Search PubMed⌕ Search

Biomedical subjects

C Brezinka

Publications and source records attributed to C Brezinka.

At least 37 records · Page 2Linked to original sources
PubMed1996

Successful treatment of primary extramedullary leukemia (EML) of the uterus with radical surgery, chemotherapy, autologous bone marrow transplantation (BMT) and prophylactic local irradiation.

Extramedullary myeloid cell tumors are rare manifestations of acute nonlymphocytic leukemia (ANLL). While many advances in diagnosis have been made, dilemmas remain concerning the treatment of this disease. In primary extramedullary leukemia (EML) most reports agree upon a local therapy followed by systemic chemotherapy such as is used for ANLL. However, further prophylactic local or systemic therapy with stem cell support remains controversial. A 20-year-old patient was diagnosed as having granulocytic sarcoma (GS) of the uterus without evidence of ANLL in 1991. After resection of the tumor at the uterine cervix and chemotherapy with daunorubicin 50 mg/m2 (days 1-3) and cytosine-arabinoside 200 mg/m2 (days 1-7) in September 1991, complete remission was achieved. In October 1991 cytosine-arabinoside 1000 mg/m2 every 12 h from day 1 to day 6 and amsacrine 200 mg from day 5 to day 7 were given as consolidation. Two years later relapse occurred in the adnexae. After radical hysterectomy, the same induction and consolidation chemotherapy was administrated. Subsequently, cytoxane 60 mg/m2 and fractionated total body irradiation (6 x 200 cGy) were given as conditioning and the previously cryopreserved bone marrow was reinfused. Finally, after hematopoietic engraftment, prophylactic local irradiation (4500 cGy) to the pelvis was given resulting in a disease-free long-term survival of more than 36 months after relapse. Although this experience is confined to one patient, it may contribute to the design of prospective therapeutic studies in patients with primary EML.

Adult↗
PubMed1995

Fetal ductus venosus flow velocity waveforms and maternal serum AFP before and after first-trimester transabdominal chorionic villus sampling.

Doppler flow velocity waveform recording in the fetal ductus venosus and umbilical artery as well as maternal blood sampling for serum alpha-fetoprotein (MSAFP) was performed before and after transabdominal chorion villus sampling (TACVS) in 36 women of advanced maternal age (> or = 36 years). Gestational age ranged between 11 and 13 weeks. No chromosomal anomaly was detected. No statistically significant difference was observed in ductus venosus velocity parameters or in the umbilical artery pulsatility index (PI) before and after CVS in 35 women with a normal pregnancy outcome. One case resulted in fetal loss. Post-CVS median MSAFP levels at 12 weeks (25 kIU/l) and 13 weeks (35 kIU/l) were significantly higher than pre-CVS levels. In three cases, post-CVS MSAFP levels were higher than 600 kIU/l, correlating with feto-maternal transfusions of approximately 1.0-1.4 ml, i.e., of around 40 per cent of feto-placental blood volume. One of these cases displayed absence of fetal peripheral blood flow velocities and fetal bradycardia following TACVS, resulting in fetal loss 1 week later. The remaining two cases had a normal pregnancy outcome, but showed a more than 50 per cent reduction in ductus venosus velocity after TACVS, whereas umbilical artery PI remained unchanged. However, similar velocity changes were associated with only small feto-maternal transfusions. Umbilical artery PI values remained unchanged.

Blood Flow Velocity↗
PubMed1995

[Adenofibroma and adenosarcoma of the uterus in young women].

We report on two similar cases of young women with irregular menstrual bleeding. Curettage and biopsy revealed an adenofibroma of the uterus in case 1 (31 yrs) and an uterine adenosarcoma in case 2 (30 yrs). Hysterectomy was subsequently performed in both patients: histological examination of the hysterectomy specimen showed no remnants of the tumour in case 1. There was adenosarcoma tissue in the uterine cavity of case 2 but no myometrial infiltration. The difficulties of differential diagnosis of uterine soft tissue tumours in young women are discussed and the literature is reviewed.

Adenofibroma↗
PubMed1995

-Educational promotion in the Netherlands-.

Dutch medical students graduate from medical school with the title 'doctorandus', the Latin term implying that he or she is now qualified to pursue further studies that will eventually lead to a doctorate. The Dutch system of an academic career leading to a PhD-type doctorate is explained and compared with the German system, leading to a 'Habilitation'. The author recounts how a long research fellowship at Erasmus University Rotterdam eventually resulted in the successful defence of his thesis 'The early human fetal ductus arteriosus' and the award of a doctorate from that institution.

Adult↗
PubMed1994

Doppler flow velocity waveforms in the fetal ductus arteriosus during the first half of pregnancy: a reproducibility study.

Reproducibility of flow velocity waveform measurement in the fetal ductus arteriosus was studied in 52 normal pregnancies between 11 and 25 weeks of gestation. The flow velocity parameters studied were the peak systolic velocity, mean velocity, end-diastolic velocity, flow velocity integral and acceleration time. In each woman two consecutive measurements were performed with a time delay of 15 min. An acceptable reproducibility was achieved for all flow velocity parameters, except for the acceleration time and end-diastolic velocity.

Journal Article↗
PubMed1994

Anatomical and sonographic correlation of the fetal ductus arteriosus in first and second trimester pregnancy.

Ultrasonic visualization of the ductus arteriosus in first and second trimester pregnancies was compared with postmortem preparations. Twenty human fetal postmortem specimens from 8 to 19 weeks menstrual age were examined, 11 with microscopic reconstruction, nine with macroscopic dissection. The angle between ductus arteriosus and aortic isthmus (upstream) and ductus arteriosus and descending aorta (downstream) was determined. In 52 normally developing fetuses between 14 and 27 weeks, the angle between the ductus arteriosus and the thoracic spine as visualized in real-time ultrasound was determined. In a further 19 normally developing fetuses between 14 and 25 weeks, ductal blood flow was visualized by colour velocity imaging (CVI). In anatomical preparations, the upstream angle was always less than 90 degrees and the downstream angle was always 80 degrees or more. These angles were unrelated to menstrual age. In both real-time and CVI ultrasound, the angle between ductus arteriosus and thoracic spine remained at approximately 90 degrees. CVI showed highest blood flow velocities at the point of ductal insertion into the aorta. When performing Doppler ultrasound examinations in the fetal ductus arteriosus, no menstrual age dependent angle adjustment appears to be necessary.

Blood Flow Velocity↗
PubMed1994

Ductus venosus flow velocity waveforms in relation to fetal behavioural states.

OBJECTIVES: To establish the reproducibility of flow velocity waveforms in the human ductus venosus and to assess the influence of fetal behavioural states on these waveforms in normal term fetuses. DESIGN: Reproducibility of Doppler waveform recording and analysis was studied in 10 normal pregnancies. The relation between ductus venosus flow velocities and behavioural states was investigated in 19 other term fetuses. Time-averaged, peak systolic, peak diastolic velocity, peak systolic/diastolic ratio and period time were calculated in both cross sectional studies. SETTING: Outpatient clinic, department of obstetrics (prenatal diagnosis section), Academic Hospital, Rotterdam--Dijkzigt. SUBJECTS: Twenty-nine women with normal singleton pregnancies at 36 to 39 weeks of gestation, resulting in uncomplicated births of healthy infants. RESULTS: Within-patient coefficients of variation, ductus venosus waveform recordings were approximately 8 to 10% except for the peak systolic/diastolic ratio (4.3%). A decrease of approximately 30% was established for peak systolic, peak diastolic velocity and time-averaged velocity during behavioural state 1F (quiet sleep) as compared with state 2F (active sleep). CONCLUSIONS: Flow velocity waveform recording in the ductus venosus demonstrates acceptable reproducibility. Fetal behavioural state-dependent changes were observed, suggesting a redistribution of umbilical venous blood through the ductus venosus shunt during the quiet sleep state.

Adult↗
PubMed1994

Denial of pregnancy: obstetrical aspects.

Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

Adult↗
PubMed1993

There are no rest-activity dependent changes in fetal ductus arteriosus flow velocity patterns at 27-29 weeks of gestation.

Blood flow velocity waveforms recorded in the fetal ductus arteriosus were related to fetal heart rate pattern (FHRP) in 13 normal pregnancies at 27-29 weeks of gestation. Recording time was always 65 min or more. In three women no low fetal heart rate (FHRP-A) variability was present, in the remaining 10 women high fetal heart rate (FHRP-B) variability was established in 80% of the recording time. There was no statistically significant difference between FHRP-A and FHRP-B pattern for all ductal flow velocity parameters, indicating rest-activity state independency in late second and early third trimester pregnancy.

Activity Cycles↗
PubMed1993

Fetal renal artery flow velocity waveforms in the presence of congenital renal tract anomalies.

Colour Doppler flow mapping of the renal arteries and subsequent pulsed Doppler measurement of impedance to flow in these vessels were attempted in 33 fetuses with postnatally confirmed renal pathology. The majority presented with unilateral or bilateral hydronephrosis (n = 21) and bilateral renal agenesis (n = 8). Renal artery blood flow could be visualized in all, except for the eight cases of bilateral renal agenesis. Bilateral flow velocity recordings were collected in six out of 12 cases of bilateral hydronephrosis and in five out of nine cases of unilateral hydronephrosis. The pulsatility index (PI), as a measure of downstream impedance, was in the normal range in 16 out of 18 kidneys (88 per cent) in bilateral hydronephrosis and in 12 out of 14 kidneys (85 per cent) in unilateral hydronephrosis. The PI was significantly higher in severe hydronephrosis compared with mild hydronephrosis. In four cases of unilateral multicystic kidney, the PI was always higher on the affected side. Colour Doppler flow mapping and pulsed Doppler evaluation may be helpful in our understanding of renal vascularization in renal pathology and in confirming the diagnosis of renal agenesis.

Fetal Diseases↗
PubMed1993

Relationship between fetal pulmonary trunk and ductus arteriosus flow velocity waveforms in early normal pregnancy.

To establish the relationship between flow velocity waveform patterns from the fetal pulmonary trunk and ductus arteriosus in normal late first- and second-trimester pregnancies, Doppler ultrasound examinations in these vessels were performed in 133 healthy women between 9 and 25 weeks of gestation. Differentiation between pulmonary and ductal blood flow was possible as from 12 weeks onwards resulting in a study population of 78 women. A linear gestational age-dependent increase in peak systolic velocity was found for both the pulmonary trunk and the ductus arteriosus. Ductal peak systolic velocity rose significantly faster with gestational age than pulmonary peak systolic velocity. This may be determined by differences in morphology and effective lumen between these two vessels.

Adult↗
PubMed1993

[Rescheduling genetic amniocentesis from the 16th to the 13th/14th week of pregnancy--report of experience].

At the ob/gy department of the Innsbruck University routine, genetic amniocentesis has been offered from the 13/14 week of gestation since 1991. In 1991 44.5% of all amniocenteses were performed as early amniocentesis, it rose in 1992 to 61.5%, the rest being performed in the 16th week of gestation. In a total of 346 genetic amniocenteses, 8 pathological karyotypes were obtained (six trisomies, one 47 XXY, one marker chromosome), six from samples obtained at early amniocentesis and two obtained at the 16th week. Three weeks following the procedure, a spontaneous abortion rate of 0.87% occurred. Cultivation took 1-2 days longer with samples from early amniocentesis than with samples collected at the 16th week. In two cases the cultures failed and a repeat procedure had to be performed at the 16th week. With early amniocentesis performed at week 13/14 results are known of gestation. The long period of anxiety, which many women see as a serious disadvantage of amniocentesis is thus significantly reduced.

Abortion, Eugenic↗
PubMed1993

The fetal ductus arteriosus, a review.

The developmental biology of the human ductus arteriosus is reviewed from its origins in the 6th branchial arch to its ultimate closure and obliteration in the neonatal period. Different concepts of ductal maturation are discussed and the role of prostaglandins in this process are highlighted. Recent advances in Doppler ultrasound have made it possible to observe and measure fetal ductus arteriosus blood flow as early as 11 weeks of gestation. During indomethacin tocolysis ductal constriction can be monitored with Doppler ultrasound in order to stop indomethacin administration when necessary, thus making indomethacin tocolysis safer.

Betamethasone↗