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Bei meinen Ausführungen über die Fehibildungen der Keimdrüse werde ich den Kranken mit seinen Anforderungen an den Arzt in den Vordergrund stellen, es aber nicht vermeiden können, einige der zahlreich auftauchenden theoretischen Fragen wenigstens kurz anzuschneiden.Am besten teilt man die Fehlbildungen in zwei große Gruppen ein: I. in den Defekt und die Kümmerformen und II. in die Fehlentwicklungen (Dysgenesie). I. Der Defekt und die KümmerformenHier begegnen wir einer ganzen Reihe von schwersten bis zu schweren und leichteren Erkrankungen.Am seltensten ist die schwerste Form, das völlige Fehlen der Keimdrüse, die man als Defekt oder auch als ,,Agonadismus" O y e r z j e r (1)] bezeichnen kann. Die Worte ,,Aplasie" und ,,Agenesie' sollte man in diesem Zusammenhang besser vermeiden, da sie für ganz verschiedene Zustände gebraucht werden, was verwirrt und die Verständigung erschwert.Der Defekt ist charakterisiert durch das F e h 1 e n d e r Keimdrüse und auch der Ausführungsgänge, also der Tuben und des Uterus, wobei das äußere Genitale mehr weiblich als männlich angelegt ist. Sein Vorkommen beim

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Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

1 Thirty pregnant women aged 22-34 yr presenting with pre-eclampsia were treated with guanfacine for periods of 16-68 days. 2 Elevated blood pressure was lowered to a statistically and clinically significantly extent in the first week of treatment, falling almost to normal levels before parturition in 24 cases. Four days after delivery all the patients had normal blood pressures. 3 Oedema (localized or generalized) was not reduced to any extent by guanfacine and additional treatment was necessary in 17 cases. There was little effect on proteinuria. 4 Twenty-five patients reported side-effects attributable to the treatment (sedation in 25 cases, dryness of the mouth in 15, and feelings of dizziness in 6 cases). 5 No notable changes were observed in either foetal or maternal heart rate during the period of treatment. Of the 30 deliveries, 19 were spontaneous, 5 by vacuum extraction, and 6 were by Caesarean section because of suspected placental insufficiency. Six of the infants were 'small-for-date babies', but all developed normally later. March 1977 and February 1978, 30 pregnant women aged 22-34 yr suffering from preeclampsia were treated with guanfacine at Kiel University Women's Hospital. The purpose of the trial was explained to the patients, who gave their consent to participate. Ten were nulliparae, twelve were primiparae and eight multiparae. The purpose of the trial was to determine whether the use of guanfacine would reduce the incidence of surgical delivery and/or neonatal morbidity. In addition observations were made regarding the efficiacy and safety of the drug and its interaction with other medication affecting the principal obstetric parameters. The total observation period comprised an antepartum phase of maximum 10, minimum 4 weeks, the period of delivery and hospital confinement (1-2 weeks), and a follow-up phase of 2-8 weeks' duration after the patient's discharge from hospital. The whole period of observation thus ranged from 14-20 weeks, during which time the relevant data were recorded at the following stages: (a) baseline data at entry into trial; (b) checks at intervals until delivery; (c) observations on the course of labour and examination of infant; (d) observations on the course of the postpartum period and checks following discharge and observations on the early development of infant. Methods BETWEENGuanfacine was given in the form of tablets of I mg, the starting dose being 1 tablet twice daily. This was later increased on an individual basis up to a maximum of 6 mg daily.The following clinical information and history were recorded: age at menarche, regularity of menstruation, number of previous deliveries and abortions, time of last menses, probable date of delivery, measurement of circumference of abdomen, pelvimetry, foetal heart rate, symptoms of preeclampsia (oedema, proteinuria, hypertension), cervical score, amnioscopy, ultrasound, documentation of the course of delivery including all the usual obstetric parameters, morphological examination of the placenta, and the record...

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By electron microscopical investigations on the cylindrical epithelium of the human cervix uteri there can be shown that the regeneration of the endocervical epithelium takes place from bipotent reserve cells, which are of fetal origin, lying in the basal layer of the epithelium. These cells are able for mitosis even in postnatal life. The reserve cells differentiate if necessary to squamous cells or secretory cells by forming typical cell organelles. There is a discussion about the question whether the reserve cells are persisting elements from fetal life or whether the numeral balance of the endocervical epithelium is kept by permanent mitosis.

Hospice care, the origin and growth of which are described, now has its own regimen and philosophy of care. Elements in this were believed to be contrary to Rabbinic prescriptions for the care of the dying, particularly the duty to sustain hope. A philosophical study shows that the practice and Rabbinic principles are not necessarily contradictory. Beliefs about life, death and dying in Eastern religions, and in Christianity, are outlined to show that these too are compatible with the goals and methods of hospice care.Les soins d'hospices, dont l'origine et le développement sont décrits, possèdent & a g r a v e ; present leur propres thérapeutiques et philosophie de soins. Certains points de celles-ci étaient soupçonnés d' être contraires aux prescriptions rabbiniques concernant les soins aux mourants, en particulier le devoir d'entretenir l'espoir. Une étude philosophique révèle que la pratique et les principes rabbiniques ne sont pas forcément opposés. Les grandes lignes des convictions concernant la vie, la mort et le décès dans les religions orientales et dans le christianisme sont tracees pour montrer que celles-ci sont également compatibles avec les buts et les méthodes des soins d'hospices.