Zentralblatt für Gynäkologie
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Reduction mammaplasties can be performed--if contraindications are respected--as oncoplastic operations. They have the advantage that the lump has clear margins and is surrounded by a thick layer of healthy tissue. ⋯ The axillary cavity must be cleared and the oncoplastic (reconstructed) breast be irradiated with 50 Gy. The mastopexia (breastlifting) is less apt to be used as an oncoplastic operation, as the removed tissue is rather skin and subcutaneous fatty tissue than the breast gland itself.
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The anamnesis, the preoperative diagnostics, the laparoscopic findings, and the therapeutic management are reported of 303 patients who underwent laparoscopy because of chronic pelvic pain during the years of 1989 and 1993. The most common laparoscopic diagnosis were adhesions of the bowel and omentum (34.7%), adhesions of the genital organs (24.1%) and endometriosis (19.8%). ⋯ PID-Patients had significantly more genital adhesions. The high frequency of surgical laparoscopies and therapeutic recommendations following a diagnostic laparoscopy emphasize the importance of a laparoscopic investigation in patients with chronic pelvic pain.
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Comparative Study
[Comparison of dinoprostone gel and gemeprost suppositories for induction of abortion in the second and third trimester].
The results of the cervical priming with a Dinoprost-containing gel and a Gemeprost-containing vaginal suppository were compared in 68 patients, who required termination of pregnancy beyond 14 weeks because of a severe maternal disease or a fetal abnormality. The priming consisted of either an intracervical application of Dinoprost (500 micrograms) in a tylose-gel in 6-8 hour intervals or a retrocervical application of Gemeprost (1 mg) as a vaginal suppository in 12 hour intervals. Although no significant parameter variances were found in the selected patient groups, abortion was induced in 75% of cases within 24 hours, in 89% within 36 hours using Gemeprost. ⋯ Using Gemeprost the additional systemic administration of Sulprost was necessary in 21% of cases, using Dinoprost, in 50% of cases. Severe complications did not occur and minor side effects such as nausea or vomiting were observed in single cases. These results demonstrate that Gemeprost can be used in cervical priming even after 14 weeks of pregnancy and that the longer application interval of 12 hours results in a reduction of side effects without a decrease in efficacy.
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We show by two case reports, that the HELLP-syndrome is the most severe form of pre-eclampsia and associated with a relative high maternal and perinatal mortality because of the sudden onset of the complications. In the first case report we describe the development of this syndrome after two eclamptical convulsions on the 6th day of puerperal period. ⋯ We want to show, that caesarean section cannot avoid this complication. It is not in all cases the most advantageous procedure of delivery in patients with HELLP-syndrome.