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J Pachaly

Publications and source records attributed to J Pachaly.

12 recordsLinked to original sources
PubMed2006

[Out-of-hospital births in Germany--a comparison of "large", "medium", and "small" free-standing birth centres].

BACKGROUND: How do maternal and foetal outcomes in out-of-hospital births vary in relation to birth centre size? PATIENTS AND METHODS: Routine perinatal data from out-of-hospital births in 80 birth centres in Germany between 1999 and 2002 were analysed. Birth centres were grouped according to their annual mean birth rate into small (< or = 70 births per year), medium (71 - 155 births per year), and large (> 155 births per year) units. Breech births (n = 43) and twins (n = 14) were excluded from the analysis (level of significance p < 0.01). RESULTS: Pregnancy and perinatal risks, foetal and maternal morbidity and mortality, perineal lacerations and transfer of newborns to NICU did not differ between the three groups which comprised a total of 14,629 births. Less episotomies were performed in large birth centres compared to small or medium-sized birth centres. Significantly less women were transferred from medium-sized birth centres to hospital following delivery. Five minute Apgar scores < or = 7 were significantly more frequent in birth centres with the highest birth rates. During labour significantly less women were transferred to hospital from medium-sized birth centres than from small or large centres. The transfer rate difference between nulliparae and multiparae was 4 : 1. CONCLUSION: Perinatal parameters appear to differ in some aspects according to how the birth centres were labelled. Nevertheless, these differences have only little clinical significance and may be explained by the demographic characteristics of the population. These results do not allow the general conclusion that the quality of out-of-hospital care in Germany differs in relation to the annual birth rates of the birth centres.

Birthing Centers↗
PubMed2006

Intrapartum transfer from a birth centre to a hospital - reasons, procedures, and consequences.

BACKGROUND: Investigation of the reasons for the transfer of women from a birth centre to a hospital in the course of childbirth as well as modalities and effects. PATIENTS AND METHOD: In the prospective investigation from September 1, 1999 to August 31, 2001, information was collected for all women in Berlin and Bavaria transferred intrapartum from a birth centre to a hospital concerning the reason for the transfer, stage of delivery at the start of transfer, details of the transport, accompaniment, state of mother and medical diagnosis on arrival at the hospital, further progress of delivery, and the condition of the baby postnatum. Comparison groups were formed by all birth centre deliveries in Berlin and Bavaria 1999/2000 (n = 3060) and hospital deliveries in Berlin and Bavaria 1998/1999 (selected data, n = 89 696 births). RESULTS: Three hundred and sixty transfer cases could be evaluated, and a majority of these were nulliparous. The most frequent reasons for transfer were prior premature rupture of membranes and failure to progress in labor. Fifty-seven percentages of the women who were transferred subsequently delivered spontaneously, with an episiotomy rate of approximately 30%. 1-min Apgar value < or = 7 were frequently in nulliparous and multiparous patients in the transfer group than in the comparison groups, as were 5-min Apgar values < or = 7 and pH < 7.10 in arterial cord blood in particular for nulliparous in the transfer group. Hospitalisation of neonates born to the transfer group and in particular the nulliparous was significantly more common. CONCLUSIONS: Women delivering in a birth centre represent in general a low-risk group as a result of careful preselection by the centres. However, some neonatal data and the high rate of operative deliveries (cesarean section, forceps, and vaginal extraction) indicate that the intrapartum-transferred women, in particular when nulliparous, represent than a special high-risk group.

Adult↗
PubMed2004

[Birthplace free-standing birth center -- perinatal data in comparison with clinic deliveries in Bavaria and Berlin].

QUESTION: The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group? PATIENTS AND METHODS: We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875). RESULTS: Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centers > clinics; operative deliveries: birth centers < clinics), in blood loss over 1,000 ml (birth centers > clinics), in the episiotomy and perineal tear rate (birth centers < clinics), in the infantile transfer rate to a neonatology unit (birth centers < clinics) and in the frequency of necessary neonatological measures in the neonate (birth centers > clinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data. CONCLUSION: The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

Adult↗
PubMed1986

[Breast saving cancer surgery. Results of a long-term study (Berlin study, 1963-1982)].

Between 1963 and 1982, 1,139 patients underwent surgery for unilateral mammary malignoma at the Charlottenburg Gynaecological Clinic of the Free University Berlin. Primary therapy consisted of simple mastectomy in 948 cases and tumourectomy/quadrantectomy with subsequent radiotherapy (40 Gy) in 191 cases. We performed a retrospective analysis of "matched samples" of tumourectomy/quadrantectomy and mastectomy. The observation period of both groups spans a minimum of one year to a maximum of 20 years after primary operation. In pT1- and pT2-tumours the overall survival after tumourectomy/quadrantectomy at 5, 10 and 15 years was no worse than after total breast removal. The results of our long-term follow-up study lead us to conclude that tumourectomy/quadrantectomy and breast irradiation are suitable for primary treatment of mammary cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1981

Control of fetal size with multiple ultrasonic measurements.

I) Out of eight different bone and soft-tissue parameters, the abdominal circumference correlates best with the birth weight: r = 0.89. Only the combination of the abdominal and the thorax circumference has a better value: r = 0.91. However, all our parameters are linear. The employment of area or volume parameters would probably still improve fetal weight estimation. II) For diagnosing intrauterine growth retardation measurement of thigh diameter seems to be of some value. The quotients of soft-tissue parameters/bone parameters are partly independent of gestational age. Therefore they may support the diagnosis of small-for-date babies where gestational age is uncertain. Prospective studies with serial measurements should be carried out to verify the feasibility and practical utility of our parameters.

Birth Weight↗
PubMed1976

Development of subcutaneous fat in infancy. Standards for tricipital, subscapular, and suprailiacal skinfolds in german infants.

In order to assess the nutritional status of healthy infants in Berlin, the tricipital (TRI), subscapular (SCA), and suprailiacal (SIL) skinfolds were measured at several instances (2--14 times) during regular presentations at the well baby clinic offices in 265 infants of normal gestation, 140 boys and 125 girls, using the Holtain skinfold caliper. The characteristic pattern of skinfold development in infancy includes a rapid increase in width of all diameters until 3--5 months of age, and a gradual decrease thereafter. This diminution of skinfold thickness is more pronounced at the trunk (SIL and SCA) than at the limbs (TRI), indicating a change in distribution of subcutaneous tissue during infancy. Compared to the present study, previous investigations in Great Britain and Sweden have shown a maintenance of maximal skinfold values rather than a decrease during the second half of the first year. It is suggested that differences of feeding habits and calorie intake may be responsible for these discrepancies. The results of this mixed longitudinal study, performed in 1974/1975, were computed to calculate centile curves of the skinfold development in infancy, which may serve as standards for infants living under similar socioeconomic and nutritional conditions.

Adipose Tissue↗
PubMed1976

Lack of correlation between clinical data and growth hormone concentrations in cord blood.

Growth hormone concentrations were measured in 182 umbilical cord blood samples taken at the time of birth. The mean value in 165 full-term, normal weight infants was 31.5 +/- 25.9 ng/ml SD. 14 prematures had significantly higher levels (50.0 +/- 38.4 p less than 0.01). There were no statistically significant correlations to any of the following parameters: complication of pregnancy by toxaemia, duration of labour, presence of umbilical cord contortion, perinatal distress, Apgar index, mode of delivery, body weight, body length, ratio of weight to length, and blood glucose. There was a wide scatter of individual values in this study as well as in previous investigations. We think it unlikely that those variations are purely accidental. Hence, yet undefined factors must play a major role in the regulation of GH secretion in the perinatal period.

Apgar Score↗
PubMed1975

[Intranarcotic infusion therapy -- a computer interpretation using the program package SPSS (Statistical Package for the Social Sciences)].

In a retrospective 18-month study the infusion therapy applied in a great anesthesia institute is examined. The data of the course of anesthesia recorded on magnetic tape by routine are analysed for this purpose bya computer with the statistical program SPSS. It could be proved that the behaviour of the several anesthetists is very different. Various correlations are discussed.

Adolescent↗
PubMedDate not supplied

[The probability of spontaneous delivery -- possibility and limits of obstetric risk scores].

QUESTION: For a sound consultation of pregnant women e. g. regarding the choice of delivery place, a simple, reliable prepartal risk estimation system would be desirable. METHODS: After exclusion of all "hospital required" risk cases, out of 203,111 records from the Berlin Clinical Perinatal Data 1993 - 1999 176,734 births remained, for which all risks already discernible before delivery (catalogues of the German Maternity Guidelines) were retrospectively valued and weighted by means of a logistic regression analysis on their real importance for the prediction of a spontaneous birth. On the basis of logarithms of the odds ratio for the individual risk factors a point system was developed. RESULTS: There is a clearly higher risk for a surgical delivery in primiparae compared with multiparae. For multiparae 27, for primiparae 26 statistically significant (p < 0.01) risk factors could be identified. After conversion of the odds ratio-values into the point system of the score, for the group of primiparae the cut off value was > 1 point (with a specificity of 0.5 and a sensitivity of 0.5), in the multiparae > 3 points (sensitivity 0.7, specificity 0.7). CONCLUSIONS: As for primiparae the resulting prognosis of birth mode (spontaneous vs. surgical birth) using the described score is false at 46 %, in multiparae at 33 %, the prognosis power of the risk score can therefore only be classified as relatively poor. The risk assessment system is therefore not suitable e. g. as aid to decision-making for or against an extra-clinical delivery place where no obstetrical operations are possible.

Adolescent↗
PubMedDate not supplied

[Computer-assisted data analysis in a pediatric intensive care unit].

Computer assisted real time data analysis introduces a reasonable method of judgment into patient monitoring systems. From fast changing vital parameters discrete heart and respiration rate samples are immediately evaluated and presented as graphs near the bedside. Thus, statistical routines can increase the better understanding of instable clinical conditions and lend support to the decision making process. The early detection of a pathological trend in a patient whose ability to compensate is still present provides necessary time for diagnostic or preventive countermeasures in case of emergency.

Computers↗