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Biomedical subjects

A Huch

Publications and source records attributed to A Huch.

At least 37 records · Page 2Linked to original sources
PubMed2000

Dandy-walker malformation: prenatal diagnosis and outcome.

Prenatal ultrasound identified Dandy-Walker malformation (DWM) in ten singleton pregnancies with concurrent central nervous system (CNS) anomalies and extra-CNS anomalies in eight cases. DWM was confirmed by postnatal magnetic resonance imaging (MRI) or pathological examination in nine cases. Karyotypes were normal in the seven infants tested. Postnatal neurological and developmental testing in the five survivors showed a spectrum of clinical outcome from minor defects to severe handicap. Postnatal investigation also disclosed additional CNS and extra-CNS findings not detected on ultrasound, as did autopsy in the other five infants. However, ultrasound diagnosis of DWM is accurate and is an indication for exhaustive screening for concurrent anomalies both within and outside the CNS and in chromosome structure and number, as the prognosis is heavily dependent on associated malformations and karyotype.

Adult↗
PubMed2000

Intraoperative endogenous erythropoietin levels and changes in intravascular blood volume in healthy humans.

There is accumulating evidence of a relationship between changes in intravascular blood volume and endogenous erythropoietin (EPO) levels. In this study, eight healthy adult American Society of Anesthesiologists class-I patients due for prolonged elective surgery were randomised either to preoperative hypervolaemic haemodilution using hydroxyethyl starch, followed by intraoperative crystalloid infusion, or to standard intraoperative normovolaemic fluid balance management using crystalloids (control group). Electrolytes, creatinine, urea, osmolality, urine output and blood gases were monitored pre- and intraoperatively for 6 h, Comparable cardiopulmonary and renal homeostasis were maintained in both groups. We found that central venous pressure increased and EPO levels decreased, both significantly, in the hypervolaemic haemodilution group relative to controls. There were no significant intergroup changes in any other parameters. By controlling for other known determinants of EPO levels, our data indicate a relationship between EPO levels and changes in intravascular blood volume in humans, supporting the notion of EPO as a volume-regulated, and possibly volume-regulating, hormone.

Adult↗
PubMed2000

Effectiveness of recombinant erythropoietin and iron sucrose vs. iron therapy only, in patients with postpartum anaemia and blunted erythropoiesis.

BACKGROUND: To compare efficacy between recombinant human erythropoietin (rhEPO) plus parenteral iron vs. iron alone (parenteral vs. oral) in postpartum anaemia. METHODS: Sixty patients (haemoglobin 8.6 +/- 1.1 g dL-1) were randomized to rhEPO plus intravenous (i.v.) iron sucrose (group 1), rhEPO placebo plus i.v. iron sucrose (group 2), or oral iron alone (group 3), daily for 4 days beginning 48-72 h postpartum. Erythropoiesis and iron status were assessed before, and on 4, 7 and 14 days after, starting therapy. RESULTS: On day 7 the group 1 haematocrit increase was 7.7 +/- 3.1% vs. 5.3 +/- 1.9% (group 2, P < 0.01) and 4.4 +/- 3.2% (group 3, P < 0.01), and on day 14, 11.3 +/- 2.9% vs. 9.2 +/- 3.4% (group 2, P < 0.05) and 8 +/- 2.8% (group 3, P < 0.01). The odds of achieving a target haematocrit > 32% on day 7 and > 35% on day 14 were higher on rhEPO (1.5-2.7) than on either iron regimen alone. Group 1 reticulocyte counts were also higher on days 4 (P < 0.05 vs. oral iron) and 7 (P < 0.01 vs. oral and parenteral iron). CONCLUSION: All three regimens were effective in postpartum anaemia, but the haematocrit and reticulocyte responses to rhEPO plus parenteral iron were significantly greater than to iron alone. Benefit was greatest in the blunted erythropoiesis subgroup with elevated post-Caesarean section C-reactive protein levels.

Anemia↗
PubMed2000

[Prenatal ultrasonography in Switzerland--a repersentative national survey] .

BACKGROUND: The cost-effectiveness ratio of routine ultrasound during pregnancy has been debated for years. However, there is a lack of population based data concerning both costs and benefit. AIM: Population based survey of ultrasound examinations (US) during pregnancy in Switzerland with respect to quantity, indications and results; estimation of total costs, the proportion paid by health insurance and the costs for routine US. METHOD: During a representative week all certified physicians and obstetrical out-patient departments in Switzerland were asked to participate in an anonymous questionnaire based national survey on the use of ultrasound during pregnancy. RESULTS: With 62.9% of the physicians and 90.6% of the out-patient departments participating a total of 6455 questionnaires were returned. On average, 4.6 US were done per pregnancy or about 520,000 scans per year. At a mean price of $ 50 per scan total costs equalied $ 26 million a year. $ 19.5 million were covered by health insurance and the rest was not billed by the physicians. The indication for the scan was a medical problem in 48%, a routine scan in 36.9% of cases a first and a second trimester scan is paid for and in 15.1% reassurance of either the women or the physician. Abnormal results were found in 40.7% of medical indications, in 15% of routine scans and in 12.6% of reassurance cases. CONCLUSION: The considerable number of scans done for reasons of reassurance and not changed for does support our hypothesis that ultrasound during pregnancy has become a tool to routinely check the general state of the fetus comparable to the stethoscope of the general practitioner. One in seven US yielded a pathological result. Maximal cost savings for the health insurance amount to about 9 million a year. This amount has to be balanced by the health benefit, respectively if routine US were abolished.

Cost-Benefit Analysis↗
PubMed1999

Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study.

OBJECTIVE: To evaluate whether measuring fasting plasma glucose concentration is an easier screening procedure for gestational diabetes mellitus than the 1 hour 50 g glucose challenge test. DESIGN: Prospective population based study. SETTING: Outpatient clinic in a university hospital. PARTICIPANTS: 520 pregnant women (328 (63%) white, 99 (19%) Asian, 31 (6%) African, 62 (12%) others) with mean age 28.4 (SD 0.2; range 17-45) years. All underwent a glucose challenge test between the 24th and 28th gestational week, followed by a diagnostic 3 hour 100 g oral glucose tolerance test within one week. This was done irrespective of the result of the challenge test. MAIN OUTCOME MEASURE: Receiver operating curves were used to determine the best cut off values for screening with fasting plasma glucose concentrations. RESULTS: Fasting plasma glucose concentration at a threshold value of 4.8 mmol/l and the glucose challenge test with a threshold value of 7.8 mmol/l yielded sensitivities of 81% and 59% respectively and specificities of 76% and 91% respectively. Measuring fasting plasma glucose concentration as a screening procedure required a diagnostic test in 30%, compared with 14% when the challenge test was used. CONCLUSIONS: Measuring fasting plasma glucose concentrations using a cut off value of >/=4. 8 mmol/l is an easier screening procedure for gestational diabetes than the 50 g glucose challenge test and allows 70% of women to avoid the challenge test.

Adolescent↗
PubMed1999

[Ureteral stent placement in hydronephrosis during pregnancy].

In this study we describe 22 cases of retrograde ureteral stent placement in pregnant women with therapy-resistant flank pain due to hydronephrosis. Eleven were primiparous and one patient expected twins. Eight of 22 patients presented symptoms of pyelonephritis. In 21 cases the hydronephrosis was located on the right and in 4 cases it was bilateral. Maximal lower calix diameter was 12 mm (range 9-22 mm). With the exception of two cases, sonographically controlled stent placement was performed under local anesthesia without sedation. All patients were painfree within 6 days and were given prophylactic low doses of antibiotic until the day of delivery. Renal function remained within the normal limits. Double-J stent displacement occurred in 3 patients - of which one underwent nephrostomy. Postnatal examination demonstrated urolithiasis in 4 of 19 patients. This study provides evidence for effectiveness of retrograde ureteral Double-J stent placement as a therapeutic option in cases of severe symptomatic hydronephrosis during pregnancy with a low morbidity rate.

Adult↗
PubMed1999

Failure to demonstrate postpartum functional iron deficiency using quantitative red blood cell analysis.

OBJECTIVE: The aim of this prospective study was to assess erythropoiesis and test for functional iron deficiency in the postpartum period using quantitative red blood cell analysis. STUDY DESIGN: Parameters were determined on admission for delivery and postpartum from 82 obstetric patients at Zurich University Hospital: full blood count, hypochromic and microcytic red cells, reticulocyte count (including subsets), reticulocyte mean corpuscular volume, reticulocyte mean hemoglobin content and reticulocyte mean corpuscular hemoglobin concentration. RESULTS: Microcytic cells increased from 0.9% prepartum to 1.4% on day 42 postpartum; hypochromic cells decreased from 4.3 to 1.9%; reticulocyte mean corpuscular volume decreased from 134 to 125 fl; reticulocyte mean hemoglobin content was unchanged. CONCLUSION: To our knowledge, this is the first medium scale application of quantitative red blood cell analysis to normal pre- and postpartum women. Our data show no evidence of functional iron deficiency or increased erythropoiesis in the postpartum period.

Adult↗
PubMed1999

Use of 3D ultrasound as a new approach to assess obstetrical trauma to the pelvic floor.

OBJECTIVE: To determine whether 3D ultrasound examination of pelvic floor anatomy after vaginal delivery allows detection of childbirth trauma. STUDY DESIGN: Pelvic floor anatomy was examined in 16 women during the puerperium with a 3D transrectal ultrasound probe. Images were acquired via the vaginal route for the assessment of anal morphology and the transrectal route to determine paravaginal fixation. Images of the anterior pelvic floor were calculated from the information stored in the volume block. Paravaginal defect is defined as a descent of the lateral vaginal wall below the suburethral vagina, whereas sphincter defects are characterised as thinning, or as gap formation of the anterior part of the internal anal sphincter. RESULTS: This new approach allowed the examination of a horizontal plane through the urethra and the periurethral tissue which is inaccessible with 2D ultrasound techniques. Morphology of the normal and traumatised anal sphincter could be demonstrated using reference planes perpendicular to the anal canal. CONCLUSIONS: Whereas in the past, defects of the vaginal attachment to the pelvic side wall could not be examined sonographically, 3D ultrasound can now be used to examine pelvic floor anatomy and to detect changes associated with trauma to the pelvic floor following vaginal delivery.

Fecal Incontinence↗
PubMed1999

Fetal ultrasound biometry: 1. Head reference values.

OBJECTIVE: To create reliable reference ranges and calculate Z scores for fetal head ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy. DESIGN: A prospective, cross-sectional study. SETTING: Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich. SAMPLE: The study data were obtained from 6557 pregnant women. METHODS: Only the first ultrasound examination between 12 and 42 weeks of each fetus with exactly established gestational age was used for analysis. No exclusions were made on the grounds of small-for-date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter. RESULTS: A total of 6217 fetal head biparietal diameters and 5510 occipito-frontal diameters were measured. Both head circumference and cephalic index were derived in 5462 cases where both biparietal diameter and occipito-frontal diameter could be measured on the same fetus. The centile charts, tables and regression formulae for biparietal and occipito-frontal diameters, head circumference and cephalic index are presented. An application to calculate Z scores was developed using Excel (Microsoft Corporation, USA) and macros are presented in detail in the Figure 8 footnote. The comparison of our charts with those of the two most recent studies revealed almost no differences in biparietal diameter centiles. In one publication, occipito-frontal diameter charts, and in another, head circumference charts were different from the current study. CONCLUSIONS: We have presented centile charts, tables and regression formulae for fetal head ultrasound biometry derived from a large and minimally selected sample size in a carefully designed cross-sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented for use in computer-aided evaluation of fetal ultrasound biometry.

Adult↗
PubMed1999

Fetal ultrasound biometry: 2. Abdomen and femur length reference values.

OBJECTIVE: To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy. DESIGN: A prospective, cross-sectional study. SETTING: Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich. SAMPLE: The study data were obtained from 6557 pregnant women. METHODS: Only the first ultrasound examination between 12 and 42 weeks of each fetus with certainly established gestational age was used for analysis. No exclusions were made on the grounds of small-for-date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter. RESULTS: A total of 5807 mean abdominal diameters and abdominal circumferences were derived from fetal transverse and anterio-posterior fetal abdominal diameter measurements. Fetal femur length was measured in 5860 instances. The charts, tables and regression formulae of the biometrical measurements are presented. A comparison of our charts with others showed no significant difference. Only Merz's centiles for abdominal biometry were lower and for femur length higher than ours. An application to calculate Z scores was developed using Excel (Microsoft Corporation, USA); the macros are presented in detail in the Figure 6 footnote. CONCLUSIONS: We have presented centile charts, tables and formulae for fetal abdominal diameter and circumference and femur length derived from a large and minimally selected sample size in a carefully designed cross-sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented to use in computer-aided evaluation of fetal ultrasound biometry.

Abdomen↗
PubMed1999

[LSD and cannabis abuse in early pregnancy with good perinatal outcome. Case report and review of the literature].

This is a case report of a 27-year-old patient who had smoked a joint (cannabis) and 20 cigarettes (tobacco) daily up to the time of a positive pregnancy test at 7 4/7 weeks (p.c.). On day 20 p.c. she had an LSD minitrip. There are reports of chromosome aberrations in in vitro animal studies with LSD. In humans the main consequences are malformations of the fetal extremities and dysplasias of the eye. In both animals and humans cannabis causes changes in dopaminergic activity. Our recommendation was to continue the pregnancy, but to monitor it closely. The patient had a spontaneous term delivery-a lively boy with weight between the 5th and the 50th percentile, length between the 50th and the 90th percentile, normal umbilical arterial and venous pH values, and Apgar scores 7/9/10. There were no visible abnormalities, and behaviour was normal. If it is suspected that a pregnant patient consumes LSD, dysplasias of the fetal skeleton and eye should be checked for. With respect to LSD and to cannabis, too, the intellectual development of the child should be closely followed.

Adult↗
PubMed1998

Reflectance pulse oximetry--principles and obstetric application in the Zurich system.

Transmission and reflectance are the two main modes of pulse oximetry. In obstetrics, due to the absence of a transilluminable fetal part for transmission oximetry, the only feasible option is the reflectance mode, in which sensor and detector are located on the same surface of the body part. However, none of the reflectance pulse oximeters developed for intrapartum use are fully satisfactory, as indicated by the fact that none have entered routine use. We have designed, developed, constructed and tested a reflectance pulse oximeter with the possibility to adjust the electronic circuits and signal processing in order to determine the effects of various parameters on signal amplitude and wave-form and to optimize the sensitivity and spatial arrangement of the optical elements. Following an explanation of the principles of reflectance pulse oximetry, we report our experience with the design, development, construction and field-testing of an in-house reflectance pulse oximetry system for obstetric application.

Adult↗
PubMed1998

Pulsatility index in the fetal anterior tibial artery during the second half of normal pregnancy.

The objective of this prospective study was to establish reference values for the pulsatility index in the fetal anterior tibial artery during the second half of pregnancy. Pulsed Doppler waveform analysis of 203 fetuses at 23-42 weeks of pregnancy was performed, each fetus being examined just once. There were neither fetal nor maternal complications detectable at the time of the examination. In the first 14 fetuses from which recordings were taken, Doppler examination was performed on both fetal legs in order to evaluate systematic differences between the right and left legs. Intraobserver variability was analyzed by repetition of the measurements by the same examiner in the first 130 cases. There was no difference between right and left tibial circulation. The repeatability coefficient, defined as the 95% range for the difference in two repeat measurements, was 1.08. The pulsatility index of the anterior tibial artery (50th centile) increased slightly from 3.29 at 23 weeks of pregnancy to 4.09 at 42 weeks. The 5th and 95th centiles were calculated, as was the 95% confidence interval of the 5th and 95th centiles. Examination of the fetal peripheral circulation during the second half of pregnancy is possible with a high degree of precision. Whether there are changes in peripheral arterial circulation in compromised fetuses remains to be evaluated.

Female↗
PubMed1998

[Effect of continuous intravenous tocolysis with beta 2-mimetics and magnesium sulfate on erythropoietin level].

14 pregnant women receiving continuous intravenous tocolysis for threatened miscarriage were studied for an effect of beta 2-mimetics on erythropoiesis in humans. After tocolytic therapy for 48 h, the hematokrit fell by 14%; conversely erythropoietin levels rose by 88.7%. Increased erythropoiesis was reflected in increased reticulocyte (and reticulocyte subpopulation) counts. There was a significant correlation between cumulative tocolytic dose and erythropoietin elevation at 48 h. The hypervolemia evidenced by the decreased hematocrit was due to the increased oral fluid intake and fluid retention, and was the presumed main cause of the elevated erythropoietin levels. This effect could enhance understanding of the control of erythropoietin secretion. A similar mechanism may account for the increase in erythropoietin levels in pregnancy.

Adult↗