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O Bauer

Publications and source records attributed to O Bauer.

At least 19 recordsLinked to original sources
PubMed1998

Serum concentration of vascular endothelial growth factor cannot predict the course of severe ovarian hyperstimulation syndrome.

Vascular endothelial growth factor (VEGF) is stated to be a possible promoter of the development and the severity of ovarian hyperstimulation syndrome (OHSS). The secretion of VEGF in granulosa cells seems to be human chorionic gonadotrophin (HCG) dependent. In this prospective study, the data of 10 patients suffering from severe OHSS with ascites and pleural effusions (haematocrit, fluid balance, serum HCG, serum oestradiol) were analysed. The serum VEGF concentration declined during the period of clinical improvement but provided no additional diagnostic information for the further course of OHSS. VEGF was neither an early marker of improvement, nor of worsening of the clinical picture of the OHSS. Serum oestradiol concentrations and serum VEGF concentrations showed a statistical correlation (r = 0.33, P < 0.001). There was no correlation between haematocrit and VEGF, nor between serum HCG and VEGF. To conclude, although VEGF may be involved in the pathogenesis of OHSS, it is not an important clinical marker for the course of an OHSS.

Ascites↗
PubMed1998

Treatment of uterine fibroids with a slow-release formulation of the gonadotrophin releasing hormone antagonist Cetrorelix.

A depot preparation of the third-generation gonadotrophin-releasing hormone (GnRH) antagonist Cetrorelix (SB-75) was used for preoperative treatment in twenty premenopausal patients with symptomatic uterine fibroids who were to undergo surgery. In a prospective, open, randomized setting 60 mg of Cetrorelix pamoate salt was administered i.m. on cycle day 2. Patients were randomized for a second dose of 30 or 60 mg of Cetrorelix depot, which was administered according to the degree of oestradiol suppression (<50 pg/ml) on treatment day 21 or 28. Surgery was done after 6 or 8 weeks of treatment, depending on second dosage administration. Weekly transvaginal sonography (TVS) and magnetic resonance imaging (MRI) before and after treatment was performed, for fibroid volume assessment. Sixteen patients showed satisfactory suppression of gonadotrophins and sex steroid secretion, avoiding any initial flare-up effect. In these patients a mean shrinkage rate of largest fibroid volume of 33.5% at the end of treatment could be observed according to TVS, while the mean shrinkage rate obtained after 14 days of treatment was 31.3%. In good responders (shrinkage >20%) largest fibroid volume at day 14 was approximately 56.7% of basic assessment. Although MRI showed minor mean shrinkage rates of only 25.4% of the initial volume, these differences in comparison to TVS assessment were not statistically significant. The avoidance of any initial flare-up in gonadotrophin secretion may explain this extremely fast reduction in fibroid size. The advantages of GnRH antagonist treatment in this indication consist in the short treatment time with a fast restoration of the ovarian function. The rate of poor responders may be reduced by using an improved slow release preparation.

Adult↗
PubMed1998

Ovarian hyperstimulation syndrome (OHSS) in a spontaneous pregnancy with fetal and placental triploidy: information about the general pathophysiology of OHSS.

An ovarian hyperstimulation syndrome (OHSS) in spontaneous pregnancies is a very rare event. Hence, clinicians might make wrong decisions, such as laparotomy, because of suspicion of an ovarian carcinoma, or severe complications such as renal insufficiency may develop because the diagnosis and treatment of OHSS are delayed. Here we report a case of a woman in the 15th week of gestation, presenting with a partial hydatidiform mole and a triploidy of fetus and placenta, with an ongoing and severe OHSS even after legal induced abortion. A low vascular endothelium growth factor (VEGF) concentration (50 ng/ml) was measured when human chorionic gonadotrophin (HCG) exceeded 1000 IU/l and was followed by VEGF concentrations >900 ng/ml, when the OHSS developed. The literature on spontaneous pregnancies associated with OHSS is reviewed, and possible reasons for the clinical course presented in this study and the reviewed reports are discussed. The findings in this case contribute to our theory that VEGF is a causative factor of OHSS, but has no impact on the course of this disease.

Abortion, Induced↗
PubMed1997

A new indication for an intracytoplasmic sperm injection procedure outside the cases of severe male factor infertility.

OBJECTIVE: To show the success of intracytoplasmic sperm injection (ICSI) in cases of a low number of oocytes retrieved. STUDY DESIGN: 715 microinjection cycles, which were performed at our center, were analyzed retrospectively. RESULTS: Within the analyzed cycles, there were 50 cycles with less than four oocytes retrieved. Twelve, 18, and 20 cases were treated with one, two, and three oocytes, respectively. The rate of metaphase II oocytes injected and subsequently fertilized, and intact oocytes was similar in the three groups. The transfer rate was not significantly different from those cases with more than three oocytes (84% vs. 94%). Therefore, the rate of fertilization failure was not higher in the low-number group. The number of embryos transferred was statistically significantly lower in the group with one and two oocytes compared to the group with three oocytes (1, and 1.31 vs. 2.27; P < 0.01) and the group of all patients (2.63; P < 0.01), as well as between the group of less than four oocytes and all patients (1.63 vs. 2.63; P < 0.01). There was no statistically significant difference between the pregnancy rates of the three groups (36.4% vs. 20% vs. 22.2%), and also no difference was found between the group with less than four oocytes and the data of all patients (22% vs. 26.9%). CONCLUSION: In our opinion, these data show that ICSI guarantees a successful treatment even if only as many oocytes are present as embryos are planned to be transferred, i.e. three embryos. This has been accepted to be a new indication in our center. Therefore it should be possible to stimulate patients mildly, with e.g. clomiphene citrate, to avoid unnecessary hyperstimulation syndromes, and to lower the cost of hormonal superstimulation.

Adult↗
PubMed1997

[An overview of ovarian hyperstimulation syndrome: a reproductive medicine-iatrogenic disease picture with internal medicine consequences].

The ovarian hyperstimulation syndrome is a complication of the controlled ovarian hyperstimulation in assisted reproduction procedures. It has become more widespread, since the techniques of ovarian hyperstimulation has become more frequent. The potentially life-threatening complication of this condition is a hemoconcentration with subsequent thrombo-embolic complications and death. In this article the pathophysiology, prevention strategies, treatment guidelines and more theoretical approaches for the therapy are reviewed and discussed.

Death, Sudden↗
PubMed1996

[Accidents of the elderly].

The topic of accidents in elderly population has been studied on 2055 injured older than 65 years. The severity of injuries indicates the importance of accidents in this age-group. The proportion of fractures in the elderly population is twice of the average-in females over 75 years of age they take the half of the total number of injuries. While the incidence rate of males in the whole material with all of the age groups is twice of that of females, in elderly population it turns into equal. The rate of home-accidents grows with ageing. The elderly people specially the males suffer a high number of road traffic accidents as pedestrians or riding their bicycles. The severity of injuries and the broken health status in elderly people is a major problem both for the health care and the whole society.

Accidental Falls↗
PubMed1996

Hormone profiles under ovarian stimulation with human menopausal gonadotropin (hMG) and concomitant administration of the gonadotropin releasing hormone (GnRH)-antagonist Cetrorelix at different dosages.

PURPOSE: The premature LH surge in ART programs seems to be avoided by daily administration of the GnRH-antagonist Cetrorelix during the midcycle phase in controlled ovarian hyperstimulation with hMG. The dosage necessary for sufficient suppression of the pituitary gland is not yet defined. METHODS: To elucidate this question three daily dosages (3, 1, 0.5 mg) were administered and the hormone profiles obtained as well as the number of oocytes retrieved, the fertilization rate, and the consumption of HMG were compared. RESULTS: No premature LH surge could be observed at any of the three dosages administered. Both gonadotropins were deeply suppressed. The fertilization rates of the oocytes obtained were 45.3% in the 3-mg group, 53.1% in the 1-mg group, and 67.7% in the 0.5-mg group. The average uses of hMG ampoules were 30 in the 3-mg group, 27 in the 1-mg group, and 26 in the 0.5-mg group. CONCLUSIONS: Cetrolix, 0.5 mg/day, administered during the midcycle phase of controlled ovarian hyperstimulation with hMG is enough to prevent completely the premature LH surge. Perhaps even lower dosages would be sufficient. Regarding fertilization rates and use of hMG, the lower dosage seems to be the most favorable.

Adolescent↗
PubMed1996

Small-diameter laparoscopy (SDL) using a microlaparoscope.

PURPOSE: To determine the ability of new sub-2.0-mm-diameter microlaparoscopes to be used for diagnostic laparoscopy, 28 small-diameter laparoscopies (SDL) were performed during a 4-month-period. METHODS: These cases were performed under general anesthesia, with immediate follow-up confirmation with conventional laparoscopic equipment. An additional 13 SDL procedures were performed under analgosedation plus local anesthesia and were well tolerated by the patients. RESULTS: For the cases performed with conventional laparoscopic control, the visualization results were comparable in 27 of 28 procedures. In the nongeneral anesthesia SDL group, patients were highly satisfied and reported less post-procedural discomfort and minimal scar formation due to the smaller access ports. In this study, two types of microlaparoscopes were used. CONCLUSIONS: While both were adequate, the newer high-resolution microlaparoscope delivered an image much more similar to that which conventional laparoscopy and required little or no change in technique in order to obtain images. With the advent of this new endoscope technology with optics performance comparable to that of conventional laparoscopes, SDL has demonstrated to be a useful procedure for certain clinical indications.

Evaluation Studies as Topic↗
PubMed1996

[Significance of tumor necrosis factor alpha (TNF-alpha) in endometriosis].

Macrophage-derived substances such as cytokines and growth promoting factors are known to be present in the peritoneal fluid of women with endometriosis. Active endometriosis of the peritoneum is characterised by hypervascularization and neoangiogenesis. TNF-alpha is a pleiotropic cytokine also involved in angiogenesis and immunoregulation. Our question was to determine whether there are differences in the peritoneal TNF-alpha concentrations in women with various degrees of active and inactive endometriosis. We found that TNF-alpha concentrations were higher in the peritoneal fluid of women with endometriosis than in the peritoneal fluid of those without. TNF-alpha concentrations were higher in cases of active endometriosis than in cases of inactive endometriosis. The highest concentrations could be detected in women with severe endometriosis (stage III and IV rAFS).

Adult↗
PubMed1996

Comparison of cryopreservation of supernumerary pronuclear human oocytes obtained after intracytoplasmic sperm injection (ICSI) and after conventional in-vitro fertilization.

A comparison was made of pronuclear stage human oocytes obtained either after classical in-vitro fertilization (IVF) or after intracytoplasmic sperm injection (ICSI). After ICSI or IVF, three fertilized oocytes from each patient were kept in culture for a further 24 h before embryo transfer. The surplus oocytes were cryopreserved using the 'open freezing system' and 1,2-propanediol and sucrose as cryoprotectants. A cohort of 817 and 1626 oocytes in pronuclear stage were frozen after IVF and ICSI respectively. Of these, 333 and 744 zygotes have been thawed, of which 78 and 76.5% were morphologically intact zygotes after IVF and ICSI respectively. From the 204 (ICSI) and 89 (IVF) zygote transfers performed, 34 (17%) and 18 (20%) pregnancies were established. Both groups showed a similar abortion rate of approximately 20%. It is concluded that pronuclear stage oocytes resulting from ICSI can be successfully frozen/thawed and the survival and pregnancy rates achieved are comparable to those for zygotes obtained after IVF.

Cryopreservation↗
PubMed1996

The combination of two semen preparation techniques (glass wool filtration and swim-up) and their effect on the morphology of recovered spermatozoa and outcome of IVF-ET.

The aim of this prospective study was to relate sperm quality, especially sperm morphology, to the outcome of IVF results, when glass wool filtration (GWF) and swim-up were used in combination for the preparation of spermatozoa. A total of 60 ejaculates were analysed. GWF was compared with glass wool filtration/swim-up (GWF-SU) by using aliquots from the same semen samples to increase the precision of the comparison and to establish the cumulative effect of these two semen preparation methods on the morphology of the recovered spermatozoa. Sperm parameters were examined in native semen, in semen preparation samples after GWF and GWF-SU. The mean percentages for motility, morphology and velocity were improved significantly over those in fresh semen only when GWF-SU was used. GWF alone resulted only in a significantly higher recovery of motile spermatozoa. In semen preparation, 10% of spermatozoa with normal morphology appeared to be the cut-off point as there was a significantly higher recovery in fresh semen samples containing > 10% morphologically normal spermatozoa after GWF-SU. Outcome of IVF-ET following preparation with GWF-SU showed better results in comparison to the swim-up procedure alone, though this difference was not statistically significant. The cut-off point was also > 10% morphologically normal spermatozoa. Improvement in all aspects of IVF-ET occurred when native semen contained > 10% morphologically normal spermatozoa. It is concluded that GWF alone did not produce significantly better results but, in combination with swim-up, it resulted in significantly better sperm morphology and in an improved outcome of IVF-ET for fresh semen samples with > 10% morphologically normal spermatozoa.

Adult↗
PubMed1996

[Use of fibrin glue in vesico-vaginal fistulas after gynecologic treatment].

Vesicovaginal fistulas develop as an early complication following gynaecological operations or as a late complication following irradiation. The waiting period for the surgical closure of the fistula implies social and psychic problems for patients and attending physicians. Three cases report on the exclusive fibrin sealing for closing vesicovaginal fistulas after which continence was re-established.

Aged↗
PubMed1996

[Discrimination of small breast lesions with Doppler ultrasound].

We performed histological examinations on 75 patients in whom a breast lesion was identified by mammography or clinical examination. We found 35 malignant and 40 benign lesions with an average size of 16 mm. In 57 cases (76%) a lesion was identified preoperatively by the use of ultrasound. Blood flow of sufficient magnitude to be visualized by Colour Coded Doppler was only detectable in 22 cases of which 20 turned out to have a malignant lesion. Thus the detection of blood flow by Colour Coded Doppler in a small breast lesion may be considered as a sign of malignancy. However the absence of such blood flow should not be considered as an indicator of a benign lesion. At the same time we would like to point out that the detection of blood flow is also dependent on technical factors of the equipment used.

Blood Flow Velocity↗
PubMed1996

[Pregnancy and extreme myomatous uterus--conservative management].

The management of a pregnancy complicated by uterus myomatosus remains being controversially discussed. Myomectomy early in pregnancy is opposed by exspectative management with myomectomy subsequent to the post partum period. Therapeutic abortion and exstirpation of the gravid uterus represent only hypothetical but not reasonable alternatives. Complications like ureteral obstruction, sepsis, and torsion of the uterus with subperimetrial bleeding as a cause of fever of unknown origin may occur. Rapid growth of a fibromatous uterus in pregnancy may call for a biopsy. Two cases are presented to demonstrate that with intensive pregnancy surveillance exspectative management is justified and may lead to successful confinement of the pregnancy.

Adult↗
PubMed1996

[Risks of expectant management of extrauterine pregnancies with low HCG titers and absent clinical symptoms].

We report on 4 cases of ectopic pregnancy with low HCG-levels and lack of clinical symptoms, in which expectant management was performed. Advantages and disadvantages of the procedure are discussed. While one can find a variety of therapeutical concepts in the literature such as conservative medical treatment alone or in combination with laparoscopy or expectant management, we dispose to prefer a fertilization providing gentle operative laparoscopic assessment as the treatment of choice in all cases of ectopic pregnancy. In all 4 cases operative laparoscopy had to be performed after an interval of expectance when the patients displayed sudden severe clinical symptoms.

Adult↗
PubMed1995

Mini-swim-up: a new technique of sperm preparation for intracytoplasmic sperm injection.

PURPOSE: The male factor is nowadays one of the major problems in the treatment of infertility. New methods of assisted fertilization such as the intracytoplasmic sperm injection (ICSI) show better fertilization and pregnancy rates than classical IVF. METHOD: In this study, we present a new technique of sperm preparation: the "mini-swim-up." CONCLUSION: This technique, used in conjunction with the ICSI procedure, improves pregnancy and fertility rates in cases of severe oligoasthenoteratozoospermia.

Cell Separation↗
PubMed1995

Preserved pituitary response under ovarian stimulation with HMG and GnRH antagonists (Cetrorelix) in women with tubal infertility.

OBJECTIVE: To examine the pituitary response in patients undergoing short-term application of the GnRH antagonist Cetrorelix in the mid-cycle phase for hypophysial suppression of premature LH surges within an IVF-program. DESIGN: Twenty patients suffering from primary or secondary tubal infertility were stimulated with hMG from cycle day 2. From day 7 till ovulation induction Cetrorelix was administered in two different dose regimens (15 patients 3 mg s.c. daily; 5 patients 1 mg s.c. daily). Three hours before ovulation induction a GnRH test was performed using 25 micrograms of native GnRH and the pituitary response examined by measurement of the serum LH concentration after 30 min. RESULTS: Premature LH surges could be avoided in the 3-mg group and in the 1-mg group, respectively. Due to this, none of the cycles had to be cancelled. Oestradiol profiles and ultrasound demonstrated a satisfactory follicular maturation. All patients showed pronounced suppression of the serum LH levels before ovulation induction. The mean increase of serum LH due to the performed GnRH test was 10 mIU/ml for the 3-mg group, while the average maximum in the 1-mg group was about 32.5 mIU/ml. CONCLUSIONS: The pituitary response is preserved by the treatment with the GnRH antagonist Cetrorelix. The extent of suppression of the adenohypophysis, as expressed by the different reactions on GnRH test, can be modulated by the dosage administered. This should allow ovulation induction by GnRH or one of its agonists instead of hCG, which could be beneficial in patients at high risk of Ovarian Hyperstimulation Syndrome (OHSS) and those suffering from Polycystic Ovary Disease (PCOD).

Adult↗