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Biomedical subjects

B K Wittmann

Publications and source records attributed to B K Wittmann.

At least 37 records · Page 2Linked to original sources
PubMed1985

Intrauterine hydrocephalus and ventriculomegaly: associated anomalies and fetal outcome.

Advances in fetal diagnostic techniques have opened many areas to prenatal anatomical scrutiny. Intrauterine hydrocephalus and ventriculomegaly are conditions which are readily diagnosed. Fetal intervention has been undertaken in humans in order to minimize the craniofacial disfigurement and to maximize the growth potential of the brain. To justify such an approach, the significance of all anomalies should be recognized prior to treatment. The authors have reviewed 41 cases of hydrocephalus diagnosed in utero in order to define associated anomalies and patient outcome. 75% of our personal series and 72% of the reviewed literature cases had other anomalies of the central nervous system. Other system malformations, some of which proved fatal, were seen commonly. Prenatal diagnostic techniques did not always reveal these additional problems. The outcome of these pregnancies is not good. Approximately one third of these fetuses have survived to be treated postnatally and to be followed up clinically. Only 7.5% of this series were felt to have attained normal developmental milestones. The remainder of the survivors have various focal and/or global cerebral deficits.

Abnormalities, Multiple↗
PubMed1984

Variant postpartum toxic shock syndrome with probable intrapartum transmission to the neonate.

We report a unique mother-infant pair with variant staphylococcal toxic shock syndrome and probable intrapartum transmission to the neonate. Diagnosis of probable toxic shock was supported by the finding of fever, desquamative skin rash, multi-organ system involvement, and pronounced mucocutaneous manifestations, including strawberry tongue, dermal swelling, pharyngitis, and vulvar edema, although hypotension was absent. Staphylococcus aureus was isolated from the vagina, placenta, chorioamnion, and surface swabs and gastric aspirates of the infant. The isolates produced enterotoxin C but not enterotoxin F, and illness developed in both mother and infant despite preexisting high antibody titers to enterotoxin F and enterotoxin C. This unique mother-infant pair highlights our present lack of knowledge of the precise etiology and pathogenesis of toxic shock syndrome and illustrates the consequent difficulty in clinical diagnosis and laboratory confirmation of this disease in certain patients with atypical presentations.

Adult↗
PubMed1984

Diagnostic ultrasound in the assessment of patients with incompetent cervix.

Twenty-five pregnant women with suspected cervical incompetence were assessed by serial ultrasound. A dilating internal os was documented in one patient, incompetence was ruled out in two, and a 'slipping suture' was demonstrated in another; the remaining patients were subjected to cerclage on the basis of their history alone. Patients in whom the diagnosis of cervical incompetence is indefinite should have a diagnostic ultrasound scan to visualize the cervix for length, opening of the canal and integrity of the internal os. Selective ultrasonography may be beneficial in both the diagnosis and treatment of cervical incompetence.

Adult↗
PubMed1984

Perinatal changes in a digoxin-like immunoreactive substance.

An endogenous digoxin-like immunoreactive substance(s) (DLIS) exists in the serum of premature and full term infants not receiving digoxin. We followed serum changes in DLIS concentration sequentially over the first 14 postnatal days in 24 premature neonates who did not receive digoxin in the intensive care nursery. All infants had measurable levels (greater than 0.6 ng/ml) of DLIS in their serum. There was a distinct peak in DLIS concentration in 19 of 24 infants occurring at 4 +/- 1.6 (SD) days after birth (range, 1-8 days). No peak was found in five infants. The peak serum level of DLIS obtained in the first 8 days of life was negatively correlated with gestational age and birth weight. DLIS levels in amniotic fluid remained constant from 16 to 33 weeks of gestation but rose from 33 wk to term. DLIS concentrations in umbilical artery, umbilical vein, and maternal serum at normal full term delivery suggested that DLIS was of fetal origin. DLIS and digoxin concentrations are additive when present in the same serum sample if measured by standard radioimmunoassay methods.

Aging↗
PubMed1984

Evaluation of the Amniostat-FLM assay for assessment of fetal lung maturity.

Results of the "Amniostat-FLM" assay, a rapid semiquantitative test for phosphatidylglycerol, were compared with determinations of the lecithin/sphingomyelin (L/S) ratio, with phosphatidylglycerol measured by two-dimensional thin-layer chromatography, and with results of the "shake test" for 94 specimens of amniotic fluid. Correlation between results with the Amniostat and the other tests was excellent. All four tests are very accurate when predicting lung maturity. The predictive value of a negative test, i.e., that hyaline membrane disease would not occur, was between 92 and 100%. However, the accuracy of predicted lung immaturity is poor. For all four tests, predictions of lung immaturity were incorrect in more than 50% of the cases. Of the 49 infants born within 72 h of testing, none developed hyaline membrane disease when phosphatidylglycerol was detectable by either method or when the shake test indicated fetal lung maturity, but three infants with L/S ratio greater than 2/1 did develop the disease. The Amniostat provides a rapid screening method for detecting phosphatidylglycerol in amniotic fluid, which could well replace the thin-layer chromatographic method for measuring phosphatidylglycerol in the panel of diagnostic tests for fetal lung maturity.

Amniocentesis↗
PubMed1982

Fetal weight estimation by real-time ultrasound measurement of biparietal and transverse trunk diameter.

Measurements of biparietal diameter and transverse trunk diameter with the use of linear array real-time B-mode scanning were performed on 100 fetuses within 72 hours of delivery to evaluate the reliability of Hansmann and associates, nomogram in predicting fetal weight. Under optimal conditions, 82% of predicted birth weights were within 10% of actual birth weight with a mean error of 150 gm (6%) and a correlation coefficient of 0.98. Predictions were most accurate in fetuses weighing less than 1,500 gm and in the 2,000 to 4,000 gm group and were least accurate in the infant weighing less than 1,500 gm and in the 2,000 to 4,000 gm group and were least accurate in the infant weighing more than 4,000 gm. Once the accuracy of the method was determined, It was applied to 100 consecutive cases to evaluate the feasibility of this technique in clinical practice. Measurements were unobtainable in 15%, but in the remainder, predictions were of sufficient accuracy throughout the range of fetal weights to complement clinical assessment in the management of high-risk pregnancies. Seventy-four percent of predicted weights were within 10% of actual birth weight; the mean error was 165 gm (7.2%) and the correlation coefficient was 0.97.

Birth Weight↗
PubMed1982

Toxic shock syndrome in the postoperative patient.

Toxic shock syndrome occurred in two patients within seven days of operation in women in whom Staphylococcus aureus was isolated from the wound incisions. Both patients had negative vaginal cultures. One patient was menstruating at the time of onset of the disease and the other was seven days' postpartum. Although toxic shock syndrome mainly occurs in menstruating women who use tampons and have positive vaginal cultures for Staphylococcus aureus, wound infection may also be a source for toxin production and adsorption.

Adult↗
PubMed1982

The sequelae of serous retinal detachment in preeclampsia.

Retinal detachment is a rare complication of preeclampsia. In 24,920 consecutive deliveries from 1970 at the Vancouver General Hospital, preeclampsia was diagnosed in 1435 patients (5.76%), and in 2 cases serous retinal detachment occurred. Despite spontaneous retinal reattachment, focal pigmentary macular disturbances with visual impairment may persist. Serial examination of the optic fundi, visual acuity, and central visual field assessment by Amsler grid are simple, indispensable tests that will help identify the visually threatened patient with severe preeclampsia. Timely obstetric intervention in severe cases is suggested.

Adult↗
PubMed1981

Real-time ultrasound observation of breathing and movements in the fetal lamb.

In seven pregnant ewes with catheters chronically implanted in the fetus, real-time ultrasound observations of fetal breathing and body movements were correlated with direct measurements of fetal arterial and tracheal pressures, heart rate, and intrauterine pressure. There was excellent correlation between the ultrasound record of fetal breathing and recordings of intratracheal pressure changes even when breath amplitude was low or frequently was high. Fetal body movements (stretches, rolls, kicks) were observed during both breathing and nonbreathing periods; vigorous movements were accompanied by rapid deflections of the amniotic and tracheal pressure traces. Movement was frequently accompanied by transient increases or decreases in heart rate. The results indicate that real-time ultrasound is an accurate method of observation of fetal movement in pregnant sheep and is particularly valuable when combined with direct measurements of fetal physiologic parameters.

Animals↗
PubMed1981

Molar pregnancy: early diagnosis by ultrasound.

This report reviews four cases with vaginal bleeding and early ultrasound diagnosis of abnormal pregnancy before nine weeks gestation, who were followed by serial ultrasound examinations and subsequently diagnosed as hydatidiform mole. The findings support the view that hydatidiform mole may arise from a blighted ovum. It is concluded that vaginal bleeding in the first trimester should be investigated by diagnostic ultrasound, and the pregnancy by terminated if an abnormal development has been confirmed.

Adult↗
PubMed1981

Antenatal diagnosis of twin transfusion syndrome by ultrasound.

The evaluation of 2 cases of twin transfusion syndrome by conventional and real-time B-scan ultrasound is described. The importance of differentiating this syndrome from the isolated growth failure of 1 fetus in a twin pregnancy with a normally developing second fetus is emphasized. Assessment of placentation, fetal size and activity, as well as amount of fluid by diagnostic ultrasound is an important aid in the management of multiple gestation.

Adult↗
PubMed1981

Human chorionic gonadotropin, estradiol, progesterone, prolactin, and B-scan ultrasound monitoring of complications in early pregnancy.

In a prospective study of women in the first trimester who were at risk for recurrent abortion, data from 20 pregnancies with normal outcomes were contrasted with those of 9 pregnancies that aborted spontaneously between 7 and 12 weeks. In pregnancies in which an embryo was present before abortion, the mean concentrations of human chorionic gonadotropin beta-subunit (hCG-beta) were low with a steady decline in progesterone levels, whereas estradiol (E2) and prolactin concentrations approximated those in normal pregnancies. With growth disorganization, mean hCG-beta, E2, and progesterone levels were significantly lower than normal. In 87.5% of embryopathic pregnancies, conclusive evidence of this disorder was obtained with ultrasound monitoring. Subnormal levels of hCG-beta, E2, and progesterone were observed in 88.9, 100, and 57.1%, respectively. The karyotype was abnormal in 80% of embryopathic pregnancies successfully cultured. The normal production of E2 appeared dependent on the presence of the embryo in the first trimester of pregnancy. Endocrine failure of the trophoblast and/or the corpus luteum in embryopathic pregnancy is suggested by diminished hCG-beta and progesterone concentrations. Serial ultrasound scanning and hormone assay, particularly of hCG-beta and E2, may be useful in assessing pregnancy at risk for recurrent abortion. However, because subnormal hormone levels may occur relatively late in the clinical course of embryopathic gestation, ultrasound scanning may yield more useful results as compared with hormone assay. Further studies are required to define more clearly the mechanisms of endocrine failure in embryopathic pregnancy.

Abortion, Spontaneous↗
PubMed1979

The value of diagnostic ultrasound as a screening test for intrauterine growth retardation: comparison of nine parameters.

In an attempt to devise a screening method for the detection of unsuspected IUGR, a battery of ultrasonic measurements of the fetus were performed in a series of 255 patients at approximately 32, 34, and 36 weeks. The results obtained from the 16 growth-retarded and the 239 normally grown babies were evaluated. While no single measurement was found to discriminate the two groups, a simple combination of crown-rump length times area of trunk allowed us to identify an at-risk group comprising 11 per cent of the population. The false positive and false negative results were acceptable at levels of 10 and 6 per cent, approximately. It is considered that these results would justify a larger and prospectively randomized controlled trial to assess the benefits and drawbacks of applying these measurements in a screening schedule.

False Negative Reactions↗
PubMed1979

Real-time ultrasound observation of fetal activity in labour.

Fetal activity was observed by realtime ultrasound for one hour in 25 patients in labour. Fetal respiratory movement, although reduced compared to the antenatal period, was observed in 13 patients. In three patients, hiccough-like movements were noted. Fetal body and/or extremity movements were observed in all patients (mean 41/hour) and frequently occurred in episodes. These bursts of movements were significantly correlated with contractions and fetal heart rate (FHR) accelerations. There was a significant association between absent or reduced number of fetal respiratory movements and/or hiccoughs (10 or less/hour) and an abnormal FHR. Absence of any type of fetal activity was also significantly associated with an abnormal FHR. The correlation between fetal activity and conventional methods of fetal assessment is discussed.

Female↗