Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 235 records · Page 13Linked to original sources

PubMedDate not supplied

Comparison of Doppler sonographic examinations of the umbilical and uterine arteries in high-risk pregnancies.

OBJECTIVE: To determine the value of Doppler ultrasonographic examinations of the uterine artery in high-risk collectives and their importance as compared to examinations of the umbilical artery. METHODS: In 142 patients with fetal growth retardation (birth weight <10th percentile) and/or pre-eclampsia/HELLP syndrome (as defined by ACOG criteria), the umbilical artery and the uterine arteries were examined bilaterally using a 3.5/5-MHz color Doppler system (Acuson 128). The patients were assigned to six groups according to the Doppler findings (uterine artery unilaterally/bilaterally normal/pathologic and umbilical artery normal/pathologic). For each group, the median of the birth weight and the gestational age at delivery was determined and the frequency of occurrence of complications was calculated. RESULTS: In cases with pathologic results in all three vessels, the median gestational age at delivery and the median birth weight were significantly lower than in all other subgroups. Of the cases with pathologic findings in the umbilical artery only, 6% had pre-eclampsia/HELLP syndrome. However, this complication developed in 90% of the cases with pathologic findings in both uterine arteries. If only the umbilical artery was examined (and not the uterine arteries) the Doppler results were normal in 40 (28%) of the patients in our high-risk group, thus incorrectly simulating undisturbed placental hemodynamics. CONCLUSIONS: Examination of both uterine arteries is an indispensable element of Doppler examination to assess placental performance and risk to the fetus.

Adolescent↗

PubMedDate not supplied

Correlation of Doppler velocimetry findings in twin pregnancies including course of pregnancy and fetal outcome.

OBJECTIVE: Subject of the study was the significance of umbilical artery Doppler velocimetry findings for the further course of pregnancy and fetal outcome in cases of twin pregnancies. METHODS: In 206 cases of twin pregnancy, the umbilical artery was examined using Doppler velocimetry in the median 9 days prior to delivery, and the result was correlated with the further course of pregnancy and fetal outcome. 174 pregnancies showed normal Doppler findings of the umbilical artery (group A), 32 twin pregnancies showed pathological Doppler findings of at least one twin (group B). The median of the maternal age and the parity between the groups were not different. RESULTS: In group B (pathological Doppler findings), intrauterine growth retardation and pre-eclampsia occurred 5 times more often than in group A (normal Doppler findings). The total rate of cesarean sections was not different between the study populations; the rate of deliveries by cesarean section in group B was significantly increased by a factor of 2.4 due to a pathological CTG. The median birth weight and the gestational age at birth were significantly lower in group B (1,660 g; 35 weeks) as compared to group A (2,460 g; 37 weeks; p<0.001). In group B, the rate of premature deliveries up to reaching the 34th week of gestation was 3. 4 times higher; the rate of SGA newborns was 6.3 times higher. Perinatal mortality was increased by a factor of 1.5 in group B compared to group A. CONCLUSION: The Doppler velocimetry findings have considerable effects on the further course of a multiple pregnancy. In case of pathological Doppler findings, early hospitalization and close monitoring of the pregnancy should be performed. In cases of additional pathological findings (maternal illness, pathological Doppler findings of fetal blood vessels), termination of the pregnancy has to be considered.

Adult↗

PubMedDate not supplied

Absence of epidermal growth factor receptor expression in squamous cell carcinoma of the uterine cervix is an indicator of limited tumor disease.

The expression of growth factors is considered as an important diagnostic and prognostic feature in tumor pathology. We investigated the value of the immunohistochemical EGF-receptor expression (EGF-R) in 30 squamous cell carcinomas of the uterine cervix, treated by radical hysterectomy and lymphadenectomy according to the Wertheim-Meigs-Okabayashi technique. Immunohistochemical reactions were performed on 4 microm sections from paraffin-embedded tissue, using an indirect peroxidase method. The staining results were evaluated semiquantitatively as negative (n=9; 30%) or as slightly, moderately or severely positive (n=21; 70%). The EGF-R-negative tumors were found in less advanced tumor stages. None had invaded into the parametrium (100%), eight were staged as T1 (89%), seven as N0 (78%), and seven showed no evidence for lymphangiosis carcinomatosa (78%). The respective values for the EGF-R-positive tumors ranged from 52% to 67%. However, only the difference in parametral invasion (EGF-R-negative: 0%, EGF-R-positive: 38%) was statistically significant (p=0.0306), probably due to the small number of cases. The EGF-R-expression was not correlated to histomorphological tumor grading. The results of this study indicate an inverse correlation between EGF-R expression and tumor spread. Assuming that this trend could be confirmed by a larger group of patients, immunostaining for EGF-R in a tumor biopsy could be useful to adapt surgical strategies and adjuvant therapy in the individual patient. Moreover, the EGF-R is an interesting target for immunotherapeutic approaches in squamous cell cervical carcinoma.

Adult↗

PubMedDate not supplied

[2 or more cesarean sections--elective repeat cesarean or vaginal delivery?].

Cesarean section rates have been steadily increasing over the past two decades in most countries of the Western world. The review of the literature suggests that a trial of labor in patients with more than one previous cesarean delivery is appropriate, and that these women should be treated no differently from those who have had only one cesarean delivery. Obstetric management should be individualized after thorough patient counseling. If women are carefully selected for a trial of labor and supervised closely, the risk of serious complications can be minimized and a successful outcome achieved. Epidural anesthesia is safe, effective and justified. Similarly, if oxytocin administration is considered medically necessary either to augment or to induce labor, it should be given. It would appear from the present data, that the use of prostaglandins for priming and induction of labor is also safe and effective under consistent supervision. Rupture of the uterine scare is a rare but catastrophic complication (0-2.8%); fetal bradycardia may be the only diagnostic sign. Prompt intervention is necessary to minimize both maternal and neonatal complications. The maternal and fetal outcomes in women who have had multiple previous sections do not differ from those in women after ordinary cesarean section. At present there is no sufficiently predictive method to identify those women most likely to benefit from an elective repeat cesarean delivery.

Cesarean Section, Repeat↗

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

Expression of CD44(v5-10) splicing variants in primary ovarian cancer and lymph node metastases.

BACKGROUND: This study was designed to detect the expression of CD44v splicing variants in primary ovarian carcinomas and their lymph node metastases, in order to evaluate the possible role in intraperitoneal and lymphogenic metastasization. MATERIAL AND METHODS: Paraffin-embedded tissue of 50 patients with ovarian cancer was available from both the primary tumors and from the lymph node metastases. The expression of the CD44 standard from (CD44s) and of the variant isoforms CD44v5, CD44v6, CD44v7 and 8, and CD44v10 was investigated in the tumor cell regions by immunohistochemistry. RESULTS: 45/50 (90%) primary ovarian carcinomas were found to be immunohistochemically positive for the CD44v5 splicing variant; 10 (20%) tumors expressed both CD44v5 and CD44v6. Apart from an additional v7 stain, all of the ovarian carcinomas studied were negative for the splicing variants v7, v7-8 and v10. No differences were revealed in the pattern of CD44 variants expression investigated in primary tumors and in the lymph node metastases. CONCLUSIONS: In ovarian cancer the expression of CD44v5 as a possible first step, as well as CD44v6, probably plays an important role in intraperitoneal implantation. In view of the comparatively heterogeneous expression patterns of CD44v in individual organs, it may be assumed that there are organ-specific differences in this respect, and that the invasion potential is influenced by both the expression pattern and the extent of expression.

Adult↗

PubMedDate not supplied

[Diagnostic and therapeutic problems in HELLP syndrome].

The HELLP syndrome is a severe and life-threatening complication of preeclampsia. Despite obstetricians are more aware of this syndrome maternal and perinatal mortality could not be reduced during the last years. The diagnostic problems of the HELLP syndrome are early detection of the disease, problems concerning differential diagnosis to other diseases with similar symptoms, and the different definition of the HELLP syndrome itself. For early detection of hemolysis determination of serum haptoglobin should be included in laboratory screening methods. Manifestation of DIG is not a principal sign of the HELLP syndrome but reflects a secondary pathophysiological process of the primary disease. Therefore administration of heparin and antithrombin III is not indicated and may lead to induction or amplification of life-threatening bleedings in these cases. Conservative approaches have shown to improve the fetal and maternal condition in individual cases, however, termination of pregnancy is the only definitive cure for patients with HELLP-syndrome. With respect to our perinatal results (n = 84) immediate delivery, predominantly by caesarean section, is recommended after diagnosis has been confirmed.

Cesarean Section↗

PubMedDate not supplied

[Changes in the basic immunologic parameters interleukin-2 receptor and CD8-antigen in pre-eclampsia].

The serum level of interleukin-2 receptor (sIl-2R) and CD-8 antigen were determined as basic parameter in terms of the stimulation of the t-cell mediated immune reaction in patients suffering from pre-eclampsia (n = 21), HELLP syndrome (n = 12) and pre-existing hypertension (n = 10). The data were compared with those of healthy nonpregnant female volunteers (n = 10) and normotensive pregnant women in the course of pregnancy. Hypertension in pregnancy was associated with an increase of sIl-2R and sCD-8 levels depending on the severity of the hypertensive disorder. In the group of patients with severe pre-eclampsia the median of sIl-2R serum level increased from 370 U/ml (normotensive patients) to 730 U/ml and that of sCD-8 from 640 U/ml to 1100 U/ml. In patients with pre-existing hypertension there was a smaller increase of sIl-2R (median 520 U/ml) and decrease of sCD-8 (median 520 U/ml). 6 to 8 weeks after delivery in the group of hypertensive patients the sIl-2R levels were normalized and the levels of sCD-8 were elevated (median 1030 U/ml). The results support the hypothesis of T-cell mediated immunological reactions as pathogenetic factors of the genesis of the hypertensive disorders in pregnancy.

Adult↗

PubMedDate not supplied

[Morphologic and biochemical aspects of prostaglandin-induced cervix ripening].

For examination by electron microscopy tissue samples were taken from the posterior lip of the cervix of 8 patients having a termination of pregnancy at 9-12th week gestation and 16 patients of comparable gestational age who had an intracervical application of either 2 ml 5% tylose or 50 micrograms sulprostone-tylose gel 8 hours before biopsy. The efficacy of cervical priming was demonstrated objectively by tonometric studies. In addition, collagenase and protease activities were determined in the cervical tissue extracts of the different treatment groups. For identification of typical collagen fragments SDS-polyacrylamide-gel-electrophoresis were carried out on the acetic acid soluble extracts. The local application of sulprostone gel induced a marked multifocal loosening of the collagenous framework; there was no evidence for leucocyte infiltration or necrosis caused by the prostaglandin (PG) pretreatment. In the areas of disorganized collagen fibres cervical fibroblasts seemed to be activated characterized by fine granular loosening of the cytoplasma, dilated cisternae of rough endoplasmatic reticulum, vacuolized enlarged mitochondria and an increased number of cytoplasmatic vesicles close to the cell surface. Collagenase and protease activities were found in all extracts of the different treatment groups, however, PG-application led to no significant increase in enzymatic activities. There was no evidence for the presence of typical collagen cleavage products in the SDS-electrophoresis. Contradictory to the hitherto published literature enzymatic collagen degradation does not play an essential role in PG-induced cervical ripening.

Abortifacient Agents↗

PubMedDate not supplied

[Relation between procoagulant activity and fetal lung maturity in amniotic fluid].

A total of 146 samples of amniotic fluid from the 15th to 43rd weeks of pregnancy were taken by either transabdominal amniocentesis or amniotomy during birth. In addition to the palmitic/stearic ratio (P/S) the following coagulation tests were determined: clotting time, modified prothrombin time, partial thromboplastin time (PTT), recalcification time and, in selected samples, thrombelastograms. In the course of pregnancy there is a significant shortening of all coagulation tests measured in amniotic fluid. Comparing the values obtained in the 15th to 18th and the 37th to 43rd weeks of gestation and literature results the following values may indicate fetal maturity: clotting time less than 100 sec., modified prothrombin time less than 80 sec., PTT less than 30 sec. and recalcification time less than 80 sec. The lower limit for P/S ratio in normal pregnancy is 5,0. In 58 cases, amniotic fluid was obtained in the 37th to 43rd week at most 24 hours before delivery; there was no case of RDS in this group. Eliminating intermediate P/S values of 4,5 to 5,0 a false negative rate of 1,7% for the prediction of fetal lung maturity was seen. The corresponding rate for the modified prothrombin time was 3,4% and for the clotting time 6,4%. In 7 RDS cases all cases could be properly predicted from the recalcification time and the PTT. The fetal lung maturity may be estimated by means of simple and rapid coagulation tests and this may facilitate the indication for RDS-prophylaxis. The determination of the L/S or P/S ratios, however, cannot yet be dispensed with.

Amniotic Fluid↗

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

[Biochemical principles of cervix ripening and dilatation].

The central function of the cervix to maintain pregnancy is biochemically characterized by an increased synthesis of collagen, proteins, glycosaminoglycans (GAG) and fibronectin within the extracellular matrix, thus leading to an increase of cervical volume without significant changes of cervical consistency. During the time of cervical ripening we found a marked reduction of collagen concentration, a 2.5-fold increase in GAG content, a significant fall in dermatan sulfate concentrations from 41% to 15% of total GAG content, a 12-fold increase in hyaluronate concentrations, and a marked reduction in fibronectin, demonstrated by immunhistochemical methods. Thus, the loss of collagen and sulfated GAGs may facilitate distensibility in the ripened cervix, while the significant gain in hyaluronate associated with hydratation may explain the soft and swollen consistency. In this connection increased hyaluronate concentrations and degradation of fibronectin may play a trigger role for subsequent cervical dilatation. The dramatic changes of the cervix during parturition occurring within a few hours require the rapid activation and action of catabolic enzyme systems. Our studies showed a significant increase of sialidase-, collagenase- and elastase activities during cervical dilatation. These proteinases originate from polymorphonuclear leucocytes (pml), which accumulate in cervical capillaries at the onset of labor; this is followed by a massive leucocyte infiltration of the cervical stroma at the beginning of cervical dilatation and a degranulation of the pml at further dilatation, thus releasing collagenase and other proteinases. This process is limited by the immediate post partum insudation of the cervix by plasma containing highly potent proteinase inhibitors. The clinical aim of our basic biochemical studies is to develop new concepts in the causal treatment of cervical pathology during pregnancy.

Animals↗

PubMedDate not supplied

[Prolonged pregnancy--prostaglandins as the cause of labor onset].

The causes of prolonged pregnancy are still largely unknown and their investigation requires a detailed observation of potential birth-initiating stimuli on the endocrine and biomolecular level. A large number of clinical and biochemical studies point to the central importance of prostaglandins for the beginning of human birth. The main places of origin of the intensified prostaglandin formation and release are the amnion and the decidua which has "macrophage-like" properties and functions. The superordinate regulation and trigger mechanisms for intensified uterine prostaglandin production has not been sufficiently investigated either. Possible factors currently being debated include local changes in estrogen and progesterone biosynthesis in fetal membranes and decidua, subclinical inflammatory reactions with the activation of macrophages and the consecutive release of cytokines, and a loss of maternal immune tolerance with a time-determined rejection reaction. In addition, the substances inhibiting and stimulating prostaglandin synthesis have been detected in the amniotic fluid, fetal membranes and decidua. The fetus itself also plays an important part in the initiation of labor. Prolongation may be due to anatomic functional disturbances of the one hand which prevent the activation of the fetal hypothalamic-hypophyseal-adrenal axis and the release of the birth-initiating stimuli originating in the fetus; on the other hand, an elevated immune tolerance with a delayed rejection reaction or the lack of "bacterial stimulus" may inhibit the activation of the macrophages and hence the formation of cytokines. The consequences would be the development and release of a quantity of prostaglandins from the fetal membranes and decidua insufficient to overcome the pregnancy-maintaining safety systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Amnion↗

PubMedDate not supplied

[Labor contraction-dependent changes in magnesium and calcium in the myometrium].

Magnesium is commonly used in the therapy and prevention of preterm labor. Therefore the differences of the concentrations of magnesium and its antagonist calcium were measured in the human myometrium to examine the interaction of labour and ionic changes. The ionic concentration in the myometrium of 37 patients without labour are determined and the values are compared to the data of 26 patients in active labour. Women of the first group without labour had a magnesium concentration of mean = 4.1 mmol/kg wet weight and a calcium concentration of mean = 2.9 mmol/kg wet weight. Women of the second group with active labour have a significantly lower (p < 0.01) magnesium concentration (mean = 3.5 mmol/kg wet weight). However, the calcium level (mean = 2.7 mmol/kg wet weight) does not show significant differences. These results indicate that the decrease of magnesium plays an important role in the physiology of parturition. A low magnesium concentration in the myometrium might have a considerable influence on premature labour in the third trimester of pregnancy. Therefore a prophylactic application of magnesium seems to be useful.

Adult↗

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

[Postpartum atony].

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Abortifacient Agents, Nonsteroidal↗

PubMedDate not supplied

[Longitudinal study of 24-hour blood pressure behavior in pregnancy and puerperium in patients with normal pregnancy, pre-eclampsia and HELLP syndrome].

Ante- and postpartum noninvasive 24-hour ambulatory blood pressure measurements were performed in 18 normotensive pregnants and 36 patients with mild (n = 16) or severe preeclampsia (n = 12) or HELLP-syndrome (n = 8). In contrast to normotensive pregnancy (n = 18) displaying a decline of systolic and diastolic blood pressure in comparison with normotensive non-pregnant, preeclamptic women demonstrate significantly elevated blood pressure profiles before delivery that remain elevated up to the eighth week postpartum. 9 out of 12 patients with severe preeclampsia and 6 of 8 women with HELLP-syndrome show a nocturnal increase of blood pressure within the first week postpartum and a non-dipping up to the eighth week after delivery. As a result of this, in preeclamptic women blood pressure control should be extended into the night and antihypertensive therapy should include a sufficient evening dose.

Adult↗

PubMedDate not supplied

[Differential HELLP syndrome diagnosis].

The early detection of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is the basic condition for immediate therapeutic management, which mainly leads to prompt delivery. The classical symptoms despite the typical laboratory evaluation (hemolysis, elevated liver enzymes, low platelets) are epigastric or right upper quadrant pain and nausea and vomiting; the classical signs of preeclampsia (proteinuria and hypertension) may be absent in 20%. The differential diagnostic problems of HELLP syndrome arise in relation to the mimicry-symptomatic: upper abdomen pain can imitate gastroenterologic diseases (e.g. cholelithiasis, appendicitis), the elevated liver enzymes combined with hyperbilirubinemia liver diseases (e.g. viral hepatitis) and thrombocytopenia in combination with hemolytic anemia, neurological symptoms and renal failure other similar pathogenetic disorders due to the category of thrombotic microangiopathies. Regarding the common symptoms thrombocytopenia, hemolysis as well as signs of preeclampsia with or without renal failure the differentiation from various autoimmune diseases also can be difficult in special cases. Rare first manifestations and serious simultaneous diseases which can overlay the typical signs of HELLP syndrome show the variety of HELLP syndrome. Interdisciplinary detours and delay are the consequences of this differential diagnostic problems, which could imply deleterious effects on the mother and the fetus, until the final diagnosis is clear. Therefore all pregnant women with upper abdomen pain irrespective of symptoms of preeclampsia should be considered to have HELLP syndrome and immediate laboratory evaluation has to be done. If there is any doubt a interdisciplinary consultation is required!

Abdomen, Acute↗