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Biomedical subjects

P Husslein

Publications and source records attributed to P Husslein.

At least 91 records · Page 5Linked to original sources
PubMed1996

Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis.

OBJECTIVE: We performed a metaanalysis of seven published randomized clinical trials to estimate more precisely the effect of prophylactic antibiotics on neonatal mortality, clinical sepsis of the neonate, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. STUDY DESIGN: To evaluate the effect of antibiotic treatment unaffected by other forms of treatment such as tocolytics or corticosteroids, investigations in which these additional measures were used were not included. We analyzed study patients and methods and abstracted quantitative outcome data. For each outcome both odds ratios and 95% confidence intervals were calculated. RESULTS: Among the 657 patients from seven trials published between 1989 and 1994, antibiotic therapy significantly reduced the risk of neonatal sepsis by 68% (odds ratio 0.32, 95% confidence interval 0.16 to 0.65, p=0.001) and that of intraventricular hemorrhage by 50% (odds ratio 0.50, 95% confidence interval 0.28 to 0.89, p=0.019). In contrast, no significant effect of antibiotics on overall neonatal mortality (odds ratio 0.92, 95% confidence interval 0.46 to 1.81), respiratory distress syndrome (odds ratio 0.84, 95% confidence interval 0.58 to 1.22), or necrotizing enterocolitis (odds ratio 1.27, 95% confidence interval 0.61 to 2.62) was found. CONCLUSION: This metaanalysis supports an improvement of neonatal morbidity in mothers with preterm premature rupture of membranes treated prenatally with different antibiotic regimens.

Anti-Bacterial Agents↗
PubMed1996

Closure or nonclosure of the visceral peritoneum at cesarean delivery.

OBJECTIVE: Our purpose was to determine whether nonclosure of the visceral peritoneum at low transverse cesarean delivery has advantages over suture peritonization with regard to postoperative morbidity. STUDY DESIGN: A prospective randomized trial of 549 women undergoing cesarean section was carried out; 262 were randomized to nonclosure and 287 to closure of the visceral peritoneum. Perioperative, intraoperative, and postoperative management decisions were made without reference to treatment groups. Statistical analysis compared intraoperative and postoperative outcome between the two groups. RESULTS: Operating and anesthesia times were significantly shorter in patients receiving nonclosure. The incidence of febrile morbidity and cystitis and the need for antibiotics and narcotics were all significantly greater when the peritoneum was closed. Hospital stay was significantly shorter after nonclosure. CONCLUSION: Nonclosure of the visceral peritoneum is associated with lower febrile and infectious morbidity. Routine closure of the visceral peritoneum should be abandoned at cesarean delivery.

Adolescent↗
PubMed1996

[Expectations of obstetrics in a large city: prepartum survey].

In recent years, obstetrics has been facing ever greater expectations on the part of its patients. An increasing number of women show a marked interest in experiencing pregnancy and delivery in a more aware and, above all, active manner. The study at hand presents the results of a survey conducted at seven obstetric departments in Vienna in which a total of 431 primiparous women were questioned with regard to their knowledge, their wishes and expectations, as well as their preparations in view of the imminent delivery. The information lag, particularly among less educated women, still appears to be considerable: 20% of the women had no clear idea as to the role of the midwife, and approximately a quarter of them only had a vague notion of the meaning of the term "Caesarean section". 62% of the women identified their gynaecologist as the main source of information. For the atmosphere during the actual delivery to be perceived as pleasant, the parturient has to be in the care of well-trained and friendly staff. Furthermore, it is interesting to note that well-informed women are less inclined to be afraid of pain and consequently tend to be more relaxed during delivery. The correlation between stress and obstetric complications is sufficiently documented. The results of this survey indicate that in future increased emphasis will have to be on education and information, as well as on meeting women's expectations in respect of expert care.

Adult↗
PubMed1996

[Pathophysiologic principles and clinical effects of local drug therapy of tubal pregnancies].

OBJECTIVE: An empirically established serum beta human chorionic gonadotropin (beta-HCG) threshold level of 2,500 IU/l is considered as the limit for successful drug therapy. The purpose of our study was to ascertain if this threshold level correlates with the histopathology. Further, we evaluated the effects of local drug therapy on the tubal wall. METHODS: Between 1988 and 1993 129 cases of tubal pregnancies were treated by local prostaglandin F2 alpha instillation. For final cure 30 patients had to undergo further surgical measures. Our study was based upon the histological samples which were excised during secondary operation. RESULTS: Below 2,500 IU/l beta-HCG, intraluminal growth of the trophoblast is more frequent, whereas at higher values extraluminal spread predominates (p = 0.0045). Cells of ectopic trophoblast proliferate significantly slower than those of intrauterine pregnancies. Prostaglandin F2 alpha application selectively destroys ectopic gestational tissue and preserves the tubal wall. CONCLUSION: The integrity of the tubal wall with its contractile potential is essential for successful therapy by local instillation of prostaglandin F2 alpha.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

The relation between depth of trophoblastic invasion and beta-HCG levels in tubal pregnancies.

beta-HCG (human chorionic gonadotropin) values of over 2500 I.U./l are associated with higher failure rates for therapy with prostaglandin F2 alpha in tubal pregnancies. The purpose of our study was to ascertain if the 2500 I.U./l limit correlates with histopathology. We therefore compared the pre-operative beta-HCG-values and intraluminal and extraluminal trophoblast growth in tubal pregnancy. Purely intraluminal trophoblast was significantly more frequent in patients of group I (beta-HCG < 2500 I.U./l), while group II patients (beta-HCG > 2500 I.U./l) almost exclusively had extraluminal growth (P = 0.0045). Since the efficacy of prostaglandin F2 alpha therapy depends on intact tubal musculature the correlation of the beta-HCG threshold level with histopathologic findings may explain the high failure rate in patients with beta-HCG values above 2500 I.U./l.

Chorionic Gonadotropin↗
PubMed1995

Fetal fibronectin as a marker to predict the onset of term labor and delivery.

OBJECTIVE: We examined whether the presence of fetal fibronectin in cervicovaginal secretions may be a marker to predict the onset of term labor and delivery. STUDY DESIGN: A prospective study was performed in 100 primiparous and multiparous women having reached their expected date of confinement. Fetal fibronectin was assayed by taking samples of both the cervical and vaginal mucus with two different fetal fibronectin tests. The study population was divided into women delivering within 48 hours and women giving birth > 48 hours after sampling. RESULTS: Seven patients had to be excluded from evaluation. Of the remaining 93 women, 37 were delivered within 48 hours; fetal fibronectin was detected in 30. Fifty-six women were delivered later than 48 hours; 51 of them had negative results for fetal fibronectin (positive accuracy 86%, negative accuracy 88%, p < 0.0001). CONCLUSION: Fetal fibronectin in the cervicovaginal secretions of women who have reached their expected date of confinement is a useful predictor of the onset of term labor and delivery.

Biomarkers↗
PubMed1995

Fetal fibronectin as a selection criterion for induction of term labor.

OBJECTIVE: We examined whether the presence of fetal fibronectin in cervicovaginal secretions can be used as a selection criterion for induction of labor at term. STUDY DESIGN: Cervicovaginal secretions of 64 women who were scheduled for induction of labor were examined for fetal fibronectin and divided into group A (positive for fibronectin) and group B (negative for fibronectin). Both groups were examined for Bishop score, the number of prostaglandin tablets administered, and the interval between induction of labor and delivery. RESULTS: In group A the interval between induction of labor and delivery was significantly shorter (p < 0.0001) than in group B. The number of prostaglandin tablets administered to group A was likewise significantly lower (p < 0.0001). Unsuccessful induction of labor only occurred in women with fibronectin-negative cervicovaginal secretions. CONCLUSION: The assessment of the fibronectin content of cervicovaginal secretions constitutes a viable instrument in the decision-making process preceding induction of labor.

Biomarkers↗
PubMed1995

[Histopathologic findings of the trophoblast and tubal wall after medicamentous therapy of tubal pregnancies].

The purpose of the study was to evaluate the effects of drug therapy on the throphoblast and on the tubal wall when protaglandin F2 alpha (PGF2 alpha) was administered in cases of tubal pregnancies. 42 patients were divided into two groups: women of group I (n = 30) were secondarily treated by surgery because of raising serum HCG levels. Group II (n = 12) consisted of patients who were operated on because of acute symptoms (abdominal pains, intraabdominal haemorrhage), despite already failing HCG values. In group I in 66% (n = 20) of the histological specimens an intact (vital) trophoblast was found. Five cases (17%) showed partly necrotic gestational tissue, whereas in another five cases (17%) the whole trophoblast was necrotic. In patients of group II all ectopic pregnancies showed histological signs of necrosis. In the histopathology of the Fallopian tubes no signs of trophic regression could be found. However, ten out of 22 cases showed ruptured tubal pregnancies. In this analysis we could show that the instillation of PGF2a electively destroys the ectopic trophoblast and does not exercise any necrotic action on the tubal wall.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

[Uterus unicornis with rudimentary horn and ipsilateral kidney agenesis: clinical symptoms and therapy].

We report on a 21-year old patient with unicornuate uterus with a rudimentary non-communicating horn (Buttram II-A-1-b), haematosalpinx, associated with ipsilateral ureteranomaly and renal agenesis. In this case we illustrate symptoms, diagnosis and therapy. Despite extensive diagnosis surgical methods finally have to be adapted to the anatomical situation during operation. A short review of literature and embryology is given, more diagnostic preoperative measures are discussed.

Adult↗
PubMed1995

Impact of trophoblast penetration through the basal membrane on the efficacy of drug therapy in tubal pregnancies.

Concentrations of beta-human chorionic gonadotrophin (HCG) of 2500 IU/l are generally considered to be maximal for successful drug therapy of tubal pregnancies [instillation of prostaglandin-F2 alpha (PGF2 alpha) or hyperosmolar glucose]. The purpose of our study was to ascertain if there was an association between the significantly higher failure rates above this threshold value and the histologically determined anatomopathological substratum. We therefore evaluated the impact of trophoblast penetration through the basal membrane of the Fallopian tube on the efficacy of drug therapy. Pre-operative serum beta-HCG concentrations were compared with the histologically determined trophoblast penetration, distinguishing between ectopic pregnancies with intra-luminal growths up to the myosalpinx, and those with extra-luminal growths going beyond the basal membrane and penetrating the myosalpinx. Basic data were obtained from a group of patients who received primary surgical treatment but it had never been the intention for them to receive drug therapy (independently of their initial beta-HCG values; group I, n = 43). These reference data were compared with the findings in preparations from another group of patients obtained during secondary surgical intervention, performed to achieve final cure of tubal pregnancy after failure of primary PGF2 alpha instillation (group II, n = 30). Group I patients showed a significantly higher rate of intra-luminal trophoblast growths (P = 0.0001) at beta-HCG values < 2500 IU/l; above this threshold value, extra-lumina spread was found significantly more often (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1995

Proliferative activity in ectopic trophoblastic tissue.

Clinical observations have shown that tubal pregnancies develop individually different biological activities such as different growth rates, levels of beta human chorionic gonadotrophin (beta-HCG), or rates of tubal wall destruction. In the present study, we evaluated the proliferative activity of ectopic cytotrophoblastic tissue using immunocytochemistry with antibodies to Ki-67 (clone MIB-1). The rates of proliferation obtained were related to the maternal serum beta-HCG values. Reference data were obtained from placentas of intact intrauterine pregnancies (group I, n = 14). The proliferative activity of this tissue was compared to that of cytotrophoblastic tissue of tubal pregnancies (group II, n = 27). Ki-67-immunostained as well as non-stained cytotrophoblastic nuclei of the villi and the trophoblastic columns were counted separately, and results were expressed as percentage of positive cells. Serum beta-HCG values were determined twice, 48 h and immediately before operation. The cytotrophoblastic cells of intact intrauterine pregnancies (group I) showed uniform and high proliferative activities (80% on average in villi, 84% on average in columns). The average Ki-67 proliferation rate was significantly lower (P < 0.001) in trophoblastic tissue of tubal pregnancies (group II; 42% on average in villi, 61% on average in columns). Within the group of tubal pregnancies, higher intragroup differences were observed. The number of Ki-67-labelled cells was independent of the absolute preoperative serum beta-HCG values in both groups, yet they were clearly related to the relative increase of beta-HCG in maternal serum. At higher proliferation rates, there was a significant, growing increase of beta-HCG values (P < 0.01). We have found immunohistochemical evidence to support the previous clinical speculations that tubal pregnancies develop more heterogeneously and more slowly than intact intrauterine pregnancies. The development of the beta-HCG concentrations may be taken as an indirect parameter, reflecting proliferative activity of the trophoblast.

Cell Division↗
PubMed1995

[Good sense and nonsense in tocolysis].

The present paper tries to evaluate the importance of tocolysis with beta-sympathomimetic drugs twenty years after their introduction into obstetrics. Intrauterine resuscitation and short-term tocolysis have proven to be very effective during this period of time. Because of potential side effects long-term tocolysis has to be considered dangerous and apparently not effective. Oral and prophylactic tocolysis are ineffective. When considering prevention of premature delivery one has to be aware of the fact that premature contractions are only ostensible symptoms of a complex event.

Adrenergic beta-Agonists↗
PubMed1994

Three-dimensional video-endoscopy: clinical use in gynaecological laparoscopy.

We describe a system that displays the abdominal organs in three dimensions during laparoscopy. The system consists of a single-rod-lens endoscope and two integrated microchip cameras. The surgeon has to wear active-liquid-crystal shutter-glasses to obtain a three-dimensional impression during the operation. Improved orientation in the abdominal cavity allows exact handling of surgical instruments. The three-dimensional system permits surgery with more accuracy, speed, dexterity, and safety than conventional two-dimensional systems.

Female↗