The prune-belly syndrome (PBS) consists of abdominal wall distention with deficiency of the abdominal wall musculature, urinary tract abnormalities, and cryptorchidism. The impaired drainage of the bladder leads to oligohydramnios and pulmonary hypoplasia. We present 4 cases of PBS diagnosed by prenatal sonography. In 2 cases, vesicoamniotic shunt therapy was not indicated because of a poor prognosis based on sonographic and laboratory findings; the pregnancies were terminated. In another case, treatment was not performed because of a twin pregnancy, and the neonate with PBS died the day of delivery by cesarean section at 31 weeks' menstrual age. In the other case, vesicoamniotic shunt therapy was successfully performed, and a healthy child was delivered. Several conditions must be met for vesicoamniotic shunt therapy to have a good chance of success: the karyotype must be normal, other malformations must be excluded by careful sonographic examination, and renal function must be normal, as determined by serial analyses of fetal urine. Generally, the shunt should be inserted as early as possible.

Abnormalities, Multiple↗

PubMedDate not supplied

[Nausea and vomiting in early pregnancy/hyperemesis gravidarum. Current status of psychosomatic factors].

BACKGROUND: Although Hyperemesis gravidarum (HG) is still a disease of unknown aetiology psychosocial aspects are involved in the genesis of this disease. MATERIALS AND METHODS: Based on experiences in our department and on actual literature psychosocial aspects and therapeutic approaches of HG are presented. RESULTS: Predisposing factors of HG are stress, inadequate information about pregnancy or delivery and problems in the marital relationship. Feelings of ambivalence towards pregnancy, a distorted perception of reality, the unconscious refusing of a wanted child and the worry about a relation between nutrition of the foetus and the HG have influence on the development of the HG. The role of the social context, especially the mother, of expectations towards vomiting and of secondary gain in the genesis and the evaluation of HG is explained. Therapeutical approaches beside the known somatic therapies are acupuncture, the electric stimulation of the N. vestibularis and different methods of psychotherapy, which can include the partner or other persons from the social context. In some cases an intensified therapy under in-patient conditions can improve therapeutic results. DISCUSSION: Psychosocial factors are involved not only in the genesis of HG, but also in the duration and intensity of symptoms as well as in the resistance especially, towards isolated somatic therapeutical approaches. CONCLUSIONS: When psychosocial factors are taken into account in the search for a cause and the treatment of HG results of treatment are more successful and persist over a longer time.

Female↗

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[Significance of detecting impaired uteroplacental perfusion for diagnosis of antiphospholipid antibody syndrome--a case report].

INTRODUCTION: The antiphospholipid antibody syndrome (APA) is a potentially life-threatening disease in pregnancy, associated with spontaneous abortion, intrauterine growth retardation (IUGR), preeclampsia and foetal death in utero. One of the sequelae of the antiphospholipid-antibodies is an impaired uteroplacental circulation. We present a case where we diagnosed an antiphospholipid antibody syndrome (APA) on the basis of a highly pathological Doppler flow in both uterine arteries. CASE REPORT: A 35-year-old G2P0 with a history of intrauterine foetal death in the 24th week was seen at 15 weeks in her second pregnancy for an ultrasound scan. The Doppler study of both uterine arteries showed highly pathological resistance indices and bilateral notching. Laboratory studies revealed elevated levels of antibodies against Cardiolipin and phospholipids. Therapy trials with low-dose aspirin, heparin, corticosteroids, hemodilution therapy and immunoglobulin remained unsuccessful. The foetus developed severe IUGR, anhydramnios and foetal distress. In the 26th week the parents insisted on a caesarean section because of a pathological heart rate pattern. The birth weight was 365 grams and the infant died immediately. DISCUSSION: There are several mechanisms which impair the uteroplacental circulation in an APA syndrome. Therefore it is essential to perform laboratory tests when detecting a pathological blood flow in both uterine arteries. In this case all therapies failed, and the preterm infant died due to severe IUGR and distress. The diagnosis, however, facilitated the introduction of early anticoagulation therapy for the mother, the exclusion of systemic lupus erythematodes and the counselling of the parents with regard to further pregnancies.

Antiphospholipid Syndrome↗

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[Prune belly syndrome--diagnosis and therapeutic possibilities].

The Prune Belly Syndrome combines dilation of the bladder and a laxity of the abdominal wall, and is of unknown etiology. The sequelae are a pulmonary hypoplasia and a deterioration of the kidney function, which determine prognosis. Via early ultrasound diagnosis, intrauterine application of a vesico-amniotic shunt can be performed and can improve survival rates. Inclusion criteria for a vesicoamniotic shunt are a lack of further sonomorphological abnormalities, a lack of an indication for an alteration of the kidney function by ultrasound or laboratory tests, and a normal karyotype.

Catheters, Indwelling↗

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[Preventive modification of risk factors--results of a health study].

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Aged↗

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[Behavior of the biological aging index and serum lipids in treatment with X50].

Lipid metabolic disorders are clinical relevant for the middle and old age. The presented paper shows that decreased HDL-cholesterol and increased triglycerides enlarge the value of pre-ageing. Therefore is a lipid lowering treatment a special problem of gerontology. We have treated 15 patients (age 56.7 +/- 7.8 years) with hypercholesterolemia and hypertriglyceridemia with the new developed lipids regulans X50 = 1-benzyl-3-(1-carboxy-1-methylethoxy)-4-methylpyrazol. There was a significant decreases of serumtriglycerides (47%) in all patients. Half of the patients showed a significant decreases of total cholesterol (32%). Biological age index and biological age were not influenced. To demonstrate an influence of biological age there are needed longterm treatments in patients with lipid metabolic disorders.

Cholesterol↗

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[12 years' analysis of serum fatty acids--final results of the Leipzig Longitudinal Gerontologic Study].

In the Leipzig longitudinal study performed from 1968 to 1980 in 383 test persons with healthy metabolism in 2-3 years time intervals gas-chromatographic analyses of the serum fatty acid pattern were carried out. In dependence upon age, sex, and body-weight the vasoprotective linoleic, linolenic and arachidonic acid increased and the vasoaggressive palmitic and eicosatrienic acid decreased. Influences of age as well as the change of the feeding habits are causally discussed for this purpose.

Adult↗

PubMedDate not supplied

[Systolic time interval, stress ergometry and 133-xenon clearance in obesity].

Systolic time intervals were measured with 55 middle aged healthy normal weight and 76 healthy overweight probands in two positions (standing and lying). In 39 adipose patients and 55 normal weight subjects an ergometric work was carried out. A significant difference between normal and extremely adipose subjects without cardiac diseases could not be noticed with regard to the preejection index. Preejection period and left ventricular ejection time showed significant differences in both positions between normal and overweight probands, independent of blood pressure. In overweight patients there was a significantly decreased heart work load. The preejection index of adipose patients with a work load below 76 watts amounted to a mean value of 1,04. A work load of 100 watts was reached by only half of the adipose patients. In 32 adipose subjects with a heart work load above 75 watts the regulation of heart-rate and blood-pressure was not different from that of normal weight persons. Muscle blood flow was measured by 133Xenon-Clearance after Lassen et al. The measurement of the 133Xenon-Clearance of the arm muscle at rest in 29 adipose patients resulted in significantly lower values compared with normal weight persons.

Adult↗