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Biomedical subjects

K Philipp

Publications and source records attributed to K Philipp.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prospective evaluation of hemostatic system activation and thrombin potential in healthy pregnant women with and without factor V Leiden.

Normal pregnancy is associated with alterations of the hemostatic system towards a hypercoagulable state and an increased risk of venous thromboembolism. The risk of venous thrombosis is higher in pregnant women with factor V Leiden (FVL) than in those with wildtype factor V. Routine laboratory assays are not useful to detect hypercoagulable conditions. A prospective and systematic evaluation of hemostatic system activation in women with and without FVL during an uncomplicated pregnancy employing more sensitive markers of hypercoagulability, such as prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), D-Dimer, or the endogenous thrombin potential (ETP), an indicator of the plasma's potential to generate thrombin, has not been performed. We prospectively followed 113 pregnant women with (n = 11) and without (n = 102) FVL and measured F1+2. TAT, D-Dimer and the ETP at the 12th, 22nd and 34th gestational week as well as 3 months after delivery (baseline) in each subject. None of the women developed clinical signs of venous thromboembolism during pregnancy or postpartum. Pregnant women with and without FVL exhibited substantial activation of the coagulation and fibrinolytic system as indicated by a gradual increase of F1+2, TAT and D-Dimer throughout uncomplicated pregnancy up to levels similar to those found in acute thromboembolic events (p < 0.0001 by analysis of variance for each parameters). Levels of F1+2 and TAT were comparable between women with and without FVL, but levels of D-Dimer were significantly higher in women with FVL than in those without the mutation (p = 0.0005). The ETP remained unchanged in both women with and without FVL at all timepoints. Our data demonstrate a substantial coagulation and fibrinolytic system activation in healthy women with and without FVL during uncomplicated pregnancy. An elevated F1+2, TAT or D-Dimer level during pregnancy is not necessarily indicative for an acute thromboembolic event. The normal ETP in both women with and without FVL suggests that the capacity of the plasma to generate thrombin after in vitro activation of the clotting system is not affected by pregnancy. Higher levels of D-Dimer in women with FVL than in women with wildtype factor V at baseline as well as during pregnancy indicate increased fibrinolytic system activation in carriers of the mutation.

Adult↗
PubMed1998

Detection of fetal congenital heart disease in a low-risk population.

Our purpose was to evaluate the efficacy of level two ultrasound screening for the detection of congenital heart defects (CHD) in a low-risk population by using three standardized cuts. Within a period of four years a total of 6727 pregnant women of a low-risk population undertook several ultrasound examinations on the basis of screening for fetal malformations. All ultrasound examinations were performed by three experienced doctors. At every single scan three standardized cuts (apical and lateral four-chamber view, crossing over of the great arteries) were obtained in order to detect congenital heart defects. Of 87 CHDs (1.33 per cent of the examined women) 39 (43.8 per cent) were diagnosed prenatally. The detection rate was 10/48 (20.8 per cent) in the presence of VSD, ASD2 or combined ASD2 + VSD, the detection rate was 29/39 (74.3 per cent) in the presence of other forms of congenital heart disease. None of the 38 missed cases in the first group but three of the ten missed CHDs in the second group had emergency neonatological problems. Aneuploidy and/or other malformations existed in 22/87 cases of CHD. The obstetrical management was changed in nearly all cases after the diagnosis of a CHD. Twenty-two women opted for termination of pregnancy because of additional fetal malformations or chromosomal defects. Five women were transferred prenatally to a tertiary centre for neonatal cardiac surgery. Ten deliveries were performed in the presence of a neonatologist. Good detection rates for CHD can be achieved in a low-risk population on the basis of level two ultrasound screening by using the above mentioned three cuts and thus, the perinatal mortality and morbidity can be improved.

Abnormalities, Multiple↗
PubMed1998

Group B streptococci during pregnancy: a comparison of two screening and treatment protocols.

OBJECTIVE: The objective was to evaluate whether the rate of neonatal group B streptococcal infection could be reduced by screening for group B streptococci during the third trimester of pregnancy. STUDY DESIGN: Two periods in which different screening and treatment protocols were applied were compared. In period A all mothers showing high-risk factors were given peripartal antibiotic coverage. In period B vaginal and rectal smears were routinely obtained in gestational week 34 and cultured for group B streptococci. If culture results were positive, the woman received peripartal antibiotics. The incidence of group B streptococcal infections and the number of peripartal antibiotic doses were established by comparing 3700 neonates (3623 mothers) in period A with 3648 neonates (3569 mothers) in period B. RESULTS: In period A, 20 group B streptococcal infections were recorded. Of these, 5 were severe to life-threatening. In period B, 4 group B streptococcal infections were observed. Two were severe and occurred in neonates born before the mothers could be screened. Another 2 were mild and occurred in neonates whose mothers had negative screening test results. The reduction was significant by the chi2 test (chi2 = 9.19, Yates' corrected P = .0024). The rates of peripartal antibiotic treatment were 11.9% in period A and 14.5% in period B. CONCLUSION: Although no neonate died of group B streptococcal sepsis in either of the 2 periods, the protocol used in period B clearly reduced the incidence of group B streptococcal infection. The number of peripartal antibiotic doses required was not much higher than in period A. Screening for group B streptococci in week 34 seems to be a valuable contribution to further improvement of neonatal outcome.

Anti-Bacterial Agents↗
PubMed1998

Second-trimester measurements of placental volume by three-dimensional ultrasound to predict small-for-gestational-age infants.

OBJECTIVE: The objective of this study was to investigate the value of second-trimester three-dimensional sonographic placental volume measurements to predict infants who are below the 10th centile for birth weight. SUBJECTS AND METHODS: Placental volume measurements were performed using three-dimensional ultrasound in 382 women with normal singleton pregnancies at 16-23 weeks' gestation. Logistic multivariate regression consisting of variables considered to influence birth weight was used to predict infants with a birth weight below the 10th centile from the placental volume measurements. RESULTS: Prognostic influence could be shown for placental volume (p < or = 0.0001), gestational week at the time of measurement (p = 0.0002) and maternal weight at the time of registration (p = 0.0025). Values for specificity and sensitivity achieved by choosing an 'optimal' cut-off point of 0.16 for the estimation probability for a small-for-gestational-age (SGA) infant were low at 82.5% and 52.5%, respectively. CONCLUSIONS: Three-dimensional sonographic measurement of the placental volume alone is not a satisfactory technique for predicting SGA infants.

Adult↗
PubMed1998

Results of routine fetal nuchal translucency measurement at weeks 10-13 in 4233 unselected pregnant women.

The aim of this study was to determine the value of nuchal translucency (NT) measurement for the detection of aneuploidies and other malformations in a low-risk population. In total, 4233 women who booked in our hospital for delivery were examined between the tenth and 13th week of gestation. Of the 17 chromosomal abnormalities that occurred, 11 were detected using the measurement of NT (65 per cent). Only three of the seven Down syndrome pregnancies were detected using this technique (43 per cent). The remaining four Down syndrome babies were diagnosed either because of positive biochemical testing or by amniocentesis because of maternal age. A total of 69 serious malformations including chromosomal defects were detected during the study period. In 18 of these cases, the NT measurement was > or = 2.5 mm (26 per cent). Most of the malformations without aneuploidies were of cardiac origin. The data show that the NT measurement is a valuable marker for aneuploidy even in a low risk-population. It is also of value in the diagnosis of other serious malformations, particularly cardiac defects.

Abortion, Spontaneous↗
PubMed1998

[Somatotropic pituitary adenoma with lesions of the oculomotor nerve in a cat].

A case of a 6.5-year-old castrated male European Shorthair Cat with an unilateral lesion of the oculomotor nerve is described. Nuclear magnetic resonance imaging revealed a mass in the area of the pituitary gland which could be identified as a somatotrope adenoma by immunochemistry. Unlike the feline somatotrope adenoma cases described in the literature this cat showed clinically no acromegalic features or hyperglycemia. An oculomotor nerve lesion in conjunction with a feline somatotropic pituitary adenoma has also not been described before.

Adenoma↗
PubMed1997

Prenatal diagnosis of facial malformations.

In a prospective study, 5407 pregnant women were screened by ultrasound to detect malformations of the fetal face. Of a total of 11 facial anomalies, eight were detected by prenatal ultrasound (72 per cent). Three pregnancies were terminated because of associated developmental abnormalities or aneuploidy. In all of them, the facial malformations were correctly diagnosed. When associated with other developmental abnormalities, facial malformations were picked up at a rate of 100 per cent. Isolated facial malformations, by contrast, were detected in no more than 50 per cent of cases. Eight cases with suspected facial dysmorphism ended with the delivery of normal babies (specificity 99.8 per cent). None of them prompted karyotyping or any other invasive testing. Only two correctly detected facial malformations (bilateral cleft lips/palate) had a minor influence on obstetrical management. There would not have been disadvantages for the newborns in any of the cases if the malformations had been missed.

Acrocephalosyndactylia↗
PubMed1996

Development of a rapid means of estimating the haemoglobin F content of candidate fetal cells isolated from maternal blood using HPLC.

Prenatal diagnosis of genetic disorders in nucleated fetal red blood cells present in maternal blood requires methods to detect and enrich for such cells. Here we describe a rapid high performance liquid chromatography (HPLC) method that allows one to determine as few as 100 cells containing haemoglobin F (HbF) in the presence of a vast excess of haemoglobin A (HbA)-producing cells. The HPLC separations of haemoglobins were performed with a weak cation exchange column-silica gel-bound asparaginic acid-and ammonium phosphate buffer as the mobile phase. Separations were carried out in 7 min. When applied to estimation of the recovery of fetal cells from maternal blood, the HPLC method indicates in a timely manner whether or not to proceed with further techniques (i.e., FISH or PCR). Several current techniques such as Ficoll gradients and fluorescence (FACS) or magnetic (MACS) activated cell sorting were thus evaluated. Unexpectedly, our method indicates high cell losses with both single gradient and triple density Ficoll pre-enrichment methods. Less than 20 per cent of the nucleated red blood cells can be recovered in the most optimal setting. Lysis of erythrocytes may be an alternative technique that leaves nucleated red blood cells of all maturation stages intact. Thus, any further improvements in the technology for fetal cell recovery may be aided by monitoring the yield with HPLC.

Cell Separation↗
PubMed1995

Screening for chromosomal abnormalities in an unselected population by fetal nuchal translucency.

The aim of this prospective study was to examine the value of nuchal translucency measurement for the detection of fetal aneuploidies in an unselected population of an Austrian National Health Service hospital. A total of 1972 women with singleton pregnancies who attended at 10-13 weeks for the initiation of routine antenatal care at our hospital were examined. Chromosomal abnormalities were found in 11 fetuses, four of then with Down's syndrome. Eight of the 11 chromosomally abnormal fetuses, including two of the four with Down's syndrome, were detected by a nuchal translucency thickness of > or = 2.5 mm. Three of the fetuses with abnormal karyotype had a nuchal translucency thickness of < 2.5 mm. Two of these were fetuses with Down's syndrome, one of which was identified by karyotyping for maternal age, the second one by positive biochemistry testing (triple test). The additional chromosomal abnormality was identified by karyotyping for maternal age. These data suggest that nuchal translucency screening for aneuploidies is efficient even in an unselected population.

Adolescent↗
PubMed1995

Monitoring of blood-10B concentration for boron neutron capture therapy using prompt gamma-ray analysis.

The aim of the present study was to monitor the blood-10B concentration of laboratory dogs receiving boron neutron capture therapy, in order to obtain optimal agreement between prescribed and actual dose. A prompt gamma-ray analysis system was developed for this purpose at the High Flux Reactor in Petten. The technique was compared with inductively coupled plasma-atomic emission spectrometry and showed good agreement. A substantial variation in 10B clearance pattern after administration of borocaptate sodium was found between the different dogs. Consequently, the irradiation commencement was adjusted to the individually determined boron elimination curve. Mean blood-10B concentrations during irradiation of 25.8 +/- 2.2 micrograms/g (1 SD, n = 18) and 49.3 +/- 5.3 micrograms/g (1 SD, n = 17) were obtained for intended concentrations of 25 micrograms/g and 50 micrograms/g, respectively. These variations are a factor of two smaller than irradiations performed at a uniform post-infusion irradiation starting time. Such a careful blood-10B monitoring procedure is a prerequisite for accurately obtaining such steep dose-response curves as observed during the dog study.

Animals↗
PubMed1989

[Practical use of blood flow measurement with pulsed ultrasound in the 3d trimester of an at-risk pregnancy].

Using a pulsed Doppler technique measurements of blood flow of the arcuate artery, umbilical artery and foetal aorta were performed in the third trimenon in a group of 163 patients with risk pregnancies and compared with the weights of the newborn. In normal values of blood flow of the arcuate artery (n = 144) less than 10% of the weights of the newborn were below the tenth percentile. In pathological values (n = 19) about 42% newborn werde below the tenth percentile. In normal values of blood flow of the umbilical artery (n = 158) about 10% of the newborn were below the tenth percentile. In pathological values (n = 5) all newborn were below the tenth percentile. In normal values of blood flow of the foetal aorta (n = 139) about 12% of the newborn were below the tenth percentile. In pathological values (n = 4) all newborn were below the tenth percentile. Of the group with "normal" blood flow data a sub-group was formed with flow values between the first and second standard deviation. These were labelled "suspicious" and had shown a significant correlation with the birth weights of the newborn. Based on these experiences a schema was prepared comprising the blood flow measurements and cardiotocography, from which recommended clinical procedures were derived.

Blood Flow Velocity↗
PubMed1989

[Results of radical radioisotope surgery of cervix cancer].

During the period 1970-1981 radioisotope radical surgery was performed in 270 patients suffering from cervical carcinoma stage Ib und II. During the development of the method, which has a three-stage process, the rate of cases with complete lymphadenectomy was increased from 52.5% to 75.8%. The 5-year recurrence mortality rate decreased in stage Ib patients during this period from 15.8% to 8.4%.

Female↗
PubMed1989

[Blood flow measurements of the utero-placento-fetal unit].

Examination techniques suitable for evaluating uteroplacental blood flow are of vital clinical interest. Whereas flow measurement using radioisotopes only catches the maternal side of the placenta, pulsed ultrasound Doppler technique makes it possible to examine the maternal and fetal side of the uteroplacental unit. The results of the examination show a good correlation to the newborns' birth weight.

Blood Flow Velocity↗
PubMed1988

Radionuclide-guided radical surgery for cervical cancer.

Radio-isotope radical operation has been developed in three steps. The rate of complete lymphadenectomies determined by the complete removal of labelled tissue was increased from 52.2% in the first observation period to 67.2% in second and finally to 75.8% in the third observation period. Although no improvement could be shown in the survival rate in histological Stage II carcinomas, a marked reduction of recurrence mortality in histological Stage I could be observed: from 15.8% in the first observation period to 12.3% in the second and finally to 8.4% in the third observation period.

Female↗