[Pharmacocinetic investigations of the transfer of antibiotics into the amniotic fluid. I. Ampicillin (author's transl)].
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Amniotic Fluid↗
Biomedical subjects
G Bastert
Publications and source records attributed to G Bastert.
[Travel diarrheas and other travel infections].
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Acute Disease↗
Prenatal diagnosis of osteogenesis imperfecta congenita; a case report.
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Adult↗
Interleukin-12 requires initial CD80-mediated T-cell activation to support immune responses toward human breast and ovarian carcinoma.
One possible reason for the poor immunogenicity of tumors is the induction of peripheral tolerance by tumor cells that fail to deliver costimulatory signals. Furthermore, T cells stimulated with wild-type tumor cells often fail to secrete cytokines. The present study has been undertaken to identify cytokines that cooperate with CD80 in T-cell activation in vitro toward human breast and ovarian carcinoma cell lines. Tumor cell-mediated T-lymphocyte activation was analyzed directly in allogeneic mixed lymphocyte/tumor cell cultures as proliferation and effector functions were assessed in cytotoxic T-cell assays. Interleukin-7 (IL-7) amplified the proliferative response toward CD80-transfected breast and ovarian carcinomas and stimulated predominantly CD4+ T lymphocytes. IL-12 represses the proliferative response of naive T cells but cooperates with CD80-mediated activation during secondary stimulations. In long-term T-cell cultures, IL-12 synergizes with CD80 expression to stimulate cytolytic CD8+ T-cell lines, which recognize a breast carcinoma line in a human histocompatibility leukocyte antigen-restricted manner. These studies illustrate that costimulation is necessary for tumor cells to function as alloantigen-presenting cells. Furthermore, when added after the priming of T cells with CD80-transfected tumor cells, IL-12 could be helpful in propagating sufficient T-cell numbers to be used in adoptive transfers during cellular immunotherapy.
B7-1 Antigen↗
Treatment of the twin-twin transfusion syndrome: initial experience using laser-induced interstitial thermotherapy.
This paper describes our initial experience with laser-induced interstitial thermotherapy (LITT) for the treatment of the twin-twin transfusion syndrome (TTTS). This procedure was utilized in four pregnancies-three monochorionic twin pregnancies and one triplet pregnancy (20-26 weeks of gestation)-with severe TTTS with fetal dropsy, polyhydramnion of the acceptor, and anhydramnion of the donor. In vitro examinations of placental tissue had shown that laser coagulation can be monitored by sonography, hence we used this method for the first time in these four pregnancies. Blood vessels connecting the two umbilical cords were determined prior to the treatment using a new ultrasound color technique which is highly sensitive and capable of representing slow blood flow velocities. A 1.2 mm thick puncture needle was then directed to the shunt under on-line ultrasound control. All patients had an anterior wall placenta. The laser fiber was inserted via this thin needle. A coagulation time of 2-3 min was necessary at 3 W. In the one twin pregnancy the intrauterine fetal death of the smaller child occurred 10 weeks after LITT, the other child survived and is healthy. A cesarian section was necessary in another twin pregnancy 1 week after LITT due to the intrauterine death of the smaller child. In the third twin pregnancy, the donor, who had already had distinct bradycardia prior to the treatment, died immediately after LITT. The intrauterine fetal death of the donor in the triplet pregnancy occurred 3 days after LITT once the volume of amniotic fluid had basically returned to normal. The tragic intrauterine death of the uninvolved child occurred 13 weeks later as a result of umbilical cord strangulation, the surviving child is healthy. All four pregnancies were severe and advanced cases of TTTS with a very poor prognosis, leaving us with no other alternative to the described method of treatment. The instruments we used are a lot thinner than those utilized for fetoscopic laser treatment to date. Furthermore, it is not necessary to penetrate the amniotic sac in patients with an anterior wall placenta; intraplacental vessels can be coagulated, and the laser energy required for LITT is also much lower. In our opinion these advantages justify the utilization of LITT under more promising conditions than those described above.
Adult↗
Increased aldosterone-18-glucuronide/tetrahydroaldosterone ratios in pregnancy.
In the present study the aldosterone-18-glucuronide and tetrahydroaldosterone values in 24 hour urine collections of healthy nonpregnant women, women with normal pregnancies and women with pregnancy induced hypertension (PIH) were compared. In pregnancy an elevated excretion of both aldosterone metabolites was found. The Q-ratio (aldosterone-18-glucuronide/tetrahydro-aldosterone+aldosterone-18-glu cur onide) was also increased compared to healthy nonpregnant women. The elevated Q-ratios point out to increased formation of aldosterone-18-glucuronide. This predominantly renal metabolite may reflect greater availability of aldosterone molecules for interaction with mineralocorticoid receptor in the kidney.
Aldosterone↗
[Puerperal uterine inversion with covered uterine rupture].
Uterine inversion is a rare complication of the postpartum period which can occur in various degrees. The three key symptoms for diagnosis are pain, cardiovascular shock and vaginal bleeding combined with corresponding vaginal and uterine signs of an inversion. Early diagnosis is one of the most important factors determining the outcome of disease. The case of an uterine inversion, caused by a covered rupture of the uterine wall after a cesarean section, is given as an example to discuss predisposing factors and etiologic factors as well as therapy of uterine inversion. As uterine inversion is a rare event, it makes sense and seems to be necessary that new data are presented and discussed in the literature from time to time, especially regarding the cases of inversion in combination with uterine rupture after cesarean section.
Adult↗
Treosulfan in the treatment of advanced ovarian cancer: a randomised co-operative multicentre phase III-study.
BACKGROUND: In August 1988 a randomised phase III multicenter trial was started in order to compare cisplatinum/treosulfan (PT) with standard cisplatinum/cyclophosphamide (PC) in advanced ovarian carcinoma, aiming at lower toxicity and maintained efficiency. PATIENTS AND METHODS: Five hundred and nineteen patients were enrolled into the protocol. Final evaluation after a median observation time of more than five years was made in July 1996 and included 398 eligible patients, of whom 366 were evaluable regarding efficiency and 290 in respect of toxicity. The tumour stages were classified as FIGO II in 53, FIGO III in 244 and FIGO IV in 68 patients. The patients were stratified regarding post-operative tumour burden. RESULTS: Hematological and gastrointestinal toxicity WHO > = 3 were comparable between the two study arms though a significant difference could be demonstrated regarding alopecia (PT 8% vs. PC 47% after six cycles). The median time to progression as the main efficiency item was in favour of the study schedule (PT 20.6 vs. PC 15.1 months) while significant differences were neither observed in the whole study group nor in the analysed subgroups (R0, < 2 cm, > = 2 cm). The same held true for overall survival. CONCLUSION: PT may be recommended as a less toxic substitute for the former standard PC. After the acceptance of paclitaxel/cisplatin as a new standard, the role of treosulfan should be investigated regarding adjuvant therapy in patients without residual tumor, as a potential partner in triple or sequential treatment and in second-line treatment.
Adult↗
[Ultrasound diagnosis of fetal lung maturity].
Until now, it has been possible to determine fetal pulmonary maturity only by amniocentesis. Since the functional changes of the fetal lung leading to maturity are also morphologically apparent, pulmonary maturity can be demonstrated sonographically. Obtaining a uniform value for maturity is a problem, since the position of the fetus, the mother's constitution and the instrument setting all influence assessment. The fetal liver was therefore used as a reference organ, since it is subject to the same influences. By frequency analysis of both organs and calculation of the ratio between the frequencies obtained, a mathematical value can be calculated by which pregnancies can be compared and which, as our studies showed, represents a measure of pulmonary maturity. This was documented in 348 patients. It was shown by amniocentesis in 32 patients and the postpartal condition of 25 premature births that a value of 1.11 for this ratio between lung and liver represents the borderline between pulmonary immaturity and maturity. Lower values indicate maturity. If these results are confirmed by further studies on larger groups of patients, it will in future be possible to determine fetal pulmonary maturity very easily and non-invasively.
Female↗
[Twin pregnancies with fetofetal transfusion syndrome].
During an observation period of 10 years 30 cases (11%) of twin transfusion syndrome were observed in a collective of 286 twin pregnancies at the University Women's Clinic Heidelberg. Typical symptoms of a twin transfusion syndrome as polyhydramnios, hydrops fetalis, polyserositis, disparity in fetal growth of the twins and pathological CTGs were examined for their diagnostic and prognostic values. A difference in birth weight of more than 25% was noted in only 28% of cases (range 2-58). A polyhydramnios was diagnosed in 63% of cases, an acute form in 30%. Eight of the nine pregnancies with an acute hydramnios ended in an abortion or intrauterine death up to 28 weeks of gestation. Amniocentesis for reduction of the excessive amount of amniotic fluid had no positive therapeutic effect. Eight of the pregnancies, in which a hydramnios had been detected, were further complicated by a hydrops fetalis (23%). Typical sinusoidal CTGs were registered in only 3 cases. Intrauterine fetal mortality respectively abortion up to 28 weeks of gestation was noted in 6 patients (12/60; 20%). Fetal mortality after 28 weeks of gestation occurred in 9/60 cases (15%). Four infants died more than 7 days post partum (7%). The fetal malformation rate was determined in our collective with 7% (4/60 fetuses). No chromosomal abnormalities were observed. The data collected show the prognostic relevance of the parameters analysed and reveal the cases in which a therapy might be effective. Ultrasonographic scanning of fetal activity or doppler flow measurements are further diagnostic procedures that can be employed in surveillance of risk pregnancies with twin transfusion syndrome. Also umbilical cord puncturing under direct ultrasonographic monitoring is of certain diagnostic and therapeutic value.
Cardiotocography↗
[The importance of pulsed Doppler sonography for prenatal diagnosis of placental insufficiency--studies of 198 patients].
Doppler sonographic measurements of the fetal aorta and the carotid artery were performed on 198 pregnant patients having been diagnosed with a placental insufficiency. A relationship between them and fetal as well as non-fetal factors was examined. For the fetal factors minus difference in weight of birth and perinatal morbidity there could be established a definite correlation with corresponding resistance-index (RI) of the examined vessels. The criteria for the fetal outcome Apgar-note and pH-value of the cord blood didn't show absolutely equal changes with a deteriorated blood perfusion, what might be due to the management of birth as well as it indicates the close correlation of these values with the course of birth. Among the non-fetal factors there could be shown close relationships between the duration of pregnancy as well as age and the values of resistance-indices. While the ones, mentioned first, decreased in an almost linear relationship with RI-deterioration, did the fetal circulatory situation ameliorate with an increasing maternal age. Possible factors of influence, especially on the duration of pregnancy as well as the relationship between the maternal age and the fetal condition of perfusion were discussed. Pulsed doppler sonographic measurement is an efficient step in diagnosing a suspected placental insufficiency and has an outstanding value in an early recognition of possible dangers for the fetus.
Aorta, Abdominal↗
Cellular and genetic properties of two melanoma cell lines established from the same tumor.
We report here the detailed cellular and genetic analysis of two new human melanoma cell lines established from the same tumor biopsy. Although derived from the same tumor biopsy, the two lines differed in their method of in vitro culture establishment with one line (HA-A) grown first in agar culture and then transferred to liquid culture, while the second cell line (HA-L) was established directly from cells grown in liquid culture. Detailed characterization of both cell lines was performed using techniques to analyze their cytogenetic, surface marker, morphology (light and electron microscopy), growth (in agar and in nude mice), and drug sensitivity profiles in comparison to the original tumor biopsy. Our results revealed no significant biologic or genetic difference between the two cell lines established by different culture techniques. Our results suggest that in some cases agar culture prior to liquid culture may be useful in establishment of human tumor cell lines.
Antigens, Neoplasm↗
[Laser in gynecology. Palliative laser treatment in genital and breast cancers].
Local, so-called incurable, recurrences of breast or genital cancers were as therapeutic challenge in the past. The authors undertook a pilot trial of laser treatment in 45 patients, as a palliative measure, in view of the serious psychological and physical problems experienced by these women constantly confronted by the presence of painful, visible and often ulcerated tumor lesions. CO2 and Nd:YAG lasers were used for tumor vaporisation and coagulation, the combined use of these two wavelengths providing the new study concept which emerged from this pilot trial.
Adult↗
Endoscopic retropubic colposuspension: "Retziusscopy" versus laparoscopy--a reasonable enlargement of the operative spectrum in the management of recurrent stress incontinence?
The technical feasibility of the laparoscopic and extraperitoneal approach to the Burch colposuspension for treatment of grade II and III (moderate to severe) stress incontinence was examined in a randomised prospective study. Irrespective of the endoscopic access, two suspension techniques, namely conventional suture and stapler fixation of alloplastic materials, were compared. A total of 20 patients entered this preliminary evaluation. Three complications occurred; a bladder perforation (during laparoscopic dissection of the space of Retzius), a postoperative detrusor instability and transient urinary retention. Both the endoscopic approaches and the suspension procedures employed proved feasible and safe, and presented the advantages of a "minimal access" procedure, with short hospitalisation and rapid recovery. Short-term follow-up (6-12 months) showed subjective and objective results comparable to those of the conventional abdominal Burch colposuspension. Detailed evaluation of the subgroups is not yet feasible, as the number of patients in this preliminary evaluation was too small and follow-up too short. Final evaluation of the entire study population and long-term follow-up will be necessary before these procedures can be generally offered as a therapeutic alternative.
Adult↗
Multifunctional instrument for operative laparoscopy: technical, experimental and clinical results in gynaecology.
Whilst endoscopic surgical procedures are getting increasingly more complex, in the various surgical disciplines mono- and bifunctional instruments are only slowly being replaced by multifunctional ones. Therefore a complex, intelligent system was developed, the central part of which is a multifunctional instrument. All basic functions necessary for surgical laparoscopy are integrated and comprise: cutting electrodes (unipolar and bipolar) which can be advanced or retracted pneumatically; coagulation forceps with mechanical control; and irrigation and suction devices. All 5 mm instruments can be used and there is an option for others, such as laser or aqua-dissection. The various functions are controlled via the handle of the multifunctional instrument which is connected to the electronic control unit, the MULTILAP system, which supplies the energy, material, and information flow required. In vivo standardised experiments in pigs were first performed to test the new instrument. Operation time was reduced by more than 20% when compared with the same procedure performed conventionally, during which frequent changing of instruments was necessary. Clinical application, without complications in all 30 patients (uterus preserving procedures or reconstructive tubo-ovarian surgery) confirmed the advantages of a multifunctional device, with optimised cutting and coagulation of vessels more than 1-2 mm in diameter, and reduced duration of operation. Safety and ergonomics were improved. Thus, an electronically controlled instrument with multifunctional working channels for lasers, ultrasound appliances, or mechanical instruments is available for application in all domains of operative laparoscopy.
Animals↗
[3d ultrasound in prenatal diagnosis].
Three-dimensional sonography is a logical development of conventional sonography, and is a consequence of the fact that every examiner tries to imagine the three-dimensional appearance of an organ on the basis of the tomographic images of it. In a long development process starting with the first 3D images in 1986/87 and lasting until today, we succeeded in developing a 3D system suitable for routine examinations, which the manufacturer is now marketing commercially. With a 3D transducer a coordinated sequence of tomograms is obtained; all the images are then computed transparently and subsequently imaged three-dimensionally as a crystalline volume. Movement of the 3D image on the computer screen is important for three-dimensional identification. The volume thus computed can then be bisected in longitudinal, transverse and horizontal planes and thus examined in real-time without any interference such as fetal movements. The horizontal sections cannot be obtained by conventional sonography. On the basis of more than 600 patients examined by this new method it was established that 3D imaging of malformations improves diagnosis and assessment, that examinations deliver accurate and reproducible results, and that section analysis can substantially facilitate diagnosis of fetal malformations.
Computer Systems↗
[Inducing labor with intracervical prostaglandin (PG) gel administration. A comparative analysis of 171 patients with 2 different preparations of PGE2 with regard to course of labor and fetal outcome].
In the present study we examined whether the difference in viscosity of two prostaglandins applied intracervically for induction of labour influences course of labour and fetal outcome. A comparative analysis was carried out in 171 patients, which received either Cerviprost (n = 85) or Prepidil (n = 86) at 6 hour intervals. The results show that the viscosity of the PG E2 has no influence on the course of induction of labour, the mode of delivery or on fetal outcome. The low viscosity does also not present an increased risk for uterine overstimulation, even in case of intracervical application.
Administration, Intravaginal↗
[Significance of myoma-induced complications in pregnancy. A comparative analysis of pregnancy course with and without myoma involvement].
In the present study we analyzed the relation between complications in pregnancy--fetal growth retardation, premature rupture of membranes, preterm labour, abruptio placentae, mode of delivery, puerperium--and the size, number and location of myomas. A retrospective comparison was performed in 474 patients (94 pregnant women with myoma and 380 with a normal uterus as controls). The course of pregnancy, the mode of delivery and the puerperium were examined. The study showed that retroplacental submucous myomas increase the risk of fetal growth retardation (14% vs. 6.6%) and abruptio placentae (3.2% vs. 1.3%). The size of the myomas was not relevant. A caesarean section, especially for fetal malpresentation, was also more frequent in patients with submucous myoma (52.9% vs. 27.9%). There was no difference, however, in the postpartal course between the submucous myoma group and the controls, respectively. Subserous or intramural fibroids had no influence on the course of pregnancy, the mode of delivery or the postpartal period.
Adult↗