Biomedical subjects

F Melchert

Publications and source records attributed to F Melchert.

98 records · Page 6Linked to original sources

PubMedDate not supplied

[Investigation of a fetal heart-rate pattern that shows a reduced oscillation amplitude].

A fetal heart-rate pattern that has a reduced oscillation amplitude may indicate a physiological fetal dormant period but could also be an indication of fetal hypoxemia. In some rare cases such a fetal heart rate-pattern can be an indicator of cerebral or cardial fetal malformation or of an intoxication caused by sedative drugs. Our patient is a 32-year-old Para III in the phase of 29 weeks and 3 days gestation. Upon admission to the clinic, the fetal heart-rate pattern showed a reduced oscillation amplitude, and there were no signs of fetal movement. The ultrasound examination gave us no reason to suspect fetal malformation, and the results of the Doppler ultrasonography were also normal. However, although the patient had denied taking any medication at all, the results of an toxicological blood test confirmed our suspicion of benzodiazepine intoxication. Throughout the night the fetal heart-rate pattern was continuously measured, and in the early hours of the morning, after breaking down of the oxazepam medication, a normalization of the fetal heart-rate pattern was observed. This case report definitively demonstrates that Doppler ultrasonography is a valuable method for assessing any uncertainty regarding a fetal heart-rate pattern.

Adult↗

PubMedDate not supplied

[Does the "fatty pelvis" exist? Quantitative computer tomography studies].

50 Patients weighing between 45 and 114 kg underwent standardized computed tomography of the pelvis. Fat compartments from inside and outside of the small pelvis were assessed quantitatively by means of tracing the fat tissue borders and planimetry. Fat compartments within the small pelvis showed a rather weak correlation with body weight and the so called Rohrer-Index as a weight/height-Index, correlations with the latter being slightly better. From the fat compartments within the single levels the functional reduction of birth channel diameters caused by fat tissue was calculated for. The weight/height-index dependent increase of space demand within the birth channel was rather pronounced at the pelvic brim becoming slighter when reaching mid-pelvis or even pelvic outlet. Hence, the common assumption can no longer be maintained, that adiposity necessarily causes soft tissue dystokia due to larger fat compartments within the small pelvis.

Adipose Tissue↗

PubMedDate not supplied

[Changes in pelvic anatomy in 8 decades--computerized tomography study of obstetrically relevant pelvic measurements].

An increasing proportion of obstetric operative procedures due to cephalopelvic disproportion gave raise to the question, whether there has been a change in pelvic anatomy during the past decades. In a retrospective evaluation of 467 computerized pelvic tomograms of patients aged between 18 and 88 years relevant parameters of pelvic proportion were determined. As these parameters are not subject to age-conditioned changes, the values may be viewed as representative for the time of patients' birth or fertility period respectively. Changes in pelvic anatomy turned out to be complex: The transverse elliptic shape of pelvic inlet changed into sagittal elliptic form, the pelvic midplane is contracted progressively, sacral concavity is reduced. Obviously, this obstetrically adverse development is influenced by the fact, that unfavourable pelvic conformation can be transmitted more intensively by the generous indication for cesarean section. This development is contrasted by the circumstance of fetal acceleration. Therefore, an increase in cephalopelvic disproportion has to be expected. For the sake of a safe obstetrical management in these situations the generous use of ante partum pelvimetric diagnosis seems to be advisable.

Adolescent↗

PubMedDate not supplied

[Pregnancy-induced changes in adrenergic receptors].

In the 24th and 26th week of pregnancy and also 6 weeks post partum, n = 32 pregnant women were evaluated for the concentration of adrenergic receptors on blood cells by radioligand binding assay and an isoprenaline stimulation of the beta-receptors. The concentrations of estradiol and progesterone in serum were also determined and nephrosonography was carried out. The stimulation and concentration of the beta-receptors were significantly higher during pregnancy than post partum. The alpha-receptors displayed contrary alterations: Here, the concentration evaluated during pregnancy was considerably lower. No connection was determined between the progesterone level in serum and the extent of the receptor alterations. However, one was found with the estrogen level and the dilatation of the upper urinary tract: Pregnant women with pronounced alterations above the median showed a distinct decrease of estradiol and a marked dilatation of the kidney collecting system. Alterations in the adrenergic receptors can therefore be determined during pregnancy. The extent of the receptor fluctuation is connected to the estradiol concentration in serum and the dilatation of smooth muscle hollow organs.

Dilatation, Pathologic↗

PubMedDate not supplied

[Effect of co-medication with magnesium sulfate in beta-mimetic tocolysis on parameters of water-electrolyte balance].

With 2 groups of 10 patients the influence of an additional therapy with 1 g magnesium sulfate/h during i.v. tocolysis with the betamimetic fenoterol (2 micrograms/min) upon parameters of water and electrolyte balance has been investigated. The whole of the magnesium administered during the 24 hours investigational period has been eliminated via the kidneys. Most probably due to a competition within the distal tubulus hypermagnesemia was associated with hypocalcemia and hypercalciuria, followed by a rise in parathyroid hormone. As PTH is able to compensate hypocalcemia not only by means of bone mobilisation but also by an increase in enteral Ca absorption, estimated losses of calcium are minimal. These may be neglected, as additional therapy with magnesium sulfate--besides the advantages yet known (cardioprotection, saving of betamimetic dosage, reduction of drug tolerance development)--reduces betamimetic induced water retention, thus significantly diminishing lung edema hazard during tocolytic therapy.

Adult↗

PubMedDate not supplied

[New aspects of radiologic pelvimetry. Digital image intensification radiography: preliminary results of validation possibilities and results in various types of pelvic disproportion].

Within 1 year with 1325 births 54 cases necessitated operative obstetric intervention due to a disproportion between fetal head and maternal pelvis. In 40 cases radiologic pelvimetry was performed, using the conventional technique. 75% of cases turned out to be due to a midplane or outlet contraction. As, on the one hand, this type of pelvic disproportion seems to be of increasing importance, on the other hand generously adoperated radiologic diagnosis is not well accepted by the patients due to X-ray burden, Digital Image Intensifier Radiography (DIR) has been introduced for pelvimetry. X-ray burden amounts to only 5% of that of the conventional technique. Enhanced postprocessing and interactive measurement possibilities are further advantages of DIR. Using the appropriate softwear, interactive measurement results are characterized by the lack of mistakes due to X-ray divergence, if only the distance between measurement level and desk surface is known. By analyzing 30 computer tomograms measurement levels of the most important pelvic distances could be calculated in relation to the position of the anterior iliac spine. These relations show a very low interindividual variation. Thus, possible errors in measurement amount to a maximum of only 3.5%. The evaluation of our cases reveals the necessity to reassess the normal ranges for pelvic parameters, for the use of those deriving from conventional pelvimetry failed to describe correctly the anatomy of birth channel. For this sake, additional measurements, esp. of sacral and pelvic outlet anatomy have to be performed. Based upon these measurements, a computer aided modelling of the birth channel and a simulation of the birth could be achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗

PubMedDate not supplied

[A knowledge-based system for the interpretation of pelvimetric findings].

Digital Image Intensifier Radiography (DIR) as well as Nuclear Magnetic Resonance Tomography (NMR) using an especially developed imaging routine for pelvimetry are suitable tools for the assessment of the anatomical conditions when mechanical problems are supposed to occur during birth (cephalopelvic disproportion, breech presentation). A concept for an optimised evaluation procedure of these imaging techniques has been developed, including: a more elaborate measuring protocol, easily and precisely executable due to appropriate software packages being implemented in the diagnostic units, calculation of obstetrically relevant parameters not deriving immediately from the imaging procedures. This is possible by means of multiple regression analysis of a data base from 467 evaluated female pelvis computed tomograms, calculation of intrapelvic soft tissue place requirements by means of correlative analysis of female computed tomograms and weight-/height-index, empirical determination of cut off values in borderline pelvi-fetometric constellations evaluating 190 births by means of logistic regression of the according pelvic-fetometric data. The calculations necessary to obtain all these parameters are implemented in a software package which also contains an algorithm for the general characterisation of an individual pelvis. Thus, a rather sophisticated knowledge base for pelvic assessment becomes easily accessible.

Adult↗

PubMedDate not supplied

[Quality of life of over 60-year-old patients with breast and uterine carcinoma, 5 years after primary operation].

In the 5-year follow-up period, we studied the quality of life of 145 patients who were at least 60 years old at the time of primary operation. Of the patients, 70 women had breast cancer and 75 endometrium cancer. We used the questionnaire "short form health survey: medical outcomes study". The areas which were analyzed were stress due to therapy, body image/femininity and social contacts. The Karnofsky-Index was determined by the physician. In both groups, most stress was felt due to the operation and at the first knowledge of the diagnosis. In the area of emotional stress 1/3 of the patients of both groups declared continuous stress due to feelings of fear, helplessness and passivity. In the area of body image/femininity half the patients with breast cancer and 2/3 with endometrial cancer felt stress. In the area of social contact 2/3 of the patients felt uncertainty in contact with others and this led to social retreat in 1/3 of the women. The Karnofsky-Index of all patients was between 50-100%. Our study supports the view that older patients with cancer should also be offered psychosocial counseling.

Activities of Daily Living↗