Advanced abdominal pregnancy.
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Diagnostic Imaging↗
Biomedical subjects
G Bastert
Publications and source records attributed to G Bastert.
The depot GnRH analogue goserelin in the treatment of premenopausal patients with metastatic breast cancer--a 5-year experience and further endocrine therapies. Cooperative German Zoladex Study Group.
Continuous administration of gonadotrophin-releasing hormone (GnRH-)analogues leads to a receptor-down regulation of pituitary GnRH-receptors and subsequently inhibits ovarian hormone production. Since October, 1984, 118 evaluable pre- and perimenopausal patients (median age 42, range 25-55 years) with metastatic breast cancer were entered into an open phase II multicenter trial to evaluate efficacy of this new treatment modality. Patients were treated with the GnRH-analogue Goserelin (3.6 mg depot s.c. every 4 weeks) as first line therapy and followed up until progression. Mean serum gonadotrophins LH and FSH were significantly suppressed by Goserelin. Within 2-3 weeks, mean serum E2 values decreased to values seen in castrated women (less than 30 pg/ml). Overall objective response with complete and partial remissions (CR + PR) was achieved in 44.9% of patients with a median time to progression (mTTP) of 59 weeks, (range 20-163 weeks), no change (NC) in 28.0% with a mTPP of 27 weeks (range 16-101 weeks), and progression (P) in 27.1%. Responses were seen in ER-positive as well as ER-negative tumors, and in patients with different sites of metastases (locoregional, bone, visceral, multiple). The value of different prognostic factors in relation to response rates, time to progression and time to death (overall survival) is discussed. Median overall survival (time from beginning of palliative Goserelin treatment to death) was 148 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Urodynamic assessment and lateral urethrocystography. A comparison of two diagnostic procedures for female urinary incontinence.
We compared urodynamic findings and results of lateral urethrocystography in 84 case. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly greater increase in the normal axis of urethral inclination was noted in patients with a urodynamic diagnosis of stress incontinence than in patients with urge incontinence or for normal urodynamic findings. Lateral urethrocystography vis-à-vis urodynamic assessment proved to be a method having high sensitivity (91%) but low specificity. These two methods supply different but complementary data. Together with the patients' medical history, the assessment of their complaints, clinical vaginal examination, and clinical stress test, they offer valuable information for an efficient therapeutic concept.
Adult↗
Laser palliation of locoregional recurrences of breast cancer.
The paper reports on the use of carbon dioxide and Nd:YAG lasers for palliation of locoregional breast cancer recurrences. On the basis of three case reports, pros and cons of laser assisted treatment of loco-regionally recurrent breast cancer are discussed. A carbon dioxide--Nd:YAG combination therapy is proposed as the method best suited. The preliminary results indicate that laser palliation of local relapse and soft tissue metastases might enlarge the therapeutic spectrum.
Aged↗
[Sonographic diagnosis of fetal lung maturity--a new method].
First results are presented to determine the maturity of fetal lung by sonography. Using the fetal liver as a reference-organ we are avoiding the known pitfalls which made it impossible in the past to standardize the fetal lung changes depending on the age of gestation. We examined 104 patients between week 27 and week 41. In one ultrasound section cut we depicted as well lung and liver. According to the known A-mode we registered frequencies in both organs. The registered frequencies were entered digitally into a computer and checked for f mean, f max and f min. Afterwards the frequencies of the lung were divided by those of the liver. Of all weeks of gestation the mean value and standard deviation were calculated. We found the liver as an adequate reference-organ, since there is no change of the reflection pattern between the different weeks of gestation, while there are significant changes to be registered in the fetal lung, a cutting line being week 35. A quotient of f mean lower than 1.1 hints to lung maturity while values over 1.1 point to immaturity. This was confirmed by several cases of analysis of amniotic fluid (L/S-ratio). Further comparisons with amniotic fluid results will have to validate these findings.
Female↗
[Improvements in 3-D ultrasonic imaging].
The problem of gaining a coordinated sequence of section cuts by ultrasound is solved by rotating the plane section around a vertical and a horizontal axle. There are two possibilities in presenting the 3D image of the examined organ: ring structure image or transparent image. Precondition in the ring structure image is time consuming and defective since it has to be done by hand using a cursor. These pitfalls can be avoided when using a method without contouring by showing the 3D image transparently. Each section cut has to be calculated transparently. Both methods are presented in this paper and compared as to their applicability in medicine. The problem of the transparent 3D presentation lies in the fact that it cannot be well presented on printed paper, as is done her. The moving picture on the computer screen gives an optimal 3D image. This new method seem to be useful in tumor diagnostic and diagnostic of malformations in early pregnancies.
Computer Graphics↗
[Effect of regionalization of perinatal management on mortality and long-term sequelae of small premature infants].
In Germany and Switzerland only 20% of the high risk neonates are born in perinatal centers with a neonatal intensive care unit adjacent to the delivery rooms. Several studies have shown that both mortality and long term morbidity (i.e. brain damage, retinopathy and chronic lung disease) of very low birth weight (VLBW) infants (less than 1500 g) are by approximately 50% lower in inborns compared with outborns. The results of the Bavarian Neonatal Study and of the perinatal centers in Baden-Württemberg indicate that every year approximately 2000 VLBW infants die and 4000 survive with severe handicaps in the western states of the Federal Republic of Germany because they are not born in a perinatal center.
Brain Damage, Chronic↗
[Fibrin gluing in surgical, laser-assisted laparoscopy].
Fibrin sealing has proved a successful procedure for a variety of indications in operative gynecologic laparoscopy. Ovaries can be reshaped after cystectomy, serosa and peritoneal defects as well as perforations of the uterus can be sealed with fibrin adhesive. At present, application for salpingotomy, fimbrial eversion and tubal anastomosis is being investigated in clinical studies. Yet larger collectives and a longer follow-up are necessary for a final evaluation of the method. No complications were observed in 75 laparoscopic fibrin sealing performed at our department for established indications. Fibrin adhesive can replace time-consuming, complicated endoscopic sutures. It is an atraumatic tissue-sealing and hemostatic technique, easy in handling, thus leading to a considerable reduction in operation times. The excellent hemostyptic and wound healing characteristics of fibrin adhesive are also an advantage.
Female↗
[The effect of pregnancy and parity on the venous system of the leg].
Pregnancy is a risk factor for development of varicosis. The reason remains unclear. Because of the secondary diseases like thrombosis, pulmonary embolism and chronic cardial and respiratory diseases treatment of risk factors is important. Therefore we examined 54 patients with sonography and venous occlusion plethysmography before and immediately after delivery. Some of the patients could be reexamined one month and one year following delivery. All veins had a significant exaggerated distensibility post partum. Other functional parameters were not changed. In another study 50 primiparae and 50 multiparae before and after childbirth and 100 women between age 40 and 50 had been examined with light reflection rheography. Pregnancy per se had a negative influence on venous function. Phlebological status had to be included into prenatal care.
Female↗
[Vaginal sonography in the diagnosis of and therapeutic indications in cervical incompetence].
Besides its contribution to the diagnosis, the vaginal sonography or transvaginal ultrasound is a remarkable support in the indication of the treatment of cervical incompetence and its control after cerclage. The study group consisted of 40 patients, their gestational age between 16 and 29 weeks, admitted in the department for cervical incompetence. After transvaginal ultrasound examination combined to the results of clinical evaluations, 32 pregnant women were retained for cervical cerclage. The other cases were given only medical treatment. It springs out from the analyse of the criteria of exploration, the absence of a funnel shaped formation of internal os in the cases non retained for cervical cerclage at the vaginosonography examination. Likewise, but in a less degree (6/8) a cervical dilatation greater than or equal to 10 mm. The softening of the cervix was also absent in the majority of the cases (5/8) at the clinical examination. On the contrary, the cervix was shortened in all cases, both in clinical and ultrasound examination. Another important element is the advanced gestational age which is in favour of medical treatment and ultrasound check up. The average gestational age of the group without cerclage is 26.87 weeks and that of the whole study group is 23.64 weeks. The vaginalsonography makes possible the follow up, in the postoperative periods after cervical cerclage and the appreciation of the outline of internal os and the localisation of the band used for cerclage.
Evaluation Studies as Topic↗
Ifosfamide combination chemotherapy in advanced breast cancer.
The objective of our clinical studies was to develop an effective combination chemotherapy regimen (CHT) with acceptable side effects, consisting of the two most potent drugs used as single agents in breast cancer. We tested the combination of an anthracycline, epirubicin (A) at 70 mg/m2 i.v. on day 1 or (B) at 120 mg/m2 i.v. on day 1 with an alkylating drug ifosfamide (IFO), (C) at 2.5 g/m2 in an i.v. infusion given over 4 h on days 1-3 or (D) at 5 g/m2 in a 24-h i.v. infusion given on day 1. Courses were repeated every 4 weeks. The combinations were given as first-line therapy as follows: CHT (A, C) in six cases and CHT (B, C) in five cases of advanced breast carcinoma, and CHT (B, D) in seven patients with primary inflammatory breast cancer. Due to side effects (e.g., stomatitis, mental disturbances) and applicability, CHT regimen (B, D) was preferred. Responses (12/18) occurred 1-3 cycles earlier than those previously achieved using the conventional epirubicin/cyclophosphamide CHT. We conclude that 5 g/m2 IFO given i.v. over 24 h with uroprotection (mesna) in a two-drug regimen is an effective dose with tolerable toxicity. Alopecia was seen in all cases. However, according to our experience, myelotoxicity is the dose-limiting factor for both of these drugs.
Antineoplastic Combined Chemotherapy Protocols↗
The effect of fibrin glue and peritoneal grafts in the prevention of intraperitoneal adhesions.
We studied the effect of fibrin sealant and peritoneal grafts applied by fibrin glue on adhesion formation in the rat. Sealing and patching of ischaemic lesions of the uterus resulted in a significant increase in adhesion formation. We conclude, that fibrin sealant and peritoneal grafts can not be given general approval for prophylaxis of intraperitoneal adhesions.
Animals↗
Decrease in uterine rupture in Conakry, Guinea by improvements in transfer management.
Lack of an effective transfer system remains a major risk factor for uterine rupture, especially in developing countries. The implementation of a program of consultation, feedback and integration between peripheral delivery units and two hospitals resulted in a decrease in the incidence of uterine rupture from 0.20% to 0.12% and of maternal mortality after uterine rupture from 28% to 21%, respectively, after 6 months.
Africa, Western↗
Uterine rupture--an analysis of 81 cases in Conakry/Guinea.
Eighty-one cases of uterine rupture in Conakry/Guinea are analyzed. With an incidence of 0.84%, i.e. 1 per 119 deliveries, uterine rupture is still a common problem in this region. In this analysis fetal mortality was found to be 75.3% and maternal mortality 20.9%. Mortality rates were statistically higher after hysterectomy than after repair. Other etiologic factors were extreme multiparity and an inadequate transfer system to the obstetric centers. A reduction of uterine rupture rates can be achieved by prevention of extreme multiparity (more than 4 deliveries) and of home deliveries and decentralization of obstetric services into peripheral units and villages.
Adolescent↗
[Doppler ultrasound flow measurement of fetal and uteroplacental blood vessels. Study of a normal population in the 2d half of pregnancy].
Weekly Dopplersonography measurements were performed on the fetal aorta abdominalis, the umbilical artery, the fetal carotid artery and the uterine arcuate artery from the 20th to the 41st weeks of gestation, mean and maximum blood flow velocities were measured, as well as the resistance index. The mean values calculated from 20 cases per week were translated into standard graphical representations serving as a criterion for the assessment of pathological pregnancies. The vessels were examined as to their value for a screening programme of fetal circulation. A sample curve of a severe placental insufficiency showed significant deviations from the standard curves.
Arteries↗
[Urodynamics and the lateral cystogram: value for incontinence diagnosis].
We compared urodynamic findings and results of lateral cystourethrography in 82 patients with incontinence. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly higher increase of the posterior urethrovesicular angle was noted in patients with a urodynamic stress incontinence than in patients with urge incontinence or those with normal urodynamic findings. Lateral cystourethrography as compared to urodynamic assessment, proved to be a method with high sensitivity (91%) but little specificity. These two methods supply different but complementary data. Together with history, assessment of patients' complaints, clinical vaginal examination, and clinical stress test they offer valuable information for an efficient therapeutic concept.
Adult↗
[Abruptio placentae].
Neither the frequency nor the clinical pattern of abruptio placentae have changed significantly in the past years. In a retrospective study (1979-1988) we found a frequency of 0.55%, that means one abruptio placentae in every 182 births. Important and significant factors which could be correlated with the abruptio placentae were: premature labour, vaginal bleeding and gestosis. The case histories show a high rate of abortions and interruptions (24.3%) of pregnancy, as well as premature rupture of membranes (15.4%) and multiple pregnancies. Ultrasound furnished valuable diagnostic criteria in only 7.7% of the cases. A high rate of breech presentation (1/5 of all cases) is seen in combination with premature birth (37% less than or equal to 33 weeks of gestation). Half of the patients showed disturbances of coagulation. The high rate of perinatal mortality (12%) is related to the prematurity on the one hand and too late diagnosis of abruptio placentae.
Abruptio Placentae↗
[A rapid test procedure for the detection of B streptococci in the perinatal period].
At the Hospital of the Department of Gynaecology of the University of Heidelberg, a latex agglutination test (Strep B Patho Dx Test) was applied after extraction of antigens from amniotic fluid and gastric aspirate, parallel to the routine screening programme (vaginal and anal swabs) for maternal colonization with B streptococci. The latex agglutination test was applied in 1336 cases. Maternal vaginal colonization was detected in 14%, anal colonization in 17% of the cases. A comparison of the results obtained with the latex agglutination test and with conventional bacteriological procedures (no gradual bacteriology, incubation 48 hours) showed antigen identification in amniotic fluid in 54%, respectively 24%. In gastric aspirates a B streptococcal contamination was detected by bacteriology in 40% of cases, by the rapid latex agglutination test in 22%. If no streptococci were found in the mother, amniotic fluid or gastric aspirates were contaminated in 4% or 6%, respectively (agglutination test or bacteriology, respectively). With a sensitivity of approximately 50% and a specificity of 98%, the latex agglutination test proved superior to routine bacteriology. All clinically contaminated newborn (positive blood specimens) were clearly identified by this test. With this new latex agglutination test, a procedure is now available to detect B streptococcal contamination in newborns within less than half an hour, thus an intra- or postpartal antibiotic therapy can be applied early.
Anal Canal↗