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Biomedical subjects

H Hepp

Publications and source records attributed to H Hepp.

At least 37 records · Page 2Linked to original sources
PubMed1998

Low-dose FSH stimulation in polycystic ovary syndrome: comparison of 3 FSH-preparations.

In patients with PCOS low dose administration of follicle stimulating hormone is accepted as a safe treatment modality with low risk for an ovarian hyperstimulation syndrome or a multiple pregnancy. In this study we have retrospectively compared the efficacy of 3 different FSH preparations in low dose protocols-urinary FSH (FSH), highly purified urinary FSH (FSHHP) and recombinant FSH (rec. FSH). A total of 68 PCOS-patients, 36 lean and 32 moderately obese patients, were treated in 116 stimulation cycles. The mean age did not differ between the groups. A mean number of 1.7 cycles per patient was performed. PCOS was diagnosed in all patients by hormonal and sonographic means. Treatment was performed with daily injections of one ampoule FSH from day 3 onwards. Ovulation was induced with 10,000 IU HCG, when the leading follicle exceeded 16 mm in diameter and no more than 3 follicles were seen. The rate of monofollicular cycles was lowest in obese patients after FSHHP stimulation (30%) and after rec. FSH (66.6% in lean and 58.3% in obese patients, respectively). The number of FSH ampoules did not differ significantly between the groups. No severe hyperstimulation syndrome was registered. 21 pregnancies were achieved without significant differences between the different FSH preparations. Besides two abortions and one ectopic implantation, 12 pregnancies were ongoing singleton pregnancies, 3 twin pregnancies and 3 sets of triplets were noted. In conclusion, low-dose stimulation with FSH offers a safe and successful treatment option in patients with PCOS with an acceptable risk for multiple gestations.

Adult↗
PubMed1998

["Evidence-based medicine"--guidelines as a threat or necessity for physician and patient?].

Guidelines derived from 'evidence-based medicine' are supposed to provide assistance and information in order to improve diagnosis and therapy of individual patients and build up confidence in medical decisions. Guidelines possess no direct legal power. The doctor's freedom of decision must be warranted. Inadequate guidelines may have serious consequences: curtailment of therapeutic freedom, hampering of medical progress, deterioration of the relationship between doctors and their patients, risk of legal implementation and emergence of a defensive medicine.

Defensive Medicine↗
PubMed1998

[Our university clinics need research--so does our specialty!].

University research has to serve as a substrate for science and technology and should raise a qualified, critical but motivated younger generation of scientists. These need a basic research which is independent and not oriented towards any short-term goals. An open and easy collaboration without any interdependence is necessary between the university and industry. All this requires greater autonomy for the universities. in German-speaking countries, many people distrust progress. However, it is not a matter of 'progress at any price' but of a careful, pertinent analysis of the benefits and risks. Parsimony in science and research is dangerous and shortsighted. To invest in research means to invest in the future.

Curriculum↗
PubMed1998

[Hormonal treatment of proximal tubal pathology with the GnRH analogue leuprorelin].

In proximal tubal occlusions (PTO) the microsurgical anastomosis or in case of extensive tubal damage the in vitro-fertilisation (IVF) are the treatment modalities of choice. Aim of our study was to evaluate the effectivity of GnRH-analogues in the treatment of PTO. In 23 patients with repeatedly proven proximal tubal occlusion the GnRH-analogon Leuprorelin was applied for a 3 month period. 20 out of 23 patients completed the entire study including a further tubal patency test. 10 patients showed open tubes on both sides and in 2 cases one oviduct was patent. In 8 patients no effect of the hormonal treatment was found. Following the therapy 4 pregnancies occurred, 2 were located ectopically. Regarding tubal patency we could demonstrate a significant effect of hormonal treatment in proximal tubal occlusions (PTO). However, in respect to the pregnancy rate the results were not satisfactory. Therefore, the hormonal treatment of PTO by GnRH-analogues is limited to certain cases and doesn't represent a standard therapy.

Adult↗
PubMed1997

Quantitative determination of the epidermal growth factor receptor in cervical cancer and normal cervical epithelium by 2-color flow cytometry: evidence for down-regulation in cervical cancer.

Expression of epidermal growth factor receptor (EGFR) was quantified by 2-color flow cytometry in cervical cancer (n = 73) and normal cervical epithelium (n = 11). EGFR was determined using a murine monoclonal EGFR antibody, and number of bound antibodies was quantified adding calibration beads with defined antigenic binding sites. Tumor cells were identified by simultaneous DNA staining. Epithelium of normal cervical tissue was detected by labeling for cytokeratin. Results were compared with EGFR quantification by autoradiography on cryostat sections using a radioligand binding assay. A high degree of correlation was found between the 2 methods. In cervical carcinomas 14,600 binding sites/cell (median; range, 160-283,000 binding sites/cell) were detected, considerably less compared with normal cervical squamous epithelium, which was 30,700 binding sites/cell (median; range, 19,900-44,000 binding sites/cell). This finding clearly contrasts with other reports of enhanced EGFR expression in cervical cancer. The discrepancy may be explained by contamination of tissue homogenates used for radioligand or enzyme immunosorbent assays by non-epithelial tissue elements with low or absent EGFR expression. Interference with quantitative EGFR determination in epithelial cells may result in false low estimates of EGFR expression predominantly in normal cervical tissue. This should be avoided by identifying tumor and normal epithelial cells prior to analysis. In our study, 63% of cervical cancers expressed low levels of EGFR compared with normal cervical epithelium, and only 10% showed overexpression. There is evidence that cervical carcinomas overexpressing EGFR represent a small, but biologically distinct group of cervical cancers exhibiting enhanced aggressiveness associated with poor survival of the patients.

Antibodies, Monoclonal↗
PubMed1997

Fertility after organ-preserving surgery of ectopic pregnancy: results of a multicenter study.

OBJECTIVE: To evaluate the postoperative fertility rate after ectopic pregnancy (EP) and to compare the impact of different surgical techniques. DESIGN: Prospective, multicenter trial. SETTING: Twenty-five centers with microsurgical facilities. PATIENT(S): A total of 1,025 patients with EP were enrolled between 1984 and 1990. INTERVENTION(S): Organ-preserving operation and at least one patent remaining tube. Evaluation of postoperative outcome by standardized questionnaires. MAIN OUTCOME MEASURE(S): Postoperative fertility in terms of pregnancy rate (PR) and recurrent ectopic implantation. RESULT(S): The PR was similar after wedge resection (45.9%) and salpingotomy or milk out (42.0%). The recurrence rates did not differ between both groups (7.5% versus 8.2%). In patients with a blocked or absent contralateral tube, the PR was poor (31.2%), and the recurrence rate of EP was high (16.0%), indicating that most pregnancies are achieved through the contralateral tube. CONCLUSION(S): The postoperative fertility rate after an EP is reduced. The type of surgery usually has no significant impact. In the case of a blocked or absent contralateral tube, the patient must be informed about the significantly reduced fertility rate and the elevated risk for EP recurrence.

Adolescent↗
PubMed1997

[Radiologic versus ultrasound fallopian tube imaging. Painfulness of the examination and diagnostic reliability of hysterosalpingography and hysterosalpingo-contrast-ultrasonography with echovist 200].

UNLABELLED: Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. PATIENTS AND METHODS: 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). RESULTS: Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). CONCLUSION: Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.

Contrast Media↗
PubMed1997

[New drugs in therapy of breast carcinoma: current status and outlook].

In breast cancer the results of the meta-analysis of the Early Breast Cancer Collaborative Trialists' Group clearly proved a significant improvement of overall survival after systemic adjuvant treatment. These therapy benefits of the years 1970-1990 are significant but still remain unsatisfactory concerning the high recurrence rates and low overall survival rates. Since 1990 many new active drugs and innovative therapy concepts have been developed. At present the new cytotoxic agents gemcitabine, vinorelbine and topotecan are being tested. Paclitaxel and docetaxel are being examined in combination therapy and in the adjuvant setting. Selective aromatase inhibitors and new antigestagens and antiestrogens are endocrine drugs under investigation in advanced breast cancer. Dose intensity concepts are performed safely due to growth factors and peripheral stem cell support. A new therapeutic approach is the application of the humanized monoclonal antibody against the CerbB-2 receptors of breast cancer cells. These new promising therapeutic approaches are under clinical investigation at present and are discussed in detail.

Antineoplastic Agents↗
PubMed1997

[Amnionic infection syndrome by retro-amniotic uterine abscess: false-negative bacteriological diagnostic amniocentesis].

UNLABELLED: In general intra-amniotic infection causes severe fetal compromise. Prematurity resulting from preterm labor, premature rupture of membranes, maternal fever, maternal or fetal septicemia and fetal tachycardia is the major problem of this clinical syndrome. Therefore early detection of chorioamnionitis gains high prospective value. Gram's staining method from amniotic fluid provides a quick and reliable diagnostic tool (sensitivity 63.8%, specificity 97.7%). A localized extra-amniotic abscess demonstrates the special case of a false negative amniocentesis performed for bacteriological reasons. CONCLUSION: In suspected amniotic infection the obstetrical management has always to take into account all different parameters--clinical symptoms, chemistry and microbiological analysis. Nevertheless Gram's stain is a reliable and quick method to verify amniotic infection syndrome.

Abdominal Abscess↗
PubMed1996

[Mortality, mode of delivery, pneumothorax and intracranial hemorrhage in 859 extremely premature newborn infants between 1984-1992].

In a retrospective study we investigated the mortality and the most important complications of all very low birth-weight infants (VLBW; < or = 1500 g and/or < or = 32 weeks) born with vital signs between 1984 and 1992 at the Klinikum Grosshadern, Munich University Hospital. During this period 859 premature infants fulfilled the entrance criteria. The perinatal mortality rate was 174/859 infants (20%). During the study period the mortality rate dropped significantly from 25% (1984-1986) to 15% (1990-1992). Premature infants born after 26 gestational weeks showed the most significant decrease in mortality. Excluding non viable infants with extreme immaturity ( < 24 weeks of gestation) or lethal malformations; the mean corrected mortality rate was 11%, decreasing over the years from 16% (1984-1986) to 5% (1990-1992). Caesarean section was performed in 70% of all children (602/859), vaginal delivery in 28% (239/859), delivery by forceps in 1% (7/859), and the mode of delivery was not clearly registrated in 1% (11/859). The incidence of Caesarean section increased significantly from 55% (1984-86) to 79% (1990-92). Evaluating the mode of delivery in relation to mortality, a significant difference was found between the infants delivered vaginally (40%, 95/239) and those delivered by Caesarean section (11%, 67/602). This improved survival after Caesarean section was statistically significant for the group with a birth weight of less than 1500 g. The rate of pneumothorax also declined significantly from 19% to 9%. The rate of intracranial haemorrhage (ICH) remained almost constant during these years, but the incidence of ICH grade 3 and 4 decreased from 15% (1984-1986) to 6% (1990-1992). Probably because of improved antenatal care and the progress in neonatal intensive care, the chance of survival for VLBW infants has substantially improved over the last decade. Estimations of the prognosis of VLBW infants based on data from the 1980s are out of date.

Apgar Score↗
PubMed1996

[Emergency cesarean section--organization and decision-delivery time].

The German Society of Gynaecology and Obstetrics has published standards for obstetrical services concerning equipment, personnel and organisation. All obstetrical services must be able to perform an emergency Caesarean section with a 20 minutes interval from decision to delivery (D-D time). This study represents an analysis of the 75 emergency Caesarean sections performed at the University hospital Grosshadern of Munich during the interval from 1987 to 1994. This being a level III hospital, there is a 24 hour obstetrical, anaesthesia and neonatal service, and personnel is readily available. The operation can and has been done in each delivery room. 1. The incidence of emergency Caesarean sections was 0.6% compared to a total Caesarean rate of 21.5% in a high risk population having a preterm rate of 19% during the period of the study. 55% of the patients who had emergency Caesarean sections presented with a gestational age of less than 37 weeks and 35% of less than 32 weeks. 2. The mean time elapsed between decision and delivery (D-D time) was 12.8 minutes; however, the 90 percentile was 22 minutes and exceeded the recommended D-D time of 20 minutes. The mean decision to incision interval represented 9.1 minutes, and 3.6 minutes were needed between incision and delivery. 3. There was a significantly higher frequency of emergency Caesarean sections, performed during daytime and evening hours compared to early morning (0-8 a.m.). However, the D-D time intervals examined for these three time periods showed only minor, non-significant differences. In conclusion, an efficient emergency Caesarean delivery requires a coordinated team effort with excellent cooperation between obstetrics, anaesthesia and neonatology. Our study demonstrates that even in this optimal setting a decision to delivery time within the 20-minute interval can not always be achieved. Based upon our results and other studies, we recommend a D-D time of 30 minutes.

Cesarean Section↗
PubMed1996

[13-cis retinoic acid and interferon-alfa-2a as palliative therapy in pretreated, recurrent squamous epithelial carcinoma of the cervix uteri and vulva].

Patients with metastasising carcinoma of the uterine cervix or recurrent disease, in whom local treatment as surgery or radiotherapy has failed, are still an unsolved problem. Platinum-based multi-agent chemotherapies achieve overall response rates up to 60%, but side effects are serious and so far no survival benefit has been proven. Recent publications report on a synergistic effect of combination therapy using 13-cis-retinoic acid and interferon alpha-2 a in the treatment of squamous cell carcinoma of the cervix. In a pilot study we include 6 patients with locally recurrent or metastasising squamous cell carcinomas, five of the uterine cervix, one of the vulva. The systemic therapy consisted of-orally administered 13-cis-retinoic acid (80 mg q. d.) and subcutaneously injected interferon alpha-2 a (6 x 10(6) I.E. q. d.). All patients were primarily treated by surgical and/or radiation therapy. In each case chemotherapy had been either already performed or rejected by the patient. Median duration of treatment was 52 days, median survival time 107 days. Out of 6 patients 3 experienced progression of disease uninfluenced by therapy. One patient with multiple subcutaneous lymph node metastases showed mixed response for a short period of 3 weeks before progression and eventual death. One patient had no change or disease for 13 months with subsequent progression and eventual death after 22 months. One patient could not be evaluated for an allergic reaction after only 15 days of treatment. Other side effects were "flu-like symptoms", skin irritations, conjunctivitis sicca and chileitis, all WHO 1-2. Overall toxicity must be rated low compared to standard chemotherapy, but is not negligible. In our study the positive reports in literature concerning the treatment of primary advanced cervical cancer and recurrent advanced carcinoma of the skin could not be reproduced. This might be due to the small number of cases, which is a common problem in immunotherapeutic studies. Moreover, very unfavourable patient selection criteria in our study compared to primarily untreated patients may also have contributed to different response rates. However, in our opinion the tested regimen cannot be considered sufficiently effective in patients suffering from pretreated, recurrent squamous cell carcinoma of the cervix or vulva.

Administration, Oral↗
PubMed1996

[Diagnosis and therapy of extrauterine pregnancy].

The combined use of transvaginal ultrasound and serial quantitative determination of the serum human chorionic gonadotropin (HCG) concentration offers an early and exact diagnosis of an ectopic pregnancy before the onset of clinical symptoms. Therefore, a large variety of invasive and noninvasive treatment options can be chosen. In patients without severe clinical symptoms, the trophoblast activity should be determined via the HCG course before invasive treatment methods are performed, because a considerable proportion part of the patients show spontaneous resolution of the ectopic pregnancy without further measures. Recently systemic treatment with methotrexate alone or local injection of different substances like prostaglandins, glucose, and methotrexate, etc. became an alternative to surgical therapy, i.e., endoscopic salpingotomy or salpingectomy. The success rates are generally lower in comparison to surgical therapy. Therefore, medical treatment is useful only in patients with a low trophoblast activity (e.g., < 2,500 mIU/ml HCG). However, in cases with low HCG values, observation alone frequently leads to a resolution. Corresponding to the data being available up to now, the postoperative pregnancy rate does not depend on this decision.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

Pain intensity following laparoscopy.

The temperature of the gas used for insufflation during laparoscopy has a significant influence on postoperative shoulder and subphrenic pain according to a prospective randomized study of 103 female patients who filled out a standardized pain assessment questionnaire with a visual analogue scale from 0 to 10. Women in group B (n = 53), who had been insufflated with warm CO2 gas during laparoscopy, had significantly less pain than women in the control group (group A; n = 50). The declared value for shoulder pain at the first postoperative day was 3.6 with cold gas versus 2.5 with warm CO2 (p = 0.013). The strongest pain was found following long operations (5.4 vs. 4, respectively) and following high CO2 gas use (5.5 vs. 2.3); in both cases, a significant advantage was noted for the group treated with warmed CO2. Further research is needed regarding the etiology and possible prevention of postoperative pain following laparoscopy. As the use of warm CO2 gas leads to significant reduction of pain, technical and mechanical parameters should be changed accordingly.

Female↗