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Biomedical subjects

H Hepp

Publications and source records attributed to H Hepp.

209 records · Page 12Linked to original sources
PubMedDate not supplied

[Prenatal diagnosis of kidney parenchyma diseases].

BACKGROUND: Aside from congenital anomalies of the urogenital tract, fetal renal tissue itself can be dysplastic. Prenatal ultrasound allows the differential diagnosis of simple cysts, different degrees of renal dysplasia and agenesis of the kidneys. MATERIALS AND METHODS: This article focuses on the multifactorious complex of parenchymal renal disease. According to the classification of Potter Syndrome and cystic renal dysplasia/Potter Sequences I-IV, pathogenesis, prenatal diagnosis, pre- and postnatal treatment options and prognosis are discussed. RESULTS AND DISCUSSION: Concomitant absence of amniotic fluid frequently refutes diagnosis until artificial amniotic fluid infusion has been performed. Although intrauterine therapy is rarely possible, the frequent association with other abnormalities and fetal syndromes may be of consequence. The sonographic appearance of parenchymal renal disease is heterogeneous. This inconsistency has lead to different classifications. This study uses the "modified Potter Classification" of parenchymal disease in kidneys (Zerres).

Female↗
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[Fetal obstructive uropathy--diagnosis and possible treatments].

BACKGROUND: Abnormalities of the urinary tract are found in up to 5% of newborns. They account for 25% of all prenatally diagnosed congenital defects and contribute 4% to perinatal mortality. When considering the prognosis of these anomalies, association with other pathological conditions has to be taken into account. MATERIALS AND METHODS: We discuss the state of the art in detection and management of fetal urinary tract abnormalities as are standard at this tertiary center of fetal medicine. RESULTS AND DISCUSSION: Posterior urethral valve, megaureter or ureteropelvic junction obstruction represent one end of a wide spectrum of obstructive uropathies, ranging from pathophysiologically minor deviations to severe impairment of renal function. Organ development, physiology of urine production and excretion as well as their potential disorders are presented. CONCLUSION: Sonographic and invasive diagnostic options in the evaluation of the urogenital tract are discussed. Careful assessment of each individual case and prognosis determine pre- and postnatal treatment.

Equipment Failure↗
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[Prune belly syndrome and congenital kidney tumors].

BACKGROUND: High end sonography allows the prenatal localization of the kidneys and the corresponding urine drainage system as early as 10-13 weeks of gestation. In mid second trimester, the voiding and filling of the urinary bladder can be demonstrated by ultrasound. Obstructions are the most common abnormalities of the urogenital tract. Though less frequent in incidence, more complex sequences of anomalies such as Prune Belly Syndrome or Megacystis-Microcolon-Intestinal-Hypoperistalsis-Syndrome (MMIHS) can also be detected in early gestational age. MATERIALS AND METHODS: Pathogenesis, prenatal diagnosis, pre- and postnatal treatment options and prognosis are discussed. RESULTS AND DISCUSSION: The same risk-adapted procedures aimed to protect the fetal urinary excretory function known in the therapeutic regimen of obstructive uropathy are available as treatment options. These range from non-invasive ultrasound for diagnosis and surveillance to needle procedures or even endoscopic interventions. Another rare entity of renal abnormalities are congenital neoplasm's--megaloblastic nephroma, nephroblastoma and neuroblastoma. CONCLUSION: Prognosis and obstetrical management are to be determined individually for each patient.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Intra-uterine fetal demise caused by amniotic band syndrome after standard amniocentesis.

The amniotic band syndrome represents a prime example of exogenous disruption of an otherwise normal fetal development. It may be a sequel of invasive diagnostic procedures such as amniocentesis or fetal blood sampling. A 38-year-old gravida II, para II delivered a morphologically normal male stillborn at term. The pregnancy history had been unremarkable but for an early 2nd-trimester amniocentesis. Cause of the intra-uterine fetal demise was noted to be an amniotic band constricting the umbilical cord. An amniotic band is a rare but potentially fatal condition which may be induced by, e.g., invasive prenatal procedures. Such bands are not usually diagnosed prenatally; however, selected patients with augmented risk may profit from intensive ultrasound evaluation including Doppler studies.

Adult↗
PubMedDate not supplied

Myomectomy as a pregnancy-preserving option in the carefully selected patient.

OBJECTIVES: To present the indications for myomectomy during pregnancy and to discuss complications possibly related and unrelated to the procedure. METHOD AND RESULTS: A 33-year-old patient at 18 weeks of gestation underwent removal of a 1,570-gram symptomatic fundic myoma. Histologically the patient had a leiomyomatous neoplasm of uncertain malignant potential. The pregnancy was continued under sequential observation with magnetic resonance imaging and ultrasound. At 36 weeks of gestation a healthy girl with an upper extremity limb defect was born via cesarean section. Follow-up of the mother and the child was uneventful. CONCLUSIONS: Certain known risk factors in pregnant women with myomas can predispose to complications during pregnancy. Women with such risk factors or women who have failed medical therapy should be offered the option of undergoing myomectomy as a pregnancy-preserving procedure.

Adult↗
PubMedDate not supplied

Sonographic cervical volumetry in higher order multiple gestation.

OBJECTIVE: The aim of this study of multifetal pregnancies was the comparison of three-dimensional (3D) volumetry of the cervix, conventional sonographic cervical length measurement and clinical assessment. METHODS: 10 mothers were investigated in an observational study between 5/1999 and 9/2000. A total of 34 consecutive 2D- and 3D-transabdominal ultrasound measurements were performed. RESULTS: Volumetry of the cervix was possible in all 34 exams. 2D-cervical length assessment could not be obtained in 6% because the presenting fetal part obstructed the sonographic plane. Both methods allowed equal judgement of the configuration of the cervix. A significant correlation was found between mean 2D-cervical length (28.7 mm, 7.7 SD) and mean cervical volume (30.0 cm3, 16.0 SD). Parity, subjective preterm labor or need of tocolytics showed no correlation with any biometrical parameter studied. CONCLUSION: Volumetry was superior for the assessment of cervical biometry and conformation in women when the transabdominal 2D-plane was obstructed. When cervical length was obtainable by a conventional scan, the technically more complex 3D-imaging did not provide further information.

Adult↗
PubMedDate not supplied

Experimental animal model for readhesion formation study.

The problem of postoperative adhesions remains unsolved. The formation of readhesions after tubal reconstructive surgery reduces the success rate. We have developed a modified uterine horn model in the rat to study the influence of peritoneal transplants on readhesion formation. A total of 58 rats were operated. In 25 animals (group III) the uterine horn was scratched on both sides and then sutured together. During relaparotomy 14 days later the tight connection between both sides was cut. The resulting defect was covered by a peritoneal transplant on one side (group IIIb) and was left open on the control side (group IIIa). After 14 days the presence or absence of adhesions was explored. There was a significant difference (p < .001) between the covered (28%) and uncovered (84%) peritoneal defects with respect to incidence of adhesions. To compare the different characteristics of visceral and parietal peritoneum, a pelvic sidewall defect was induced in 33 animals. There was no significant difference between covering the defect by a peritoneal transplant (group II; 42.9%) and the control side (group I; 33.3%). These data suggest that defects on visceral peritoneum should be closed to prevent adhesion formation. The incidence of adhesions after injury of parietal peritoneum seems to be much lower and of less clinical significance.

Animals↗
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[Course of pregnancy following in vitro fertilization and embryo transfer].

Worldwide analysis of pregnancies after IVF/ET allows the evaluation of the pregnancy outcome compared to normal population. The mean age of IVF-patients is significantly higher. The incidence of clinical abortions after IVF/ET is within normal range, correlating rather with age than with treatment modalities. The rate of multiple gestations is increased after IVF/ET as well as GIFT or hMG-stimulation, leading to more high risk pregnancies. Gestosis is seen in 7% of singletons and 17% of triplet pregnancies. Preterm deliveries before 36 weeks of gestation occur in 17% of singleton and 52% of twin pregnancies after IVF/ET (control 7.3%). This leads to an increasing rate of caesarean section. The global malformation rate is 2% and in a comparable range to normal population. A presumably higher incidence of neural tube defects has to be proven in a larger number of IVF pregnancies.

Embryo Transfer↗
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[Serum morphine concentrations and analgesia in epidural or subcutaneous morphine administration in obstetrics].

The analgesic effect of three mg morphine hydrochloride administered either epidurally or subcutaneously to 14 primiparae was compared. The maternal serum concentrations of morphine were determined in defined intervals over a period of four hours. Analgesia was significantly superior following epidural morphine, but unsatisfactory in both groups. Good pain relief was achieved by subsequent epidural administrations of bupivacaine.

Adolescent↗
PubMedDate not supplied

[Prevalence and follow-up of hepatitis C virus infection in pregnancy].

Hepatitis C shows an increasing distribution in countries of western Europe. The aim of our study was to assess the prevalence of antibodies to hepatitis C (anti-HCV) in pregnancy, to evaluate the risk factors for anti-HCV positive women and the course of hepatitis C during pregnancy. 3712 pregnant patients of the university hospital Grosshadern, Munich, were analyzed for anti-HCV, anti-HIV and hepatitis B surface antigen. Anti-HCV seropositive women were further tested with western blot and polymerase chain reaction for HCV-RNA. Thirty-five (0.94%) of the 3712 pregnant women were found anti-HCV positive. 20% of them had present or previous injection drug abuse, hereof one patient had an associated seropositivity for HIV. Parenteral transmission through blood transfusion was likely in 11%. However, no parenteral exposure was recognized in 57% of the anti-HCV positive patients. The presence of serum HCV-RNA was detected in 16 (57%) of the 28 patients tested. In 17% (6/35) of the anti-HCV positive pregnancies elevated liver enzymes were noted, which did not show any significant change during the course of pregnancy. In conclusion, the prevalence of hepatitis C in pregnancy is relatively high with nearly 1%-comparable to chronic hepatitis B infection. Selected pregnancy screening based on perceived high-risk groups alone fail to detect about 60% of HCV antibody-positive women. Pregnancy did not influence the course of hepatitis C.

Adult↗