Biomedical subjects
Publications and source records attributed to A Rempen.
A chronic tuboovarian abscess with vaginal fistula occurring after vaginal hysterectomy was removed laparoscopically. The fistula was closed by a combined laparoscopic-vaginal procedure. A complete cure was achieved without complications.
The concentration of total cathepsin D in tumor cytosol was measured in 300 patients with primary breast cancer treated at the Women's University Hospital in Würzburg between 10/86 and 9/92. Patients were followed for a median of 28 months. The level of cathepsin D was correlated with estrogen receptor status and tumor size but seemed to be independent of progesterone receptor status, histological grading, patient's age, axillary lymph node involvement and primary distant metastases. Overall survival, disease-free survival and metastases-free survival did not differ between patients with cathepsin D-levels above the median value of 47 pmol/mg of protein and patients with cathepsin D-concentration below 47 pmol/mg. Patients with node-negative disease and low cathepsin D-levels (< or = 47 pmol/mg) had a longer disease-free survival than those with cathepsin D-concentration > 47 pmol/mg (p < 0.05). Our findings could not confirm cathepsin D as a useful additional prognostic marker in all breast cancer patients. In the low-risk collective the measurement of total cathepsin D may be significant by isolating subgroups with a poorer prognosis who might benefit from adjuvant therapy.
Six consecutive patients with sactosalpinx after preceding hysterectomy were treated by laparoscopic surgery and the outcome was analysed. Irrespective of extensive intraabdominal adhesions the operation could be completed by laparoscopy and the sactosalpinx was successfully removed in all cases. No complications were observed. Operative laparoscopy may be an adequate procedure to remove a sactosalpinx after antecedent hysterectomy.
The pressure exerted on the foetal head was continuously measured with a specially designed instrument in 4 children delivered by vacuum extraction because of arrested delivery. The results were compared with the values obtained in spontaneous deliveries. Lower head pressure values were found in the vacuum group, with a head pressure to amniotic pressure ratio < 1 (normal > 1) before application of the cup. During extraction the head pressure exceeded the intraamniotic pressure. Normal progress of labour requires not only sufficient intrauterine pressure but also an adequate pressure transmission to the presenting part that must widen the birth canal. A prolonged course of labour may therefore be associated with increased pressure values due to elevated resistance of the birth canal as well as with decreased pressure values due to insufficient transmission of pressure. Hence, the load of the foetal head during uterine contraction cannot be determined from the duration of birth.
Benign dermoid cysts between 1.5 and 6 cm in diameter were laparoscopically removed in 9 premenopausal women. Cystectomy was performed in eight patients, and unilateral oophorectomy in one. Surgical and postoperative complications were not observed. Chemical peritonitis due to the dermoid contents can be avoided, provided, careful lavage of the peritoneal cavity is performed.
Explore the source record for details and available documents.
The spontaneous abortion rate in singleton pregnancies with sonographically proven heart activity between 5 and 13 weeks was analysed. Up to 15 weeks 8.6% of 395 patients miscarried. The abortion rate was higher in pregnancies with a gestational age < 9 weeks (12.5%), a maternal age > or = 35 years (15.5%) and vaginal bleeding (16.3%). The correlation of the abortion rate with these factors has to be taken into account when the prognosis of an individual gestation or the risk of invasive procedures is determined.
The concentration of total cathepsin D, which is regarded as an additional prognostic factor, was measured in 87 patients with primary breast cancer by a radioimmunoassay in tumour cytosol. The distribution of values was approximately log normal with a median value of 49 pmol/mg protein. Relating the level of cathepsin D to other prognostic factors, no significant association to the patients' age, menopausal status, tumour size, axillary lymph node involvement, distant metastases, type of tumour, histological grading or hormone receptor status could be established. Therefore, cathepsin D seems to be independent from other established prognostic criteria, which is a prerequisite for this protease to be useful as an additional prognostic marker.
To study the pressure to which the fetal head is exposed during the second stage of labor, an instrument was designed to measure continuously the pressure between the presenting part and the birth canal on both sides of the fetal head. Pressure parameters during and between the uterine contractions were calculated from 42 spontaneous vertex deliveries presenting as occiput anterior. During the second stage the overall average of the mean maximum head pressure during uterine contraction was 31.8 +/- 11.0 kPa, that of the mean head pressure measured 13.3 +/- 4.8 kPa during uterine contraction and 5.5 +/- 3.7 kPa during the interval between contractions. The pressure on the fetal head was about twice as high as the amniotic pressure. It increased towards the end of labor. The objective measurement of fetal head pressure is the prerequisite in the study of the relationship between birth-related injuries and excessive head compression during parturition.
The pressure recordings from both parietal regions of the fetal head during the second stage of labor of 44 spontaneous deliveries with vertex presentation were evaluated and compared to the simultaneously recorded pressures in the amniotic cavity by calculating pressure parameters during and between uterine contractions. Analysis of the bearing down period revealed on the average higher values at the anterior side in comparison to the posterior side of the skull. This is explained by the complex anatomy of the curved birth canal. Overall, the head pressure values averaged from the recordings of both parietal regions were about twice as high as the corresponding amniotic pressure values. During the descend of the head through the birth canal, an increase of pressure on the fetal head was observed that is mainly due to the rising resistance of the narrowing pelvis and stretched tissue of the passageway. A marked interindividual deviation of head pressure was found that was independent from amniotic pressure variations thus preventing indirect deduction of head strain from internal togography.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The detection rate of embryonic heart action using vaginal sonography was evaluated in 363 normal singleton pregnancies in the first trimester. Visible cardiac activity was present at the earliest at a gestational age of 40 days; in addition, the smallest chorionic cavity had a mean diameter of 9.3 mm, the lowest human chorionic gonadotropin (beta-hCG) concentration (calibrated against the first international reference preparation) measured 6,770 mIU/mL, the thinnest trophoblast was 1 mm, and the shortest crown-rump length was 2 mm. Cardiac pulsations were identified in all cases either at a menstrual age greater than or equal to 46 days, a beta-hCG greater than or equal to 47,171 mIU/mL, a mean chorionic cavity diameter greater than or equal to 18.3 mm, or a trophoblast thickness greater than or equal to 5 mm. The heart rate (mean +/- SD) increased from 110 +/- 8 beats per minute (bpm) at 5 weeks menstrual age to 170 +/- 6 bpm at 9 weeks and declined thereafter to 159 +/- 3 bpm at 13 weeks. Vaginal sonography enables a rapid and reliable assessment of embryonic life in early pregnancy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The detection rate and size of the yolk sac were evaluated by means of vaginal sonography in a prospective study in 377 singleton pregnancies. 298 were normal pregnancies and 79 were spontaneous abortions, the latter of which were viable in 18 cases at the time of examination and non-viable in 61 cases. With a reliable gestational age between 5 and 10 weeks, the yolk sac was recognized in 158 of 172 normal pregnancies (91.9%), in all 14 viable but later aborted pregnancies, but only in 10 of 29 non-viable pregnancies (34.5%) (p less than 0.0000005). With a mean diameter of the chorionic cavity between 5 and 50 mm, the yolk sac was identified in 237 of 253 normal gestations (93.7%), in 16 of 18 viable but later aborted gestations (88.9%), but only in 14 of 41 non-viable gestations (34.1%) (p less than 0.0000001). A diameter of the yolk sac above 6 mm was observed in 5 of 253 normal pregnancies (2.0%), but in 7 of 29 spontaneous abortions (24.1%) (p less than 0.00005). A diameter above 7 mm was not seen in any instance of normal development but in 4 of the pathological courses (13.8%) (p less than 0.0001). It is concluded, that a yolk sac which is not visible in vaginal sonography between 5 and 10 complete weeks menstrual age or a chorionic cavity diameter between 5 and 50 mm and a yolk sac diameter above 6 mm can serve as indicators of a developmental disturbance in early pregnancy.
Among 404 first-trimester pregnancies examined with vaginal sonography in a prospective study, there were 21 ectopic gestations. Considering only the initial scans, the endometrial canal showed a linear echo surrounded by an echogenic zone in 18 cases, but in three cases the uterine cavity demonstrated a small echo-free area representing blood. Free fluid within the cul-de-sac was seen in 17 patients. An adnexal tumor representing the extrauterine gestation, was detected in 19 cases. Fifteen of these masses exhibited a thick-walled ring characteristic of a gestational sac with a viable embryo in five cases and a yolk sac in one. Other cystic adnexal masses, such as corpus luteum cysts, seen in 14 of the 21 patients were not confused with the ectopic pregnancy. A correct tentative diagnosis of ectopic gestation was made in 18 patients (86%) after the initial scan and in 20 cases (95%) including four controls. There was one false-positive suspicion of ectopic gestation in a patient who actually had a spontaneous abortion. Interpretation of the sonographic image should generally be done in correlation with laboratory and clinical data. The results of the study indicate that vaginal sonography is a valuable diagnostic procedure in the evaluation for ectopic pregnancy.