diagnostic laparoscopies were carried out because of the suspected diagnosis of primary tubal infertility. In this preselected series 27.9% of the cases had normal findings. It was remarkable that the previous diagnosis was not confirmed in 21 cases which had a prior infertility work-up. In 17 of these cases tubal occlusion was diagnosed by laparoscopy or hysterosalpingography but was not confirmed by the repeat laparoscopy. In addition 1 case of tubal tuberculosis and 1 case of tubal anomaly were detected which were missed with the prior work-up. Because of the findings in this series the repeat diagnostic laparoscopy prior to micro-surgical reconstruction of the fallopian tubes is necessary and the referring clinics should show comprehension for the repeat laparoscopy prior to micro-surgery. In the sequence of diagnostic test, laparoscopy it selected prior to hysterosalpingography.
Seventeen parturients in regular and painful labor received lumbar epidural analgesia with 3 - 10 mg morphine. The degree of analgesia was determined with a linear visual analgesia scale (14).30 min after the injection, the decrease of pain was sufficient only in one parturient. Following injections of 10 ml 0,25% bupivacaine resulted in good analgesia for all parturients. Possible causes for the insufficient efficacy of epidural morphine in obstetrics are discussed.
A thirty-nine year old gravida 2 was allowed to have a trial of labor 4 years after Cesarean section. A continuous epidural anaesthesia was applied. During the well placed epidural anaesthesia pain in the cesarean section scar area started. Despite a normal fetal heart rate and normal intra-uterine pressure, normal pulse and blood pressure the trial of labor was discontinued and a repreat caesarean section for impending rupture of the uterus was performed. During the caesarean section a 2 cm. long concealed rupture without bleeding was found in the old scar. The importance of stringent criteria for indications for continuous epidural anaesthesia is stressed. The lowest effective dose of local anaesthesia need to be used. Continual intensive monitoring is necessary in order to detect a pathological pain during a continuous epidural anaesthesia.
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The use of hysteroscopy for the diagnosis of corpus neoplasma has its limitations. In 180 cases with suspected neoplasma or with an unknown localisation of a corpus neoplasma, identification by histology and hysteroscopy was performed. The results lead to the conclusion that the CO2-hysteroscopy is a valuable additional method in single cases. As an endoscopic method however, it cannot replace the sample of cell material and histologic preparation. Hysteroscopy might be of clinical value not only for the localization of a tumor with reoccurring bleeding after a negative curettage, but also to evaluate the extent of a malignant tumor. However, this method takes too much time for it to be recommended as a screening method.
Report on 18 patients who were treated in hospital during the last 4 years because of a lost intrauterine contraceptive device. Carbon dioxide hysteroscopy was found to be a more advantageous diagnostic procedure in the search than radiography. In 14 cases, the intrauterine contraceptive device was grasped and removed under hysteroscopic control. In 4 cases the uterine cavity was empty on hysteroscopy. The device had perforated into the uterine muscle or into the peritoneal cavity. These 4 cases are reported in detail.
In a multi-centre study 1117 morning urine samples were tested using the new immunochemical pregnancy tube test (Roche), based on the principle of indirect latex-agglutination inhibition. The test proved to be both qualitatively and semi-guantitatively suitable for demonstration of HCG in urine. There was only one false-negative result among 320 pregnancy tests (after 50th postmenstrual day). In 94 early pregnancies (test done before the 50th day) there were only two false-negative results. No false-positive result were seen. In the prognosis of threatened abortion, diagnosis of incomplete abortion, hydatid cyst, or chorionepithelioma the semiquantitative performance of the test was clinically useful and especially suitable because the result of the agglutination-inhibition reaction is unequivocal.
In a joint study of five laboratories the immunochemical tube test for pregnancy 'Roche', which uses the principle of the latex-agglutination inhibition test, was examined. A total of 1117 samples, complemented by a number of laboratory studies, proved that the test is specific, reproducible and low in interference with a sensitivity of 900-1000 U/l HCG. It is a simple test, the results can be easily read after 90 minutes. pH of the urine sample, protein, urea or calcium content, presence of oral contraceptives, detergents, disinfectants or organic solvents cause no or very little interference.
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