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Biomedical subjects

H Hopp

Publications and source records attributed to H Hopp.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Diagnostic reliability of vaginal ultrasound in ectopic pregnancy].

The therapeutic approach to ectopic pregnancy (EP) has changed over the last decade. A prerequisite for a differentiated management is an early diagnosis of EP. This can be achieved by transvaginal sonography (TVS). The purpose of this study was to evaluate the accuracy of TVS in the diagnosis of EP. 184 patients with clinically suspected ectopic pregnancy were examined by TVS. In 103 cases suspicion of EP was confirmed, in 81 cases it was ruled out. All cases were evaluated by laparoscopy, D&C, serial HCG determinations or sonographic follow-up in case of an intrauterine pregnancy. Sensitivity of TVS in the diagnosis of EP was 96%, specificity 88%, the positive predictive value was 89%, the negative predictive value was 95%. Four cases with a false negative result at TVS were very early in pregnancy and were subjected to laparoscopy because of persistent high HCG values without demonstration of an intrauterine pregnancy. Five cases of sonographically confirmed ectopic pregnancies were missed by the first laparoscopy. These cases required intervention because of clinical symptoms and had low levels of HCG. TVS has a high diagnostic accuracy in the diagnosis of ectopic pregnancy.

Adolescent↗
PubMed1995

[Prevention of neonatal risk by general screening for diabetes in pregnancy, intensive diagnosis and subsequent therapy].

Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.

Amniotic Fluid↗
PubMed1995

[Diabetic retinopathy and nephropathy--complications in pregnancy and labor].

The purpose of this retrospective study was to determine the risk factors for the morbidity of the mothers and their fetus in patients with diabetic retinopathy and/or nephropathy with an open family planning. We compared the course of pregnancies, complications as well as the maternal and neonatal morbidity in 76 patients with diabetic retinopathy or nephropathy (White R F) with 85 patients without severe microangiopathy (White C D). We found a correlation between retinopathy progression and hyperglycaemia during the first trimester (p < 0.05). There was an increase in the deterioration of visual acuity up to blindness due to the progression of this microangiopathy in cases of proliferative retinopathy. There was a significant increase of the mean diastolic blood pressure (mdp) and preeclamptic symptoms occurred in 71% of the cases with severe microangiopathy (p < 0.05). Deterioration of the diabetic nephropathy with excessive proteinuria (> 10 g/d) and unmanageable hypertension or a progression of the retinopathy led to an earlier delivery in 80% of the patients (p < 0.05). A high rate of preterm deliveries (39%) and a frequent occurrence of intrauterine growth retardation's (9%) characterised the fetal outcome. The following examinations for a patient with an open family planning, if diabetes is diagnosed during childhood or the course of the disease is between 10 and 15 years, should be done: Ophthalmological evaluation, control of the renal function, contraceptive advice and an improvement of the metabolic situation. In case of a diabetic nephropathy in combination with hypertonus the patients shoud be warned against pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Antibodies to cytokeratins bind to epitopes in human uterine smooth muscle cells in normal and pathological pregnancies.

Cytokeratin antibodies have been widely used for the identification of trophoblast cells in the placental bed, following their invasion from the developing conceptus. Their identification centres upon the expression of cytokeratin in epithelial cells, from which trophoblast cells are derived. Our recent observations indicate that this strict relationship may be more complex than was thought. Cryostat and paraffin sections of human decidua and myometrium, taken from the placental bed and the uterotomy cut, were examined immunocytochemically for cytokeratins using ten antibody clones selected to identify different cytokeratin proteins and antigenic epitopes. Biopsy specimens were obtained from normal and pathological pregnancies (pre-eclampsia, fetal retardation, amnioninfection, hysterorrhexis, placenta praevia) at the time of caesarean section (26-41 weeks of pregnancy). Antibodies against nine clones, CAM 5.2, MNF 116, AE1/AE3, CK5, KS-B17.2, CY-90, M20, E3, and 34 beta E12 identified, as expected, syncytial giant cells and mononuclear trophoblasts within the placental bed and glandular epithelial cells throughout the uterus. In addition, they stained numerous fusiform cells that were classified by established criteria to represent smooth muscle cells, both within blood vessels and myometrium. No staining differences were observed between normal and pathological disorders. These results indicate that cytokeratin antibodies CAM 5.2, MNF 116 and AE1/AE3, and other antibodies targeting proteins 8 and 18, cross-react with epitopes expressed in cells other than giant trophoblastic cells and mononuclear trophoblasts in the uterus and, thus, caution has to be used when such antibodies are used for the diagnostic characterization of tissues related to the placental bed.

Actins↗
PubMed1995

[An unusual series of complications in therapy with implantable cardioverter-defibrillator].

A 48-year-old man with dilative cardiomyopathy and a history of resuscitation due to ventricular fibrillation received an implantable cardioverter-defibrillator (ICD) with epicardial sensing and defibrillation electrodes in March 1990. An early battery depletion due to increased electrical leakage of a filter capacitor necessitated a generator exchange in July 1990. Subsequent inappropriate discharges occurred, but no underlying cause could be documented by history, clinical examination, Holter monitoring, and beepograms. Only 3 months later was it possible to demonstrate oversensing by repeated beepograms, and a new generator and transvenous sensing electrode were implanted in October 1991. Four months later, inappropriate shocks were suspected again. Once more, history, clinical examination, Holter monitoring, and beepograms were without pathological result. At follow-up, repeated beepograms during exercise demonstrated an oversensing, and an insulation defect of the newly implanted sensing electrode close to the edge of the generator could be documented on x-ray. Since replacement of generator and sensing electrode in July 1992 the patient is doing well. He received two appropriate shocks which were associated with presyncope. ICD therapy is very complex and therefore should only be performed in centers providing the necessary personal, apparative and logistic conditions.

Death, Sudden, Cardiac↗
PubMed1994

[Kinetocardiotocographic and Doppler ultrasound findings before termination of risk pregnancies].

42 pregnancies complicated by severe intrauterine growth retardation (IUGR) were monitored between 1991 and 1992 with the kinetocardiotocogram (K-CTG) comparing them with normal pregnancies of the same gestational age. We evaluated the foetal movements and the heart rate patterns establishing a correlation with pulsed Doppler ultrasound findings. There was a significant reduction of foetal activity in cases of IUGR and pathological Doppler sonography (p < 0.01). The reduction of foetal movements was noticed several days prior to pathological FHR patterns. There was a significant reactivity after vibroacoustical stimulation (VAS) correlating with the Doppler findings. The evaluation of foetal movement patterns in the kinetocardiotocogram proved to be an important complementary method in the monitoring of severe IUGR.

Abortion, Eugenic↗
PubMed1990

Circulating levels of placental protein 12 (PP 12) in diabetic pregnancy complicated by retinopathy.

Placental protein 12 (PP 12) is a soluble tissue antigen. Immunohistochemical studies have localized PP 12 in the placental syncytiotrophoblast, chorion and amnion, and also in the decidua. During normal pregnancy serum-PP 12 is already raised in the first trimester, there is then a peak at 18 weeks, a gradual fall until 32 weeks, and a moderate increase thereafter. The mean of the healthy control group at 18 weeks of pregnancy was 122.9 +/- 47.5 micrograms/l. The mean of the diabetic group with retinopathy at the same time was 192.2 +/- 78.8 micrograms/l. There was no significant difference between background retinopathy and the proliferative form of diabetic retinopathy. At all times during pregnancy the median values of PP 12 in diabetic pregnancies were significantly (p less than 0.01) above the control values. Increased PP 12 levels in diabetic pregnancy complicated by retinopathy are probably caused by decidual, placental and amniotic leakages.

Adult↗
PubMed1990

Circulating levels of placental protein 10 (PP 10) in diabetic pregnancy complicated by retinopathy.

Placental protein 10 (PP 10) is a soluble tissue antigen of the placenta. PP 10, a glycoprotein, was tested in diabetic pregnancy complicated by retinopathy. A continuous increase in PP 10 serum levels until weeks 35-36 is followed by a fall thereafter up to term. The mean of the healthy control group between 32 and 39 weeks gestation was 22 +/- 10 micrograms/l. In diabetic pregnancies complicated by retinopathy there were measured 69 +/- 24 micrograms/l in benign form and 77 +/- 26 micrograms/l in proliferative form. Both of these values are significantly (p less than 0.05) above the control values. Increased PP 10 levels in diabetic pregnancy complicated by retinopathy are probably caused by placental and amniotic leakages.

Adolescent↗
PubMed1989

Neonatal jaundice in infants of diabetic mothers.

357 IDMs and 20 healthy newborns of non-diabetic mothers were examined at term for body measurements, red blood cell count, serum bilirubin, cord blood insulin and blood glucose during the first postnatal week. The stage of maternal diabetes did not influence the course of neonatal bilirubin levels, but the IDMs had prolonged and higher bilirubinaemia compared with the controls. Hyperbilirubinaemia was found to be most prominent in newborns with an increased birthweight/length ratio and was not simply related to macrosomia (LGA). These infants had significantly lower blood glucose concentrations immediately after birth, whereas cord blood insulin was found to be identical between the IDM sub-groups. Bilirubinaemia in heavy for length infants was slightly correlated to haematocrit. For the pathogenesis of hyperbilirubinaemia in IDMs induction of heme oxygenase (due to a lack of energy provision following a phosphorylation disorder) is discussed. Nutritional support (early feeding, glucose infusions) does not affect the course of bilirubinaemia.

Bilirubin↗
PubMed1989

[Placental protein 12 (PP 12)/insulin-like growth factor binding protein (IGF-bp) in pregnancy in metabolically healthy patients and diabetic patients with retinopathy].

The placental protein 12 (PP 12) was found to be identical with the insulin like growth-factor binding protein (IGF-bp). In present investigations serum samples of 420 healthy pregnant women between 7th and 40th weeks of gestation were proved regarding to their IGF-bp concentrations by means of a radioimmunoassay. For each pregnancy week means and standard deviations were estimated. IGF-bp serum concentrations continuously increased up to the 18th week (140 +/- 40 micrograms/l); followed by decreasing of the values up to the 30th week (102 +/- 44 micrograms/l) and then slightly increased up to term (121 +/- 46 micrograms/l). In addition the IGF-bp estimations were performed in maternal serum samples of 45 diabetic pregnant women complicated by retinopathia diabetica benigna as well as proliferativa; sum total 101 serum samples. In patients with benign retinopathy 82% (12/68) and in patients of proliferative retinopathy 85% (5/33) of the IGF-bp values were increased above the two times standard deviation.

Adult↗
PubMed1989

[Somatomedins--insulin-like growth factors].

Growth factors act after specific binding with cell membrane receptors, i.e. these factors mediate mitogenic signals. Insulin-like growth factors (IGF) (syn.: somatomedins) as well as insulin have the same biological activity caused by structural homology. But under normal physiological conditions neither IGF I nor IGF II appear to be involved in the regulation of glucose homeostasis, in contrary to insulin IGFs have mostly mitogenic features. On the other side it is possible that under pathophysiological conditions hypoglycemic effects are caused by an increase of free IGF in the circulation. Insulin acts as a regulating factor in the GF-expression. IGF-I and IGF-II are different peptides especially regarding to their biological role. The synthesis of IGF-I secretion in the liver is dependent on growth hormone (GH). GH is secreted by the pituitary under the influence of the growth-hormone releasing factor (GHF) and is inhibited by somatostatin. In response to GH the liver secretes somatomedin which exerts negative feed back effects on the pituitary and stimulates somatostatin release. The IGF-synthesis is dependent on the human placental lactogen (HPL), i.e. IGF-II is mainly responsible for fetal development the estimation of the production of IGFs by the fetus supports investigations about fetal somatomedins to clear fetal growth retardations and diabetic macrosomia respectively.

Animals↗
PubMed1989

[A successful procedure in mitral valve rupture accompanied by rupture of the papillary muscle and the chordae tendinae following multiple injuries and blunt thoracic trauma].

In a considerable number of cases, blunt chest trauma also involves cardiac lesions including myocardial contusion or disruption pericardial effusion, or valve rupture. Definite cardiac trauma poses a challenge to everyone involved in intensive care, as early diagnosis and prompt treatment may be necessary to prevent a fatal outcome. We report a 32-year-old patient with fractures of the humerus, forearm, left clavicle and 2nd rib, and right ribs 4-6 after an 8 m fall. He was intubated in the emergency room because of arterial hypoxemia. Despite fluid administration the blood pressure deteriorated and the patient rapidly developed congestive heart failure that required huge doses of catecholamines. A systolic murmur was heard in the apex and left axilla. Conventional transthoracic echocardiography showed mitral valve prolapse and was suggestive of a flail mitral valve. Transesophageal echocardiography confirmed the diagnosis of mitral valve rupture, which proved to be grade IV by angiography. Because of continuous deterioration with low cardiac output and critical blood pressures and heart rates, surgery was carried out on the day of admission. Complete rupture of the anterolateral papillary muscle was found with laceration of the ventricular muscle, rupture of the secondary chordae tendineae, partial rupture of the valve base and partial dissection of the valve leaflets from the base. As expected from the echocardiography, there was no pericardial effusion. The destroyed valve was replaced by a Duromedics prosthesis. Operative stabilization of the subcapital humeral fracture followed 3 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Nocardial endocarditis after aortic valve replacement. Reports of two cases.

Nocardial sepsis occurred after aortic valve replacement in two patients. A septic suture aneurysm of the aortotomy was resected and the prosthesis exchanged in one of them. The other received conservative treatment for sternal osteomyelitis and local mediastinitis. Clinical cure was followed by relapse and death from cerebral infarction, and necropsy revealed a septic suture aneurysm of the aortotomy. Radical surgical revision seems to be necessary for lasting cure in such infections.

Aged↗
PubMed1988

[Mortality and morbidity of thromboembolism in drug prevention--5-year analysis].

In a period of five years a general medical prevention of postoperative venous thromboembolic disease was tested in major gynaecological operations, in patients undergoing radium insertions for gynaecological cancer and in patients with caesarean section. Preoperatively was the beginning of the daily therapy with Dihydroergotamine (DHE) and every four days the therapy with Acetylsalicylic acid (ASS). The results of 2,346 therapy-cycles with medical prevention of thromboembolic disease in 2,280 patients are reported. Risks of thromboembolic disease were in 63% of the gynaecologic patients (mean age 52.4 +/- 8.9 years) and in 34% of the obstetrical patients (mean age 24.6 +/- 5.1 years). Postoperative bleeding complications occurred in 12 cases (0.5%) and the number of reoperations was lower than 1 0/00). Postoperative thromboembolic complications were found clinically and radiologically in 0.3% of the patients. Letal embolism of the lung happened in 2 patients (0.9 0/00). A general medical prevention of thromboembolic disease with DHE and ASS can be recommended because of the low rate of postoperative bleeding complications and of the reduced rate of postoperative thromboembolic disease. A prevention of thromboembolic disease by individual dosage of heparin must be considered in patients at high risk for thromboembolic disease.

Adenocarcinoma↗
PubMed1986

Successful management of dissection of the aortic root during aortic valve replacement.

We present a case of intraoperative dissection of the aortic root in a patient with non-calcified aortic valve incompetence. This complication led to life-threatening bleeding from the dissection line into the layers of the left ventricle as well as the aortic wall with formation of an increasing subadventitial hematoma. The only possible management was to remove the valve prosthesis and to close the entry site of the dissection when reinserting the valve implant. The mechanism of this complication is discussed.

Aortic Dissection↗
PubMed1986

[Stimulation or blocking of the periurethral region--an expansion of conservative therapeutic measures in irritable bladder and urge incontinence].

In an open study we report about the therapeutic influence of neural therapy in the periurethral region in patients with urgency. We treated 50 patients with neurohormonal urgency three times in 2-weeks interval by periurethral injections of 10 ml 0.25% Bupivacaine. Success was controlled in 46 patients with clinical and urodynamical methods. 10% of the least one time treated patients had the same complaints after therapy, 60% were improved by therapy and 30% were free of symptoms. We registered with urodynamic measurements a significant increase of the bladder volume up to the first sensation to void and a significant reduction of the bladder compliance. In a second randomized study the influence of a single acute maximum functional electrostimulation (AMFES) by vaginal electrode was tested. 10 patients with anamnestic urge incontinence in each case with uninhibited detrusor contractions and 10 patients without detrusor contractions was treated. The subjective statements yielded in urge incontinence without detrusor contractions a higher percentage of improvement than in motoric urge incontinence. The urodynamic diagnostic evaluation showed a relation between the unchanged objective conditions and the symptoms of complaint four weeks after treatment in patients with motoric urge incontinence. We recommend the use both of the neural therapy and functional electrostimulation as additional methods besides the dominant medicamentous treatment of the urgency and the urge incontinence.

Autonomic Nerve Block↗
PubMed1986

[Cryosurgical treatment of cervical intraepithelial neoplasia following cervical smears and curettage].

65 patients exhibiting colposcopically and cytologically atypical epithelium in the cervix were treated by cryosurgery with liquid nitrogen. 63 of whom were confirmed histologically after surface scraping and curettage of the cervix. The patient then were followed cytologically and colposcopically 8 and 12 weeks after cryosurgery. According to that the definitive histological diagnosis was performed after conization (48 patients) hysterectomy (12 patients) and surface scraping and curettage of the cervix (8 patients). Colposcopical, cytological and histological findings after surface scraping of the cervix showed a correlation rate in the 95% range. Treatment failure rate following cryosurgery showed an increased percentage with increased grade of CIN. A complete destruction of ectocervical pathologic tissue in CIN 1 and 2 is opposed to a persistent disease rate of 20 percent in patients with CIN 3. The failure rate was significantly higher in cases without fully visualization of squamocolumnar junction. Cytological follow-up predicted all cases with histologic diagnosis of persistent disease. Colposcopical evaluation was frequently unsatisfactory after cryosurgery. Cryosurgery of CIN should be reserved for the treatment of those patients in whom the criteria for patient selection are performed and the benefits of this method outweigh the possible drawbacks.

Carcinoma in Situ↗