Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 127 records · Page 7Linked to original sources

PubMed1994

[Sialidase activity in cervical connective tissue during cervix maturation and dilatation during labor].

The authors obtained small pieces of materials from portio vaginalis uteri of 122 women being in postmenopause and premenopause, in different stages of pregnancy and parturition concerning directly after delivery. Different biochemical investigations of these 30-200 mgs specimens were performed to study the physiological background of its ripening process. They examined the changes in activity of sialidase which cleaves terminal sialic acids. The authors performed these investigations with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. The evaluation of the lectin linkage happened with fluorescence microscope. They evaluated the whole fluorescence of extracellular matrix but separately of different extracellular matrix elements as well. From their investigations was stated that the number of WGA and LPA binding sites of the uterine cervix increases predominantly in the 1st trimester pregnancy compared to the non-pregnant state. As compared to the 1st trimester they described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA and WGA binding sites in the extracellular matrix were observed during parturition. These results coincide with the authors' previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play a recently yet not cleared role in the ripening of the human uterine cervix during pregnancy and in dilatation at the time of parturition.

Adult↗

PubMed1994

Elevated serum levels of a c-erbB-2 oncogene product in ovarian cancer patients and in pregnancy.

Amplification of the proto-oncogene c-erbB-2 (HER-2/neu) has been shown to be a prognostic marker in ovarian cancer. In order to obtain further information on the biological role of the c-erbB-2 gene product p185 it is necessary to quantify expression levels. In this study we evaluated an enzyme-linked immunosorbent assay (ELISA) for the extracellular domain of p185 to determine whether a soluble oncoprotein fragment can be detected in the serum of ovarian cancer patients and in the serum of pregnant women. Sera from 199 women (57 previously untreated ovarian cancer patients, 62 pregnant women and 80 healthy controls) were assayed in a sandwich ELISA utilizing two mouse monoclonal antibodies. To study c-erbB-2 overexpression in ovarian cancer tissue samples we have used an immunohistochemical technique involving a monoclonal antibody specifically reactive with the external domain of the protein p185. The mean serum value for the normal controls was 1203 HNU/ml with a standard deviation (SD) of 279 HNU/ml and a range of 595-1947 HNU/ml. We chose a level of 1761 HNU/ml (2 SD above the mean) as a cut-off to distinguish individuals with elevated levels. The ovarian cancer patients' serum values ranged from 526 to 16,332 HNU/ml. Immunohistochemically detectable p185 was noted in 8 of 57 ovarian cancer patients. The oncoprotein fragment levels in the sera from these 8 patients ranged from 878 to 16,332 HNU/ml. Of 8 patients with p185 overexpression in their tumors, 4 had elevated serum levels. In the sera from the 49 cancer patients without overexpression the values were distributed in the range 526-2892 HNU/ml. There was no association between serum oncoprotein fragment levels and tumor stage, histological type or grading. Serum concentrations of the p185 fragment in pregnancy ranged from 612 to 3265 HNU/ml. The highest levels were found in the third trimester. The results of the present study raise the possibility that the soluble c-erbB-2 protein level in serum is an indicator for cell proliferation and therefore deserves further evaluation as a diagnostic tool in ovarian cancer patients and pregnancy.

Adult↗

PubMed1994

Serum collagenase levels during pregnancy and parturition.

Recent studies have described the origin of the collagenase responsible for the degradation and loss of collagen during cervical ripening and dilatation to be polymorphonuclear leukocytes. In the present study the clinical feature of cervical dilatation was correlated to the serum levels of human granulocyte collagenase. The serum collagenase level was measured in 19 premenopausal women and in 181 pregnant women. In 15 of these pregnant women serum samples were obtained from the onset of labour to the active phase of labour at four different times. The collagenase concentrations remained low up to the 35th week of gestation (19.4 ng/ml) in comparison with the beginning of pregnancy. From the 35th week of gestation on we found a slight increase in collagenase in maternal serum. The maximum peak was reached during parturition at a cervical dilatation of 6-8 cm (71.2 ng/ml). The serum levels returned to non-pregnant values the first day following delivery. The results show that collagenases are critically involved in parturition.

Collagenases↗

PubMed1994

[When may, should, must the ovary by removed--with which technique?].

The growing demand for minimally invasive operative processes and the unmistakable progress in pelviscopy, have led to an extension of the indications for minimally invasive surgery. At the same time, the operative treatment of ovarian cysts is the third most frequently performed pelviscopic operation. The indication for ovarectomy depends, above all, on anamnestic factors, the clinical findings and the results of pre-operative vaginal sonography. In the event of inadequate hormone secretion by the ovaries, the indication for organ removal should be generously applied. Vaginal sonography is not capable of proving or excluding the existence of a malignancy with 100% certainty. The average rate of ovarian carcinomas is 2.6% in case of smooth-walled, unicamerate cysts. Pelviscopy is also unable to differentiate reliably between benign and malignant ovarian tumours. With the aid of pelviscopic operative processes, a cystic ovarian tumour cannot be extirpated in toto with the necessary certainty. In spite of the conflicting results in the literature, an iatrogenic rupture of an early ovarian carcinoma can be expected to result in worsening the prognosis. The Department of Obstet. Gynecol. University of Göttingen, adopted the following procedure: 1. A (mini-) laparotomy with immediate section for microscopic examination is always performed on sonographically suspect ovarian tumours. 2. On smooth-walled unicamerate ovarian tumours > or = 3 cm which persist or fail to respond to treatment with oral contraceptives, (mini-) laparotomy is performed with complete extirpation of the cystic ovarian tumour and immediate section for microscopic examination; a conceivable alternative is, if possible, total pelviscopic extirpation of the ovarian cyst with immediate section for microscopic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗

PubMed1994

[Termination of pregnancy in the 2nd trimester by serial administration of gemeprost vaginal suppositories. A prospective study (corrected)].

In a prospective study termination of pregnancy was performed between the 16th and 24th week of gestation by serial applications of a 1 mg gemeprost containing vaginal pessary at 6h intervals. The reasons for termination were medical and fetal indications in 20 cases and missed abortion in 14 cases. The median induction to abortion interval was 17.4 hours (range: 3.7 - 73.0h) in the therapeutic abortion group, and a median of 3 applications were necessary to terminate pregnancy. In cases of missed abortion the median induction to abortion intervals was 11.0h (range: 3.5 - 32.5h) with a median of 2 necessary applications. Expulsion of the fetus occurred in 31 out of 34 patients (91.2%) within 24 hours. Spontaneous or surgically induced cervical lesions and blood loss > 500 ml were not observed, systemic prostaglandin-induced side effects were documented in 7 cases (20.6%). Epidural anesthetic gave a painless induction of abortion in all of patients. Our experience has shown that serial application of gemeprost vaginal pessaries is a feasible and efficient method for termination of second trimester pregnancies.

Abortifacient Agents, Nonsteroidal↗

PubMed1994

[Gemeprost vaginal suppositories versus intracervical sulprostone gel administration for cervic priming in the 1st trimester. A tonometric controlled comparative study].

In a prospective, randomised study, 40 primi- and plurigravida were treated either intracervically with 50 micrograms Sulprostone gel or vaginally with a pessary containing 1 mg Gemeprost in order to soften the cervix prior to first trimester termination of pregnancy. Curettage was performed on average 6.0 and 3.2 hours, respectively, after prostaglandin administration. 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 treatment and before operation. The free passability of the cervical canal, the maximal dilatability with a force of 10 N and the increase in dilatability after local prostaglandin application were measured. A modified visual analogue scale was used to evaluate the subjective pain experience. During the time between administration and curettage, no abortion occurred in any of the patients. There were no statistically significant differences between both groups regarding the free passability and the maximal dilatability, however, the increase in dilatability was significantly greater in the Gemeprost group. The visual analogue scale allows the patient to quantify, at least to some extent, her experience of pain, but there were no differences in the rate of uterine cramps between both groups; gastrointestinal symptoms did not occur. Both methods were found to be equally efficient; the advantages of Gemeprost are the ease of administration and the short application-curettage interval; however, the cost for one Gemeprost application is nearly 6-fold higher than that of one Sulprostone gel application.

Abortifacient Agents, Nonsteroidal↗

PubMed1994

[Taxol--a new cytostatic drug for therapy of ovarian and breast cancer].

Taxol is a cytostatic agent of plant origin with a complex structure and a special mode of action. Owing to the small content of this substance in the bark of the Pacific yew, from which Taxol is derived, it has only been available on a limited scale. Hitherto, Taxol's chemical structure has precluded the synthesis of large quantities of this cytostatic agent. Analogue substances can be obtained from the needles of the yew, although more efficient methods are needed for the manufacture of this medicine on a commercial scale. The present paper summarises the results of preclinical and clinical studies of patients suffering from ovarian and breast cancer. In phase I studies, it was possible to delineate the side effect profile of Taxol, neutropenia being dose-limiting in most investigations. The efficacy of Taxol on patients with ovarian cancer was initially demonstrated in phase I studies. These results led to phase II studies, in which response rates of 20-36% were obtained on patients with relapsing or therapy-refractory ovarian carcinomas. In phase III studies, the efficacy of Taxol combined with cisplatinum is currently being compared with the classical regimen of cisplatinum/cyclophosphamide. Further studies are under way testing Taxol in combination with G-CSF and cisplatinum. As a supplement to intravenous Taxol therapy, initial experience with intraperitoneal Taxol treatment is now available. Taxol's cytostatic efficacy has also been confirmed in the treatment of patients suffering from metastatic breast cancer with remission rates of 56-62%. Taxol is an important new cytostatic agent for the treatment of ovarian and breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗

PubMed1994

Overexpression of the oncogene c-erb B2 in primary ovarian cancer: evaluation of the prognostic value in a Cox proportional hazards multiple regression.

To date, there are no prognostic factors in ovarian cancer that adequately account for tumor biology and disease behavior. In recent years, some reports have described the prognostic significance of the amplification and overexpression of the oncogene c-erb B2 in various human cancers. Concerning ovarian cancer, this is still a matter of discussion. In the present study, tumor tissue of 275 patients treated for ovarian cancer at the Department of Obstetrics and Gynecology of the University of Göttingen between 1982 and 1992 was immunohistochemically analyzed for overexpression of c-erb B2-encoded transmembrane protein p185. In 19% (51 of 275 cases), p185 overexpression was detected. The percentage of p185-positive cases varied from 7 to 46% according to histological subtype. Correlation with tumor stage and the degree of histological differentiation was not observed. Patients with p185-positive tumors had a significantly worse prognosis (p = 0.001); median survival was 20 months compared with 33 months for p185-negative tumors. In the Cox proportional hazards regression, p185 overexpression was identified as an independent prognostically relevant factor. These results suggest that overexpression of oncogene c-erb B2 in ovarian cancer characterizes a group with unfavorable tumor biology and a significantly worse prognosis.

ErbB Receptors↗

PubMed1994

Efficacy and safety of a 2-tier prostaglandin labor induction schedule.

OBJECTIVES: To determine the efficacy and safety of a 2-tier, Bishop score-driven induction schedule using gel and tablet formulations of PGE2 to establish new monitoring guidelines. DESIGN: Prospective descriptive study. SETTING: eight Germany University obstetric departments. SUBJECTS: 467 high risk patients. INTERVENTIONS: Bishop score < 5: intracervical 0.5 mg PGE2 gel; Bishop score 5-7: intravaginal 3 mg PGE2 tablet. MAIN OUTCOME MEASURES: Uterine hyperstimulation: > 5 contractions/min, contraction duration > 2 min and emergency tocolytic therapy; perinatal outcome: secondary caesarean section rate, operative vaginal delivery and fetal acidosis. RESULTS: PGE2 induction resulted in spontaneous delivery in 76.9% (6.4% fetal acidosis) and 14.1% secondary c. section. The gel was associated with more adverse uterine effects and a poorer fetal outcome than the tablet. Adverse uterine events increased significantly on repeat dosing with the gel (39.5 vs 29.3%), but not the tablet: they also increased with a dosing interval < 8 h with either formulation. Overall, adverse uterine events were fewer and perinatal outcome better in multiparae than in nulliparae. CONCLUSIONS: The higher adverse uterine event rate with the gel should be viewed against the backdrop of the low Bishop score. The interval between repeat dosing should not be less than 8 h after PGE2 gel treatment. Primigravidae must be monitored with special care following labour induction with PGE2.

Dinoprostone↗

PubMed1994

[Pathologic appendix findings in gynecologic operations].

We report our experiences on three cases with pathologic findings of the appendix vermiformis diagnosed during gynecological operations including mucocele, carcinoid and adenocarcinoma. Mucocele of the appendix is a descriptive term for an abnormal mucous accumulation distending the appendiceal lumen, which can be complicated by pseudomyxoma peritonei. Carcinoid tumours arise from the neuroendocrine system and present a characteristic morphologic picture. Predilicted sites are the appendix and the small bowel. Adenocarcinomas of the appendix that are not associated with mucoceles have a clinical course resembling large bowel cancer. Patients with pathological findings of the appendix may be asymptomatic or present with a palpable right lower quadrant mass and/or pain. We discuss differential diagnosis and present a spectrum of histologic findings.

Adult↗

PubMed1994

[Labor induction with prostaglandin in post-cesarean section status].

60 pregnant women with previous cesarean section and induction of labour with prostaglandins (PGE2) in the following pregnancy were compared to a collective of 1412 patients with PGE2 induction without any previous uterine surgery, and to a collective of 82 patients with previous cesarean section, but an uncomplicated course of pregnancy and therefore no indication for an induction of labour. Uterine hyperstimulation was more frequent in both collectives with previous cesarean section than in the collective without that risk. In the case of previous cesarean section induction of labour with prostaglandins did not lead to an increased number of uterine ruptures compared to cases with a previous cesarean section. Therefore the induction of labour itself in the case of a previous cesarean section doesn't lead to an increased maternal risk during delivery. Uterine hyperstimulation being rare, the increased number of fetal acidosis and vaginal-operative delivery in the group with previous cesarean section and consecutive PGE2 induction of labour seems to originate rather from the risk which was the indication for labour induction than from the PGE2 application itself. The information of a patient with previous cesarean section and planed induction of labour with PGE2 should therefore put the stress in the necessity of an intensive surveillance during delivery because of the basic risk "previous cesarean section" and the secondary risk resulting from the induction of labour.

Acidosis, Respiratory↗

PubMed1994

[Prevention of thromboembolism with low molecular weight heparin (Fragmin) in obstetrics].

A total of 130 obstetrical patients were treated with either low molecular weight (LMW) or unfractionated (UFH) heparin as part of prospective study comparing their efficacy in the prevention of thromboembolism. A single daily dose of 2500-5000 anti-Xa-units LMW heparin (Fragmin) or two to three daily doses of 5000 IU UFH (Liquemin) were given to two groups of 15 patients with therapeutic tocolysis and 50 patients with cesarean section. Patients with cesarean section were given 500 ml Dextran 60 i.v. during surgery followed by subcutaneous injection of heparin eight to ten hours after surgery. Heparin therapy was continued for ten days after surgery. None of the patients exhibited clinical signs of thrombosis. The majority of patients showed symptoms of local irritation at the site of heparin injection (69% of patients with LMW heparin; 80% of patients with UFH). Hematomas at the site of injection were significantly smaller when LMW heparin was used instead of UFH. A number of patients experienced headache after heparin application (10% of patients with LMW heparin; 13% of patients with UFH). There were no cases of post surgical haemorrhage. Comparison of daily profiles revealed a significantly higher anti-Xa-activity of LMW heparin compared to UFH. In contrast, other coagulation parameters were not different in the two experimental groups (antithrombin III, partial thrombin time, thrombin time). Hematologic parameters and liver enzymes were in the physiological range in both experimental groups and none of the patients exhibited signs of heparin induced thrombocytopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

[Labor induction with prostaglandin E2 in post-term pregnancy-- results of a multicenter study].

Post-term pregnancy has been the indication for induction of delivery in 542 patients from a multicenter study with 1472 patients undergoing induction with prostaglandin E2 given as vaginal tablet (3 mg) or as intracervical gel (0.5 mg), according to cervical ripeness. The obstetric characteristics of these 542 patients were compared to the data of the Baden-Wuerttemberg obstetrical trial as controls. Although cervical ripeness parameters differed significantly from those of the controls, birth intervals were significantly shorter in the study group. Fetal outcome parameters (umbilical artery pH, Apgar values, frequency of admission to pediatric ward) turned out to be more favorable in the study group. Frequency of operative vaginal deliveries (12.7%) and of Cesarean sections (15.5%) was significantly higher in the study group as compared to the reference group (operative vaginal deliveries 8.1%, secondary Cesarean sections 7.3%). If we relate these frequencies to data from prospective, randomized studies comparing active management of post-term pregnancies, it can be demonstrated that active management in general is associated with lower frequencies of operative deliveries. Additionally, the data from our study with active management of post-term pregnancy revealed even lower frequencies for operative deliveries as seen from actively managed post-term deliveries in the literature reviewed. Hence, the induction protocol adapted to cervical ripeness reported in this study is an efficient and safe management for post-term pregnancy minimizing the rate of operative deliveries.

Administration, Intravaginal↗

PubMed1994

Changes in binding capacity of sialic acid-specific lectins in the connective tissue of the uterine cervix during its physiological maturation.

The authors obtained small pieces of materials from portio vaginalis uteri of women being in postmenopause and premenopause, in different stages of pregnancy and parturition respectively after delivery. Biochemical investigations of these specimens were performed to study the background of physiological ripening of the uterine cervix. They examined the changes in activity of sialidase which cleaves terminal sialic acids. Investigations were performed with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. These lectins bind specifically to the sialic acids. The evaluation of the lectin linkage was carried out with fluorescence microscope. Separately was evaluated the fluorescence of different extracellular matrix elements concerning the whole fluorescence of connective tissue as well. It was stated that the number of WGA- and LPA-binding sites of the uterine cervix compared to the non-pregnant state increases predominantly in the 1st trimester pregnancy. In relation to the 1st trimester we described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA- and WGA-binding sites we observed during parturition in the extracellular matrix. These results coincide with the author's previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play certain role in human uterine cervix during the gestational process. Their role at the time of pregnancy and delivery however remains to be cleared.

Cervix Uteri↗

PubMed1994

[HELLP syndrome].

The HELLP syndrome is a severe and life-threatening complication of preeclampsia with typical laboratory findings. The frequency of the disease is 1 to 150-300 live births in perinatal centers. The median gestational age at presentation is 34 weeks, however, the disease may also develop during the early postpartum period. Right upper quadrant pain is the most striking clinical symptom; in up to 15% of cases neither hypertension nor proteinuria is present on admission. For the detection of hemolysis determination of haptoglobin levels is the most suitable method. Coagulation disorders are more pronounced in patients with the HELLP syndrome as compared to those with preeclampsia without the HELLP constellation, however the full-blown syndrome of disseminated intravascular coagulation (DIC) is not a leading symptom but the consequence of delayed diagnosis and/or therapy of the primary disease. The course of the HELLP syndrome is unpredictable. On the one hand, complete reversal of symptoms under conservative treatment have been reported in individual cases, on the other hand, rapid, therapy-resistant deterioration of the disease had been observed in the majority of patients accompanied by severe complications (e.g. liver rupture). As a consequence the mother and the newborn need intensive care, and these women should be delivered in an obstetric intensive care unit. The maternal mortality reported from the international literature is 3.3%, and the perinatal mortality 22.6%.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗

PubMed1993

The relationship between urinary Tamm-Horsfall glycoprotein excretion and urinary activity of glycosidases in normal pregnancy and pre-eclampsia.

Electrophoretic analyses of the urinary proteins of pre-eclamptic patients revealed a decrease in the staining intensity of the protein band representing the Tamm-Horsfall glycoprotein (THP). In the present study the quantitative analysis of the THP excretion rate and the urinary activity of THP oligosaccharide metabolizing glycosidases were investigated. The median THP excretion rate of non-pregnant women (n = 24) was 20 mg/g creatinine (crea.). An increase in the THP excretion rate was seen in pregnancy to a level between 43 mg/g crea. (II. trimester) and 32 mg/g crea. (III. trimester) (n = 29). Hypertension in pregnancy was associated with a decrease in the THP excretion rate to 9 mg/g crea. (n = 85). Post partum, a transient elevated THP excretion rate up to 109 mg/g crea was recorded in the group of hypertensive patients. The urinary activities of the lysosomal beta-mannosidase, alpha-fucosidase, alpha-mannosidase (pH 4.5) and beta-galactosidase increased in normal pregnancy. This effect was most pronounced in the beta-galactosidase activity which increased from 50 U/mg crea. before pregnancy to 280 U/mg crea. at term. Hypertension in pregnancy was associated with a further increase in the activities of the lysosomal glycosidases. In the case of the beta-galactosidase a significant rise from 68 to 310 U/mg crea. was found. The urinary activity of the alpha-mannosidase (pH 5.5) originating from the Golgi apparatus was only elevated in patients with severe pre-eclampsia. Casuistic post partum recordings demonstrated that an elevation of the lysosomal glycosidases activities was followed by a transient increase in the THP excretion rate.

Adult↗

PubMed1993

Biochemical changes in human cervical connective tissue after intracervical application of prostaglandin E2.

Cervical biopsies were taken during the first trimester from primigravidae and plurigravidae at different time points after intracervical application of prostaglandin E2-gel. Collagenase activity was determined by a highly specific technique using native, triple helical collagen as substrate. Elastase-alpha 1-proteinase-inhibitor complex (elastase) was measured by a commercially available assay, and glycosaminoglycan (GAG) analyses were performed as described by Greiling et al. (5, 6). The maximum activity of collagenase was found 2 hours after PGE2 application in plurigravidae and 4 hours after application in primigravidae. Elastase activity rose nearly 7-fold to maximum values 4 hours after PGE2 application. The total GAG concentrations and the dermatan sulfate concentrations increased by approximately 10%, while the hyaluronic acid concentrations were found to be elevated significantly by nearly 50% in the PGE2-primed cervices. We conclude that a time-dependent enzymatic collagen degradation by collagenases and other proteinases and an increase in hyaluronic acid concentrations are the significant biochemical events underlying PG-induced cervical ripening.

Abortion, Induced↗

PubMed1993

[Laparoscopy-assisted vaginal hysterectomy with the Endo GIA 30].

The improvements in laparoscopic techniques have led to the development of laparoscopic assisted hysterectomy. We report on our experience since 1991 with this method on 30 patients using a Multifire Endo GIA 30. After cutting the upper ligaments and the uterine vessels, the uterus was removed through the vagina. To avoid urological complications, the distance between the ureter and the uterus was determined preoperatively by a combined sonographical-radiological procedure. To be absolutely safe from ureter lesions, it is recommended to use an illuminated ureter catheter. Laparoscopic hysterectomy should be used in selected cases only. In a critical indication situation with this technique, it is possible to avoid abdominal hysterectomy without loss of safety because of the excellent intraabdominal view, similar to laparotomy. There were no major complications with this procedure, except one ureter lesion, which was recognised intraoperatively. All patients remained in the hospital for only four days after the operation.

Adult↗