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Biomedical subjects

R Boos

Publications and source records attributed to R Boos.

At least 37 records · Page 2Linked to original sources
PubMed1989

Twin pregnancy in the right horn of a uterus didelphys: a case report.

A rare case of a twin pregnancy occurring in the right horn of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. The occasional diagnosis of this uterine anomaly was made after the pregnancy was detected. Both embryos, with cardiac actions which proved the viability of the gestation from the very early stage of pregnancy, were detected by transvaginal ultrasonography. Two male infants were delivered by Cesarean section in the 34th week. The importance of the transvaginal sonography and the handling of the case during this high-risk pregnancy are reported.

Adult↗
PubMed1989

Three years' experience with large ovarian cysts diagnosed in utero.

Thirteen fetuses with abdominal cystic tumors were diagnosed by routine prenatal ultrasonography between the 28th and 36th week of gestation. Postnatal ultrasonography of the full-term newborns confirmed the findings. Laparotomies were performed in all cases except one. Patients who were operated on had large ovarian pseudocysts with volumes between 24 and 120 cc. In seven patients (54%), the cysts arose from the left ovary; this included four cases in which the postnatal ultrasound was interpreted as showing the cysts in the right abdomen. Very thin cystic walls threatening perforation were found in 91%. In 33%, we found salpingotorsion on the affected side. Small contralateral ovarian cysts were found in 66% of the patients. One infant required resection of 30 cm of necrotic jejunum because adhesions to the cyst had caused bowel volvulus. Histology of the cysts showed hemorrhage and calcifications, but ovarian stroma was absent in all but one patient. Serum estradiol-17 beta, progesterone follicle-stimulating hormone, and luteinizing hormone were normal in all cases, and similar levels were found in the cyst fluid. These results show that large abdominal cystic masses in full-term infant girls with normal gonadotrophin levels and normal serum estradiol-17 beta and progesterone levels are very likely to require surgery; this is in contrast to preterm neonates with elevated gonadotrophins who can be treated with medroxyprogesterone acetate in the absence of clinical signs necessitating surgery.

Female↗
PubMed1988

[Ultrasonography in the primary diagnosis and follow up of ovarian tumors].

Preoperative sonographic data in 317 patients who underwent surgery at the University Women's Clinic Heidelberg for an ovarian tumour during a 6 years' observation period, were compared with the results of clinical examination. The prognostic value of both techniques was examined, by relating the findings (as to tumour size, demarcation from the uterus) to the postoperative histological or cytological diagnosis. In the 214 cases of benign and 103 of malignant ovarian tumours a correct diagnosis was provided by ultrasound in 88% and 74% respectively. Thus significantly more often than by clinical examination alone (p less than 0.001 for benign and p less than 0.01 for malignant tumours). The sonographic findings in 49 patients during follow-up after surgery for ovarian carcinoma and polychemotherapy were checked by a second look laparotomy. The detection rate of tumour progression, recurrence, residual tumour or remission was of 98%.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Behavior of fetal position in the 2d half of pregnancy in labor with breech and vertex presentations].

In a retrospective analysis, presentation behavior during pregnancy of 501 infants with breech presentation at birth was compared with that of a control population (n = 520) with vertex presentation at birth. Since the fetus usually changes position frequently during the sonographic examination prior to the 20th week of pregnancy, and since its presentation behavior is generally unstable, presentation of the fetus was only determined sonographically from this point onward. In both populations it was found in 40% of the cases that the fetus remained in either breech or vertex presentation up to birth; and in both populations there was one change of position to the definitive presentation at birth in 44% of the cases (before the 33rd week of pregnancy in 95%). Seventeen percent of the infants born from breech presentation and 15% of those born from vertex presentation changed position several times during pregnancy. The stability of presentation behavior during pregnancy of infants with breech presentation at birth was similar to that of infants with vertex presentation. At about the 32nd week of pregnancy, 90% of the fetuses in both breech and vertex presentation had assumed their final presentation prior to birth. Even when breech presentation is found between the 33rd and 36th week of pregnancy there is still a 54% probability of a change to vertex presentation at birth. In contrast, the probability of the fetus turning from vertex to breech presentation at birth in this period of pregnancy is only 0.4%.

Amniotic Fluid↗
PubMed1986

[Sonographic evaluation of the quantity of amniotic fluid. II. Oligohydramnios--significance for the course of pregnancy and labor].

3,274 pregnant women were examined sonographically in this study, with particular emphasis on the quantity of amniotic fluid present. In 8% of the patients a reduced amount of amniotic fluid was seen. If the largest pocket of amniotic fluid was less than 2 cm that particular case was classified as oligohydramnios. If the largest pocket of amniotic fluid was between 2 cm and 3 cm, it was assumed to be in the lower standard range. These cases were compared with a randomly selected control group with normal amounts of amniotic fluid, in respect of the occurrence of complications during gestation and delivery and of the incidence of fetal malformations. Patients with reduced amounts of amniotic fluid showed signs and symptoms of gestosis more often (p less than 0.001) and delivered more often before the 36th week of pregnancy (p less than 0.001) and growth-retarded children (p less than 0.001) than women with standard amounts of amniotic fluid. The incidence rate of Caesarean section was 42%, and hence far above the standard level (p less than 0.001). In oligohydramnios, 13% (p less than 0.001) of the children had severe fetal malformation, whereas, with an amount of amniotic fluid in the lower standard range, only 5.5% (not significant) showed severe foetal malformation. The stated sonographic criteria are suitable as an objective measure for quantifying the amount of amniotic fluid.

Adult↗
PubMed1986

[Pathological insertion of the placenta after the 20th week of pregnancy--its importance in the course of pregnancy and delivery].

The present paper reports on the results of sonographic diagnosis of a pathologic insertion of the placenta after the 20th week of pregnancy and its importance with regard to the course of pregnancy and birth. The conversion of a primarily pathologic placental insertion to a "normal" insertion at term depends on the severity of the placental insertion disorder and the date of diagnosis. The frequency of pathologic insertions after the 20th week of pregnancy amounted to 4.2% of the patients examined. The rate of conversion from pathologic to normal placental insertion was 91%, if marginal/partial and total placenta previa are accepted as definitive diagnoses at term. The insertion remained unchanged up to term in approximately 90% of the cases in which total placenta previa was sonographically diagnosed. The sonographic diagnosis of "pathologic insertion of the placenta" after the 20th week of pregnancy is associated with severe complications in the subsequent course of pregnancy and birth. There is a significant cluster of vaginal hemorrhage in the last trimester of pregnancy; cesarean deliveries are common; there are more cases of transfer to pediatric clinics, and the incidence of retarded fetal growth and perinatal mortality is higher. The present authors believe that where the diagnosis of placenta previa has been confirmed sonographically, prophylactic measures and, in the last resort, a planned cesarean delivery can contribute to a reduction in maternal morbidity and also to a decrease in perinatal morbidity and mortality.

Abortion, Spontaneous↗
PubMed1986

[Diagnosis of holoprosencephaly with cyclopia in the fetus].

The typical ultrasound findings in cases of fetal holoprosencephaly with hypotelorism and cyclopia are explained with reference to a case history. Hypotelorism was confirmed by measurement of the distance between the orbits of the fetus.

Abnormalities, Multiple↗
PubMed1985

Fetal behavioural states and controlled sound stimulation.

The aim of this study was to investigate responses of human fetuses near term (37-42 wks) (increase/decrease of fetal heart rate and/or fetal motility) to acoustic stimuli. The study group consisted of 43 patients and the control group of 27 patients. Polygraphic recordings of 5 different fetal variables were carried out synchronously for the categorization of the actual fetal behavioural state according to Nijhuis et al. (Nijhuis, J.G., Prechtl, H.F.R., Martin, C.B., Jr. and Bots, R.S.A.M. (1982): Early Hum. Dev., 6, 177-195). Controlled acoustic stimulation was performed either with sine wave tone (2 kHz, 120 dB and 5 s duration) or modulated sine wave tone (0.5-2 kHz, 'sawtooth' modulation, 120 dB and 5 s duration). An additional group of patients received 'sham' stimulation. Overall 84 acoustic stimulations have been carried out. In 26 out of 84 stimulations (30%) a fetal response could be observed within 5 s after acoustic stimulation. In general, there were far fewer fetal responses in sleep states than in states of wakefulness. Whereas in state 1 F only 1 out of 28 acoustic stimulations was followed by an immediate fetal response, more responses were observed in state 2 F. An obvious increase in fetal reactivity to acoustic stimulation was noted in states of wakefulness (states 3 F and 4 F). Comparison between the true and sham stimulations revealed a relatively high level of spontaneous fetal activity (high variation of fetal heart rate and fetal motility) present in states 2 F and 4 F. This must be taken into account in all assessments of fetal responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗
PubMed1985

[Sonographic diagnosis of severe fetal malformations].

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗
PubMed1985

[Diagnosis of benign and malignant ovarian tumors].

The present paper reports on the value of gynecological-clinical examinations and preoperative ultrasonography in the diagnosis of benign and malignant ovarian tumors. Out of a group of 42 patients, in all of whom "ovarian cyst" had only been diagnosed clinically, 14% were not found to be suffering from this condition at surgery. In a comparison of preoperative gynecological-clinical and ultrasonographic findings (in 68 patients) it proved possible to determine the side on which the tumor was localized, its actual size, the extent to which it was delimited from the uterus, and its consistency (whether solid or cystic) significantly better by ultrasonography (p less than 0,01). However, the results of this study indicate that 2% of the cases diagnosed ultrasonographically as "benign ovarian tumor/ovarian cyst" are likely to be ovarian carcinomas. In the group of patients with malignant ovarian tumors also (42 patients), there was a significant difference in the preoperative diagnosis "suspected ovarian carcinoma". On the basis of clinical findings it was only diagnosed in 45%, while it was found in 74% by ultrasonography (p less than 0,01). In 3 cases with ovarian carcinoma there was no pathologic palpation finding, and in only one other case was a "suspected ovarian cyst" diagnosed. By means of ultrasonography, on the other hand, all of the cases of ovarian carcinoma were classified either as "ovarian carcinoma" or as "cystic-solid/complex abdominal tumor". The most frequent diagnoses on the basis of the sonographic scan (approx. 90%) were cystic-solid ovarian tumors, followed by cystic-ventriculated ovarian tumors with solid portions and finally solid ovarian tumors with only a few cystic portions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Value of high-resolution real-time sonography in breast cancer].

1015 women were examined via scanning echo sonography in the course of a prospective study. Histological results are available from 370 patients following sample excisions or breast amputations. 122 histologically established malignant findings were compared with the preoperatively effected tumour status prognosis obtained via echo mammography and x-ray mammography. In 60 of 122 cases (50%) we found that the patients had carcinomas of stage T1. The sonographic accuracy rate was high (49 out of 60 carcinomas = 81%), whereas x-ray mammography yielded an accuracy of only 77%, since 46 out of 60 cases only had been classified as malignant. The smallest carcinomas visualised by sonography had diameters of 4 mm, 5 mm and 6 mm. In accordance with the fine structure of the tissue, solid carcinomas were recognised most frequently, compared with all other carcinomas, the rate of detection being 96% (26 out of 27). In 64% of all carcinomas, a retrotumourous sonographic shadow was seen. In cases with solid carcinomas, this "sonographic shadow phenomenon", however, was actually present in 34.6% of the cases only, although the rate of identification was highest of all. The results show that echo mammography is the most important additive investigation method in diagnosis of diseases of the breast, besides x-ray mammography, which is of course also an important method. Echo mammography offers a high degree of accuracy in preoperative differential diagnostic assessment of tumour status in malignant processes of the breast.

Adenocarcinoma, Scirrhous↗
PubMed1984

[Observations on fetal behavioral states at term in normal pregnancy].

The authors report on results of examinations of 18 women between the 38th and 42nd weeks of pregnancy in respect of the observation of foetal sleep/waking cycles. The following parameters were noted simultaneously, i.e. with time synchronicity: foetal heart rate, foetal eye movements, foetal thorax movements, and movements of the body and extremities. On the basis of the criteria published by Prechtl (1974) and by Nijhuis et al. (1982) it is possible to define with relative accuracy foetal sleep/waking cycles just before the term of birth; 4 independent researchers achieved agreement in the allocation of the various cycles in 86% of the cases investigated by them. In view of the fact that monitoring is complicated and exacting, recording cannot be continuous all the time and certain dropout periods must be taken into account. This applies, for example, to the foetal heart rate, foetal eye movements and movements of the thorax. The average dropout time during recording of foetal heart rate is 16%, during recording of foetal eye movements 22%, and of foetal thorax movements 3%. 11% of the recordings could not be evaluated because of poor recording quality and faulty monitoring. In the study under reference the shortest period of a cycle was three minutes, whereas the longest phase recorded so far was 39 minutes. In 55% of all monitored pregnancies between the 38th and 42nd weeks of pregnancy the foetus was awake, whereas in 45% the foetus was found to be asleep.

Electrocardiography↗
PubMed1984

[Prenatal ultrasonographic diagnosis of a cystic ovarian tumor].

Clinically important ovarial cysts are extremely rare in the female foetus and newborn. About 70 cases only have been published so far. There are only four reports on antepartally diagnosed ovarial tumours. The article reports on the prenatal ultrasonographic diagnosis of a foetal ovarial tumour in the 34th week of pregnancy. Diagnosis "on suspicion" was substantiated by the identification of an intact and properly functioning foetal urogenital system and no abnormal findings in the intestinal organs, as well as by the identification of the sex of the foetus. Differential diagnosis in all cases of cystic foetal space-occupying tumours should consider, in the first place, malformations of the urogenital system, cysts of the liver, pancreas and mesenterium, as well as disturbances of function or malformations of the foetal digestive tract.

Adult↗
PubMed1984

[Prenatal diagnosis of a coccygeal teratoma--consequences for continued pregnancy].

The complex problem of a coccygeal teratoma diagnosed prenatally is described, using a case report as basis. The possibility of a coccygeal teratoma should always be considered in solid and/or cystic processes in the caudal range of the foetus when performing differential diagnosis in which possible disturbances of neural tube occlusion and rare neurogenic tumours should be included. After having confirmed the diagnosis of a coccygeal teratoma via supplementary examinations and after having excluded other concomitant foetal malformations, the physician should communicate with the parents while considering the duration of pregnancy and the extent of the tumour. Whether abortion should be performed or whether the pregnancy should continue, is a decision which can only be arrived at, first of all, after full clarification of the expected malformation and, secondly, after ensuring closest possible interdisciplinary cooperation between obstetrician, neonatologist, paediatric surgeon and genetic engineer; as a matter of fact, such cooperation is absolutely imperative. In case of small coccygeal teratomas, it will be necessary to plan the time and mode of delivery as early as possible and to make sure that the newborn receives immediate surgical attention post partum by the paediatric surgeon.

Abortion, Eugenic↗
PubMed1982

A contribution to the monitoring of fetal arrhythmias.

Antepartum and intrapartum monitoring problems are discussed with reference to a case history of a fetal AV-block detected during the 36th week of pregnancy. CTG instruments where the internal logic criteria can be turned off are suitable for monitoring arrhythmias. During labor the direct fetal ECG permits exact diagnosis as to the type of arrhythmia. The necessity of antepartum diagnosis in regard to postpartum pediatric management and hypoxic states during labor justify the large expenditure on monitoring apparatus. During labor continuous tissue pH measurement via the fetal scalp give added information as to fetal condition.

Adult↗
PubMed1981

[Ultrasonographic diagnosis of a combined malformation syndrome - hydrocephalus - evisceration and dysplasia of the extremities (author's transl)].

The article reports on the ultrasonographic criteria in a complex malformation syndrome (hydrocephalus, evisceration and phocomelia of the lower extremities). Additional examination methods which are suggested whenever there is a suspicion of foetal malformation, are described. The majority of severe congenital malformations can be discovered antenatally via thorough sonographic examination of the foetus in the longitudinal and transverse axes.

Abnormalities, Multiple↗