We studied 56 pregnant women and 24 partners after ultrasound examination in the 18-24h gestational week revealed a fetal malformation. The subjects were followed through the process of examination, information sharing and counselling about the option of terminating the pregnancy. Regardless of sociodemographic variables or attitude towards the pregnancy, the diagnosis was always traumatic. A detailed critique of the physician's behavior and function emphasized his important role in the process of coming to terms with the malformation and gave clear indications of the positive expectations parents had. The affected patients expected the role of the professionally competent expert to be combined with that of the empathetic approachable counsellor, whose ste-by-step explanation would allow them to decide for themselves whether to terminate the pregnancy. The partner's participant was an essential aid to adjustment. It remains to be seen to what extent the functions of the doctor are realistic and justified.

In 108 patients with nonpuerperal mastitis (inflammatory symptoms of duct ectasia), serum prolactin levels were determined before, during, and after treatment. Twenty-nine patients (26.8%) exhibited transiently elevated prolactin levels during the period of inflammation (mean +/- SD level, 42 +/- 22 micrograms/L) that returned to normal within 4 weeks. Twenty-two patients (20.4%) presented with more severe hyperprolactinemia (78 +/- 56 micrograms/L), and 15 were found to have pituitary microadenomas. In 11 cases, mastitis was the first symptom of hyperprolactinemia. A second group of 83 patients with known hyperprolactinemia and 83 normoprolactinemic controls were interviewed with regard to recent symptoms or past treatment of nonpuerperal mastitis. Sixteen hyperprolactinemic women (19.3%) and none of the controls reported that they had experienced mastitis. We conclude that duct ectasia is due in part to increased prolactin secretion. Thus, nonpuerperal mastitis may be a symptom of hyperprolactinemia. On the other hand, nonpuerperal mastitis may induce transient hyperprolactinemia (neurogenic hyperprolactinemia) of about 3 weeks' duration that is less pronounced than central hyperprolactinemia.

Befindlichkeitsstörungen Viele Frauen werden in ihrem Wohlbefinden zyklusabhängig beeinträchtigt. Regeltempostörungen und Regeltypusstörungen können den Ablauf des täglichen Lebens erheblich beeinflussen. Häufig werden mittzyklisch Ovulationen als Schmerz empfunden. Mit dem Eintritt der Menstruation werden viele Frauen durch krampfartige Schmerzen geplagt, die mit Beendigung der Blutung wieder verschwunden sind. Dieses Beschwerdebild wird als Dysmenorrhö bezeichnet. Schon Hippokrates war bekannt, dass viele Frauen unmittelbar vor der Menstruation erheblichen Stimmungsschwankungen unterliegen.Die Symptomatik dieses prämenstruellen Syndroms (PMS) ist vielfältig; sie reicht von psychischen Auffälligkeiten, von trauriger Verstimmung, Angst und Affektlabilität, manchmal mit suizidaler Gefährdung, bis hin zu somatischen Veränderungen wie Brustspannen, Wassereinlagerungen und subjektiv empfundenem wie objektiv nachweisbarem Geblähtsein. Die Prävalenz dieser Erscheinungen wird mit 40-73% angegeben bei enger Definition und subjektiv leidenstiftender Symptomausprägung: 2-9%, d. h. symptomatische Frauen durchleben bis zu symptomatischen 2.800 Tage bis zur Menopause. DysmenorrhöDefinitionsgemäß muss zwischen einer primären und einer sekundären Dysmenorrhö unterschieden werden [1].Primäre Dysmenorrhö. Die primäre Form schmerzhafter Regelblutungen ist klinischdiagnostisch nur durch Ausschluss somatischer bzw. pathologischer anatomischer Befunde einzuordnen.Die Zyklen sind regelmäßig, Ovulationen sind vorhanden; wenn man Hormonbestimmungen durchführt, so findet man zumeist völlig normale Werte, bei der gynäkologischen oder sonographischen Untersuchung findet man keinerlei Besonderheiten, das innere Genitale ist unauffällig. Man ist gerne bereit, die zumeist von jüngeren Frauen vorgebrachten Beschwerden unkritisch psychischen Alterationen anzulasten.Die Beiträge der Rubrik "Weiterbildung" sollen dem Stand des zur Facharztprüfung für den Gynäkologen entsprechen und zugleich dem niedergelassenen Facharzt als Repetitorium dienen. Die Rubrik beschränkt sich auf klinisch gesicherte Aussagen zum Thema.

Objective-To study the lactational and hormonal responses to nasal administration of thyrotrophin-releasing hormonc (TRH) in puerperal women with inadequate lactation. Design-Prospective randomized double-blind placebo-controlled study. Subjects-19 pucrperal womcn with inadequate lactation (<50% of normal milk yield) on the 5th day postpartum. Interventions-10 women were allocated to receive TRH administered by a nasal spray of 1 mg, four times daily, between suckling episodes, for 10 consecutive days starting on day 6 postpartum. Nine women werc allocated to receive placebo sprays. Main outcome measures-Daily milk yield, serum lcvcls of prolactin and thyroid hormoncs. Results-Before trcatment all the women had significant prolactin responses to TRH and suckling stimuli. At the end of 10 days of treatment, milk yield incrcascd significantly in the TRH group from a mean of 1424 (SD 33.9) to 2534 (SD 105.3) @day (P = 0414). There was no significant change in the placebo group. Basal prolactin levels increased from a mean of 117.4 pgA (SD 45.2) to 173.3 pg/l (SD 55.5) (P

Objective— To study the lactational and hormonal responses to nasal administration of thyrotrophin‐releasing hormone (TRH) in puerperal women with inadequate lactation. Design— Prospective randomized double‐blind placebo‐controlled study. Subjects— 19 puerperal women with inadequate lactation (<50% of normal milk yield) on the 5th day postpartum. Interventions— 10 women were allocated to receive TRH administered by a nasal spray of 1 mg, four times daily, between suckling episodes, for 10 consecutive days starting on day 6 postpartum. Nine women were allocated to receive placebo sprays. Main outcome measures— Daily milk yield, serum levels of prolactin and thyroid hormones. Results— Before treatment all the women had significant prolactin responses to TRH and suckling stimuli. At the end of 10 days of treatment, milk yield increased significantly in the TRH group from a mean of 142–0 (SD 33.9) to 253–0 (SD 105.3) g/day (P = 0.014). There was no significant change in the placebo group. Basal prolactin levels increased from a mean of 117–4 μg/1(SD 45.2) to 173–3 μg/1 (SD 55.5) (P < 0.001) in the TRH group whereas in the placebo group prolactin levels decreased from 137–2 (SD 69.5) to 82–0 (SD 37.7) μg/1. A further rise in prolactin levels and milk yield was seen in seven women in the TRH group who received a second 10‐day course of TRH treatment at their own request. There was no significant change in levels of thyroid stimulating hormone, thyroxine and triiodothyronine during treatment in either of the two treatment groups and no signs of hyperthyroidism. Conclusion— Repeated nasal TRH administration between suckling episodes may improve defective lactation.