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Biomedical subjects

A Funk

Publications and source records attributed to A Funk.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

[Significance of detecting impaired uteroplacental perfusion for diagnosis of antiphospholipid antibody syndrome--a case report].

INTRODUCTION: The antiphospholipid antibody syndrome (APA) is a potentially life-threatening disease in pregnancy, associated with spontaneous abortion, intrauterine growth retardation (IUGR), preeclampsia and foetal death in utero. One of the sequelae of the antiphospholipid-antibodies is an impaired uteroplacental circulation. We present a case where we diagnosed an antiphospholipid antibody syndrome (APA) on the basis of a highly pathological Doppler flow in both uterine arteries. CASE REPORT: A 35-year-old G2P0 with a history of intrauterine foetal death in the 24th week was seen at 15 weeks in her second pregnancy for an ultrasound scan. The Doppler study of both uterine arteries showed highly pathological resistance indices and bilateral notching. Laboratory studies revealed elevated levels of antibodies against Cardiolipin and phospholipids. Therapy trials with low-dose aspirin, heparin, corticosteroids, hemodilution therapy and immunoglobulin remained unsuccessful. The foetus developed severe IUGR, anhydramnios and foetal distress. In the 26th week the parents insisted on a caesarean section because of a pathological heart rate pattern. The birth weight was 365 grams and the infant died immediately. DISCUSSION: There are several mechanisms which impair the uteroplacental circulation in an APA syndrome. Therefore it is essential to perform laboratory tests when detecting a pathological blood flow in both uterine arteries. In this case all therapies failed, and the preterm infant died due to severe IUGR and distress. The diagnosis, however, facilitated the introduction of early anticoagulation therapy for the mother, the exclusion of systemic lupus erythematodes and the counselling of the parents with regard to further pregnancies.

Antiphospholipid Syndrome↗
PubMedDate not supplied

[Prune belly syndrome--diagnosis and therapeutic possibilities].

The Prune Belly Syndrome combines dilation of the bladder and a laxity of the abdominal wall, and is of unknown etiology. The sequelae are a pulmonary hypoplasia and a deterioration of the kidney function, which determine prognosis. Via early ultrasound diagnosis, intrauterine application of a vesico-amniotic shunt can be performed and can improve survival rates. Inclusion criteria for a vesicoamniotic shunt are a lack of further sonomorphological abnormalities, a lack of an indication for an alteration of the kidney function by ultrasound or laboratory tests, and a normal karyotype.

Catheters, Indwelling↗
PubMedDate not supplied

[Transvaginal Doppler ultrasonographic patterns of total uterine perfusion in the development of utero-placental insufficiency with pre-eclampsia].

In the case reported pathological flow velocity was detected by means of transvaginal Doppler imaging from the 7th week onwards. In correlation with pathological flow patterns placental insufficiency with pre-eclampsia developed later in the pregnancy. In the 29th week caesarean section became necessary because of a severe hypertensive crisis and pathological CTG's.

Adult↗
PubMedDate not supplied

[Cerebral blood flow during labor].

The successful results obtained using Doppler sonography for antepartal diagnosis gave cause to use the method during labor. For this purpose doppler measurements of the intern fetal carotid artery of a group of 7 patients with normal course of pregnancy were made and a continuous direct CTG was recorded simultaneously. The Doppler parameter, the S/D-ratio, for the contraction phases were compared with those of the contraction--free phases. During the contraction phase the S/D-ratio was higher than during the relaxation period of the uterus. The difference between these values were proved to be statistically significant. A comparison of the doppler parameter of the patients at onset of labor and the patients at the end of labor showed, that the S/D-ratio increased significantly at the end of labor. This result demonstrates, that the intravascular resistance in the fetal carotid artery increased due to the cephalic pressure.

Blood Flow Velocity↗
PubMedDate not supplied

[Transvaginal sonography: the differential diagnostic significance of the secondary vitelline sac in early pregnancy].

In the study reported here, yolk sac size and vertex-breech length were determined by transvaginal sonography, in addition to other parameters relevant to early pregnancy. Vital pregnancy was found without abortion symptoms in 72 cases, and with these symptoms in 35 cases; in 29 cases a missed abortion was found. The secondary yolk sac, which was detectable and measurable in 95 of 107 vital early pregnancies, showed constant growth from the fifth (diameter 3.9 mm) to the twelfth completed gestational week p.m. (diameter 6.5 mm). From the tenth completed gestational week p.m. onward, the yolk sac was not always detectable. Of the yolks sacs in the group of missed abortions, seven were found to be too small and 15 rudimentary. The correlation coefficients determined between yolk sac size and gestational age on the one hand and vertex-breech length on the other indicate that there is a significant relationship between the development of the yolk sac and that of the embryo up to the tenth completed gestational week p.m. Where a normally developed secondary vitelline sac is sonographically detected up to the tenth gestational week, the prognosis may be regarded as good. However, any finding which deviates from the norm must be verified, and the prognosis must be considered poor even when a living embryo is detected.

Abortion, Missed↗
PubMedDate not supplied

[Improved diagnosis of extrauterine pregnancy by endosonography].

Between July 1987 and January 1988, 44 patients with a tentative diagnosis of ectopic pregnancy underwent sonographic examination by means of vaginal probe at the Department of Gynecology and Obstetrics of the RWTH Aachen. The sonographic findings, all of which were confirmed by subsequent clinical and or surgical clarification, were as follows: an ectopic pregnancy was diganosed in 16 cases, an early intrauterine pregnancy in seven, an intrauterine abortion in seven, and in one case a uterine malformation-a dermoid cyst and a functional cyst. In 11 cases sonographic examination showed the interior genital region to be normal, with no sign of pregnancy. In the 16 ectopic pregnancies diagnosed, it was possible in 13 cases to visualize the pregnancy directly by sonography, including the amniotic sac, and to make measurements. In one case a normally developed ectopic pregnancy with living embryo was seen at the end of the seventh week of gestation post menstruationem. In the remaining three cases the diagnosis was established on the basis of an empty cavum uteri associated with a slightly enlarged uterus and demonstration of fluid in the pouch of Douglas. In two cases the ectopic pregnancy was correctly localized by "feeling" with the intravaginal probe to establish the cause of circumscribed pain. In three case the tentative diagnosis of an ectopic pregnancy made on the basis of sonographic findings was not confirmed by subsequent clarification procedures. The results described show that in most cases ectopic pregnancies can be demonstrated directly by sonography using an intravaginal probe.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMedDate not supplied

[Sampling of the chorionic villi: transcervical fine-needle and endoscopic aspiration].

In 63 cases chorionic villi sampling has been performed under complete anesthesia just before legal abortion; nine of them were endoscopic transcervical and 54 transcervical by means of a catheter under direct ultrasonic control. 81% offered useful chorionic villi, 17.4% only decidual material. The last 21 aspirations by means of a catheter between the 8th and the 12th week of gestation (p.m.) caused no problem at all. From the first punction on useful chorionic material has been obtained.

Abortion, Legal↗
PubMedDate not supplied

[Ultrasound echographic imaging and measurement of the amniotic cavity and yolk sac in early pregnancy: comparative study of intact and disordered pregnancies].

The chorionic cavity, vertex-breech length, yolk sac, and amnion were systematically demonstrated and measured in 50 early pregnancies, i.e., between the end of the sixth and the tenth week of gestation post menstruationem (p.m.). This was done in 23 cases with clinically and sonographically intact pregnancies without symptoms of abortion, in 12 cases with living embryos with symptoms of abortion, and in 15 cases of retained miscarriage. The thin amniotic membrane is sonographically demonstrated as a narrow, sharply defined reflected band in the chorionic cavity. In addition to direct demonstration of the amniotic membrane, the amniotic cavity can be demonstrated by a density difference in the echogenicity of the chorionic and amniotic fluids. While there are delicate, homogenously distributed inner echoes in the chorionic cavity, the amniotic cavity is empty save for the embryo structure. Sonographically, therefore, the amniotic cavity stands out as a spherical structure within the chorionic cavity. In all pregnancies with a living embryo it was possible to demonstrate the yolk sac sonographically as a sharply defined ring structure in the chorionic cavity. In 10 of the 15 cases of retained miscarriage only a rudimentary remnant of the yolk sac could be detected. The development of the amniotic and chorionic cavities and vertex-breech length was constant in the pregnancies with living embryos, the amnion developing synchronously with the vertex-breech length.(ABSTRACT TRUNCATED AT 250 WORDS)

Amnion↗
PubMedDate not supplied

[Non-invasive diagnosis of pre- and postpartum urination disorders].

Postpartal disorders of urinary discharge due to birth trauma are frequently the cause of rising infections of the urinary tract during the puerperium. In diagnosis, noninvasive methods should be preferred. Bladder-emptying function was checked by means of uroflowmetry and sonographic measurement of residual urine in 83 patients at the Department of Gynecology and Obstetrics at the RWTH, Aachen, in the third trimester and post partum. A considerable restriction of urine flow was found both prepartally as well as on the third day post partum. In contrast, there was practically no disturbance of bladder emptying on the sixth day post partum. This function is restored more quickly in cases of cesarean section than in cases of vaginal delivery. As early as the third day post partum no further influence of subpartal analgesia could be demonstrated. The findings failed to show any difference between the group with vaginal/surgical delivery and that with spontaneous birth. Generous use of these noninvasive diagnostic methods to identify postpartal micturition disorders can be recommended.

Cesarean Section↗
PubMedDate not supplied

[Ultrasonic diagnosis of congenital uterine abnormalities].

1-2% of women has abnormal uterine development due to nonunification of the Müllerian ducts in the embryonal period. At the RWTH Aachen, in the department of gynaecology and obstetrics, between January and June 1987, we had searched systematically for maldevelopment of the uterus in 2299 echosonografies. In 13 cases we found maldevelopment of internal genital; 5 of these cases were diagnosed by an echosonografic routine-examination. The echografic criteria of the different grades of uterine malformations have been determined, systematized and discussed in relation to the symptoms. The most frequent malformations as uterus subseptus, uterus septus, uterus bicornis and uterus duplex are subject of a detailed discussion. This work demonstrates that echosonografic is a very efficient instrument to diagnose uterine malformations and gives us a very exact anatomic interpretation of malformations.

Abortion, Incomplete↗
PubMedDate not supplied

[Initial studies of 3-dimensional imaging using ultrasound].

In the study reported here three-dimensional sonographic imaging of organs was achieved for the first time. To make this possible it was first necessary to ensure, by appropriate guidance of the probe, that the sequence of sonographic sections was coordinated in their spatial arrangement. This was accomplished by constructing a probe guide with which parallel sonographic sections could be demonstrated. The distance between these sections was known, so that with the aid of suitable computer programs three-dimensional reconstruction of a kidney examined in a water bath was possible. Since, however, due to the uneven surface of the body, it will hardly be possible to obtain parallel sonographic sections of an organ, a new solution had to be found to ensure the necessary coordinated sequence of sections. The solution lay in rotating the probe. A further device was constructed in which the probe could be rotated farther, by known angles, from section to section. The pivotal point was at the center of the probe tip. The computer knew the angular distance between these sections and reconstruction to a three-dimensional image was therefore possible. Prior the three-dimensional reconstruction the ultrasonographic sections had to be contoured, since only the surface of the organ was available for three-dimensional image construction. Three-dimensional imaging of an organ can be achieved on the one hand by binary representation and on the other with a continuous organ surface. The advantage of binary representation is that the original sonographic data are incorporated in the image-producing process without any computer manipulation; with a continuous surface the distance between the individual sections has to be interpolated.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗
PubMedDate not supplied

[Transvaginal Doppler ultrasound in early pregnancy--normal values and comparison with a risk sample with threatened abortion].

In the study introduced here, norm values for embryo-feto-placental circulation are illustrated. The values were gained by examining 75 singleton pregnancies of uncomplicated course and ending with non-problematic birth of an eutrophic child. In addition to qualitative parameters such as A/B-ratio and Pulsatility Index, the maximum systolic frequency shift was measured by transvaginal Doppler sonography between the fifth and 24th week of gestation (post menstruation), to obtain another quantitative parameter. The increasing circulation can be impressively visualized by viewing the corresponding norm value curves. This is valid for both the embryo-fetal as well as maternal side of the placenta. Over the same time period, 53 high-risk pregnancies with symptoms of premature labor were followed to enable comparison with the circulatory changes in normal pregnancy. It was not possible to differentiate normal and abnormal pregnancy regarding premature labor by examining the utero-feto-placental unit with transvaginal Doppler sonography. In direct comparison, the Doppler values showed no significant differences. The norm curves introduced in this study should be considered as a basis to evaluate the utero-feto-placental circulatory system using Doppler sonography and be of use to differentiate abnormal changes of perfusion during the course of pregnancy, soby making it possible to recognize a pregnancy at risk early on.

Abortion, Threatened↗
PubMedDate not supplied

[Doppler ultrasound studies of venous retrograde flow in precardiac veins of the fetus in normal and abnormal pregnancies].

Precardiac venous blood flow, umbilical artery and aortal blood flow of 120 unselected patients has been investigated by means of Doppler ultrasound. Measuring a hepatic vein directly before entering the inferior vena cava we found a characteristic blood flow pattern with a moderate foreward flow during systole and a small foreward flow during early diastole and a very small reverse flow because of atrial contraction during late diastole. We found changes in this flow pattern with reduction of the mean velocity in cases of high risk pregnancies with intrauterine growth retardation. Comparing normally developed fetuses with growth-retarded fetuses and vaginal delivery or caesarean sections without fetal distress with caesarean sections because of fetal distress we found significant differences with lower mean velocities in the precardiac veins of the latters. Comparing the precardiac venous flow velocities with the umbilical artery flow velocities and the fetal descending aortal flow velocities we found similar results of statistical values predicting growth retardation and caesarean section because of fetal distress. We concluded that venous Doppler flow velocity analysis is also able to predict perinatal risks like intrauterine growth retardation or caesarean section because of fetal distress as good as flow velocimetry of the umbilical artery or the fetal aorta; if it is impossible to demonstrate the fetal descending aorta or the vena cava inferior sonographically correctly the investigation of the hepatic vein may give you more reliable Doppler values for your clinical management.

Adult↗
PubMedDate not supplied

[The importance of measuring both umbilical arteries for accuracy in Doppler ultrasound studies].

In a quarter of our Doppler investigations differences between the S/D-ratios of the arteries of one umbilical cord were more than 20%. In these cases one Doppler value was decided to be normal and the other to be pathological. In cases with two pathological values most caesarean sections because of fetal distress had to be performed and most SGA babies were born. There were relatively more caesarean sections and SGA babies in cases with one normal value and one pathological value than in cases with two normal Doppler values. Sensitivity and specificity of perinatal risks like intrauterine growth retardation or caesarean section because of fetal distress were different depending on which Doppler value was used to calculate these statistical parameters. Taking always the better values compared to the worse ones we found as greatest difference 20.0% for sensitivities and 24.1% for specificities. Taking the means of the better and the worse Doppler values we found as greatest difference 5.6% for sensitivities and 8.7% for specificities compared to the cases with two identical Doppler results. To decide whether the fetus is jeopardized and to describe the nutritional function of the placenta correctly by means of Doppler ultrasound of the umbilical artery we conclude that in some cases the investigation of both arteries is important to avoid false positive or false negative results.

Blood Flow Velocity↗
PubMedDate not supplied

[The value of Doppler ultrasound studies in threatened premature labor].

95 patients were investigated using Doppler ultrasound to evaluate its usefulness during the clinical management of patients with preterm labor, preterm rupture of membranes and incompetent cervix. Cases with additional pregnancy complications as preeclampsia or intrauterine growth retardation or infection of the amnion or the birth canal were excluded from our study. We examined the umbilical artery and the uterine arteries. Predicting preterm birth we found a sensitivity of 31.4% and a specificity of 70% for the former and a sensitivity of 34.3% and a specificity of 83.3% for the latter. As a result of our investigation we have to conclude that Doppler ultrasound is not able to predict sufficiently reliable preterm birth to use it in clinical management. Normal uterine blood flow in cases with preterm labor seems to indicate birth at term in a high degree.

Adult↗