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Biomedical subjects

T Schwenzer

Publications and source records attributed to T Schwenzer.

13 recordsLinked to original sources

[Immunoblastic highly malignant lymphoma of the uterine cervix].

Report on a case of a highly malignant solitary lymphoma of the cervix uteri in a 51-year-old patient. The only noticeable finding leading to the diagnosis was the pathological result of the routine cervical smear. Solitary malignant lymphomas of the cervix must be seen as systemic diseases. They should therefore be treated by local surgical intervention and consecutive systemical chemotherapy in an interdisciplinary conception.

Cervix Uteri

[Double umbilical cord knot in mono-amniotic twin pregnancy as the cause of intrauterine fetal death of both twins].

In cases of rare monoamniotic-monochronic geminie pregnancies there is a high risk of complications by real umbilical cord knots, including the cords of both gemini. In these cases fetal mortality is very high. Modern examination techniques (Colour doppler sonography) are able to detect such cord knots in monoamniotic twins. Therefore it is necessary in all twin pregnancies, especially following fertility treatment, to examine precisely by a routine examinator the question of mono - or diamniotic pregnancy. In monoamniotic pregnancy there should be a look for real knots of umbilical cord in regular intervals. In such a case, if a knot is present, the pregnant woman had to be supervised by CTG, to react immediately at first signs of hypoxia.

Adult

[Forensic aspects of bladder and ureteral injuries in standard gynecologic operations].

Damage to the efferent urinary passages during abdominal or vaginal hysterectomy cannot always be prevented no matter how carefully one may proceed preoperatively and intraoperatively. However, all possibilities of avoiding complications or at least of recognising and eliminating them before surgery, must be explored. Nevertheless, formation of vesicovaginal or ureterovaginal fistulas or of a congested ureter will be rare. In such cases, one cannot jump to the conclusion of mismanagement or a therapeutic error from the mere occurrence of damage. In each individual case, there must be an expertise and a legal judgment as to whether there has been any infringement of the legal requirement to exercise all possible medical care lege artis. Claims for damages are justified only if the conditions of an individual case show, on close examination, that such care had not been exercised.

Documentation

[Definition and etiologic factors of hypotonic urethra in relation to urinary stress incontinence in the female].

In 555 stress-induced urinary incontinent and 119 continent women patients, we studied the history, clinical and urodynamic investigations to define the hypotonic urethra and to find out important etiological factors of the low urethral closure pressure. The linear depression of the urethral pressure and the urethral closure pressure at rest--well known from literature--has been confirmed in this study. With hypotonic urethra, closure pressure values were found to be below the simple standard deviation from a norm-curve. Also, in cases of stress urinary incontinence, we found a nearly linear depression of closure pressure. The stress incontinent patients could be divided in two groups: 46% with hypotonic urethra, 54% with nearly normal closure pressure. History of former incontinence surgery, but also of other operations such as simple abdominal or vaginal hysterectomy, is correlated with low urethral closure pressure. The degree of closure pressure is correlated with shortening of the functional urethral length. The maximum closure pressure shifts distally. Women, who, despite hypotonic urethras, are continent, build up a positive closure pressure throughout a broad zone of the functional urethral length. Contrarily, in the case of incontinent patients, even a weak coughing spasm, which does not even break through the bladder sphincter in maximum closure, can cause opening of the urethra and establishment of pressure equilibration between bladder and urethra.

Adult

[Beta-endorphin in premature labor and in mature newborn infants following vaginal and abdominal delivery].

Umbilical venous plasma concentrations of beta-endorphin in 20 premature and 30 mature newborn infants after vaginal delivery or elective caesarean section were determined by specific RIA. In the premature infants the beta-endorphin levels after vaginal and abdominal delivery were significantly higher than in mature newborns. Our data indicate that for premature infants the delivery is more stressful and therefore most likely the release of beta-endorphin from the pituitary is more pronounced. Since high opioid levels can cause respiratory and circulatory difficulties, premature infants are exposed to risk of these problems.

Bradycardia

[Is there a correlation between the degree of proliferation of vaginal and urethral epithelium and the incidence of stress incontinence? A contribution to estrogen therapy in stress incontinence].

The extent of proliferation of the vaginal and urethral epithelium, as well as urodynamic parameters, were studied in 232 patients in order to determine whether there is a relation between the development of stress incontinence and hormone-related epithelial proliferation. A higher build-up of vaginal than of urethral epithelium was found in 74% of the patients. Even in post-menopause patients, epithelial atrophy in the vagina was only found in 29.3%, while in the urethra it was found in 61.3%. Therefore, the vaginal epithelium cannot with confidence be taken as a basis for conclusions concerning the condition of the urethral epithelium. In the group of 145 patients with urinary stress incontinence no link could be established between the extent of proliferation of the urethral epithelium, the urethral occlusion pressure and the functional length of the urethra: The occurrence of an age-related excessively low urethral occlusion pressure (hypotonic urethra) is independent of the extent of proliferation of the vaginal or urethral epithelium. Sedimentation phenomena are also seen equally frequently in cases with atrophic and eutrophic epithelium. Owing to the high percentage of overweight women among those with stress incontinence, the extent of proliferation of the vaginal and urethral epithelium often corresponds to premenopausal cell pictures even in perimenopausal and postmenopausal women; this is a consequence of increased estrogen production in the peripheral fatty tissue. Therefore, estrogen therapy is unsuccessful in women with pure urinary stress incontinence. However, the efficacy of an equivalent therapy, e.g., with estriol, has been confirmed in cases of active and combined incontinence.

Atrophy