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Biomedical subjects

H Graeff

Publications and source records attributed to H Graeff.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Septic ovarian vein thrombosis--diagnosis and therapy].

Septic ovarian vein thrombosis is commonly the sequela of puerperal purulent endomyometritis. The incidence has been reported to be 1 in 600-6000 deliveries. The predominant location is the right ovarian vein according to the puerperal uterine drainage. The diagnostic and therapeutic experience in 9 cases is described. The leading symptoms were abdominal pain localized at the psoatic muscle and a tender, barrel-shaped tumor. Ultrasound and computed tomography (CT) added in the correct preoperative diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course; in complicated cases surgical intervention becomes mandatory.

Endometritis↗
PubMed1988

Fibrin-fibronectin compounds in human ovarian tumor ascites and their possible relation to the tumor stroma.

Covalently linked heterogeneous fibrin-fibronectin compounds were detected in ascitic fluid of 31 patients with advanced ovarian cystadenocarcinoma by means of enzyme-linked immunosorbent assay techniques, immunoaffinity chromatography, and Western blot analysis. Deposition of fibrin and fibronectin could also be demonstrated immunohistochemically in Carnoy-fixed tissue sections. Fibrin and fibronectin were found in the tumor stroma within tumor nests and more prominently in stroma surrounding the tumor nests. The association of fibrin and fibronectin was especially pronounced in the stroma surrounding the tumor islands. Fibronectin was also found to be associated with stroma cells. Areas within the tumor stroma showed superimposed staining for both fibrin and fibronectin supporting the assumption that the covalently linked fibrin-fibronectin conjugates found in ascitic fluid may stem from the provisional tumor stroma by proteolytic release.

Ascitic Fluid↗
PubMed1988

The role of coagulation, fibrinogenolysis and fibrinolysis in the development of fluid and clotted cadaver plasma.

Parameters for coagulation, fibrinogenolysis and fibrinolysis were measured in order to understand the formation of fluid or clotted cadaver plasma. All values found were distinctly elevated without significant differences between fluid and clotted material. The electrophoretic banding pattern of the fibrinogen and fibrin material also proved extensive coagulation and fibrinolysis in all cases. In vitro experiments in which similar electrophoretic banding patterns were obtained suggested that the development of fluid cadaver plasma depends on the activation of fibrinolysis prior to complete coagulation, and is enhanced by persistence of circulation as well as a physiological pH (7.4). In correspondence to post mortal time only an increase in elastase values was found.

Blood Coagulation↗
PubMed1988

[Genital infections and the course of pregnancy: a prospective study].

The reported study investigates the relationship of genital infections, pathobiochemical findings and demographic data to preterm labor, premature rupture of membranes (PROM) and premature delivery. The predictability of chorioamnionitis, puerperal and neonatal infections by these parameters was evaluated concurrently. 301 patients were included in this study between July 1985 and June 1986. 147 of these patients were studied longitudinally during pregnancy, delivery and puerperium (longitudinal group). A second group consisted of 154 women who presented themselves on start of labor to the labor and delivery unit of our Department (peripartal group). The incidence of preterm labor and of PROM was 26%. The incidence of premature delivery, chorioamnionitis, puerperal and neonatal infection was 11.4%, 5.5%, 7.6% and 3% respectively. Cervical colonization with Mycoplasma hominis correlated positively with PROM (relative risk 2.2), premature delivery (3.9) and neonatal infection (6.9). Chorioamnionitis, premature delivery and puerperal infection were also significantly increased in patients with positive vaginal Ureaplasma urealyticum cultures during pregnancy and delivery. Premature delivery (2.8) and puerperal infection (4.0) were associated with a vaginal group B-Streptococci (GBS) colonization during pregnancy, as was a positive GBS culture during delivery associated with puerperal infection. Bacterial vaginosis also correlated positively with premature delivery (5.6) and puerperal infection. Preterm labor correlated negatively with the socioeconomic level, PROM correlated negatively with the marital status, positively with age, a history of cervical cerclage, conization or PROM during former pregnancies. Sexual intercourse more often than once weekly during the last month of pregnancy was also associated with an increased number of PROM. Gardnerella vaginalis, Candida and Trichomoniasis during pregnancy and delivery were associated with preterm labor and puerperal infections. Levels of maternal plasma fibrinogen concentrations in patients with PROM were elevated 48 hours after delivery in accordance to the characteristics of acute phase proteins. In contrast, the maternal PMN-granulocyte-elastase concentration was significantly elevated at time of delivery and 24 hours thereafter in those patients who developed puerperal infections. The derived positive predictive value was 26%, the negative 94.7%, respectively. The overall accuracy of the prediction was 83.1%. Six out of seven mothers with neonates treated because of neonatal infection showed significantly elevated plasma concentration of PMN-granulocyte-elastase.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacterial Infections↗
PubMed1988

[Puerperal ovarian vein thrombophlebitis--a rare puerperal complication].

Puerperal ovarian vein thrombosis (POVT) commonly results from purulent necrotic endomyometritis. The incidence is published to be 1 in 600 deliveries, however, according to own data, the incidence is at least 10 times less frequent. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain localized anteriorly to the psoatic muscle and a tender, barrel shaped unilateral tumor. Discrepancy between the grave clinical picture and the insignificant findings on gyn. examination is common. Ultrasound and computed tomography frequently add in the correct diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course. If clinical improvement is delayed despite non-invasive treatment, surgical intervention with resection of the involved veins and all septic foci becomes mandatory. Despite non-invasive and invasive treatment, pulmonary emboli or septic complication refractory to therapy may contribute to mortality. Therefore POVT should always be included in the differential diagnosis of those patients presenting with a variable fever curve or an unexplained septic course following delivery or miscarriage.

Adult↗
PubMed1988

[Peri-operative preventive use of antibiotics in abdominal hysterectomy].

In patients undergoing abdominal hysterectomy, the efficacy of antibiotic prophylaxis was compared to no treatment. Additional studies on the influence of risk factors such as D&C, conisation and IUD's on post-operative morbidity were evaluated. 144 patients were recruited into the study and prospectively randomised into one of four groups. Groups IV and II received 2 g i.v. Cefotetan and were comprised of patients with or without risk factors, respectively. Similarly, groups III and I, again with or without risk factors, received no treatment and served as the control groups. Infectious post-operative morbidity was significantly reduced in both groups of patients receiving antibiotic prophylaxis, the maximum benefit being observed in those patients with accompanying risk factors. The need for additional antibiotic therapy was highest in those patients receiving no antibiotic prophylaxis, i.e. groups III and I. Additionally if concomitant risk factors were present, the duration of hospitalisation was increased by a further 1.4 days.

Bacteriuria↗
PubMed1988

[Significance of early laboratory diagnosis for obstetrical procedures in severe gestoses and the HELLP syndrome].

HELLP syndrome is a severe complication of preeclampsia, incalculable in its course and involving high risk for mother and fetus. Over a period of three years and eight months a total of 24 patients with HELLP syndrome were treated at Göttingen University Gynecological Clinic and the Gynecological Clinic of Munich Technical University. In all cases the correct diagnosis had already been made by the referring physician or by the obstetrician on admission, taking laboratory parameters into account. The chief clinical symptom was upper abdominal pain, All of the patients presented with thrombocytopenia and elevated liver enzymes. The signs of hemolysis derived from the increased bilirubin concentrations and the LDH; in 13 cases fragmentocytes were detected in the peripheral blood smear. No indications of a pronounced DIG were found. The mean time elapsed between hospitalization and delivery was six hours (0.5-40 hours); 22 patients were delivered within 24 hours. Cesarean section was performed in all cases. The mean gestational age at the time of birth was 35 weeks (25-38). Three of 24 children died prepartially; with the surviving infants no major problems arose in the postnatal course. In 19 cases the abdominal cesarean delivery and clinical course were without complications. Reoperation, in two cases combined with a puerperal hysterectomy, was necessary in three patients, due to subfascial and intraperitoneal or retroperitoneal hematomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Fibrinolysis in ascitic fluid: isolation and characterization of fibrin derivatives, their interaction with albumin.

A method for the preparative isolation of high molecular weight fibrin degradation products (XDP) from ascitic fluid of patients with advanced ovarian cancer is described. By non-reduced and reduced PAA-Gel electrophoresis we could demonstrate that high molecular weight fibrin derivatives exist as E-complexes. A similarity of the polypeptide chain composition from in vitro samples and ascitic fluid could be shown. Immunoadsorption with anti-albumin followed by Westernblotting with anti-fibrinogen-demonstrated the existence of XDP/albumin-associates in ascitic fluid.

Ascitic Fluid↗
PubMed1987

Monitoring arterial oxygen saturation in the neonate.

Term neonates (N = 35) with an one minute Apgar score of greater than or equal to 8 and mean umbilical artery pH values within normal were monitored by pulse oximetry. SaO2 monitoring started one minute after delivery. The initial SaO2 ranged from 40 to 75%. Neonates with a SaO2 above 80% five minutes after delivery remained untreated, neonates with a SaO2 below 80% received mask CPAP (figure 1). The initial difference in SaO2 between the groups was statistically significant (p less than 0.05). Mean umbilical artery pH and one, five and ten minutes Apgar score values were statistically not significant between the groups (p greater than 0.05). CPAP had been terminated as soon as SaO2 had reached 90%. This had been the lowest value monitored in spontaneously breathing neonates one day after delivery. Our findings indicate that neonates may sustain prolonged periods of decreased SaO2 which had not been detected by umbilical artery pH nor by the Apgar score. SaO2 monitoring by pulse oximetry served as a valuable method in the immediate newborn evaluation.

Apgar Score↗
PubMed1987

Maternal arterial oxygen saturation during labor and delivery: pain-dependent alterations and effects on the newborn.

This study evaluated the effects of labor pain on maternal arterial hemoglobin oxygen saturation and neonatal acid-base status. Arterial oxygen saturation was monitored noninvasively by pulse oximetry during labor and delivery. The patients studied (N = 46) were divided into four groups according to obstetric history (primiparas and multiparas) and pain management during labor (lumbar peridural anesthesia versus meperidine and nitrous oxide). Nine patients at term but not in labor served as controls. Decreases of arterial oxygen saturation were related to both subjective pain, reported by visual pain analog scales, and to neonatal acid-base status at delivery. All values are reported as mean +/- standard deviation (SD). Primiparas with peridural anesthesia showed significantly less decrease in arterial oxygen saturation (1.7 +/- 1.4%; P less than .001; N = 15), superior scores on the visual pain analog scale (3.5 +/- 2.0), and a significantly better neonatal acid-base status (pH 7.29 +/- 0.06; P = .01; base excess -6.4 +/- 2.2; P less than .05) as compared with primiparas treated with meperidine and nitrous oxide (SaO2 7.2 +/- 3.9%; visual pain analog scale 7.1 +/- 1.2; pH 7.21 +/- 0.1; base excess -9.5 +/- 4.5; N = 16). In multiparas there was no statistically significant difference in decrease of arterial oxygen saturation, visual pain analog scale, and neonatal acid-base status.

Acid-Base Equilibrium↗
PubMed1986

[Perioperative antibiotic prevention with cefoxitin in cesarean section. Management and uses].

Antibiotic prophylaxis and febrile morbidity following non-elective Caesarean section were studied retrospectively. Febrile morbidity was found to be 5.4% in the treated group as compared to 20% in the untreated group. Percentage of endomyometritis was 2.2% in the treated group and 16% in the untreated group. Our results prove the efficacy of antibiotic prophylaxis in patients undergoing Caesarean section. Antibiotic application in 79% of all these patients led to a significant reduction in puerperal febrile morbidity and endomyometritis. Experience shows that positive results gained by the study do not have a positive feedback on the ward if there is lack of communication or reconfirmation.

Cefoxitin↗
PubMed1986

[Tumor-associated antigens and fibrin derivatives as reaction products of ovarian cancer].

The detection of tumour-associated antigens in blood, ascites fluid, and tissue by the use of monoclonal antibodies establishes new aspects for the course control of ovarian cancer therapy and the evaluation of tumour-associated fibrinolysis. Monoclonal antibodies to the cross-linking site of fibrin derivatives in an enzyme immunoassay (D-dimer-ELISA) allow to compare quantitative results of fibrinolysis products with different tumour markers and the clinical tumour situation. In a prospective follow-up-study in 102 patients with epithelial ovarian carcinoma Ca 125, D-dimer, TPA, Ca 19-9, and CEA were investigated as tumour markers. Specificity (control group 61 gynaecologic patients with benign diseases) and sensitivity were compared in sensitivity-specificity diagrams (receiver operating characteristic curves) for different clinical tumour situations (preoperative, S0-S3). Applying a limit value of normal range, indicated in parentheses, the specificity of Ca 125 (greater than 65 mu/ml) amounts to 100%, D-dimer (greater than 700 ng/ml) 100%, TPA (greater than 120 mu/ml) 90%, CEA (greater than 5 ng/ml) 96%, Ca 19-9 (greater than 37 mu/ml) 98%. In the same sequence, sensitivity values came to 91%, 82%, 65%, 8% and 19% in manifest tumour situations. Antigen-concentration levels and frequency of pathological values depend on the degree of tumour disease. The results of seroimmunodiagnostic methods correlate with the clinical tumour situation: In 11 of 12 cases clinical tumour progression or relapse were accompanied by increasing concentrations of Ca 125 and D-dimer. In 21 cases of second-look laparotomies, tumour marker values in the normal range were often found not to be conclusive for diagnosing a tumour-free situation. The predictive value for true negative results amounted to only 18%. Immunohistochemical investigations and plasma-ascites diffusion ratios of antigens indicate that enrichment occurs in ascites. Fibrin deposition often surrounds tumour plugs and is found in interstitional tissue, whereas Ca 125 is expressed mainly at tumour cell surface. The histochemical image reflects fibrin as a tumour surrounding antigen and Ca 125 as a tumour-originated antigen. Clinical relevant serodiagnostic methods for ovarian cancer are brought about by the monoclonal detection of the investigated antigens.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

[A test for the detection of fibrin in the plasma].

The article reports on measurements of D dimer, a terminal plasmic lysis product of crosslinked fibrin, with an enzyme immunoassay (ELISA) employing recently developed specific monoclonal antibodies. Due to its sensitivity the test can be used on plasma samples. The D dimer concentrations in patients with deep vein thrombosis diagnosed by laboratory apparatus were significantly increased compared to a control group; in one patient with additional pulmonary embolism, the level was even higher. Moderately elevated concentrations of D dimer were observed in the hypercoagulable state of pregnancy, puerperium and during the postoperative course. This reduces the specificity of the test with regard to the recognition of thromboembolic episodes under these conditions. Obstetric patients with disseminated intravascular coagulation (DIC) showed excessively increased levels of D dimer. Hence, a marker function with regard to the recognition of thromboembolic disease can be attributed to the D dimer; the diagnosis of DIC can be confirmed if very high concentrations are detected.

Adult↗
PubMed1986

[Detection of fibrinolysis in chronic subdural hematoma].

Various biochemical processes in hematoma fluid arising from chronic subdural bleeding have not yet been clearly explained. We examined the question whether formation of hematoma fluid after onset of bleeding is preceded by complete clotting with fibrin formation and subsequent lysis of the clot. 22 samples of hematoma fluid taken during operation were used. The protein content was 5.7 +/- 9.8 g/l (mean +/- SD), and coagulable fibrinogen could not be demonstrated whereas 0.99 +/- 0.45 mg/ml fibrin(ogen) break-down products were found immunologically. The high levels of crosslinked D-D fibrin derivatives (0.32 +/- 0.26 mg/ml) were conspicuous: there was a correspondingly high degree of crosslinking (86.2% x/- 12.2%) of the fibrin(ogen) break-down products (calculated from the proportion of dimeric to monomeric gamma-chains). Monoclonal antibodies specific for D-D were employed for the first time to answer the question. The characterization of the crosslinked fibrin derivatives together with their submolecular sub-units and the quantification of the D-D content serve to prove that fibrin is both formed and broken down in chronic subdural hematomas.

Adult↗