Biomedical subjects
Publications and source records attributed to H Kucera.
A report is given on 814 patients who had undergone a mamma examination by means of mammographies, plate thermographies, and, if indicated, punction cytologies. On the basis of our experiences with this triple diagnosis we drafted a preliminary control scheme.
According to Saling's Prematurity-Dysmaturity-Prevention Program (PDP-Program) all high-risk pregnancies in a time limited period were collected (n = 105). From these a group of 72 gravidae (PDP-group) were controlled by an intensive care-staff, a group of 33 gravidae (controll group) refused an intensive care. The initial situation of both groups was very similar. In the PDP-group 3 quarters of the gravidae delivered after the 36th week of gestation, in the control group the half of gravidae. In the PDP-group 1 quarter of the newborn infants had a birth-weight of less than 2 500 g, in the control group the half. The condition of the newborn infants were similar.
The value of plate thermography in the determination of placental localization was investigated in 120 cases, and compared with the results obtained by the ultrasonic B-Scan method. The duration of pregnancy in these cases ranged from 15 to 37 weeks. The results of plate thermography corresponded with ultrasonic localization in 94 cases (78.3%), but the placenta was incorrectly localized by plate thermography in 26 patients. The highest degree of correspondence was observed in the group of anterior wall placentae, the localisation of the placenta by plate thermography being correct in 52 out of 62 cases. The group of posterior wall placentae showed the lowest rate or correspondence, plate thermography giving the correct localization in only 32 out of 45 cases. Hence, plate thermography does not appear to be of sufficient accuracy for clinical use or scientific investigations. Furthermore, no accurate determination of placental surface area and placental thickness is possible with plate thermography. For all these reasons it may be concluded that this method is greatly inferior to the ultrasonic B-Scan method in respect to placental localization.
The case is reported of a 19 year-old patient in whom Caesarian section was successfully performed under combined method of anaesthesia. Square waves, which consist of high frequency impulses were transmitted to the cerebrum, and in addition, a 50:50 nitrous oxide and oxygen gas mixture was administered to the patient. The intraoperative condition of the patient was satisfactory. No reactions to pain were seen, as judged from constant observation of the blood pressure, pulse rate, colour of the face, pupils and the condition of the body extremities.
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The effect of cerebral electrotherapy (CET) on the pain threshold was investigated in 3 test persons, on 5 points of the neck of these persons. Altogether 1200 algesimetric measurements were performed. The statistical evaluation showed a significant tedency (p less than 0.01) towards an elevation of the pain threshold by CET.
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With the aid of the ultrasound scan technique the amniotic sac was measured on more than 700 occasions between the 8th and 20th week of gestation. In each examination the greatest transverse, anterior-posterior and longitudinal diameters were determined. The statistical mean and the double standard deviation were calculated from these data. The areas of the transverse diameter and of the longitudinal diameter show a distinct and continuous increase, whilst the area of the anterior-posterior diameter displays a small and uncharacteristic increase during pregnancy. The values of 12 patients were registered in the region of the transverse and of the longitudinal diameter. The clinical findings, as well as the ultrasonic values, had shown no abnormalities at that time. The data show a decrease in these diameters during the following examinations; the last measurement was carried out when the fetal heart beat was absent for the first time. The increase in size of the amniotic sac during pregnancy can be observed by means of these examinations. Repeated examinations enable the detection of disturbances in the developement of the pregnancy at an early stage.
This is a report on 35 patients on whom electro-acupuncture was tested as a method of initiating contractions. In all cases the membranes remained intact up to the end of the electro-acupuncture. Before the electro-acupuncture none of the patients had experienced any labor pains. The subjective reports were checked by planimetric evaluation of the tocogram curves. A statistical comparison of the values before and after electro-acupuncture was undertaken. Thirty-one cases evidenced certain increase in the intensity of labor contraction frequency (p less than 0.01). Amniotomy was performed immediately after the electro-acupuncture on 31 cases. In a control group likewise consisting of 35 gravidae with intact membranes, no electro-acupuncture was performed. In this control group no significant increase in labor activity could be observed. If amniotomy was performed on gravidae with contractions induced by electro-acupuncture, there was no latent period to be observed. Through avoidance of a lengthened latent period after amniotomy, fetal jeopardy during labor induction can be reduced.
The course of pregnancy and delivery of 600 primiparae is being reported. These were divided into four age groups: very young primiparae (14-16 years of age, Group I), older primiparae (35-39 years of age, Group III) and old primiparae (40 years and more, Group IV). These age groups are being compared to a collective of primiparae, by whom the delivery took place at an age between 17 and 34 years (Group II). In these age groups the difference in complication rate during pregnancy, delivery and puerperium is demonstrated. The differences were statistically secured by means of X-2-test. The very young primipara shows the least tendency to delivery complications, still her pregnancy should be considered more risky as compared to Group II, owing to the higher rate of gestosis and the tendency to premature delivery. Groups III and IV show a rising risk rate with increasing age in regard to gestosis (10, 8-30, 8%) and premature delivery (15, 4-28, 6%); also the higher rate of operational delivery was significant (38, 9-44, 6%). The highest risk rate is to be expected in women, who deliver the first time at an age above 40 years. Also the perinatal mortality of newborn is at its highest in this group.
During the period 1969--1973, a total of 7933 deliveries was carried out at the First University Clinic of Obstetrics and Gynaecology in Vienna. Of these, 328 deliveries were breech presentations and 260 were single-born. The frequency of Caesarean sections in the case of breech presentations was 16,6%, i.e. about four times higher than the average frequency of Caesarean sections in relation to the overall number of obstetric patients of our clinic. The high frequency of premature deliveries in breech presentation (18,46%) is reflected in the perinatal mortality rate; 5,67% of all children born in breech position died sub or post partum. The net perinatal mortality rate was 1,15%.
The influence of electric acupuncture on the sphincter of the femal urethra was checked on 15 patients with stressincontinence without gross anatomic variation recognized by means of simultaneous cystourethrometry. After 30 minutes of electric stimulation through acupuncture-needles, which were placed into the skin of the lower legs and lower abdomen, a significant increase of the so-called "closing pressure" was to be found. 11 patients even showed a positive pressure. In a control collective of 15 other patients, who however did not undergo acupuncture there was only one case of slight increase of closing pressure. In addition 15 patients were given a placebo suppository, in order to eliminate as far as possible any psychical factor. In none of these cases a significant change of the closing pressure could be found. Even though the actual working manner of electric acupuncture is not understood, these experiments seem to confirm the assumption of the electric acupuncture as having a positive influence on the closing mechanism of the femal urethra.
Radioimmunoassay of human placental lactogen (HPL) is a valuable diagnostic tool for the early recognition of placental dysfunction. But, the rather wide normal range hampers HPL estimations to be used as a good prognostic tool. However, the simultaneous determination of HPL in maternal serum and in amniotic fluid allows a better diagnosis of the fetal well-being. Results of amniotic fluid HPL levels are expressed as percent of maternal serum levels. In this pilot study it was shown that this ratio of maternal serum HPL level to amniotic fluid level is below 10% in normal pregnancies. The ratio is between 10 to 20% in subjects where fetal distress was recorded, and dystrophic babies were observed. The value is above 20% in cases where intrauterine fetal deaths were found. This good correlation of the HPL ratio in maternal serum and amniotic fluid with the outcome of pregnancy offers a new means of using HPL estimation as prognostic tool.
In the literature 47 cases of congenital cystic adenomatoid malformation of the lung are reported. The case here described, is remareable because of two lung lobes being affected and the resulting hydrops fetalis. The possible developing mechanisme of the hydrops is being discussed.
15 cases of malignant ovarian neoplasms of the period 1948-1974 are being reported. All these women were less than 30 years of age. The youngest patient was 15 years old and 7 were less than 25 years old. These 15 cases represent 2,2% of all ovarian neoplasms with primary surgical treatment at the I. University Clinic of Obstetrics and Gynecology in Vienna in this period. Anamnestic datas, symptomatology and clinical aspects of these cases are reported. Surprisingly high was the rate of 9 cases of primary stage cancer Ia in these young women and girls, which was significant higher than in the total material of the clinic. Therefore it seems intelligible that in spite of the high rate of conservative surgical treatment 9 patients have survived 5 and more years without any symptoms. The possibility of conservative surgical treatment of malignant ovarian neoplasms in young women and teenaged girls of primary stage of cancer Ia is discussed.
By means of the radionephrogram it is possible to discover a disturbance of the excretion of the upper urinary tract at an early stage. Since there can be no pathological function of the urinary excretion without negative effect on the renal function, measures must be taken in order to prevent this from happening. By conventional surgical methods the eventual success of an operation can be judged only at a postoperative stage, sometimes an additional operation will prove necessary. A continuous intraoperative registration of a sequential scintigram, using a gammascintillation camera that has beem modified into an operation table, enables the control of method and extention of the operation. This method permits an optimal surgical result and we may save the patient from the strain of a possible second correcting operation. The method is being described by means of a case.
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