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Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 199 records · Page 11Linked to original sources
PubMed1985

Preoperative cervical priming by intracervical application of a new sulprostone gel.

In a prospective, randomised dose-finding study involving 60 women scheduled for termination of 1st trimester pregnancy, 25 micrograms, 50 micrograms or 100 micrograms of a sulprostone gel with a constant injection volume of 2.5 ml were applied intracervically 6-8 hours before curettage. The gelatinising agent was Pluronic F 127, which is liquid at temperatures less than 20 degrees C but gelatinises immediately at body temperature. A sterile, ready-to-use gel can be produced within a minute by mixing the active substance with the gelatinising agent; this rules out any loss of activity due to storage of the substances. The priming effect was verified in 30 patients by means of comparative examinations with a special tonometer before application of the gel and immediately before the surgical procedure. The 100-micrograms dosage proved to be the most effective method in nulliparae, achieving a mean free patency (i.e. force less than 1 Newton) of 8.7 mm. In primiparae and multiparae, a comparable good effect was achieved with the 50-micrograms dose. After application of 25 micrograms sulprostone gel, the mean free patency was only 5.3 mm in the nulliparae and 8.5 mm in the primiparae and multiparae. The results of the tonometric studies agreed with the clinical documentation of the priming effect, which was assessed by means of a special score. The efficiency of the cervical priming correlated with the rate of vaginal bleeding and with the frequency of contraction-related lower abdominal pain. According to the present results, local application of this sulprostone gel represents a practicable and promising method for preoperative cervical priming because of its special electromechanical properties.

Abortifacient Agents↗
PubMed1985

Cervical ripening and induction of labor by intracervical and extra-amniotic prostaglandin gel application in cases of intrauterine fetal death.

In 42 patients with intrauterine fetal death between the 29th and 43rd week of gestation, a standard, 2-step procedure was employed to deliver the dead fetus. After priming with an intracervical application of PGF2 alpha- or PGE2-gel, labor was induced by extra-amniotic prostaglandin (PG) gel or oxytocin infusion while under epidural anesthesia. Intracervical PG application led to a significant improvement in the modified Bishop score from 1.3 to 7.6 after a mean of 8 h. In 20 patients labor and progressive dilatation of the cervix occurred after intracervical PG gel application alone. The average total therapy time was 18.1 h in patients treated with PGF2 alpha and 13.7 h in the PGE2-treated group. The average induction of labor to delivery intervals were 8.8 h in the PGF2 alpha- and 7.1 h in the PGE2-group. Gastrointestinal side effects were observed in only 5 patients. The combination of cervical ripening with intracervical PG gel application and induction of labor by extra-amniotic PG gel under epidural anesthesia is an efficient and safe method for treatment of intrauterine fetal death.

Adolescent↗
PubMed1985

Facilitation of cervical dilatation by intracervical application of sulprostone gel prior to hysteroscopy.

In a prospective, randomized study, 10 patients with primary sterility received an intracervical application of 0.1 mg Sulprostone-Tylose gel for cervical priming 12 hours prior to panoramic CO2-hysteroscopy and pelviscopy with chromopertubation. Ten patients who served as controls were not treated with the local prostaglandin. The force required to overcome the cervical canal was measured with a special tonometer for Hegar 3 before application of the gel in the group treated with Sulprostone and was 3-8 mm in both groups of patients immediately preoperatively. Cervical priming led to a significant reduction in the force required to dilate the cervix. After priming with Sulprostone, the cervical canal was freely passable for an average of 6.7 mm. In none of these patients was a force of 7 Newton exceeded for Hegar 8, whereas in the control group a mean force of 8.2 Newton was required to dilate the cervix for Hegar 6. Haemorrhage and epithelial lesions of the cervix caused by the dilatation can largely be avoided, and the risk of uterine damage reduced by local priming of the cervix. The intracervical application of prostaglandin gel is an easy, efficient and gentle method of dilatation for hysteroscopy, particularly in patients with a firmly closed and rigid cervix.

Adult↗
PubMed1985

[Cervix priming in induced abortion in the 1st trimester using intracervical administration of sulprostone gel].

In a prospective, randomised study 40 primigravidae were treated intracervically with 0.05 mg or 0.1 mg Sulprostone-Tylose gel in order to soften the cervix prior to first trimester termination of pregnancy. Curettage was performed on the average 7.5 hours after prostaglandin administration. For objective demonstration of the priming effect, the force required for dilatation of the cervical canal was measured in Newtons by a special tonometer before prostaglandin application and before operation. The maximal dilatability with a force of 10 N, the increase in dilatability after local PG application, and the patency of the cervix were measured. The occurrence of PG-induced lower abdominal pain associated with contractions was analysed with regard to the number of episodes at pain, their timing and the required amount of analgesics. A modified visual analogue scale was used to evaluate the subjective pain experience. The abortive effect of 0.1 mg Sulprostone was found to be more efficient than the 0.05 mg dose. There was no statistical significant difference between the two doses, however, for the priming effect detectable with the tonometer. The subjective experience of pain, use of analgesics and the frequency of gastrointestinal side effects were significantly higher with 0.1 mg than with 0.05 mg Sulprostone. The visual analogue scale allows the patient to quantify, at least to some extent, her experience of pain, and enables a differentiated analgetic therapy. Because of its effectiveness and low rate of side effects, the intracervical application of 0.05 mg Sulprostone gel promises to be an advantageous alternative to other methods of cervical priming.

Abortifacient Agents↗
PubMed1984

Changes of the clinical presentation of abruptio placentae.

There is an increase of the diagnosis "a.p." during the last years, especially stage 0 + 1. Qualified US monitoring seems to be responsible for this fact. Abruptio placentae is reversible in some cases. Conservative management can be done under intensive care conditions if antenatal treatment is indicated.

Abruptio Placentae↗
PubMed1983

Comparative study of various intracervically administered PG gel preparations for termination of first trimester pregnancies.

In a randomized, double-blind study, 30 healthy, nulliparous women of similar gestational age were given intracervical applications of 0.5mg PGE2, 0.05mg Sulprostone or 0.1mg Sulprostone gel in order to soften the cervix prior to curettage for first trimester termination of pregnancy. The preparations were administered 8 hours before curettage. The number of complete and incomplete abortions, ease of passage through the cervical canal, as measured by a tonometer before and 8 hours after the administration of prostaglandin, the degree of pain experienced and the quantity of analgesics required, plus the frequency of systemic side effects were all always assessed by one trialist. With regard to the rate of abortion and cervical softening, the administration of 0.1mg Sulprostone gel proved the most effective method. However, in comparison with the others, it also caused the greatest degree of pain and necessitated the greatest use of analgesics. The softening effect of the prostaglandin E2 gel was significantly less and in this group there were two cases of cervical lesion due to tenaculum laceration. The intracervical application of 0.05mg Sulprostone gel is to be recommended for pre-operative ripening of the cervix before termination of pregnancy in the first trimester, as it effectively dilates the cervix and does not cause systemic side effects or pain in the lower abdomen, enough to make treatment necessary.

Abdomen↗
PubMed1983

[Plasma hormone concentrations in induced abortion with local prostaglandin administration in the 1st trimester].

Abortion was performed by curettage on 71 women with pregnancies between the 7th and the 13th week of gestation seven to eight hours after intracervical application of a tylose gel containing 3mg prostaglandin F2 alpha. Prior to the application of the prostaglandin and immediately before the surgical intervention a sonographic examination for determining the vitality of the pregnancy was carried out.--Plasma progesteron, estradiol and HPL levels were determined radioimmunologically prior to the application of prostaglandin, at four-hour intervals on the day of intervention, and 24, 48 and 72 hours after the intervention. In 22 women a complete or an incomplete abortion occurred; in two cases a blighted ovum was observed; 47 pregnancies, according to sonographic examination, remained intact until curettage. After seven to eight hours duration of the effect of the prostaglandin gel, progesterone levels were found to be reduced to 60.5 per cent and 17-beta-estradiol to 31.4 per cent of the initial values, whereas the HPL values fell below the specificity of the testing procedure (12.5 ng/ml). Comparative investigations of the pregnancies which, according to sonographic findings, remained intact until curettage and those which were aborted after the application of prostaglandin did not, in spite of low plasma progesterone and estradiol levels in the abortive group, reveal any statistically significant differences. The abortive effect--even with local application--of the prostaglandins was confirmed. Conclusions regarding the effective mechanism of the prostaglandins upon the fetoplacental unit and the function of the corpus luteum remain subject to speculation.

Abortion, Induced↗
PubMed1982

Objective demonstration of cervical softening with a prostaglandin F2 alpha gel during first trimester abortion.

In a prospective study the cervix softening and dilating effects of intracervically applied prostaglandin F2 alpha gel were investigated in 100 patients during induced abortion in the 7-12th week of pregnancy. A specially designed tonometer was used to measure the resistance of the cervical canal before as well as 6-8 h, 4 days and 5-6 weeks after gel application. The cervix of 99 patients proved to be freely passable without use of undue force for at least Hegar 8 after treatment. Measurements in 96 patients 5-6 weeks after the operation showed good general agreement with those values obtained before gel application. No spontaneous or operation-induced lesions of the cervix occurred. Intracervical prostaglandin gel application proved itself to be a safe, practicable and gentle method for avoiding dilation-induced complications during first trimester abortions.

Abortion, Induced↗
PubMed1982

[Early stage of a cloverleaf skull malformation].

Cloverleaf skull anomaly was diagnosed sonographically and in the fetogram, together with concomitant chondrodystrophy. This resulted in an indication for intentional abortion in the 29th week. Consequently, this rare form of skull monstrosity could be examined pathologico-anatomically for the first time in a very early stage of foetal development. Contrary to the widely held opinion that the reason for such hideous malformation is a hydrocephalus internus due to a deformation of the skull base, we found a practically negligible hydrocephalus, although the cloverleaf skull had already developed in a very marked manner. Hence, this case contradicts the generally adopted formal pathogenetic interpretation of cloverleaf skull monstrosity.

Abnormalities, Multiple↗
PubMed1979

[Necessity of training and safety in gynecological laparoscopy--a contradiction?].

At the Gynaecological University Hospital Göttingen 1659 laparoscopies were performed 1961-1978 by 67 gynaecologists with an average of 24,8 laparoscopies per gynaecologist. Most of the doctors were still in their training period, assistance was always given by a specialist gynaecologist. Only in 5 cases (0,3 per cent) laparotomy was necessary due to complications following laparoscopy or laparoscopicsterilization. Injuries of the transverse colon, the greater omentum and a mesenteric artery-caused by the trocar-were seen, also diffuse bleeding from the parietal peritoneum and from the ramus of the Fallopian tube. No deaths due to laparoscopic complications occurred. The incidence of severe complications can be kept within tolerable limits in a training hospital where the majority of the operations are performed by doctors in training, when the following conditions are strictly adhered to: Careful consideration of the risks involved in laparoscopy/laparoscopic sterilization and other less invasive diagnostic and contraceptive methods, strict attention to the contraindications of laparoscopy and performance of a standardized laparoscopic technique under the supervision of an experienced operateur.

Burns↗