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Biomedical subjects

U Göhring

Publications and source records attributed to U Göhring.

At least 19 recordsLinked to original sources
PubMed2001

[Risk of uterine rupture after cesarean section--analysis of 1,086 births].

OBJECTIVE: In the presented paper, obstetrical management after previous caesarian section was studied in a large patient collective at the University Department of Gynaecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of rupture of the uterus. PATIENTS: From a total of 15,166 deliveries, 1,086 of the births had been preceded by one or more caesarian section. These 1,086 births formed the patient collective for the present study. RESULTS: Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. If there had been a previous caesarian section, the percentage shifted in favour of vaginal delivery. All patients with more than two previous caesarian sections were delivered by a primary caesarian section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for primary (11.5%) or secondary resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. CONCLUSION: This retrospective study confirms the general recommendation of vaginal delivery following previous caesarian section as long as risks are minimized by a readiness to proceed with resectioning when signs of imminent rupture of the uterus arise.

Adult↗
PubMed2001

The risk of rupture of the uterus: an analysis of 1086 births after previous caesarean section.

In the work presented here, obstetric management after a previous caesarean section was studied in a large patient group at the University Department of Gynecology and Obstetrics in Cologne from 1979 to 1995. Particular attention was given to the feared complication of uterine rupture. From a total of 15 166 deliveries, 1086 of the births had been preceded by one or more caesarean sections. These 1086 births formed the basis for the present study. Vaginal delivery was attempted in 44.5% of patients and was successful in 86% of those cases. Where there had been only one previous caesarean section, the percentage shifted in favor of vaginal delivery. All patients with more than two previous caesarean sections were delivered by elective caesarean section. The feared complication of rupture of the uterus occurred in four cases, for which case reports are presented. In view of such cases, signs of imminent uterus rupture often constitute an indication for elective (11.5%) or emergency resectioning (31.9%). No relationship was found between fetal outcome and mode of delivery. This retrospective study confirms the general recommendation and safety of vaginal delivery after a previous caesarean section as long as risks are minimised by a readiness to proceed with a repeat caesarean when signs of imminent rupture of the uterus arise.

Journal Article↗
PubMed1999

[Locked dorsal shoulder dislocation and contralateral ventral shoulder dislocation fracture. A rare combination].

The posterior luxation of the shoulder joint is a rarely reported and often not recognized lesion in the clinical workday. The authors present the first case of a posterior luxation of the shoulder joint in combination with an contralateral anterior shoulder joint fracture dislocation. In that case the authors stress the importance of an exact clinical and radiology diagnostic and the right way to reduce a posterior luxation of the shoulder joint. Finally they draw the readers attention to operative steps to prevent a reluxation of the shoulder joint.

Adult↗
PubMed1998

[Gliding nail osteosynthesis. A new universally applicable implant for management of per- and subtrochanteric femoral fractures].

Age, high physiological load and the great number and different fracture types of the proximal femur are the main challenges for implants used in the management of these fractures. For use in these types of fracture with immediate restoration of full weight-bearing capacity and for reduction of the intra- and postoperative complication rate, the gliding nail was developed. The development is based on a large number of experimental and clinical examinations of per- and subtrochanteric fractures. The advantages of an intramedullary implant and the gliding screw systems are combined with increased moment of resistance of the double-T femor-neck blade profile. We performed a prospective clinical evaluation of the first 186 patients with per- and subtrochanteric fractures who were treated between 15 September 1994 and 29 February 1996 in the Aschaffenburg Trauma Department with a follow-up examination at least 3 months after the operation. The intraoperative complication rate was 1.1%. The postoperative complication rate was 4.9%. Change of the blade because of fracture impaction and tractus iliotibialis problems was the most frequent problem with 2.2%. The most severe complication (1.1%) were caused by subchondral placement of the blade in the cranial one-third of the femur head. In these cases reosteosynthesis was indicated. Ninety-three percent of the survivors were able to return home. The rate of bed-ridden patients (7.7% and 11.7%) was not very different before or after the operation. However, many patients do not reach the condition they had before the fracture and they are one step worse in mobility and social independence.

Activities of Daily Living↗
PubMed1998

[3-dimensional ultrasound in clinical diagnosis of meniscus lesions].

AIM: To compare the significance of the two-dimensional and three-dimensional sonography in the diagnosis of meniscal tears under clinical conditions. METHODS: Sixty menisci of knees with clinical symptoms (44 medial and 16 lateral menisci) were examined by an identical transducer in a two- and three-dimensional sonography technique. The findings were compared with the diagnosis made with subsequent arthroscopy. RESULTS: In the diagnosis of meniscal lesions the two- and three-dimensional sonography reached a sensitivity of 92% and 100% and a specificity of 83% and 88%, respectively. The positive predictive value of these methods was 58% and 67%. The negative predictive value was 98% and 100%. Because of the good results with the two-dimensional sonography, there were no statistically significant differences between both methods. The three-dimensional sonography, however, proved to be superior, to the two-dimensional sonography in the analysis of subgroups (medial and lateral menisci, menisci with and without clinical symptoms). The negative predictive value of the three-dimensional sonography was 100% for all of these subgroups. CONCLUSION: Although this study shows no significant difference in the results of two- and three-dimensional sonography, the analysis of subgroups displays a slightly improved significance for diagnosis of meniscal tears by three-dimensional sonography. The high negative predictive value shows that three-dimensional sonography, performed by an experienced examiner, may be useful to exclude meniscal tears. This result may help focus further cost-intensive or invasive examinations.

Adolescent↗
PubMed1997

[3-dimensional sonography in the diagnosis of meniscal lesions. An experimental and clinical study].

There is no consensus regarding the clinical significance of conventional two-dimensional ultrasound in the diagnosis of meniscal tears of the knee. Three-dimensional ultrasound spatially reconstructs a transparent image of subsequent ultrasound scans. In an experimental study of 96 menisci, radial and oblique tears were detected more often by three-dimensional ultrasound. In a clinical study of 60 menisci the two- and three-dimensional ultrasound reached a sensitivity of 92% and 100%, a specificity of 83% and 88%, a positive predictive value of 58% and 67%, and a negative predictive value of 98% and 100%, respectively. Altogether, there was no statistically significant difference between both methods. The high negative predictive value, however, shows that the three-dimensional ultrasound may be a clinically relevant examination for special questions in the diagnostics of meniscal tears.

Adolescent↗
PubMed1996

[Experimental study of meniscus lesions. Significance of 3-dimensional ultrasonography].

AIM: The clinical value of two-dimensional ultrasound in examining the menisci of the knee compared to other methods is controversial. We studied the utility diagnosed by three-dimensional sonography in evaluating meniscal tears. METHOD: 96 menisci with standardised artificial lesions were examined in a bath of Ringer solution. Two-dimensional ultrasound was compared to three-dimensional ultrasound, which creates three-dimensional reconstruction of sequential ultrasonographic images. RESULTS: The three-dimensional ultrasound had a higher sensitivity of 88% vs 69% with a specificity of 83% vs 94% for the diagnosis of meniscal tears compared with the two-dimensional method. The sensitivity in imaging was 54% in each case for longitudinal tears, 63% vs 96% for horizontal tears, 67% vs 37% for oblique tears and 54% vs 0% for radial tears. The difference of these results, however, was not statistically significant. Radial tears were more frequently diagnosed by three-dimensional sonography. CONCLUSION: In our model, sonographic diagnosis of meniscal tears was improved only partially by using three-dimensional ultrasound. Whether in vivo other factors alter the minimal differences between the two techniques is the subject of ongoing investigation.

Humans↗
PubMed1995

Expression of intercellular adhesion molecule-1 is regulated by the actin network in epidermoid carcinoma cells.

Expression of the cell surface protein intercellular adhesion molecule-1 (ICAM-1) is a prerequisite for the interaction of a large variety of cells with leukocytes. Constitutive expression of ICAM-1 in human epidermoid carcinoma cells is low, but is inducible through inflammatory cytokines including interferon gamma (INF gamma). Disruption of the actin cytoskeleton with dehydrocytochalasin B (CB) increased constitutive and potentiated INF gamma-induced ICAM-1 cell surface expression, but did not alter formation of soluble ICAM-1. Actinomycin D inhibited CB-induced ICAM-1 surface expression and CB increased the steady-state levels of ICAM-1 transcripts. However, CB did not alter the glyceralaldehyde-3-phosphate dehydrogenase mRNA levels and the ICAM-1 mRNA half-life. These studies indicate that in human epidermoid carcinoma cells the actin cytoskeleton regulates ICAM-1 transcription and cell surface expression.

Actins↗
PubMed1994

[The pre-positioned intracutaneous suture--a method for treatment of soft tissue defects after fascia splitting in acute compartment syndrome].

In the treatment of the acute compartment syndrome open fasciotomy gives rise to a wide soft tissue opening. The persistence of this opening prevents a timely change to internal osteosynthesis in case of additional fractures usually treated by a fixateur externe. Closure of the skin defect itself requires additional surgery. The cosmetical results particular in cases of a mesh-grafting are unsatisfactory. After open fasciotomy the prepositioned intracutaneous suture is a simple operation technique leading to early wound closure with a good cosmetical result.

Adolescent↗
PubMed1994

[Bilateral Hoffa fracture--a rarity].

The isolated, tangential fracture of the dorsal part of the femoral condylus was first described by Friedrich Busch (1844-1916), a surgeon from Berlin in 1869, and not as always supposed by Albert Hoffa (1859-1907) in 1904. This is a case report describing a bilateral type B3-fracture of the distal femur (AO-fracture-classification) in a 58 year old man. Diagnostic, surgical procedure and outcome are described and discussed.

Femoral Fractures↗
PubMed1993

[Results of treatment after different surgical procedures for management of acromioclavicular joint dislocation].

Sixty-four patients underwent surgery for acromioclavicular (AC) disruption, Tossy type III, at the Department of Surgery, University of Heidelberg, between January 1983 and May 1990. Surgery consisted of a suture of the AC and coracoclavicular ligaments. Fixation of the joint was achieved with three different techniques: tension band wire with two Kirschner wires, special hook-plate (Wolter), double tension band fixation using polydioxanon (PDS) cordula. The early postoperative complication rate was higher following tension band wires (42.9%) and hook plate (58.3%) than after tension band PDS cordula (16.7%). The patients were re-examined after an average of 35.3 months. An instability of the AC joint was found in 31.8% of patients with tension band wire, 50.0% of patients with Wolter plate, and 23.8% of patients with tension band PDS cordula. The comparison of these results with those after conservative treatment, as reported in the literature, emphasizes the need for limiting surgery to young adults and athletes. The long term results of AC joint fixation are better using PDS cordula than tension band wire or hook plate. PDS cordula has the additional advantages, that dislocation and fracture of metal implants do not occur, and metal removal is avoided. Therefore, tension PDS cordula is associated with a marked reduction of the overall hospitalization period. Further improvements of results of AC joint fixation can be expected using the described technique of double tension band PDS cordula.

Acromioclavicular Joint↗
PubMed1993

[Isolated Ledderhose fibromatosis plantaris].

Plantar fibromatosis or Ledderhose syndrome has rarely been discussed in the medical literature. This clinical entity includes nodular Dupuytren-like indurations of the plantar aponeurosis. We present a case of a young man with isolated disease of his right foot and describe the clinical and pathomorphological features of this disease as well as its characteristic findings at magnetic resonance tomography. The therapy of choice is a subtotal resection of the plantar aponeurosis to prevent irreversible contractions of the toes. The prognosis following fascietomy is good.

Adult↗
PubMed1992

Bilateral elastofibroma dorsi.

Elastofibroma dorsi was diagnosed in a 76-year-old woman with bilateral subscapular tumor masses and a 3-year history of recurrent, right-sided scapular pain. A bilateral tumor extirpation was performed and the patient left the hospital free of symptoms 10 days later. We suggest that both constant trauma with resulting excessive elastin production and collagen degeneration might play a major role in the pathogenesis of this rare proliferative lesion.

Aged↗
PubMed1991

Antigen CA 19-9: presence in mucosa of nondiseased müllerian duct derivatives and marker for differentiation in their carcinomas.

CA 19-9, a side branch of the Lewis blood group system, is a sialylated Lewis A antigen that is highly expressed by many adenocarcinomas of the digestive tract. The müllerian duct-derived mucosa of the uterus and fallopian tubes also synthesizes Lewis blood group antigens. To test whether the expression of CA 19-9 is enhanced in carcinomas of müllerian duct origin, we performed immunohistochemical staining for CA 19-9 in normal tissues from 33 women and in adenocarcinomas from 88 patients. In the normal uterine cervix, CA 19-9 was expressed in the cytoplasm of scattered glandular cells in 26 of 29 specimens. It was observed in the apical regions of mucosal cells in six of 26 normal endometrial samples and two of 13 normal fallopian tube specimens. These results are consistent with the presence of antigen CA 19-9 on a secretory product of the nondiseased mucosa of the müllerian duct. In adenocarcinomas of the endocervix, endometrium, and fallopian tubes, CA 19-9 was found in seven of 11, 57 of 71, and five of six samples, respectively. Progressive loss of differentiation was accompanied by disruption of subcellular localization of CA 19-9 and its secretion toward the glandular lumina. In well-differentiated regions of tumors, the antigen was detected mainly at the luminal surface of cancerous glands, whereas the staining was mostly cytoplasmic or vacuolar in less differentiated areas. The degree of CA 19-9 expression was inversely related to tumor differentiation (P less than .001).

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

[When should incidentalomas of the adrenal gland be surgically treated?].

Between January 1981 and December 1988 a total of 95 patients underwent surgery for adrenal tumors. In 24 cases (25.3%) a so-called "incidentaloma" was found. While seven of these tumors showed hormonal activity, in seventeen patients the tumor was hormonal inactive. The size of the tumors ranged between 2 and 11 cm. Histologically all tumors were found to be benign neoplasms. Because of the lack of lethality and minimal morbidity we indicate surgery on incidentaloma of the adrenal gland for the following reasons: tumors with hormone activity, tumor size larger than 3 cm, suspecting malignoma or metastasis and finally in proven enlargement of small tumors. Only in adrenal tumors smaller than 3 cm we suggest a follow-up by ultrasound or computed tomography.

Adenoma↗
PubMed1988

Two-site assay of intact parathyroid hormone in the investigation of primary hyperparathyroidism and other disorders of calcium metabolism compared with a midregion assay.

We compared the utility of measurements of serum intact human PTH-(1-84) and midregion human PTH-(44-68) in patients with disorders of extracellular calcium metabolism. Serum midregion PTH was determined by RIA, and serum intact PTH was measured by a sensitive and specific immunoradiometric two-site assay. The serum intact PTH concentrations in 70 patients with primary hyperparathyroidism were above the normal range in 69, and thus widely separated from the levels in 40 patients with hypercalcemia of malignancy, in whom serum intact PTH values were usually below normal. In contrast, both groups had overlapping serum midregion PTH values. In patients after renal transplantation and those with chronic renal failure, serum intact PTH levels were in the normal range twice as often as were serum midregion PTH values. The intact PTH assay was also superior in detecting venous gradients of the hormone and changes in PTH secretion caused by altered serum calcium concentrations, and serum intact PTH was remarkably low in hepatic venous effluent. We conclude that this new assay for serum intact PTH is superior to the midregion RIA in investigating parathyroid function in several different clinical conditions.

Adult↗
PubMed1988

[Ileostomy versus colostomy as temporary deviation stoma in relation to stoma closure].

Between January 1, 1982 and June 30, 1987 a total of 122 patients suffering colorectal cancer (n = 88) or diverticulitis of the colon (n = 24) underwent surgery for construction of a transient defunctioning stoma. Closure of the stomata was performed in 71 of the 79 ileostomies (89.9%) and in 36 of the 43 colostomies (83.7%). Regarding sex, age and primary surgical treatment both patient groups were very well comparable. However there were clear differences with regard to closure of the stomatas: Complications following closure occurred in 22.5% of the ileostomies but only in 5.6% of the colostomies. Also lethality was markedly increased following closure of the ileostomies (5.6%) as compared to closure of the colostomies (0%). These results show that ileostomy is a technically complicated procedure and the indication for a transient ileostomy therefore should be made carefully.

Colorectal Neoplasms↗