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Biomedical subjects

W Kuhn

Publications and source records attributed to W Kuhn.

At least 163 records · Page 9Linked to original sources
PubMed1995

Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio.

In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.

Ascitic Fluid↗
PubMed1995

Prognostic value of transvaginal sonography in asymptomatic endometrial cancers.

In the period between 1985 and 1991, 83 postmenopausal women with endometrial cancer were examined by transvaginal sonography. None of them were on hormone replacement therapy and all had amenorrhea of more than 2 years. Twenty-two were asymptomatic and had an endometrial cancer detected by transvaginal sonography and 61 showed atypical bleeding as their only clinical symptom. Women with asymptomatic endometrial cancers detected by transvaginal sonography exhibited significantly less mean myometrial tumor infiltration and more well-differentiated tumors than those with atypical bleeding (4 mm and 45% compared with 10 mm and 18%, respectively). In 75% of the cases the estimation by transvaginal sonography of tumor stage completely agreed with the histological staging. These preliminary data show that asymptomatic endometrial cancers screened by transvaginal sonography are likely to have a better prognosis than symptomatic cancers. Furthermore, transvaginal sonography can be used as a reliable tool for tumor staging prior to surgery or radiotherapy.

Aged↗
PubMed1995

[Laparoscopic preliminary surgery of ovarian malignancies. Experiences from 127 German gynecologic clinics].

A controversial discussion has arisen between endoscopists and oncologists about laparoscopic management of ovarian cancer and borderline tumours. A questionnaire was mailed to 273 German Departments of Gyn./Obst. A response rate of 46% (127 hospitals) was obtained concerning the endoscopical technique used, the kind and delay of post-endoscopical cancer operation and the early findings (follow-up) in cases of ovarian cancer, dysgerminoma, malignant teratoma, tubal cancer and borderline tumours of the ovary. In this German survey it could be shown that laparoscopic management of malignant ovarian tumours was not uncommon between 1991-1994. Totally, 61% of ovarian cancer stage Ia and 84% of ovarian borderline tumours stage Ia have been reported without any pathological finding in laparotomy subsequent to laparoscopic management of the lesions. The 192 cases cited here are undoubtedly an underestimate of the real present frequency of endoscopically managed ovarian malignancies. Patients with this early "negative" report should be followed up carefully and may not permit conclusions that laparoscopic management of ovarian malignancies may be harmless for them. In 16% of the stage Ia borderline tumours and in 39% of the stage Ia ovarian cancer early spread has been found totally, demonstrating that implantations and metastases subsequent to the endoscopical procedure can be found even in an early follow-up phase. In 92.4% laparoscopic capsule rupture, tumour morcellement with intraabdominal spilling, subsequent cystectomy or adnectomy had been the technique of choice with additional rinsing of the intraabdominal cavity. This was harmful for the majority of patients if the subsequent cancer surgery by laparotomy was delayed for more than 8 days. Early progression of these cases to stage I c has been reported in 20% (7/36 cases) and to stage II-III in 53% (19/36 cases). Only in 7.4% the endobag procedure was used in laparoscopic management of ovarian cancer stage Ia. In ovarian cancer stage Ic-III (n = 50) an early seeding in the laparoscopic tract was reported in 52% (13/25) if subsequent cancer surgery by laparotomy was delayed more than 8 days. The endoscopical techniques and the early findings after an endoscopical management are reported in detail. In conclusion, in respect of common oncological standards the actual practice in laparoscopic management of ovarian malignancy is considered poor surgery. Capsule rupture, tumour morcellement and unprotected "biopsy" in the intraabdominal cavity and an additional delay of adequate cancer surgery are the main pitfalls of that procedure. For the overwhelming majority of patients undergoing such endoscopical procedures very early implants and metastases in the pelvis, the abdominal cavity or the laparoscopic tract have been found. It seems necessary that laparoscopic management of ovarian malignancies and borderline tumours under the present technical conditions are given up and that we should return to reliable standards of oncological surgery comparable to laparotomy. This should be discussed urgently.

Biopsy↗
PubMed1995

[Successful therapy of heparin-associated thrombocytopenia with a low sulfated heparinoid].

Heparin-associated thrombocytopenia (HAT) is a relative frequent complication of thromboembolic prophylaxis and therapy. There is good evidence that the more severe HAT Type II is caused by an antibody dependent on polysulfated oligosaccharide epitopes. At present, low molecular weight heparins are used with varying success in patients with HAT that require further anticoagulation, although there are several known cases of cross reactivity between standard and low molecular weight heparins. Using our present case as an example, we show that the In-vitro- diagnostic of cross-reactivity is an indispensable precondition for any sufficient therapy. Additionally, we give support to previous findings that the low-grade sulfated heparinoid Org 10,172 shows no (or less) cross reactivity with standard or low molecular weight heparins. Thus, it might be the most appropriate choice if an anticoagulation is necessary before the results of In-vitro-diagnostics are available.

Adult↗
PubMed1995

[Septic ovarian vein thrombosis. Conservative management with CT-controlled follow-up].

Puerperal ovarian vein thrombophlebitis (POVT) is a rare complication during the puerperal period. A late diagnosis can lead to a high rate of morbidity and even mortality. By CT the POVT can be diagnosed early. This enables initiation of an adequate therapy with broad-spectrum antibiotics and i.v. anticoagulation well in time. In this way the disease can often be managed conservatively. CT controls can confirm the effectiveness of the therapy and are helpful in determining the duration of the i.v. anticoagulation.

Adult↗
PubMed1995

Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome.

Pregnancies complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) have been associated with both a poor maternal and a poor neonatal outcome in several publications. Because many studies were small and gave only scant information regarding the infants, we analyzed the clinical course of 89 neonates born to mothers with the HELLP syndrome. Ninety-eight percent of the neonates were born by cesarean section. Infants with a maternal HELLP syndrome were often small for gestational age (39%). The incidence of perinatal asphyxia was found to be 5.6%. Additionally, the affected very low birthweight (VLBW) infants had relatively high incidences of leukopenia (21%), neutropenia (33%), and thrombocytopenia (33%). Initially, 54% of the LBW infants were found to have normoblasts and 25% erythrocytosis. The incidence of these changes in blood cell count increased with decreasing birthweight. Nosocomial infections occurred more often in infants with a reduced neutrophil count. The overall mortality rate was 56 per 1000. Comparing the statistics of the VLBW infants with a maternal HELLP syndrome (n = 32) to all infants with a birthweight less than 1500 g (n = 521) during the investigational period, we found a similar mortality rate (9.3% and 8.4%, respectively). The pulmonary morbidity was also similar. The incidence of intracranial hemorrhage in VLBW infants with a maternal HELLP syndrome was lower (12.5% versus 18.2%) and of necrotizing enterocolitis was higher (6.2% versus 1.9%).

Birth Weight↗
PubMed1995

Color vision in Parkinson's disease: missing influence of amantadine sulphate.

In recent studies, disorders of chromatic and achromatic vision in parkinsonian patients have been demonstrated; these could be partially restored after application of L-Dopa. In this study, the effect of a 3-day infusion therapy with amantadine sulphate on color vision was evaluated in 19 parkinsonian patients by use of the Farnsworth-Munsell 100-Hue test. Under this treatment, the motor symptoms of parkinsonism improved significantly as assessed by the part "motor examination" of the Unified Parkinson's Disease Rating Scale (UPDRS). However, the total error scores of the Farnsworth-Munsell 100-Hue test before and after amantadine sulphate infusions were unchanged [before therapy, 94.53 (SD = 52.09); after therapy, 99.5 (SD = 58.81)]. From these results, it can be concluded that the pathophysiology of dopaminergic pathways in the visual system differs from that of the basal ganglia.

Aged↗
PubMed1995

EGF-R and overexpression of the oncogene c-erbB-2 in ovarian cancer: immunohistochemical findings and prognostic value.

PURPOSE: The purpose of this study was to investigate the prognostic value of EGF-R (c-erbB-1) compared to the overexpression of the c-erbB-2 oncogene product p185 in ovarian cancer. PATIENTS AND METHODS: The study was conducted on 266 previously untreated ovarian cancer patients with FIGO stage I-IV disease. EGF-R and c-erbB-2 oncogene product p185 have been evaluated using immunohistochemistry. Survival times were analyzed according to the method described by Kaplan and Meier. For the simultaneous evaluation of the prognostic relevance of the analyzed factors, a Cox proportional hazards regression was performed. RESULTS: EGF-R was detected in 13%, and c-erbB-2 oncogene product p185 in 18% of primary tumors. EGF-R showed no significant impact on the survival time, whereas c-erbB-2 oncogene product p185 positive patients had a significantly worse prognosis compared to p185 negative cases (p = 0.002). In the multivariate analysis, c-erbB-2 oncogene product p185, like tumor stage, histological grade and age, was found to be a significant prognostic factor. CONCLUSION: These data confirm the prognostic importance of the c-erbB-2; oncogene product p185 in ovarian cancer at the time of primary surgery, while EGF-R does not seem to have prognostic relevance.

ErbB Receptors↗
PubMed1995

Biochemical events in cervical ripening dilatation during pregnancy and parturition.

In specimens taken from the posterior lip of the cervix uteri we determined the collagenase activity and the glycosaminoglycan concentration. In biopsies obtained from the lower uterine segment during cesarian section we measured cytokines (IL-8, IL-2, TNF alpha) and matrix metalloproteinases (MMP-8, MMP-9). We found that the release of collagenases is critically involved in the process of cervical dilatation. The glycosaminoglycan concentration increases during pregnancy and shows remarkable changes of the distribution patterns of the different glycosaminoglycans. The parturition is characterized by a dramatic loss of most of the glycosaminoglycans. Furthermore, the IL-8 shows a close correlation to the clinical feature of cervical ripening and is closely associated with the release of MMP-8 and MMP-9. Summarizing the process of cervical maturation and dilatation is a complex enzymatic controlled process with substantial remodelling of the cervical extracellular matrix. The cytokines IL-8 seems to play an essential role in triggering the process of cervical dilatation.

Biopsy↗
PubMed1995

Palinopsia as sensory epileptic phenomenon.

Visual perseveration (VP) is defined as persistence or recurrence of visual images, when the stimulus is no longer present. We report three patients with occipital cortical lesions in the right hemisphere and VP. Electroencephalography showed epileptic abnormalities in all cases. In one patient synchronous electroencephalic recordings during the onset of palinopsia-a subtype of VP-revealed, that VP was associated with a clear cut right occipital seizure with a secondary diffusion of the discharge over both hemispheres, which has not been reported in combination with the onset of palinopsia heretofore. In all three patients sensory seizures have to be considered as probable cause of VP.

Adult↗
PubMed1995

Plasma levels of the beta-carbolines harman and norharman in Parkinson's disease.

Several lines of evidence suggest that endogenous and exogenous toxins may play a major role in the pathogenesis of Parkinson's disease (PD). In vivo aromatic beta-carbolines, like harman or norharman, may easily be formed by cyclization of indoleamines with e.g. aldehydes. Because of the structural similarity to MPTP, beta-carbolines have been proposed as endogenous toxins. For further elucidation of the role of beta-carbolines in neurodegenerative disorders, harman and norharman plasma levels were measured in 36 patients with PD and compared to an age- and sex-matched control group. Plasma levels of norharman in PD were significantly higher compared to the control group. Harman in the plasma of Parkinsonian patients was also elevated compared to controls, but this difference was not significant. Correlation of beta-carbolines with plasma levels of L-dopa, oral doses of bromocriptine and selegiline in treated Parkinsonian patients showed no significant results. On the one hand these results may suggest a possible role of beta-carbolines in the pathophysiological processes initiating PD, by, e.g., inducing mitochondrial respiratory inhibition like MPP+. One may speculate, however, that elevated levels of norharman and harman are due to an endogenous upregulation caused by unknown metabolic processes.

Aged↗
PubMed1995

Alterations in chromatic contour perception in de novo parkinsonian patients.

Recently abnormalities of chromatic visual perception were reported in treated patients with Parkinson's disease (PD). We studied 28 previously untreated Parkinsonian patients and 28 age- and sex-matched controls using a computer-aided method to determine the chromatic fusion time (CFT). CFT indicates the acuity of the perception of monochromatic contours. Patients with PD have a shortened CFT especially for the light-blue and dark-green stimuli. The chromatic perception disorder is correlated with the severity of PD. It can be concluded from our data that the dysfunction of colour perception is related to the pathophysiology of PD.

Adult↗
PubMed1995

[Comparative study of maternal side effects of various forms of intravenous therapy with fenoterol in premature labor].

OBJECTIVE: The aim of the present study was to compare different regimes of intravenous fenoterol tocolysis concerning their side effects. METHODS: A total of 59 patients with intravenous tocolysis due to preterm labor has been studied. They were chronologically alternating and thus randomly stratified into three groups: (a) continuous i.v.-tocolysis and oral application of magnesium sulfate (b) continuous i.v-tocolysis and i.v.-application of magnesium sulfate (c) pulsatile i.v.-application of fenoterol (bolus tocolysis) and oral application of magnesium sulfate. For all groups, heart rate, systolic and diastolic blood pressure, need for beta-blockers, K+, water balance over 24 hours as well as different subjective side effects were quantified. RESULTS: The side effects were found to be significantly less among patients treated with bolus tocolysis and they were also found to be slightly less in continuous tocolysis with i.v.- application of magnesium compared to continuous tocolysis with oral Mg2+ substitution; however, the difference between the two groups treated with continuous tocolysis was not significant. CONCLUSION: The present results suggest that bolus tocolysis shows significantly less side effects compared to the continuous tocolysis and thus it should be favored in clinical practise.

Administration, Oral↗
PubMed1995

[Reaction of umbilical cord arteries to PGF2 alpha and glycerol trinitrate during the first days post partum].

OBJECTIVE: Are there changes in the reactivity of umbilical cord arteries within the first day after parturition? METHODS: Groups of rings made from umbilical cord arteries were investigated by a force transducer for their reactions to PGF2 alpha and glycerol trinitrate after 1, 6, 12 and 24 hours after parturition. RESULTS: PGF2 alpha induces vasoconstriction, glycerol trinitrate vasodilatation of the umbilical cord arteries. The quantity of these reactions remains the same at each of the investigation times. But the standard deviation decreases 12 and 24 hours after parturition. CONCLUSIONS: There is an increase of the reproducibility of these investigations in the second half of the first day after parturition. The higher standard deviation in the first 6 hours after parturition may be caused by endogenous autacoids.

Autacoids↗
PubMed1995

[Increased serum level of c-erbB-2-coded protein p105 in patients with pre-eclampsia].

OBJECTIVE: This study investigated p105 serum levels in normal pregnancies and in preeclamptic women. PATIENTS AND METHODS: The p105 serum level was determined in 65 women with normal pregnancy and 25 preeclamptic women. RESULTS: The mean p105 serum level for the control group was 102-333 fmol/ml (median 163 fmol/ml). Preeclamptic women had significant higher serum levels (97-368 fmol/ml, median 202 fmol/ml, p < 0,005). CONCLUSION: Elevated serum levels of the c-erbB-2-encoded protein p105 in preeclamptic women could be the result of endothelial dysfunction in preeclampsia.

Adult↗
PubMed1995

Distorted color discrimination in 'de novo' parkinsonian patients.

We performed the Farnsworth-Munsell 100-hue test in 16 "de novo" patients with Parkinson's disease and 16 age-matched controls to determine their color discrimination ability. The mean total error score in patients was significantly elevated as compared with controls (64.6 in patients versus 16.0 in controls). We conclude that the impairment of color discrimination may be an early sign in Parkinson's disease.

Color Perception↗
PubMed1995

Ovarian angiogenesis. Phenotypic characterization of endothelial cells in a physiological model of blood vessel growth and regression.

Angiogenesis occurs during embryogenesis and is a down-regulated process in the healthy adult that is almost exclusively linked to pathological conditions such as tumor growth, wound healing, and inflammation. Physiological angiogenic processes in the adult are restricted to the female reproductive system where they occur cyclically during the ovarian and uterine cycle as well as during pregnancy. By systematically analyzing the phenotypic changes of endothelial cells during bovine corpus luteum (CL) formation and regression, we have established a physiological model of blood vessel growth and regression. Quantitation of vessel density, percentage of vessels with lumen, and ratio of Bandeiraea simplicifolia-I to von Willebrand Factor-positive endothelial cells were established as parameters of angiogenesis. Sprouting endothelial cells invade the growing CL and continue to grow throughout the first third of the ovarian cycle. Thereafter the mature CL is characterized by a dense network of vessels with gradually decreasing vessel density. During luteolysis and for several weeks thereafter (regressing and residual CL) all newly formed vessels regress, which is accompanied by gradual foreshortening and rounding of endothelial cells and subsequent detachment. Based on histochemical detection of nucleosomal fragmentation products physiological blood vessel regression in the cyclic CL does not appear to involve endothelial cell apoptosis. Lectin histochemical analysis revealed a distinct alteration of endothelial cell glycoconjugate expression during ovarian angiogenesis comparable with the distinct pattern of hyperglycosylation of cultured migrating endothelial cells (up-regulation of binding sites for Lycopersicon esculentum lectin, wheat germ agglutinin, neuraminidase-treated peanut agglutinin, and Ricinus communis agglutinin-I on sprouting ECs). Northern blot analysis of glycosyltransferases during the different stages of angiogenesis revealed an up-regulation of beta-galactoside alpha 2,6-sialyltransferase and alpha 1,3-galactosyltransferase mRNA expression during the angiogenic stages of CL formation. These data establish the ovarian angiogenesis model as a suitable experimental system to study the functional and phenotypic properties of endothelial cells in sprouting and regressing blood vessels and provide additional evidence for the importance of endothelial cell surface glycoconjugates during angiogenesis.

Animals↗