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W Rath

Publications and source records attributed to W Rath.

At least 145 records · Page 8Linked to original sources
PubMed1993

[Maternal and fetal morbidity and mortality in premature abruptio placentae--a retrospective analysis].

The frequency of abruptio placentae has nearly tripled in our clinic since 1974 and now stands at 1.4% of all deliveries. In a retrospective analysis it was investigated whether improved diagnostic and therapeutic methods have decreased the morbidity and mortality of this severe obstetrical complication. During 3 stages of observation--1974-1979, 1980-1985 and 1986-6/1990--we registered 123 cases. The division into time intervals was based on the introduction of sensitive ultrasonic methods in 1980 and the vaginal scan in 1986. Important risk factors of abruptio placentae were found to be bleeding in pregnancy (32%), previous curettages (38%), premature labour (29%), and pre-eclampsia (14%). The diagnostic sensitivity of sonography rose from 40% in the first to 78% in the third interval of observation. The rate of vaginal deliveries decreased from 15% to 2%. Simultaneously, the perinatal mortality decreased, despite increasing foetal prematurity, from 30% to 2%. The improvement in foetal outcome could be demonstrated by 1- and 5-minute Apgar score values. During the entire period, we lost one mother with abruptio placentae complicated by fulminant lung embolism intra operationem. The frequency of serious stages of abruptio placentae (Page 2-3) decreased from 69% to 33%. While 54% of the mothers developed shock (shock index > or = 1) during delivery in the first observation period, this figure was finally only 10.5%. At the same time the frequency of coagulation disorders decreased from 31% to 4%.

Abruptio Placentae↗
PubMed1993

[New oncologic therapeutic approaches with hematopoietic growth factors].

The haematopoietic growth factors interleukin-3 (IL-3), erythropoietin (EPO), granulocyte colony-stimulating factor (G-CSF, Neupogen) and granulocyte macrophage colony-stimulating factor (GM-CSF) are highly effective endogenous regulators of blood cell proliferation and differentiation. The results of initial clinical studies with these substances show a stimulation of haematopoiesis for numerous dysfunctions of the bone marrow, whereby the therapy of cytostatic-induced myelosuppression is of particular significance for the gynaecologist, specializing in oncology. After further experience with the individual substances, future development in this field will probably focus on the combined use of these growth factors, to stimulate all early developmental stages of haematopoiesis in the bone marrow and--in view of the line-specific effect--to achieve an effect on several lines of differentiation. Of the cytokines quoted, G-CSF (Neupogen) is so far the only growth factor, which is available for oncological indications. The approval of GM-CSF, IL-3 and EPO for oncological indications is pending. If the currently available results are confirmed by further clinical studies, it will be possible--over and above the improvement of cytostatic tolerance--to raise the current cytostatic doses limited by myelodepression, and to analyse, whether better oncological results can be achieved by more intensive chemotherapy, shorter application intervals, or by using previously impossible cytostatic combinations. The employment of haematopoietic growth factors could, in this way, lead to new oncological therapy concepts.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Effects of etomidate on the adrenocortical and metabolic adaptation of the neonate.

The effects of etomidate on corticosteroid synthesis were compared with those of methohexitone. We studied 40 neonates, 22 delivered by elective and 18 by emergency Caesarean section. Apgar scores, blood sugar and plasma concentrations of cortisol and etomidate were evaluated at birth and 2 and 6 h postpartum. There was no difference in Apgar scores attributable to the induction agent. The median cortisol concentrations in cord blood were small (136 nmol litre-1; range 47-478 nmol litre-1, and 259 nmol litre-1; range 58-1504 nmol litre-1 after elective and emergency sections, respectively). During the study, cortisol concentrations increased in the infants in the methohexitone groups and decreased in those in the etomidate groups; this effect was most evident 2 h after delivery (methohexitone groups 245 nmol litre-1, range 70-959 nmol litre-1; etomidate groups 121 nmol litre-1, range 56-320 nmol litre-1). There was no difference at 6 h postpartum (methohexitone groups 183 nmol litre-1, range 25-756 nmol litre-1; etomidate groups 190 nmol litre-1, range 33-628 nmol litre-1). The concentration changes during the study period differed significantly (P < 0.005) with respect to the induction agent. Blood glucose concentrations were small (mean (SD) in all 40 neonates 2 h postpartum was 2.64 (0.77) mmol litre-1), and did not differ between the groups. There were 17 cases of moderate to severe hypoglycaemia (blood glucose concentrations less than 2.5 mmol litre-1): nine in the etomidate group and eight in the methohexitone group.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Obstetrical↗
PubMed1993

Visualization of 125I-endothelin-1 binding sites in human placenta and umbilical vessels.

Endothelin-1 (ET-1) has potent vasoconstrictor effects and thus may be involved in regulating fetoplacental vascular resistance. By using quantitative in vitro autoradiography, the 125I-ET-1 binding sites in human placentas and umbilical vessels were localized and quantified. A high density of specific 125I-ET-1 binding sites was found in the placental villi and vessels. In the media of umbilical vessels, affinity for the peptide was higher in arteries than in veins. In all structures, 125I-ET-1 binding was inhibited with unlabeled ET-1 in the picomolar range. Unrelated peptides such as oxytocin or atrial natriuretic peptide failed to compete for 125I-ET-1 binding. The localization of binding sites points to a regulation of hemodynamic functions of ET-1 on the fetal side of the placental circulation and supports evidence regarding ET-1 as a paracrine-acting vasoconstrictor.

Binding Sites↗
PubMed1993

[Endothelin--possible significance in pregnancy and hypertensive pregnancy].

Endothelin (ET) is the most potent endogenous vasoconstrictory substance known. There are three structurally and pharmacologically separate endothelial isopeptides in humans; Endothelin-1 is exclusively produced in the vascular endothelium. It seems likely that ET acts as a local paracrine signal rather than a circulating hormone. The synthesis and release of ET is stimulated among others by hypoxia, thrombin and endotoxin. Its effects are mediated by specific, membrane-bound receptors, which are detectable in high concentrations in the fetoplacental tissue. ET-1 causes an initial transient fall in blood pressure, followed by a strong, long-lasting increase in peripheral resistance and blood pressure. Plasma ET-1 levels are increased in preeclampsia as compared to those of normal pregnancies, and do not correlate with mean arterial blood pressure and degree of proteinuria. In umbilical cord blood ET-1 concentrations are 2.5-10-fold higher than those of maternal plasma. Determination of plasma ET is unlikely to be of value in the prediction of the disease. ET-1 induces an increased synthesis of vasodilatory prostaglandins (PGI2, PGE2) and an increased production of endothelial-derived relaxing factor (EDRF); thromboxane concentrations in blood are elevated by thrombin-induced activation of platelets. In animal models ET-1 causes an activation of plasmatic coagulation with consecutive hypercoagulability. In preeclampsia ET may play an important role in the regulation of the endothelial balance. Future therapeutic approaches may include the development of effective ET-antibodies or of inhibitors of the endothelin-converting enzyme.

Disseminated Intravascular Coagulation↗
PubMed1993

Glycosaminoglycans in cervical connective tissue during pregnancy and parturition.

OBJECTIVE: To investigate the content and distribution patterns of glycosaminoglycans in the human cervix during pregnancy and parturition. METHODS: We obtained a total of 87 specimens from nonpregnant and pregnant women. Biopsies (weight 50-200 mg) were taken from the posterior lip of the cervix. Hyaluronic acid, dermatan sulfate, chondroitin sulfates, and heparan sulfate were separated on a Dowex 1 x 2 column and identified. RESULTS: The total amount of glycosaminoglycans increased during pregnancy from 2800 to 5000 nmol/g dry weight. The highest values were observed at the onset of labor (7100 nmol/g dry weight), followed by a sharp decrease during parturition. The clinical features of cervical ripening and dilatation were also associated with remarkable changes in glycosaminoglycan patterns. CONCLUSION: Besides collagenolysis during pregnancy, the glycosaminoglycans are also important regulators of cervical function. The different clinical features of the human cervix are characterized not only by variation in the total glycosaminoglycan content but also by changes in the proportions of the different glycosaminoglycans.

Cervix Uteri↗
PubMed1992

Origin of cervical collagenase during parturition.

Cervical biopsy specimens were obtained under standard conditions from the posterior lip of the uterine cervix in 105 patients. A significant increase of collagenase activity was observed during parturition as determined with an assay with iodine 125-labeled native triple-helical collagen type I as the substrate. The collagenase was not likely to originate from cervical fibroblasts because in situ hybridization failed to detect synthesis of the specific procollagenase messenger ribonucleic acid. However, migration of polymorphonuclear leukocytes into the cervical stroma occurred on onset of labor, and an antibody specific for human leukocyte collagenase that did not cross react with fibroblast collagenase revealed the presence of the enzyme in the granules of polymorphonuclear leukocytes and subsequently in the extracellular matrix of the cervix. Therefore it is likely that the cells critically involved in collagen degradation during cervical dilatation are not resident fibroblasts but rather polymorphonuclear leukocytes emigrating from blood vessels.

Blotting, Northern↗
PubMed1992

Haptoglobin as a sensitive marker of hemolysis in HELLP-syndrome.

In a prospective study we measured laboratory variables of hemolysis in 25 patients with HELLP-syndrome. Reduced haptoglobin levels were observed in all 25 patients at diagnosis. Elevated bilirubin and plasma hemoglobin levels were observed in 5/25 patients while an abnormal peripheral blood smear was found in 11/25 patients. Our results suggest that haptoglobin is a sensitive parameter for early detection of moderate hemolysis in HELLP-syndrome and should be included in laboratory screening to aid diagnosis.

Adult↗
PubMed1992

[Overexpression of c-erbB-2 oncogene in primary ovarian cancers: incidence and prognostic significance in 243 patients].

In ovarian cancers, no valuable prognostic factors are available so far for predicting biological behaviour and clinical outcome. During the last years, overexpression of c-erbB-2-oncogene has been reported to be a prognostic factor in various human carcinomas. Its prognostic value in ovarian cancer is still a matter of controversy. The records and histological specimens of 243 patients with primary ovarian cancer were reviewed. Overexpression of c-erbB-2-oncogene encoded transmembrane protein p185 was determined immunohistochemically using polyclonal and monoclonal antibodies. Of 243 investigated tumours, 45 (19%) were positive. We examined the relationship between p185 and clinical stage, histological type, grading and prognosis. p185 overexpression differs within the histological subtypes of tumours. No correlation was found between p185 overexpression and stage or histological grade. The follow-up data demonstrate that patients with positive staining for p185 have a significantly worse prognosis (p = 0.001) than those with negative staining. These results suggest that overexpression of c-erbB-2 oncogene is associated with higher biological aggressiveness and unfavourable course of disease.

Adenocarcinoma↗
PubMed1992

[The magnesium and calcium content of pre- and postmenopausal myometrium].

Magnesium and calcium, as well as sodium and potassium, have an important influence on the physiology of contraction of the uterus. The ionic concentrations in the pre- and postmenopausal myometrium were examined. We assumed, that there are differences in the electrolytic contents because of the different functions of the corpus, isthmic part and cervix uteri during pregnancy and throughout labour. Small tissue samples from 37 premenopausal and 20 postmenopausal patients, who underwent an operation with different indications, were dissected after hysterectomy. Magnesium and calcium levels were determined by atomic absorption spectrophotometry and potassium and sodium by emission spectrometry in the wet tissue. In both groups, we found significant differences of the electrolytic contents of the myometrium. In the premenopausal uteri, the magnesium levels decrease significantly (p < 0.001) from the corpus (mean = 4.14 mmol/kg) to the cervix (mean = 2.14 mmol/kg). The same scenario can be observed for the potassium levels (Corpus mean = 56.2 mmol/kg and cervix mean = 25.4 mmol/kg). In contrary, the calcium levels (Corpus mean = 1.60 mmol/kg and cervix mean = 2.26 mmol/kg) and sodium levels (Corpus mean = 69.3 mmol/kg and cervix mean = 93.0 mmol/kg) increase significantly (p < 0.001). In the postmenopausal group, we found slightly elevated concentrations of magnesium, sodium and potassium. Only the calcium content of the corpus uteri rises up to three times about 20 years after the menopause (from mean = 1.60 mmol/kg) (p < 0.001). The electrolytic contents in the myometrium were shown to be different in the corpus, isthmus and cervix uteri.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Paracrine actions of oxytocin, prostaglandin F2 alpha, and estradiol within the human corpus luteum.

Human luteal cells are known to interact in an auto- and paracrine fashion using a variety of substances, including prostaglandins (PGs), steroids, and peptides. In cultures of dispersed luteal cells obtained from several animal species prostaglandin F2 alpha (PGF2 alpha) and oxytocin (OXT) inhibit progesterone (P) secretion, indicating a luteolytic effect of these substances. The disadvantage of luteal cell cultures is that the different luteal cell types do not communicate with each other, i.e. auto- and paracrine effects cannot be studied. Therefore, we used a microdialysis tubing, which is implanted in human corpora lutea (CL) kept under short term organ culture conditions. Ringer's solution is pumped through the dialysis tubing, and substances secreted by the luteal tissue can be determined in the effluent fractions. This system also allows topical application of substances with putative intraluteal effects. In the present report we used PGF2 alpha, OXT, and estradiol (E2) to examine the effects of these substances on the respective other hormones and on P release from young human CL. Intraluteal application of PGF2 alpha stimulated OXT, E2, and P release. OXT was stimulatory to E2 and P secretion, an effect that can be blocked by a specific OXT antagonist and by tamoxifen. Elevation of intraluteal E2 concentrations also had marked stimulatory effects on P secretion. From luteal cell culture experiments it is known that PGF2 alpha and OXT have direct inhibitory effects on P production, but both substances stimulate E2 release. It was also shown that E2 counteracts the inhibitory effects on P release. Therefore, the PGF2 alpha- and OXT-induced E2 release may be responsible for the increased P release. This assumption is further substantiated by the observation that intraluteally applied E2 stimulates P secretion, and preexposure of human CL to tamoxifen prevents the OXT-induced stimulation of P, but not E2, secretion. We conclude that in young human CL, PGF2 alpha and OXT have dual effects: direct inhibitory effects on P release and E2-mediated stimulatory effects, which in young CL result in a net stimulation of P secretion.

Chorionic Gonadotropin↗
PubMed1992

[Results of postoperative radiotherapy with iridium-192 in patients with ovarian cancer].

While the surgical and chemotherapeutic therapy is an established procedure for the treatment of ovarian cancer, the role of radiotherapy is not quite clear. We investigated whether the recurrence rate concerning the vaginal cuff and pelvis in ovarian cancer patients can be reduced by postoperative irradiation with afterloading technique. In retrospective analysis 20 patients with ovarian cancer, stage I-IV, received radiological contact therapy with 192-Iridium 2 x 7.5 Gy in 0.5 cm tissue depth after surgical and chemotherapeutic treatment. A control group of 20 patients with similar oncological parameters was formed. In both groups a local recurrence occurred in 6 women, which was confirmed clinically, histologically and by diagnostic devices. After 2 years, 6 of the irradiated patients survived and 11 of the control group. The results show, that the irradiation of the vaginal cuff, as applied in endometrial carcinoma, will not reduce local recurrence rate of ovarian cancer.

Aged↗
PubMed1992

[Breast carcinoma in pregnancy. Clinical, histological and immunohistochemical findings].

The hormonally induced changes in the breast during pregnancy make the diagnosis of breast cancer difficult. Furthermore, examinations during pregnancy tend to concentrate only on the pregnancy itself. In this report the clinical, pathological and immunohistochemical results from 7 patients with breast cancer during pregnancy are presented. All women first noticed the tumor by self-examination. The time periods between discovery of the tumor and medical treatment were between 4 and 22 weeks. An overexpression of c-erbB-2-oncogene coded transmembrane protein p185 could be demonstrated in 4 cases. Of the seven patients, 5 have already passed away. Three of the deceased had p185-positive tumors, and died 4, 8 and 21 months after diagnosis. The two p185-negative patients lived 34 and 65 months post diagnosis. Despite the small amount of cases presented, a trend can be seen that p185 may be an additional prognostic factor for breast cancer in pregnancy.

Adult↗
PubMed1992

[HELLP syndrome].

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Asphyxia Neonatorum↗
PubMed1992

[The Hellp syndrome. Clinical and laboratory test results].

The Hellp syndrome is a complication of toxemia. It may occur before, during or after childbirth and may not be accompanied by any sign of toxemia. The main clinical sign is pain in the hepatic region. Haptoglobin is the most reliable parameter to demonstrate hemolysis, which is one of the disorders related to this syndrome. In the authors' opinion, early diagnosis and immediate delivery by Cesarean are the appropriate methods to use to reduce maternal and perinatal mortality. Conservative treatment is not generally effective and is dangerous.

Adolescent↗
PubMed1991

Collagenase activity in the human cervix uteri after prostaglandin E2 application during the first trimester.

Cervix biopsies were obtained during the first trimester from plurigravidae and primigravidae at various times after intracervical application of prostaglandin E2. The tissues were extracted with Ca(2+)-containing buffer, and collagenase activity was determined in these extracts using a solid phase assay in which triple helical 125I-labelled collagen was cleaved. Collagenase was detected in all samples but elevated activity was present only during a short temporal window after prostaglandin application. Maximal activity was observed 1 and 2 h after application of prostaglandin in multigravidae and 4 h in primigravidae. These data can explain why collagenase activity in cervical tissues after prostaglandin application had previously not been found. They indicate somewhat different mechanisms of cervical ripening in primigravide compared to multigravidae.

Cervix Uteri↗