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Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 181 records · Page 10Linked to original sources
PubMed1989

[Vaginal sonography: a screening method for early detection of ovarian tumors and endometrial cancers?].

In total we performed a vaginosonographic measurement of 212 patients with or without a postmenopausal bleeding. Altogether 424 ovaries were sonographically examined. An endometrial thickness greater than 4 mm was histologically clarified by means of a curettage and all detectable ovarian tumors by means of a laparotomia. In total we found seven asymptomatic endometrial carcinomas, one cervical carcinoma and two ovarian cancers. The vaginosonography showed to be a very sensitive and acceptable method for the early detection of postmenopausal ovarian and endometrial tumors.

Female↗
PubMed1989

[Septic ovarian vein thrombosis--diagnosis and therapy].

Septic ovarian vein thrombosis is commonly the sequela of puerperal purulent endomyometritis. The incidence has been reported to be 1 in 600-6000 deliveries. The predominant location is the right ovarian vein according to the puerperal uterine drainage. The diagnostic and therapeutic experience in 9 cases is described. The leading symptoms were abdominal pain localized at the psoatic muscle and a tender, barrel-shaped tumor. Ultrasound and computed tomography (CT) added in the correct preoperative diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course; in complicated cases surgical intervention becomes mandatory.

Endometritis↗
PubMed1989

Enzymatic collagen degradation in the pregnant guinea pig cervix during physiological maturation of the cervix and after local application of prostaglandins.

The role of enzymatic collagen degradation in prostaglandin-induced and physiological cervical ripening was studied in guinea pigs. The cervices were removed from (a) 8 non-pregnant guinea pigs, (b) 8 animals at day 45 of pregnancy, (c) 14 pregnant animals of comparable gestational age which had either an intracervical application of 0.2 ml 5% tylose or 10 micrograms sulprostone gel, and (d) 8 guinea pigs at day 63 to 65 of pregnancy. Collagenase activity was assayed in a highly specific and sensitive system using native collagen type I as substrate. Protease activity was measured by the method of Green and Shaw. Collagen fragments were identified by SDS-polyacrylamide electrophoresis (SDS-PAGE) of acetic-soluble fractions. Collagenase and protease activities were found in all extracts from the different groups. However, there were no differences in enzymatic activities between the non-pregnant, early-pregnant and late-pregnant cervical specimens. Prostaglandin pre-treatment of the cervix led to no significant increase in either collagenase or protease activity as compared to the control groups. The absence of typical collagen degradation products in the SDS-PAGE suggested that no significant collagen breakdown had taken place. In contrast to previously published literature, we conclude that enzymatic collagen degradation is unlikely to be a key factor in prostaglandin-induced and physiological cervical ripening.

Animals↗
PubMed1989

[Vaginosonographic measurement of the postmenopausal endometrium in the early detection of endometrial cancer].

Vaginosonographic measurements of the endometrium were performed in 155 postmenopausal women without abnormal gynecological findings and free of any clinical symptoms. An endometrial thickness of greater than or equal to 4 mm was clarified histologically by means of a curettage. We found endometrial carcinomas in seven cases, cervical carcinomas in one, endometrial polyps in ten and glandular-cystic hyperplasia in three cases. One patient showed an atrophic endometrium associated with a submucous myoma. In total, endometrial carcinomas were detected by sonography in 4.5% of our patients. On the basis of our preliminary results, we conclude that vaginosonographic examination of the endometrium is a highly sensitive (81%) and specific (89%) method, with good acceptance by the patients, in the detection of asymptomatic benign and malignant neoplasms of the postmenopausal woman.

Aged↗
PubMed1989

[Congenital hyperthyroidism in maternal Basedow disease].

A case of congenital hyperthyroidism, after pregnancy complicated by Graves' disease is presented. Fetal tachycardia was the cardial symptom. Caesarean section was performed in the 29 years old patient with normal thyroid function in the 29th week of pregnancy. The neonate showed symptoms of a congenital hyperthyroidism with goitre. Antithyroid antibodies were found in the serum of both mother and child. At the age of ten weeks, after a short course of thyrostatic treatment, the infant was discharged with normal thyroid function following complicationfree progress.

Adult↗
PubMed1989

[Serum level of the tumor marker CA 125 before second-look laparatomy in primary epithelial ovarian cancer in relation to intraoperative findings].

Serum CA 125 levels were evaluated in 76 patients undergoing second-look laparatomy for primary epithelial ovarian cancer. The findings were related to the presence of intraabdominal tumor. CA 125 levels were greater than 35 U/ml in 26 cases in accordance to the intraoperative findings. CA 125 levels less than or equal to 35 U/ml were found in 50 cases out of which 29 were free of tumor, while 21 showed intraabdominal tumors. Thus a CA 125 level greater than 35 U/ml revealed to be a strong predictor of the presence of intraabdominal tumor. Due to low sensitivity monitoring serum CA 125 levels cannot replace second-look laparotomy.

Adult↗
PubMed1989

[Changes in Tamm-Horsfall protein excretion in the urine of patients with hypertension in pregnancy].

In previous studies we detected an intensively stained protein band with an apparent molecular weight of 105 kD in the urinary electrophoresis pattern of healthy control subjects and pregnant women; this protein band was identified as Tamm-Horsfall protein by using Western blot. The aim of the present study was to determine the changes of this THP band in 64 patients with an uncomplicated course of pregnancy and 135 hypertensive pregnant women by use of a special urine preparation and a modified SDS-PAGE. The number of protein bands did not change in the course of pregnancy and in the post partum period. The THP band was constantly found in all these patients independent of the gestational age. In 83% of the hypertensive pregnant women we observed a marked reduction in intensity or complete disappearance of the THP band. These changes correlated significantly with the severity of the disease. Follow-up analyses in 39 of these patients showed, that in 22 cases disappearance of the THP band occurred simultaneously with and in 11 women before clinical manifestation of the disease. In 81 of the 85 hypertensive pregnant women complete reappearance of the THP band was observed 2 to 14 days after delivery. Our findings may reflect a transitory tubular dysfunction in cases of preeclampsia and support the hypothesis of an immunological pathogenesis of the disease.

Electrophoresis, Polyacrylamide Gel↗
PubMed1989

[Dose-dependent effect of locally administered sulprostone gel on serum luteal and placental hormones in cervix priming in the 1st trimester].

In a prospective, randomised study 30 primigravidae were treated with 25 micrograms, 50 mu, or 100 micrograms sulprostone gel in order to soften the cervix prior to first trimester termination of pregnancy. 10 multigravidae received only the gel vehicle tylose. For objective demonstration of the priming effect, the force required for dilatation of the cervical canal was measured in Newton by a special tonometer before prostaglandin (PG) application and before operation. Serum progesterone, 17-beta-estradiol and hP1 levels were determined radioimmunologically prior to PG application and at two-hours intervals until curettage. A sonographic examination for determing the vitality of the pregnancy was performed before PG administration and immediately before the surgical intervention. There were no significant differences in the primig effect between the 50 micrograms and 100 micrograms sulprostone-treated group; the application of 25 micrograms sulprostone was significantly less effective. After 100 micrograms sulprostone gel abortion occurred in 2 patients, 6 women showed a marked decrease in hPl concentrations, progesterone levels were found to be reduced to 31.6-78.7% and 17-beta-estradiol to 10-40% of the initial values before PG application. We found a close time correlation between the occurrence of contraction-induced lower abdominal pain and the fall in hormone concentrations. No abortions occurred in any of the patients treated with 50 micrograms sulprostone gel; in 9 women without clinical symptoms no significant changes of the hormone concentrations were observed. In contrast to the previously published literature our results indicate that effective cervical ripening can be achieved by this method without disturbance of the feto-placental unit and the trophoblast respectively.

Abortifacient Agents↗
PubMed1988

[Puerperal ovarian vein thrombophlebitis--a rare puerperal complication].

Puerperal ovarian vein thrombosis (POVT) commonly results from purulent necrotic endomyometritis. The incidence is published to be 1 in 600 deliveries, however, according to own data, the incidence is at least 10 times less frequent. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain localized anteriorly to the psoatic muscle and a tender, barrel shaped unilateral tumor. Discrepancy between the grave clinical picture and the insignificant findings on gyn. examination is common. Ultrasound and computed tomography frequently add in the correct diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course. If clinical improvement is delayed despite non-invasive treatment, surgical intervention with resection of the involved veins and all septic foci becomes mandatory. Despite non-invasive and invasive treatment, pulmonary emboli or septic complication refractory to therapy may contribute to mortality. Therefore POVT should always be included in the differential diagnosis of those patients presenting with a variable fever curve or an unexplained septic course following delivery or miscarriage.

Adult↗
PubMed1988

[Changes in the urinary protein pattern in SDS polyacrylamide gel electrophoresis in normal and hypertensive pregnancies].

The urinary protein pattern was determined in 46 healthy male and female subjects, 64 patients with an uncomplicated course of pregnancy and 88 hypertensive pregnant women by use of a special urine preparation and a modified SDS-polyacrylamide gel electrophoresis (SDS-PAGE). There were no differences in the protein electrophoresis pattern between the control subjects, independent of sex and age, and the pregnant women. The number of protein bands did not change in the course of pregnancy and in the post partum period. In both groups, an intensively stained protein band with an apparent molecular weight of 105 kD was detected. In 71 of the 88 hypertensive pregnant women we found a marked reduction in intensity or complete disappearance of the 105 kD protein band. Follow-up analysis in 30 of these pregnant women showed, that in 24 cases disappearance of the 105 kD band occurred simultaneously with and in 6 women before clinical manifestation of the disease. There were no differences in the protein electrophoresis pattern between patients with preexisting renal or hypertensive disease and hypertensive women without a complicated history. In 49 of the 52 hypertensive pregnant women complete reappearance of the 105 kD band was observed 2 to 14 days after delivery. By using silver staining and Western blot, the 105 kD band was identified as Tamm-Horsfall protein. Our findings may reflect a transitory tubular dysfunction in cases of preeclampsia and support the hypothesis of an immunological pathogenesis of the disease.

Adolescent↗
PubMed1988

[Significance of early laboratory diagnosis for obstetrical procedures in severe gestoses and the HELLP syndrome].

HELLP syndrome is a severe complication of preeclampsia, incalculable in its course and involving high risk for mother and fetus. Over a period of three years and eight months a total of 24 patients with HELLP syndrome were treated at Göttingen University Gynecological Clinic and the Gynecological Clinic of Munich Technical University. In all cases the correct diagnosis had already been made by the referring physician or by the obstetrician on admission, taking laboratory parameters into account. The chief clinical symptom was upper abdominal pain, All of the patients presented with thrombocytopenia and elevated liver enzymes. The signs of hemolysis derived from the increased bilirubin concentrations and the LDH; in 13 cases fragmentocytes were detected in the peripheral blood smear. No indications of a pronounced DIG were found. The mean time elapsed between hospitalization and delivery was six hours (0.5-40 hours); 22 patients were delivered within 24 hours. Cesarean section was performed in all cases. The mean gestational age at the time of birth was 35 weeks (25-38). Three of 24 children died prepartially; with the surviving infants no major problems arose in the postnatal course. In 19 cases the abdominal cesarean delivery and clinical course were without complications. Reoperation, in two cases combined with a puerperal hysterectomy, was necessary in three patients, due to subfascial and intraperitoneal or retroperitoneal hematomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Collagenase activity in cervical tissue of the non-pregnant and pregnant human cervix.

Collagen degradation has been suggested to play an important role in the process of cervical ripening at term. After giving informed consent tissue samples were taken from the posterior lip of 10 non-pregnant women of child-bearing age, 10 women having a termination of pregnancy at 9-12 weeks' gestation and 12 women who had had normal spontaneous deliveries at term. Collagenase activity was measured by a specific technique using native, triple helical collagen. Proteolytic activity was determined with commercially available 14C-methaemoglobin as substrate. For identification of collagen fragments SDS-polyacrylamid-gel-electrophoresis was performed using a modified Laemmli-technique. Collagenase and protease activity were found in all extracts of the different groups. There was a marked increase in enzymatic activities in the postpartum tissue samples suggesting that significant collagen breakdown had taken place. The absence of typical collagen fragments in the SDS-electrophoresis seemed to be due to a very rapid further degradation of the fragments by proteases into small peptides which then readily left the cervix. The present findings confirm the essential role of proteolytic enzymes in cervical dilatation at term.

Adult↗
PubMed1987

[Use of prostaglandins in pregnancy termination in the 1st and 2d trimester].

Successful termination of pregnancy can be achieved at any stage of gestation by the administration of prostaglandins (PG). The methods used for preoperative cervical priming are: intramuscular and intramural-cervical injection of sulprostone, as well as intracervical application of PG-containing gel preparations. According to our own extensive investigations, intracervical application of 50 micrograms sulprostone-tylose gel is superior to other procedures of cervical priming as regards efficiency and acceptance. For termination of second trimester pregnancy a combined procedure is advisable, namely cervical priming (e.g. intracervical PG gel application) and induction of labour (e.g. intramuscular sulprostone). The advantages of this method as compared with the exclusively systemic administration of PGs are: a higher success rate, a lower incidence of undesired concomitant side effects and the avoidance of serious complications (e.g. cervical rupture). In our experience administration of PGs is not contraindicated under certain well-defined conditions, even in the case of previous uterine operations.

Abortifacient Agents, Nonsteroidal↗
PubMed1987

Collagen degradation in the pregnant human cervix at term and after prostaglandin-induced cervical ripening.

The role of enzymatic collagen degradation in prostaglandin-induced and physiological cervical ripening was studied by determining collagenase and other proteolytic activity in extracts of cervical biopsies. Collagenase activity was assayed in a highly specific and sensitive system using native collagen type I as substrate. The intracervical application of sulprostone gel prior to termination of 1st trimester pregnancy led to a marked improvement in cervical dilatability. Collagenase and proteolytic activity were found to be significantly higher in postpartum samples than in specimens obtained from the nonpregnant or early pregnant cervix. After sulprostone treatment enzymatic activities were only marginally elevated. Analysis of extractable peptides showed that sub partu collagen was degraded in preference to noncollagenous proteins into very small fragments, whereas in the process of prostaglandin-induced cervical ripening collagen degradation appears to be of minor importance.

Cervix Uteri↗
PubMed1987

The role of collagenases and proteases in prostaglandin-induced cervical ripening.

Tissue samples were taken from the posterior lip of the cervix of 10 non-pregnant women, 10 women having a termination of pregnancy at 9-12 weeks' gestation and 16 women having a termination who had had an intracervical application of either 50 micrograms sulprostone gel or 2 ml 5% tylose 8-12 hours previously. The efficacy of cervical priming was demonstrated objectively by tonometric measurements. Collagenase activity was determined by a new highly specific technique using native, triple helical collagen. Protease activity was measured by a modified Anson-test. For identification of collagen fragments SDS-polyacrylamide electrophoresis was done on the acetic acid soluble fractions. The sulprostone gel induced effective cervical ripening in all of the patients. Collagenase and protease activity were found in all extracts from the different groups, however, PG-pretreatment of the cervix led to no significant increase in enzymatic activities. In addition, the absence of typical collagen cleavage products in the SDS-electrophoresis suggested that no significant collagen breakdown had occurred. In contrast to previously published literature we conclude that enzymatic collagen degradation does not play a predominant role in PG-induced cervical ripening.

Abortifacient Agents, Nonsteroidal↗
PubMed1987

[Facilitating cervix dilatation of the non-pregnant uterus by intracervical administration of gels containing prostaglandin and calcium chloride].

In a prospective, randomised study, 50 non-pregnant patients were treated intracervically with 3 ml 5% tylose, 50 micrograms sulprostone, 100 micrograms sulprostone gel, 3 ml 2.5 mM or 9.0 mM calcium chloride gel in order to soften the cervix 12-14 hours before diagnostic curettage. The gel was not used in a further 20 patients. To objectively demonstrate the priming effect, the force required for dilatation of the cervical canal was measured in Newtons, using a mechanical tonometer both before gel application and before the operation. In comparison with the administration of tylose only, the intracervical application of either sulprostone gel or calcium chloride gel led to a significant improvement in cervical dilatability. Tylose alone had a slight but measurable effect on the cervix. An increase in sulprostone from 50 micrograms to 100 micrograms or calcium molarity from 2.5 mM to 9.0 mM brought no further improvement in the dilatory effect. Dilatation-induced cervical lesions could be avoided by preoperative cervical ripening. After application of sulprostone, 3 out of 20 patients experienced doses-dependent uterine cramps, while all patients treated with calcium chloride gel were free of side effects. The intracervical administration of sulprostone and calcium chloride gel allowed gentle dilatation of the non-pregnant cervix, thus lowering the risk of uterine lesions. Under clinical aspects, cervical priming facilitates diagnostic and therapeutic procedures, which, in exceptional cases, can be performed without anaesthesia.

Administration, Intravaginal↗
PubMed1985

[Cervix ripening and labor induction in therapeutic abortion in the middle and late 2d trimester using intracervical and extra-amniotic prostaglandin gel administration].

In 64 patients for therapeutic abortion between the 17th to 26th week of pregnancy abortion was induced with a standardized two-step procedure. After priming of the cervix with intracervical application of prostaglandin gel, labour was induced with extraamniotic PG-administration under epidural anaesthesia. The priming effect was demonstrated objectively in 10 patients with a mechanical tonometer. Prostaglandin F2 alpha, PGE2 and sulprostone were used in the study. There were no significant differences in the total length of therapy (cervix priming time plus induction of labour to abortion interval) between the three groups of patients. Except for 4 patients who required an instrumental extraction of the fetus, abortion occurred in all the patients within a total time of 30 hours (93.8%). The mean induction of labour to abortion interval was 8.3 hours (range: 1.0 to 17.3 hours) in all patients and there was, again, no significant difference between the three groups. Epidural anaesthesia gave a painless induction of abortion in 60 out of 62 patients, while 2 patients required additional analgesics. In 2 patients epidural anaesthesia was contraindicated. In contrast to the systemic administration of PG the incidence of gastrointestinal side effects was low (10.9%). In one case a cervical lesion was observed due to a tenaculum laceration. Although there was no general antibiotic prophylaxis endometritis occurred in only 3 cases (4.7%). The combination of intracervical PG gel for cervical priming, extraamniotic PG gel for labour induction and epidural anaesthesia presents a gentle and efficient method for the termination of pregnancy in the middle to late second trimester.

Abortifacient Agents, Nonsteroidal↗