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Biomedical subjects

R Huch

Publications and source records attributed to R Huch.

At least 73 records · Page 4Linked to original sources
PubMed1996

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia.

The authors compared the effect of recombinant human erythropoietin (rhEPO) in combination with iron with that of iron therapy only in the treatment of postpartum anaemia. Ninety patients (30 patients/group) received either rhEPO (300 U kg-1, i.v. or s.c., once) and iron (parenteral and oral), or iron therapy only. Erythropoiesis was assessed by haemoglobin and haematocrit increase, absolute reticulocyte counting and reticulocyte flow cytometry. Ferrokinetics was assessed by serum ferritin, transferrin and transferrin saturation measurements. There was no difference before therapy for baseline haematological values or iron status. Patients with endogenous EPO levels below 145 mU mL-1 had a significant benefit from intravenous rhEPO administration with highest haematocrit and haemoglobin levels 4 and 14 days after therapy. rhEPO-treated groups showed a higher absolute reticulocyte count 1 and 4 days after therapy and an elevated percentage of high fluorescent reticulocytes (HFRs). Parenteral iron therapy caused a significant increase of ferritin and transferrin saturation, while transferrin concentration decreased. Ferritin and transferrin levels were lowest after i.v. administration of rhEPO, 1 and 4 days after therapy. C-reactive protein concentration was highest in patients who underwent caesarean section until the end of the observation period. A single dose of rhEPO in combination with iron was more effective in treating postpartum anaemia than iron therapy only, in patients who had low EPO levels despite peripartal blood loss. Postpartum low endogenous EPO levels might be a consequence of inhibiting inflammatory cytokines that are released after spontaneous or operative deliveries.

Anemia↗
PubMed1996

Bilateral brachial amelia, facial clefts, encephalocele, orbital cyst and omphalocele: a recurrent fetal malformation pattern coming into focus.

Ultrasonographic and pathoanatomical features of a fetus displaying bilateral brachial amelia, complex facial clefting, encephalocele and omphalocele are described. The findings are compared with the few previously published cases. Bilateral brachial amelia with complex other organ malformations in previable fetuses may be more frequently diagnosed with improving prenatal ultrasonography.

Abnormalities, Multiple↗
PubMed1996

Umbilical vein oxygen tension independent from gestational age at birth.

Umbilical venous oxygen tension (UVPO2) and gestational age are negatively correlated antepartum. To see if the negative correlation between UVPO2 and gestational age would still be present postpartum, a retrospective study of all 7522 births at the University of Zurich Hospital from 1989 through 1992 was performed. The 6612 infants with UVPO2 values were divided into low and higher risk groups. Singletons between the 10th and 90th weight percentiles, born vaginally with cephalic presentation after spontaneous onset of labor from healthy mothers were considered low risk. All other births were considered higher risk. No correlations between UVPO2 and gestational age were found in any group studied (low risk, higher risk or total population). The higher risk group had a lower mean UVPO2 than the low risk group (p < .0001). Since there is a negative correlation before birth and none after birth, this indicates that some preterm infants may be subject to greater drops in UVPO2 during delivery than term infants. The magnitude of the drop increases with additional complications and immaturity. However, not all preterms have normal UVPO2 values for gestational age antepartum. Some preterms already have a low UVPO2 in utero and experience a drop in UVPO2 during delivery as well.

Blood Gas Analysis↗
PubMed1996

Does labor start too late?

To determine the optimal time of delivery, in terms of lowest risk of peripartum complications, the relative incidences of the parameters. Abnormal cardiotocogram (CTG), operative vaginal delivery, Apgar < 7 at 1 and 5 min, artery cord blood pH < 7.20, blood loss > 500 ml, epidural anesthesia, and Cesarean section, were retrospectively analysed with regard to mode of labor onset (spontaneous, induced) and gestational age in all deliveries between gestational weeks (GW) 35 + 0/7 and 42 + 6/7 from 1986 through 1993 at Zurich University Hospital (n = 11,834) and additionally with regard to birth weight in the same population from 1987 through 1993 (n = 10,346). The distribution of most parameters was parabolic with nadirs at GW 37-38; the incidence of low Apgar scores and Cesarean sections, however, was lowest nearer term (GW 39-40). Mode of labor onset had little effect (< or = 1 week) on the time of lowest incidence. The birth weight associated with the fewest complications was 3000 g, with the optimal time of delivery being GW 37-38, assuming a birth weight normal for gestational age.

Anesthesia, Epidural↗
PubMed1995

[Trisomy-21 screening using AFPplus in the eastern part of Switzerland].

Two years after introduction of maternal serum screening for Down's syndrome in German-speaking Switzerland, based on measurements of alpha-fetoprotein, unconjugated estriol and total beta-HCG, results were analyzed of the two cytogenetic laboratories in Zurich and of a separate collective of the Department of Obstetrics at the University of Zurich. In a total of 489 cases with increased risk for Down's syndrome (> or = 1:380 at term) 19 (1:26; approximately 4%) had an abnormal fetal karyotype from which 16 had a trisomy 21. 13 out of these 16 mothers were aged below 35 years. Thus, after ultrasound, maternal serum screening detects the highest percentage of fetuses with chromosomal abnormalities. At the Department of Obstetrics 2962 serum screening tests were performed during a period of 2 1/2 years. 14.6% of the women were > or = 35 years old, 7.6% showed increased risk and 14 fetuses had an abnormal karyotype including 10 with Down's syndrome. 7 of these 10 were detected by the serum test. Nevertheless, the limited sensitivity of serum screening, its limitation predominantly to detection of fetuses with Down's syndrome and the rather late stage of screening, make effective first trimester screening mandatory.

Adult↗
PubMed1995

Elevated alpha-fetoprotein and human chorionic gonadotropin as a marker for placental trisomy 16 in the second trimester?

In a series of 2961 consecutive cases with second-trimester biochemical triple screening for Down's syndrome and neural tube defect (NTD), ten (0.3 per cent) showed an apparent increased risk for both conditions. Three cases had chromosomal abnormalities, namely trisomy 16 confined to the placenta. Since placental trisomy 16 as well as cases with increased alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) are associated with (intrauterine growth retardation (IUGR), oligohydramnios, and fetal demise, at least some cases with this atypical biochemical profile could be explained by this chromosomal abnormality. From our results we recommend that in cases with increased risk for both Down's syndrome and NTD, fetal karyotyping should preferably be done on a placental biopsy, especially when ultrasound in the absence of anomalies demonstrates early IUGR.

Adult↗
PubMed1995

Limitations of forehead pulse oximetry.

During initial clinical tests to calibrate our reflectance pulse oximetry system, we observed serious physiologic limitations to the use of pulse oximetry in the forehead region. We present a case of simultaneous reflectance and transmission mode pulse oximetry monitoring in a child undergoing cardiac surgery for congenital cyanotic heart disease with a large intracardiac shunt. During general anesthesia, when the patient was endotracheally intubated and mechanically ventilated, the transmission mode saturation agreed well with arterial oxygen saturation measurements; but, our reflectance pulse oximeter, with the sensor applied to the forehead, displayed spuriously lower (-18%) oxygen saturations. Before and after anesthesia and surgery, there was fine agreement between reflectance and transmission mode saturation values. We suggest that the difference was caused by vasodilatation and pooling of venous blood due to compromised venous return to the heart, and a combination of arterial and venous pulsations in the forehead region. This means that the reflectance pulse oximeter measured a mixed arterial-venous oxygen saturation.

Anesthesia, General↗
PubMed1995

Reflectance pulse oximetry in neonates.

OBJECTIVE: To test the feasibility and reliability in neonates of an in-house reflectance pulse oximetry (RPOX) system as an alternative method of non-invasive oxygen saturation monitoring when transmission pulse oximetry (TPOX) cannot be used, as in fetal scalp oxygen saturation monitoring during delivery. STUDY DESIGN: The study population consisted of 31 intensive care neonates. The RPOX sensor was attached by suction to the forehead, cheek, occiput and back; recordings were under simultaneous TPOX control. RESULTS: There was close agreement between RPOX and TPOX oxygen saturation and heart rate values, even in periodic breathing. RPOX signals from the back were unreliable because of breathing artifacts. Differences in mean absolute RPOX and TPOX oxygen saturation values were due to different calibrations. Both systems were equally sensitive to motion artifacts. CONCLUSION: As a feasible and reliable method of non-invasive oxygen saturation monitoring in neonates, RPOX has potential applications in fetal scalp monitoring.

Heart Rate↗
PubMed1995

The oxygen status of fetal blood.

OBJECTIVE: To estimate the acid-base and oxygen status of fetal blood and compare with maternal placental venous blood. DATA SOURCES AND CALCULATIONS: We selected pH and blood gas data from the literature pertaining to umbilical vein and artery blood obtained by cordocentesis and estimated values for the 30th and 40th gestational week. Average values for maternal venous blood leaving the placenta were estimated on the assumption of equal maternal arterio-venous and umbilical veno-arterial total oxygen concentration differences. RESULTS: pH and pCO2 of maternal blood leaving the placenta and umbilical vein blood are almost identical at week 30. A small pCO2 and pH difference may exist at week 40. The pO2 of the maternal placental venous blood and umbilical vein blood are almost identical at week 30, but at week 40 a pO2 difference indicates an umbilical arterio-venous shunting of as much as 30%. The fetal mixed venous pO2 falls from 2.6 kPa to 2.2 kPa from the 30th to the 40th gestational week. CONCLUSION: More accurate measurements are needed to confirm our results. Future measurements should be performed with a combined pH-blood gas analyser and haemoximeter to allow determination of the complete oxygen status of the blood.

Acid-Base Equilibrium↗
PubMed1995

rhEPO treatment of postpartum anemia.

Postpartum hemorrhage is a continuing problem occurring in 5-10% of all deliveries. Due to recent problems with blood transfusion, heterologous blood is nowadays restricted to life-threatening indications. As a consequence the clinician is faced with many patients suffering from overt symptoms of anemia. We therefore investigated the effect of recombinant human erythropoietin (rhEPO) in combination with adequate iron supplementation as an alternative for blood transfusion in postpartum anemia. In a pilot study we could show that rhEPO can enhance the effect of endogenous erythropoietin on erythropoiesis. These data could be confirmed in a larger randomized trial. In another study we could show that rhEPO given s.c. is as effective as i.v. Measurement of the iron stores, however, demonstrated low values at the end of pregnancy indicating that iron is a limiting factor for erythropoiesis in postpartum anemia. In a next study i.v. iron combined with rhEPO showed a greater increase in Hb compared to i.v. iron alone. The chosen dose of i.v. iron, however, was too small as shown by the low ferritin levels. We concluded from these previous studies that rhEPO enhances endogenous erythropoiesis, but so far the effect was only slight (ca 1 g/dl within 14 days); all treated patients developed overt iron deficiency in terms of low ferritin levels despite oral and i.v. iron supplementation; no major side-effects were seen. A further study in healthy non pregnant volunteers demonstrated an effect on erythropoiesis lasting for 3-4 days after a single dose of 300 U/kg rhEPO.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗
PubMed1995

Erythropoiesis in the postpartum period.

The puerperium is a time of immense physiological changes for the female organism. Erythropoiesis plays one of the central roles in these processes. The aim of this investigation was to describe physiological erythropoiesis in healthy women during the puerperium. Blood samples were taken just before delivery and on days 1, 2, 3, 4 and 14 postpartum. In addition to the usual parameters such as hemoglobin, hematocrit, platelets, leucocytes, ferritin, CRP, endogenous erythropoietin, etc., the absolute and the percentage reticulocyte counts-both the total and for the subpopulations-were determined by flow cytometry. The mean Hb values decreased in the first 24 hours postpartum by 0.8 g/dl and then rose to 0.2 g/dl more than the initial value on day 14. The reticulocytes reflected erythropoietic stimulation with an increase from day 0 to day 1 of 2.1% (79.1 x 10(9)/1) and a continual decrease thereafter. The hematological parameters followed a characteristic course in the puerperium. For the reticulocytes and the subpopulations, a definite erythropoietic stimulation was evident even before delivery, as was an increase in the erythropoietic activity in the early puerperium.

Adult↗
PubMed1995

Recombinant human erythropoietin and parenteral iron in the treatment of pregnancy anemia: a pilot study.

Our aim was to correct severe iron deficiency anemia during pregnancy by using a combination therapy of recombinant human erythropoietin and parenteral iron. Eleven anemic pregnant women were treated once weekly until a hemoglobin value of 11.0 g/dl was reached. Red blood cell production was monitored by reticulocyte flow cytometry and hemoglobin increase. Iron status was assessed by serum ferritin values and transferrin saturation values. 8/11 patients showed an immediate response, noted by a continuous increase of reticulocytes, high fluorescent reticulocyte ratio and hemoglobin levels. Three patients who had lower serum ferritin values, low transferrin saturation and a lower reticulocyte count before treatment showed little response. The combination of rhEPO and parenteral iron is effective in stimulating erythropoiesis and in treating certain pregnancy anemias. This therapy could be an alternative for patients refusing blood transfusions or who are resistant to iron alone. Poor response to the treatment can be due to insufficient iron supplementation during therapy with rhEPO or due to factors that inhibit erythropoiesis during pregnancy, such as undetected infections.

Anemia↗
PubMed1995

Does recombinant human erythropoietin not only treat anemia but reduce postpartum (emotional) distress as well?

Based on the established rhEPO treatment of anemia in endstage renal failure, which results in improved quality of life, and on the clinical observation that patients with postpartum anemia treated with rhEPO seemed to gain a more stable mood, we inferred that there is a beneficial side-effect of rhEPO on postpartum blues. The aim of this study was to test the hypotheses 1) that postpartum anemia aggravates, and 2) that treatment of postpartum anemia with rhEPO reduces maternity blues. The results show that on the fifth day postpartum anemic patients score consistently worse than nonanemic women on the Symptom Checklist SCL-90-R, indicating more symptoms and distress in general, and also more symptoms characteristic of maternity blues (p < 0.05). On a "Blues Questionnaire," postpartum anemia expresses itself with a reduced "well-being" (p < 0.001). Thus, our first hypothesis was verified. There were no differences by the fifth day postpartum between anemic patients receiving either rhEPO or placebo. Our second hypothesis was thus not confirmed within this limited time. We conclude as clinicians that postpartum anemia should be treated effectively to reduce distress and hence the risk for postpartum affective disorders. Follow-up studies after rhEPO treatment beyond the first week post partum are needed. In addition, in investigations on postpartum affective disorders, the hemoglobin concentration should be considered.

Anemia↗
PubMed1995

Pharmacokinetics of fenoterol in pregnant women.

The beta 2-sympathomimetic drug fenoterol (fenoterol hydrobromide, CAS 1944-12-3, Partusisten) is routinely used to inhibit uterine contractions (tocolysis). Investigations of plasma concentrations of those receiving i.v. or oral tocolysis often show different results, both within particular groups of pregnant women and in comparison with non-pregnant persons. The aim of this study was to determine the pharmacokinetics of fenoterol in pregnant women, an important factor which so far had not been known. Four healthy pregnant women with similar weight and gestational age and all with premature labor were administered a continuous intravenous infusion of 4 micrograms fenoterol/min. During and up to 24 hours after the end of the infusion, venous blood samples were taken in order to determine the fenoterol plasma concentrations by radioimmunoassay. From a steady state concentration (css) of 2242 +/- 391 pg/ml (x +/- S.E.), a non-linear two-phased plasma elimination was seen with half-lives t1/2 of 11.40 min and 4.87 h. The area under the plasma concentration-time curve (AUC0-12h) was 6.27 ng/ml x h. The total clearance (Cltot) was 114.8 l/h. These data are nearly the same as the data already known for healthy non-pregnant (male) volunteers. The deviations which are seen in the plasma concentrations in pregnant women in comparison to non-pregnant persons during or after continuous i.v. infusion can therefore not be caused by differences in the pharmacokinetics. Other factors, however, such as body weight and/or gestational age, might influence the results.

Adult↗