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Biomedical subjects

W Heyl

Publications and source records attributed to W Heyl.

At least 37 records · Page 2Linked to original sources
PubMed1997

The Cantrell-sequence: a result of maternal exposure to aminopropionitriles?

The characteristic features of the Cantrell-sequence--anterior thoraco-abdominal wall defect with ectopia cordis and diaphragm, sternum, pericardium, and heart defects--have been observed in animals following maternal administration of beta-aminopropionitrile, a toxic amino-acid derivative. We report on an unusual case of the Cantrell-sequence in a premature infant with associated dysmelia, aplasia of the right kidney, cerebellar hypoplasia and circumscribed aplasia of the cutis, which has not been reported previously. Maternal history suggested an occupational exposure to aminopropionitriles prior to pregnancy. Prenatal ultrasound, differential diagnosis, perinatal management, and the teratogenic role of aminopropionitriles in this rare genetic disorder are discussed.

Abnormalities, Multiple↗
PubMed1996

[Balloon dissection of the cavum retzii--an innovative preparatory technique for endoscopic, extraperitoneal Burch colposuspension-plasty].

Colposuspension is known as "Gold Standard" in incontinence surgery; however, a variety of different techniques exist for performing this measure. Minimal invasive surgery offers new treatment possibilities. Besides the intraperitoneal approach, there is also an extraperitoneal technique for the Burch procedure. We describe an innovative technique, namely, balloon dissection, which is well known in endoscopic hernioplasty for an atraumatic approach to the cavum retzii. This technique that was used in six patients with urinary stress incontinence has the following advantages: minimal blood loss, better visualisation of the operative field, and a shortened hospital stay and recovery period than with abdominal colposuspension.

Catheterization↗
PubMed1996

[Does lung maturation therapy with 16-methylene-prednisolone modify maternal infection parameters in threatened premature labor?].

UNLABELLED: Silent intrauterine infection is a frequent cause of preterm labour. Maternal C-reactive protein (CRP) and leukocyte count are important predictors of such infections. Treatment with corticosteroids is known to elevate leukocyte count and in this manner can possibly interfere with its accuracy as a predictor of infection. Therefore, we investigated the impact of antenatal administration of 16-methylene-prednisolone (Decortilen solubile) on the maternal serum level of CRP and leukocyte count. Furthermore, we determined the haptoglobin, the platelet count as well as the percentage of stab cells and lymphocytes. PATIENTS AND METHODS: 20 patients with preterm labour between 25 + 6 and 34 + 2 weeks of gestation were enrolled in a prospective study. Premature rupture of the membranes, uterine bleeding, infection and treatment with antibiotics were criteria for exclusion. Three doses (60 mg) of Decortilen solubile were given intravenously 24 h apart. Blood samples were obtained before, twice a day (8.00 a.m. and p.m.) during treatment and until the day 4 after termination of corticosteroid treatment. For statistical analysis the Wilcoxon rank sum test was used. RESULTS: Before corticosteroid treatment the medians (range) were: CRP: 5.2 ( < 5.0-28.0) mg/l, haptoglobin: 1.4 (0.7-2.0) g/l, leukocytes: 10.5 (5.2-16.0) G/l, platelets: 246 (128-424) G/l, stabs: 9.5 (3.0-14.0)% and lymphocytes: 28.5 (16.0-50.0)%. During the after termination of corticosteroid administration no significant changes in the CRP and haptoglobin levels were seen. The leukocyte count was unchanged during treatment and decreased on day 1-2 after termination of treatment. The platelet count remained unchanged during corticosteroid treatment and increased significantly thereafter. The stab cell percentage increased slightly from day 1-2 to day 3-4 after termination of treatment. The lymphocyte percentage increased during treatment and decreased significantly from day 1-2 to day 3-4 after treatment. CONCLUSION: Decortilen solubile treatment is not associated with an increase in maternal CRP-level and leukocyte count. We emphasise that the accuracy especially of the CRP for early prediction of silent infection in preterm labour does not seem to be impaired by this corticosteroid in a dosage usually administered for prevention of respiratory distress syndrome.

C-Reactive Protein↗
PubMed1996

[Prostaglandin-induced labor--is the prostaglandin E2 vaginal gel a "new" alternative?].

In Germany, intracervical application of 0.5 mg PGE2 gel and the 3 mg PGE2 vaginal tablet are registered for induction of labour. Both methods are highly effective; however, the are associated with several problems in practice. Major problems of the intracervical route are the strict application of the gel into the cervical canal, not spreading it to the vaginal and/or extra-amniotic space, the "technical" difficulties of application in cases of an unfavourable cervix in a posterior position and the risk of artificial rupture of the membranes. The problems with the PGE2 vaginal tablet are the incalculable release and absorption, the unpredictable clinical response and the unclear definition of CTG monitoring intervals. The application of the 2 mg PGE2 vaginal gel has proved an efficient and practicable method for induction of labour in both the unfavourable and the favourable cervix. The advantages over the intracervical procedure are in particular the practicability and safety of administration, even in "anatomically" difficult situations (e.g., narrow cervical canal); the advantages over the PGE2 vaginal tablet are greater bioavailability with a quicker release and absorption, the more predictable clinical response and the closer correlation with the subsequent changes in cervical scores. Since well-defined comparative studies are lacking, no definite conclusions can so far be drawn regarding the method of choice for induction of labour. Recently, a prospective, randomised multi-centre study has gone under way to clarify this question.

Administration, Intravaginal↗
PubMed1996

[HELLP syndrome in the 21st week of pregnancy in mosaic trisomy 9].

We report for the first time the case of postabortional HELLP-syndrome in the 21st week of gestation. In this case mosaic trisomy 9 was confirmed by amniocentesis prior to induction. Pertinent history, clinical course and pathoanatomical morphology are described. We emphasize the early onset of the HELLP-syndrome in association with trisomy 9 after abortion. The possibility of interconnections between trisomy 9 and the occurrence of HELLP-syndrome (sparse blood, vessels in the villi, circulatory deficit on the fetal side of the placenta, increased production of e.g. vasopressive substances) is discussed.

Abortion, Eugenic↗
PubMed1995

[Subpartal diagnosis of umbilical cord encirclement using color-coded Doppler ultrasonography and correlation with cardiotocographic changes during labor].

Umbilical cord complications are the most common cause of pathologic fetal heart tones during delivery. The inauguration of colour-coded Doppler ultrasound in obstetrics has made the definite diagnosis of umbilical cord encirclement during delivery possible. The prospective study introduced here examines the question of how exactly an encirclement can be seen by Doppler during delivery, its influence on cardiotocographic results, delivery mode, and fetal outcome. 107 patients in labour with cervical dilatation were examined in a prospective study using colour-coded Doppler ultrasound to determine cases of umbilical cord encirclement. In 50 cases, encirclement could be visualised, 48 of which were confirmed post partum. Encirclement could be ruled out in 57 other cases. A sensitivity of 96% and specificity of 100% resulted. No significant differences could be found with regard to mode of delivery and fetal outcome. However, the umbilical cord in cases of encirclement was significantly longer than when no encirclement occurred. Assessment of fetal heart tones demonstrated a significantly higher rate of variable decelerations in the patient group with umbilical cord encirclement compared to that without. In conclusion, our results show that the early diagnosis of umbilical cord encirclement during delivery allows appropriate assessment of fetal heart tone changes,justifying temporising management under continuous monitoring with possible micro-blood analysis.

Asphyxia Neonatorum↗
PubMed1995

[Determination of postpartum fructosamine for assessment of gestational diabetes--a suitable method?].

Postpartal screening of undetected gestational diabetes has proven to be difficult. Rapid decrease in diabetogenic hormones and normalisation of the former delayed insulin-response make it difficult to detect disturbed glucose tolerance in the puerperium. Therefore, glycolysated serum proteins offer the opportunity for retrospective diagnosis. They allow an evaluation of the patient's carbohydrate metabolism, retrospectively over several weeks. In this context, we were most interested in the significance of fructosamine. In a prospective study covering 12 months, 123 patients with several risk factors for gestational diabetes underwent a 100 g glucose tolerance test in the puerperium. Furthermore, we measured fructosamine and glycolysated hemoglobin. A carbohydrate intolerance could be detected by the oral glucose tolerance test in 22.7%. In 12.2% of the cases, glycolysated hemoglobin was found to be higher than 5.5%. Fructosamine levels were normal for all patients, with a mean value of 1.84 mmol/l. Even though fructosamine concentration was significantly higher (p < 0.05) in patients with a pathologic glucose tolerance, our study showed the oral glucose tolerance test to be better to detect unknown gestational diabetes than measurement of serum fructosamine.

Adult↗
PubMed1993

HELLP-syndrome. Difficulties in diagnosis and therapy of a severe form of preeclampsia.

As in cases of HELLP-Syndrome both the mother and the fetus are at greater risk we analyzed retrospectively the clinical records of 14 patients concerning changes of typical laboratory parameters, clinical course including time of correct diagnosis, as well as fetal and maternal complications. The death of one woman represents a maternal mortality rate of 7.1% whereas perinatal mortality ranged 20% due to 3 intrauterine fetal losses. In our study group the mean time interval from onset of clinical symptoms like pain, vomiting etc. until admission to our department was 8.2 days (median: 4 days). Incorrect interpretation of abdominal pain as the leading symptom, the absence of signs of toxemia and missing or only moderate changes of the typical laboratory parameters cause this delay in correct diagnosis, which presumably has the major negative impact on the unfavorable obstetrical data in cases of HELLP-Syndrome.

Adult↗
PubMedDate not supplied

The distribution of macrophages in spiral arteries of the placental bed in pre-eclampsia differs from that in healthy patients.

Placental bed biopsies taken during caesarean section from 10 patients with pre-eclampsia and six healthy pregnancies were studied. We applied antibodies against cytokeratin and different macrophage markers to analyse the distribution of invasive extravillous trophoblast cells as compared to that of macrophages in myometrial segments of uteroplacental arteries. The data were evaluated quantitatively. We found a clear inverse relationship between local infiltration with macrophages and trophoblast invasion. In pre-eclampsia, vessel cross-sections prevailed which were characterized by large numbers of macrophages but a low degree of trophoblast invasion. In contrast, in normal third trimester pregnancies the respective arterial segments had a high degree of trophoblast invasion but were largely void of macrophages. These data suggest causal links between macrophages and inhibition of intra-arterial trophoblast invasion in pre-eclampsia.

Adult↗
PubMedDate not supplied

[Significance of detecting impaired uteroplacental perfusion for diagnosis of antiphospholipid antibody syndrome--a case report].

INTRODUCTION: The antiphospholipid antibody syndrome (APA) is a potentially life-threatening disease in pregnancy, associated with spontaneous abortion, intrauterine growth retardation (IUGR), preeclampsia and foetal death in utero. One of the sequelae of the antiphospholipid-antibodies is an impaired uteroplacental circulation. We present a case where we diagnosed an antiphospholipid antibody syndrome (APA) on the basis of a highly pathological Doppler flow in both uterine arteries. CASE REPORT: A 35-year-old G2P0 with a history of intrauterine foetal death in the 24th week was seen at 15 weeks in her second pregnancy for an ultrasound scan. The Doppler study of both uterine arteries showed highly pathological resistance indices and bilateral notching. Laboratory studies revealed elevated levels of antibodies against Cardiolipin and phospholipids. Therapy trials with low-dose aspirin, heparin, corticosteroids, hemodilution therapy and immunoglobulin remained unsuccessful. The foetus developed severe IUGR, anhydramnios and foetal distress. In the 26th week the parents insisted on a caesarean section because of a pathological heart rate pattern. The birth weight was 365 grams and the infant died immediately. DISCUSSION: There are several mechanisms which impair the uteroplacental circulation in an APA syndrome. Therefore it is essential to perform laboratory tests when detecting a pathological blood flow in both uterine arteries. In this case all therapies failed, and the preterm infant died due to severe IUGR and distress. The diagnosis, however, facilitated the introduction of early anticoagulation therapy for the mother, the exclusion of systemic lupus erythematodes and the counselling of the parents with regard to further pregnancies.

Antiphospholipid Syndrome↗
PubMedDate not supplied

Immunohistochemical analysis of prostate-specific antigen does not correlate to other prognostic factors in breast cancer.

BACKGROUND: Prostate-specific antigen (PSA) is found in 30-40% of female breast tumors, as recently described. Diamandis and co-workers could demonstrate that PSA correlate significantly to a relapse-free survival and lower tumor stages in patients with breast cancer using a time-resolved immunofluorometric analysis. The presence of PSA in these tumors seems to reflect a favourable prognostic marker for that disease. The aim of our study was to evaluate the role of PSA as a prognostic factor in breast cancer using an immunohistochemical technique. MATERIALS AND METHODS: The PSA immunoreactivity of tissues from one-hundred women with malignant breast tumors was correlated to tumor staging, histomorphological tumor type, and biochemical estrogen and progesterone receptor content. Additionally, survival analysis was performed according to Kaplan and Meier. RESULTS: 49% of the tumors revealed positive staining for PSA. No significant correlation between PSA and the other parameters, or the mean survival time (PSA pos.: 5.3 years, PSA neg.: 5.4 years) could be demonstrated. CONCLUSIONS: As there were no significant correlations between PSA and other prognostic markers, PSA detected by immunohistochemistry seems not to be helpful in prognostic evaluation of breast cancer.

Biomarkers, Tumor↗
PubMedDate not supplied

[Monitoring the pregnant diabetic patient].

Despite improved surveillance of pregnant diabetic women perinatal mortality and morbidity remains higher than in the general population. Low detection rates of patients with gestational diabetes represent one of the main reasons as screening programs based upon the presence of risk factors only comprise 30% of all women with gestational diabetes. Concerning maternal risks in patients with insulin-dependent diabetes mellitus the incidence of pregnancy induced hypertension is increased up to 12-28%. Macrosomia (6-32%) and malformations (1.5-6%) are the most frequent fetal complications and depend on the quality of controlling the blood glucose level. However, the decrease of fetal and maternal risks requires a general screening program for gestational diabetes as well as an intensive surveillance of the mother and the fetus by an obstetrician and internal specialist, respectively. Delivery of pregnant diabetic women should preferable be performed in specialized hospital units.

Combined Modality Therapy↗
PubMedDate not supplied

[The course of pregnancy and fetal outcome in diabetic patients with anamnestic fetal death].

Of 116 pregnant patients with diabetes mellitus type 1 or gestational diabetes, 12 (10.3%) had previously suffered stillbirth, while in four (3.4%) cases spontaneous abortion after the 6th month had occurred. In these 16 cases, we examined the mean daily blood glucose concentration, glycosylated hemoglobin (HbA1c), fructosamine as well as glucose and albumin elimination via urine. These control data on carbohydrate metabolism were correlated with the intensity of gestational monitoring in relation to course of pregnancy and neonatal morbidity and/or mortality. In addition, we retrospectively analyzed the cause of prior intrauterine death. In six of eight cases evaluable, we could hereby demonstrate disturbed carbohydrate metabolism. Pregnant women with diabetes mellitus type 1 were hospitalized twice as often (on average four times) as patients with gestational diabetes (2.1 admissions on average). While five of seven type 1 diabetics were primarily admitted prior to the 20th week of gestation, the majority of gestational diabetics (7/9) were first examined by qualified medical personnel trained in the care of gestational diabetes after the 28th week of gestation. Two of nine were first diagnosed post partum. 13 of 14 patients with prepartally known diabetes demonstrated mean blood glucose values under 110 mg/dl. While one of the two patients with postpartally diagnosed diabetes suffered stillbirth once again, the other had to be delivered by emergency C-section because of fetal distress (pH art. 7.08). Our results show that adequate monitoring of carbohydrate metabolism and proper care of diabetic pregnant women can lower obstetrical/neonatal risks to more acceptable levels, especially in those patients who have had stillbirth in their prior medical history.

Blood Glucose↗
PubMedDate not supplied

[Intrapartum therapy-resistant fetal bradycardia--color Doppler sonographic diagnosis of umbilical cord compression due to fetal grasping].

Fetal heart rate pathology is seen in up to 40% of complications of the umbilical cord. We report a case in which long lasting bradycardia was associated with fetal grasping of the umbilical cord. Using colour doppler, the reason for the bradycardia could be detected. After vibro-acoustic stimulation the fetus released the grasp of the umbilical cord, following by a normalisation of the fetal heart rate and a spontaneous delivery two hours later. This case report underlines the importance of colour doppler for the diagnosis of fetal heart rate pathology.

Adult↗
PubMedDate not supplied

[Diabetic nephropathy and pregnancy].

With a percentage of 20% diabetic nephropathy represents one of the most common causes of end-stage renal failure. During pregnancy it is associated with an increased perinatal morbidity as a striking result of the consistently high rate of 50% preterm deliveries mainly due to the frequent development of pre-eclampsia ranging between 35-55%. Perinatal mortality (0-11%) seems to be less increased in recent years. Simple and reliable screening methods by means of test-strips are available in order to detect microalbuminuria, which characterizes incipient diabetic nephropathy (stage III). Strict maternal metabolic control achieving normoglycemic blood glucose levels represents the basic of treatment. Furthermore, an adequate diet and control of blood pressure are fundamental issues of sufficient therapy. Currently, there are no data available to assess definitely the influence of pregnancy on the clinical course of diabetic nephropathy.

Diabetic Nephropathies↗
PubMedDate not supplied

Evaluation of the success of hemodilution therapy for fetal growth retardation by Doppler sonography.

The aim of our study was to evaluate the success of a hemodilution therapy in patients with intrauterine growth retardation (IUGR) using Doppler sonography. Therefore, 22 patients with IUGR were subjected to hemodilution therapy using infusions of 500 ml hydroxyethylstarch in combination with 500 ml Ringer solution on 14 successive days. The 22 patients were divided into two groups on the basis of the actual birth weight, whereas 13 patients gave birth to an eutrophic infant (AGA group) while 9 infants remained dystrophic (SGA group). The following parameters were determined: hematocrit, prolongation of gestation, pulsatility and resistance index of the umbilical artery, the fetal aorta, the uterine arteries and the middle cerebral artery as well as the fetal outcome. Although the hematocrit decreases in both groups were almost identical, the Doppler sonographic examinations in the AGA group revealed in all cases more favorable improvements in perfusion under therapy in comparison with the SGA group. Considering the fetal aorta we could determine a worsening of perfusion in the SGA group. In the course of our investigations we have found that hemodilution therapy with hydroxyethylstarch represents a promising approach to counteract retarded fetal growth. Doppler sonography progress monitoring appears to be highly suitable for evaluating the response to therapy, especially since it can be assumed that the absence of an improvement in flow indicates only a slight advantage for the child.

Adult↗