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Biomedical subjects

H G Hillemanns

Publications and source records attributed to H G Hillemanns.

At least 19 recordsLinked to original sources
PubMed1994

[The pubococcygeus patch--a method for correction of female stress incontinence in simultaneous prolapse].

The pubococcygeus patch procedure is introduced as a vaginal method for treatment of severe stress urinary incontinence of the female in combination with a marked descensus requiring vaginal surgery. It is based on physiological conceptions of urethral closure mechanisms. The primary success rate in 47 women with severe stress-urinary incontinence was 85% after 3-6 months, and 60% in women with hypotonic urethra (< 30 cm H2O). The complication rate was low. The material used for the patch was lyodura (n = 43) and gore-tex (n = 4), the latter showing a 50% repulsion rate.

Adult↗
PubMed1993

Human papillomavirus, type 16, DNA in multicentric anogenital neoplasia associated with idiopathic panmyelopathy. A case report.

A 27-year-old woman suffering from panmyelopathy for six years presented with a cervical low grade squamous intraepithelial lesion (SIL), vulvar high grade SIL and perianal squamous cell carcinoma with an inguinal metastasis. Southern blot hybridization with 32P-labeled human papillomavirus (HPV) DNA revealed HPV 16 DNA in varying copy numbers in material from the four locations. HPV 16 genomes persisting after surgery on the perianal tumor area were no longer detectable after betatron radiotherapy.

Abdominal Neoplasms↗
PubMed1991

[Primary pulmonary hypertension and pregnancy].

Primary pulmonary hypertension (PPH) is an uncommon disease with a poor prognosis. Most patients with PPH are young women of child-bearing age. We report on such a case of PPH during pregnancy, discuss the aetiology, pathophysiology, morphological characteristics and the management in pregnancy and delivery.

Adult↗
PubMed1991

[Fetomaternal transfusions in complicated and uncomplicated pregnancy].

Fetomaternal bleeding in pregnancy is the most common cause of rhesus immunization. In this study we evaluated the amount of fetomaternal bleeding during pregnancies with and without complications. The data from 1204 patients are analyzed. Fetomaternal bleeding was of clinical relevance (HbF greater than 0.01%) in 6% of all uncomplicated pregnancies. There was no increased fetomaternal bleeding in pregnancies complicated by gestosis, preliminary labour, placenta praevia, trauma, and diabetes in pregnancy. In cases with premature rupture of the amnion or vaginal bleeding in pregnancy we observed an increased percentage of fetomaternal bleeding into the mother's circulation. Nearly 25% of all patients with hydrops fetalis had clinical relevant fetomaternal bleeding (HbF greater than 0.01%).

Adolescent↗
PubMed1990

[Pregnancy and labor in idiopathic thrombocytopenic purpura (Werlhof disease)].

The managing of the pregnant patient with immune thrombocytopenic purpura (ITP) is complicated by the unavailability of the foetal platelet count and the risk of bleeding. We report on our experiences of 17 pregnancies in 15 patients, who delivered in the Department of Gynaecology of Freiburg University from 1969 to 1989 (frequency: 0.5 per 1,000). ITP was established prior to pregnancy in 9 of 15 patients, and developed in 6 cases during pregnancy. The a patients received steroid therapy ante partum. However, maternal platelet count did not relate to infant platelet count. Eleven infants were born vaginally, six by caesarean section. One of the 17 live births died immediately post partum at the 28th week of gestation. Six infants were temporarily thrombocytopenic at delivery without further morbidity. Based on our experience and the literature, an individual management of delivery for parturient patients with ITP is recommended.

Blood Transfusion↗
PubMed1990

[Disseminated, highly malignant non-Hodgkin's lymphoma and pregnancy: polychemotherapy in the 2d and 3d trimester].

The coincidence of Non-Hodgkin-lymphoma (NHL) and pregnancy is rare. Even rarer is the use of chemotherapy in pregnancy complicated by NHL. We report on a case of malignant NHL IVa, where diagnosis was established in the 24th week of gestation. The patient was treated with polychemotherapy in the second and third trimester of pregnancy and delivered a normal infant. We review the literature and discuss possibilities and risks of chemotherapy in pregnancy.

Adult↗
PubMed1990

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

Cervix Uteri↗
PubMed1990

[Effect of stress incontinence surgery on urodynamic parameters. 2. Are various surgical methods comparable?].

This study examines the pre- and postoperative clinical data of 215 women operated on during 1983-87 at the University Hospital of Freiburg for stress incontinence. The following procedures were used: Anterior colporrhaphy (n = 27), anterior colporrhaphy in combination with a ventral levator plasty (n = 61), sling procedure with the Lyodura sling (n = 44), and a colposuspension within the total abdominal concept (n = 83). All the procedures, with the exception of anterior colporrhaphy, were followed by a decrease in maximum urethral pressure. The functional urethral length was not changed by any of the methods. Colposuspension showed a marked postoperative improvement of urethral stress profile parameters in the proximal and midurethra, the sling had a steep, unphysiological increase of pressure transmission ratio in the proximal urethra. The vaginal methods did not improve pressure transmission to the proximal section of the urethra, their effect was only measurable in the mid section. The urodynamic effects of different types of surgery were very individual, a fact which may be helpful in the selection of the surgical approach.

Adult↗
PubMed1990

[Systemic lupus erythematosus and pregnancy. Clinical aspects, serology and management].

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting the connective tissue of the skin and the vascular system. In about 90% of the cases, the first diagnosis is made in women of child-bearing age. We report on 11 pregnancies in 5 patients with SLE. The incidence of SLE was found to be 1:2966 in relation to obstetric cases in our hospital. In one patient, an acute exacerbation of the disease led to preterm delivery in the 31st week of pregnancy. The affected patient died postpartum due to generalised disease and septic complications. In general, perinatal mortality was found to be 25% (excluding early abortion). The number of spontaneous abortions, premature deliveries and small for date babies was elevated in our group of patients, in comparison to the normal group. As a result of our own observations in serological controlled pregnancies and of an extensive review of the literature, we came to the following conclusions: Uncomplicated SLE is no contraindication for pregnancy. However, an SLE nephritis represents a relative or even absolute contraindication, depending on the clinical course. Recent prospective studies permit us to conclude, that a pregnancy will not lead to an aggravation of SLE. On the other hand, SLE can cause complications in pregnancy with a subsequent rise in maternal and foetal morbidity and mortality. Most frequent are preeclampsia, premature labour, foetal maldevelopment and flare-ups of the underlying disease. For monitoring the disease, frequent determinations of complement proteins C3/C4 are helpful. The measurement of the C3 turnover can be used to distinguish between the development of preeclampsia and exacerbation of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Antinuclear↗
PubMed1989

[Computer-assisted urodynamics].

Advantages of computer assisted urodynamics with the "Urosoft" program (Wiest KG, Munich) are: Better Display with colormonitor and enhanced graphic adapter, a more rapid quantitative data evaluation, especially with larger data volumes, a better data storage and management, the possibility of program extension for scientific purposes, and the providing of a medical report. Disadvantages are additional costs for hard- and software, an individual time for familiarizing and adjustment and an additional expenditure in cases where only a qualitative evaluation is done. Important is a data analysis in a second step, not done automatically with the measurements, to eliminate artifacts.

Female↗
PubMed1989

[Disseminated intravascular coagulation disorder in the 2d trimester of pregnancy. Case report from the 16th week of pregnancy with spontaneous parturition at term].

After exercising on a trampoline, a 29-year-old primigravidae in the 16th week of gestation was admitted to our hospital with the clinical signs of premature ablatio placentae and acute coagulation disturbances with disseminated intravascular coagulation and uncontrolled secondary hyperfibrinolysis. The coagulation disturbance was stabilized by conservative therapy (Substitution with fresh-frozen-plasma (ffp), whole blood and low-dose heparin treatment without having to terminate the pregnancy by evacuation of the uterus. An appropriate antifibrinolytic treatment was not performed in this case. The continuous controls of fibrinmonomeres and reptilase time indicate the possibility of a persisting latent coagulation disturbance after the acute phase. Thus, the necessity of a low-dose heparin therapy after an acute coagulation disturbance becomes evident.

Abortion, Threatened↗
PubMed1989

[Graduated ruler for making a transverse suprapubic incision].

The transverse suprapubic incision is the most usual approach to laparotomy in obstetrics and gynaecology. It has many advantages both from the aesthetic as well as the functional points of view. The low transverse scar is hidden in the region of the pubis. Post-operative breakdowns (such as hernia and eventertion) that occur with longitudinal incisions have almost disappeared. The site, the length and the height of the incision vary according to the surgeon's ideas and his experience. The result cosmetically therefore varies and the optimum benefit is not always achieved. We describe a graduated ruler specially designed for the transverse suprapubic incision. It was worked out in 1984. It makes it easier to standardise the technique of suprapubic incision, but one that can be changed according to variations in body contours. The ruler can be sterilised. It is available in two models: one, a flexible one which is ideal for caesarean sections and laparotomies in fat women or where the abdominal wall is distorted by tumours under it; the second model is rigid and should be able to be used on the normal flat abdomen. One and a half years experience shows that the ruler can be used to standardise the technique of transverse suprapubic incision. It also helps to teach this method of laparotomy; and the cosmetic results have become better.

Female↗
PubMed1988

[Use of gonadotropin releasing hormone analogs in Marcumar-treated patients for contraception and prevention of life-threatening ovulation hemorrhages].

Five severe cases of intra-abdominal gynaecological haemorrhage (four haemorrhages from corpora lutea haemorrhagica and one haemorrhage of the endometritis genitalis externa) are described in relation to prolonged marcumar therapy. The problem of contraception in patients under marcumar therapy is highlighted and the possibility is discussed of prevention of ovulation and cardio-vascularly neutral treatment, to achieve contraception as well as avoidance of haemorrhage at ovulation with the Gn-RH analogue Buserelin.

4-Hydroxycoumarins↗
PubMed1988

[Late morbidity following cesarean section--a neglected factor].

Based on the data of a questionnaire this study was designed to follow the obstetrical and gynecological history of 269 women who were delivered at our hospital by Caesarean section during 1960-1969. The Caesarean section group was compared with a control group of 229 women who were delivered spontaneously during the same period. Patients with cesarean sections had less children and more often they had been afraid of further deliveries. In patients with vaginal deliveries there was a significant higher incidence of descensus and prolapse uteri and more often a therapy because of premalignant or malignant diseases of the cervix had to be performed. However, there was no significant difference in the frequency of hysterectomies in both groups. The main indication for hysterectomy in the vaginal delivery group was prolapse and descensus, and in the Caesarean section group fibromyoma of the uterus. Except one case of uterine rupture the rate of complications in subsequent pregnancies was similar for both groups. Compared to the control group a higher rate of maternal morbidity due to Caesarean section could not be proved.

Cesarean Section↗
PubMed1988

[Surgical technic of cesarean section. A preparatory cesarean section method primarily for saving the amnion].

A new technique of Caesarean delivery which makes adequate room for safe and gentle extraction of the infant and prevents injury to the foetus and the uterus is presented. The method consists of careful, layer by layer dissection in the lower uterine segment while keeping - whenever possible - the amniotic membranes intact. The opening can be made as large as needed. In a second step, the amniotic sac, now in full view, is carefully opened and the foetus safely extracted. In the ideal case, the lower part of the still intact amniotic sac containing the presenting part of the infant can be lifted out in front of the incision. There the membranes are opened and the foetus delivered. Bleeding is minimal and injury to the foetus and uterus is almost impossible. The wound can be closed with a single-layer suture, which promotes rapid healing and eliminates the danger of rupture during subsequent pregnancies. Further investigations will be necessary to prove whether this technique - lower cervical transverse Caesarean section with late amniotomy - will be worthy of becoming a standard procedure.

Adult↗
PubMed1988

[CO2 laser therapy and typing of human papilloma virus in follow-up studies of cervix intraepithelial neoplasms].

In 104 woman patients with cervical intraepithelial neoplasia (CIN) I-III who had been treated between 1981 and May 1986 in the dysplasia consulting-room of the Department of Gynecology by means of conisation effected by laser, we checked on therapeutic success via cytology and colposcopy as well as by human papilloma virus (HPV) typing. In 90.3% of the cases 1.25 laser treatments sufficed for healing of the lesion. Relapses occurred mainly in severe intraepithelial neoplasias with identified HPV 16/18. Incidence of HPV was reduced from 56% before therapy to 13.3% after therapy. This shows that laser therapy can be regarded as an effective treatment of the causes of the disease even in CIN associated with HPV. The markedly increased relapse rate in CIN III (24%) makes a reliable follow-up mandatory especially in such cases.

Cervix Uteri↗
PubMed1988

[Effect of stress incontinence operations on urodynamic parameters. 1. Is surgical success measurable?].

Urodynamic parameters are changed by stress incontinence surgery. Our study, comparing pre- and postoperative measurements in 141 women with urinary stress incontinence, shows an increase of the transmission ratio in the proximal urethra and a decrease of depression factors in the proximal and mid urethra after surgery. The functional urethral length remains unchanged while the maximum urethral pressure decreases. Except for the maximum pressure decrease, these changes were only found after successful surgery and not in failures. Thus, effectiveness of operations can be quantificated by urodynamic measurements. The unfavourable prognostic influence of a preoperative hypotonic urethra on the results of surgery was confirmed by this study.

Female↗