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Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 163 records · Page 9Linked to original sources
PubMed1991

[Gas embolism with cardiac arrest during hysteroscopy. A case report on 3 patients].

Hysteroscopy and laparoscopy are relatively non-invasive methods routinely employed in the investigation of infertility. The danger of air embolism during these procedures was recognized early, and carbon dioxide was substituted for air since it is more readily soluble in blood. In this report we describe 3 cases of circulatory collapse and cardiac arrest in healthy young women during routine hysteroscopy (out of a total of 62 patients during the period 1989-1990) which were most probably caused by massive carbon dioxide embolism. Premedication was with oral diazepam 10 mg. Anesthesia was induced with 0.1 mg fentanyl, 2.5 mg droperidol and 100 mg methohexital (100 mg propofol in one case). Intubation was facilitated with 2 mg pancuronium and 50-100mg succinylcholine. Anesthesia was maintained with nitrous oxide 66% and halothane. Ventilation was controlled with a tidal volume of 10 ml per kilogram body weight at a rate of 10 per minute. Monitoring included ECG, automated non-invasive blood pressure, capnometry, pulse oximetry and body temperature. Anesthesia was uneventful prior to insufflation. In each case the signs and symptoms began approximately 5-8 minutes after the start of insufflation and consisted of an initial tachycardia rapidly followed by ventricular dysrhythmias, bradycardia and cardiac arrest. The end-tidal CO2 decreased during the tachycardic phase and prior to asystole. The patients were cyanotic with engorged jugular veins. Resuscitation with closed chest heart massage and intravenous epinephrine or orciprenaline was successful in every case. The typical "mill wheel phenomenon" of gas embolism was audible on auscultation after heart activity had returned, but disappeared after about 5 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Pregnancy termination in the 2d and 3d trimester with prostaglandins depending on the cervix status].

Termination of pregnancy was performed in a standardized, on the cervical state depending manner in 48 patients with abortion between the 16th and 27th week of gestation and in 20 women with intrauterine fetal death (IUFD) between the 28th and 41st week of gestation. At a Bishop-Score (B.S.) less than 7 cervical ripening was induced by intracervical application of 0.1 mg sulprostone gel. In patients with a very unripe cervix (B.S. less than or equal to 3) local applications of prostaglandin gel were repeated at 6 hours intervals until a B.S. greater than or equal to 5 had been achieved. For induction of labour 0.5 mg sulproston was injected intramuscularly after at least one sulproston gel application in a range between B.S. greater than or equal to 5 to 7. At a B.S. 7 intravenous infusion of oxytocin was administered, if necessary, for augmentation of labour. Most of the patients received epidural anaesthesia before induction of labour. The time interval between the beginning of the procedure and expulsion of the fetus ranged from 6.5 to 49.5 hours (mean = 26.3 h) in the abortion group and from 2.0 to 46.0 hours (mean = 20.0 h) in the IUFD group. The median interval between induction of labour and abortion/delivery was 4.3 hours (range: 0.5-27.0), and 5.5 hours (range: 0.7-9.3 h) respectively. No surgical interventions were necessary in any of the patients, and no cervical lesions occurred. Undesired systemic side effects to prostaglandins were observed in only 4 out of the 68 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortifacient Agents, Nonsteroidal↗
PubMed1991

[Importance of 24-hour blood pressure monitoring in secondary hypertension].

A typical diurnal variation in blood pressure is observed in patients with essential hypertension. Attenuation or lack of circadian periodicity might be expected in patients with secondary hypertension. Therefore, non invasive ambulatory blood-pressure monitoring was performed in 172 patients with secondary hypertension and in 201 patients with essential hypertension. The following patients with secondary hypertension were investigated: renoparenchymatous nephropathy (n = 29), diabetic nephropathy (n = 24), morbus Conn (n = 6), renal artery stenosis (n = 32), pheochromocytoma (n = 5), hemodialysis patients (n = 30), and patients after kidney transplantation (n = 44). In addition, 36 pregnant women (17 normotensives, 19 hypertensives) were studied. 98.5% of patients with essential hypertension showed a nightly decline in blood pressure of at least 15 mmHg (systolic + diastolic), whereas 70% of patients with secondary hypertension showed either an attenuated circadian rhythm or no circadian rhythm. Patients with pheochromocytoma who had a nighttime increase in blood pressure demonstrated the greatest difference in the essential hypertension collective, followed by patients with diabetic nephropathy and patients after kidney transplantation. After successful treatment of the condition leading to hypertension, circadian periodicity returned in some patients. In summary, these results suggest that the absence of a nighttime decline in blood pressure during 24-h-ambulatory monitoring is an indication of secondary hypertension, which should be further investigated. As a practical consequence, antihypertensive drugs should also be applied in an evening dose in secondary hypertensives. Noninvasive ambulatory blood-pressure monitoring is recommended for treatment control, especially in patients who need an efficient blood-pressure control.

Adrenal Gland Neoplasms↗
PubMed1990

[24-hour blood pressure measurement in normal pregnancy in hypertensive pregnant patients].

Noninvasive 24-hour ambulatory blood pressure monitoring was performed in 17 normotensive and 19 preeclamptic pregnant women. The normotensive women showed a significant nightly decline in their systolic and diastolic blood pressure. In contrast, the preeclamptic women demonstrated either an attenuated circadian rhythm or no circadian rhythm at all. This result was even more pronounced in patients with severe hypertension, some of whom had a nocturnal increase in blood pressure in spite of being treated with antihypertensive drugs in an evening dose. The lack of nocturnal blood pressure decrease was also found 24 hours post partum. In summary, these results suggest that preeclamptic women are endangered by hypertensive emergencies mostly during the night. Therefore blood pressure controls should be extended into the night, and antihypertensive drugs should also be given in a sufficient evening dose.

Blood Pressure↗
PubMed1990

Collagenase activity in the cervix of non-pregnant and pregnant women.

Cervical biopsies were obtained from non pregnant patients and from pregnant at various stages of gestation and during labour. The tissues were extract with a Ca(++)-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 significantly elevated activity was only present in labour at 6-8 cm cervical dilatation. This provides direct evidence for the crucial role of specific collagen degradation during cervical ripening and dilatation.

Abortion, Induced↗
PubMed1990

Vaginosonographic detection of endometrial cancer in postmenopausal women.

In a prospective study 155 postmenopausal women not on hormone treatment underwent a vaginal ultrasound investigation. All women were routine patients of the regular ambulance. In addition to uterus biometry, the endometrial thickness was also measured. An endometrium of greater than or equal to 4 mm thickness was clarified histologically by means of a curettage. In total we found 7 endometrial cancers and 1 cervical cancer. Vaginal sonography proved to be a very sensitive (81%) and specific (89%) method for the detection of endometrial neoplasia.

Aged↗
PubMed1990

[Clinical management of cystic ovarian tumors].

In a prospective study at the University of Göttingen 206 cystic ovarian tumours were examined vaginosonographically. Basing on a graduated schedule, the individual therapy of each ovarian tumour was determined. By use of this clinical management, all blastomas could be detected correctly and in 6.8% of all cases a follicle or corpus luteum cyst was operated per laparotomiam. Basing on the created data, the authors suggest a simple and effective clinical management of cystic ovarian tumours.

Adolescent↗
PubMed1990

[The value of preoperative diagnosis before second-look laparotomy in ovarian cancer].

In a retrospective analysis, the diagnostic validity of computed tomography (CT), sonography (US), CA 125 and CEA serum levels in the detection of tumor-masses were evaluated in 135 patients with primary ovarian cancer. A second-look-laparotomy followed in each patient and the surgical-pathological findings were correlated to preoperative results. Sensitivity, specificity, positive and negative predictive value of the different methods were as follows: CT (n = 102) 70%, 65%, 68%, 67%, US (n = 97) 52%, 94%, 94%, 49%, CA 125 serum levels (n = 76) 55%, 100%, 100%, 58%, CEA serum levels (n = 40) 15%, 86%, 67%, 35%. CT, US and CA 125-serum levels appear to be suitable for routine control in ovarian cancer, but cannot replace the diagnostic value of a second-look-laparotomy.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

[Principles of physiologic and drug-induced cervix ripening--recent morphologic and biochemical findings].

Maturation of the cervix during pregnancy is an essential pre-requisite for an uncomplicated delivery at term. Physiological cervical ripening is characterised by a diffuse loosening of the collagenous connective tissue with widely scattered collagen fibrils and an increased amount of extracellular ground substance. These morphological changes are similar to those after prostaglandin (PG)-pre-treatment of the cervix. The local application of PG leads to a marked mulifocal loosening of the collagen fibre bundles with "activated" fibroblasts, characterised by a fine granular loosening of the cytoplasm, vacuolised enlarged mitochondria and an increased number of cytoplasmatic vesicles close to the cell surface. In the course of pregnancy the volume of the cervix increases by a significant rise in synthesis of collagen, protein, glycosaminoglycan and fibronectin. The change in consistency during late pregnancy corresponds to a significant decrease in dermatan sulphate coninciding with a marked increase in hyaluronic acid concentration associated with increased water uptake. Contrary to the already published literature, enzymatic collagen degradation does not play an important role in physiological cervical maturation. The action of catabolic enzymes (collagenases, glycosidases), liberated from polymorphonuclear leukocytes invading the extracellular matrix, is responsible for the rapid dilatation of the cervix at parturition. This process is limited by the immediate postpartum insudation of the cervix by plasma containing highly potent proteinase inhibitors (e.g. alpha 2-macroglobulin). PG-induced cervical ripening is associated with a time-limited enzymatic collagen degradation, an increased synthesis of non-collagenous proteins and a significant increase in hyaluronic acid concentration. Our basic biochemical findings in cervical ripening and dilatation during parturition may greatly contribute to the development of new concepts in the causal treatment of cervical pathology during pregnancy.

Cervix Uteri↗
PubMed1990

[CA-125 serum level in early pregnancy follow hMG/hCG stimulated and unstimulated cycles].

The CA-125-antigen could not only be identified in the epithelium of serous ovarian carcinoma, but also in the regular surface epithelium of the endometrium, the decidua and the peritoneum. The aim of this study was, to examine the pattern of CA-125 in the serum of women at early stages of pregnancy, after hMG/hCG-stimulation and subsequent insemination, IVF or GIFT. In particular, it was differentiated between simple or twin pregnancies, ovarian hyperstimulation syndrome and mole pregnancies. 16 patients, who spontaneously became pregnant after cyclus-monitoring, served as a control group. Among the total of 77 patients, 16 women with single pregnancies without stimulation showed an increase of CA-125 values to maximum amounts of 42.9 +/- 18.8 U/ml in the 8th week. 21 patients with single pregnancies after hMG/hCG-treatment and IVF, exhibited maximums of 97.5 +/- 66.8 U/ml in the 6th week, in cases of twins (n = 10) of 216.8 +/- 85.1 U/ml in the 7th week. Considering the group with the hMG/hCG-stimulation and following insemination (n = 20), maximum values of 91.4 +/- 57.3 U/ml were found in the 6th week, just as in the IVF-group. In cases of ovarian hyperstimulation syndrome (n = 5) as well as in such of a mole pregnancy (n = 5), drastically elevated values of 9519 and 1496 U/ml respectively, have been demonstrated. The decidua is regarded as a presumable source of high antigen levels in normal pregnancy, while the peritoneum is assumed to be such as for the ovarian hyperstimulation syndrome. Concerning mole pregnancy, the antigen levels could possibly emerge from the amniotic fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers, Tumor↗
PubMed1990

[Vaginal ultrasound as a screening method for detection of adnexa tumors in postmenopause?].

424 ovaries of 212 postmenopausal women not on hormone treatment were examined by vaginal ultrasound. 155 patients had no clinical complaints, 57 patients showed atypical uterine bleeding. 48 pathological findings could be detected sonographically (11.3%). Among the histologically clarified cases were 2 asymptomatic ovarian cancers. Altogether, the vaginosonography proved to be a very simple and effective method to detect ovarian tumors in postmenopausal women.

Aged↗
PubMed1990

A randomized double blind study of a new ready-for use prostaglandin gel (Org 2436) for cervical ripening prior to first trimester pregnancy termination.

In a placebo-controlled double-blind randomized study involving 50 primigravidae scheduled for termination of first trimester pregnancy 500 micrograms PGE2 gel or placebo gel were applied intracervically 6 hours before curettage. The priming effect was verified in all patients by means of comparative examinations with a special tonometer before application of the gel and immediately before the surgical procedure. No abortion or vaginal bleeding occurred in any of the patients. After 500 micrograms PGE2 gel the mean free passability (i.e. force less than or equal to 1 Newton) was 7.8 (+/- 2.0) mm, the corresponding value for the placebo group 5.2 (+/- 1.2) mm (p less than 0.0001). The prostaglandin pretreatment led to a significant increase in dilation of 5.9 +/- 2.3 mm versus 2.0 +/- 1.2 mm in the placebo group (p less than 0.0001). 17 of the 25 PGE2-treated patients complained of lower abdominal pain, gastrointestinal side effects were observed in one of these patients. In the placebo group there were no undesired concomitant symptoms. No intra- or postoperative complications occurred in the PGE2 gel-treated group. After application of the placebo gel cervical lesions and incomplete curettages were demonstrated in 4 cases. According to this preliminary experience, the intracervical application of the new ready-for-use-PGE2 gel represents a practicable and efficient method for preoperative cervical priming. In view of the intraoperative complications in the placebo group the frequency of side effects after PG application are within tolerable limits.

Abortion, Induced↗
PubMed1990

[Anesthesiologic and intensive care aspects of severe pre-eclampsia with HELLP syndrome].

From 1984 to 1988 22 patients with preeclampsia and HELLP syndrome were treated in our ICU. The HELLP syndrome is defined as preeclampsia complicated by thrombocytopenia, hemolysis and disturbed liver function. 3 patients developed a severe DIC with consumption of hemostatic potential. One patient died in multiorgan failure having a consumption coagulopathy, liver rupture and renal failure. To prevent severe hemostatic complications, it is essential to start therapy of DIC as soon as possible by inhibition of the activated coagulation system. Bleeding caused by blood coagulation disorders can occur spontaneously and during operative treatment. Epidural or spinal anaesthesia should be avoided in patients with HELLP syndrome. Because of severe complications such as respiratory failure, diffuse bleeding caused by DIC and progressive deterioration of the renal and liver function in most of the cases, patients with HELLP syndrome require a close cooperation between obstetrics and anesthesist.

Acute Kidney Injury↗
PubMed1989

Urinary protein electrophoresis profile in normal and hypertensive pregnancies.

By using of modified urine preparation and a highly sensitive SDS-polyacrylamide gel electrophoresis (SDS-PAGE) we determined the urinary protein profile in 21 healthy males, 25 healthy females, 64 patients with uncomplicated pregnancy and 110 hypertensive pregnant women. The urinary protein patterns were similar in controls and in women with a normal pregnancy. There were no increase in the number of protein bands from the 1st trimester to term, and the electrophoresis pattern did not change in the postpartum period. In both groups, an intensively stained protein band with an apparent molecular weight of 105 kD was detected. The 105 kD band was significantly reduced or completely absent in 91 (83%) out of 110 hypertensive pregnant women. The urinary protein electrophoresis profile correlated significantly with the severity of the disease. The 105 kD band disappeared just before or simultaneously with the onset of clinical symptoms in 18 out of 32 hypertensive pregnant women followed throughout pregnancy. Postpartum the 105 kD in urine reappeared at 2 to 14 days after delivery in 49 of the 53 patients. Using a silver staining and Western blot, the 105 kD band was identified as Tamm-Horsfall protein, which is identical to the immunosuppressive glycoprotein uromodulin. The findings in the SDS-PAGE may reflect a transitory tubular dysfunction in cases of pre-eclampsia, which is usually reversible after delivery. The results of our study support the hypothesis of an immunological basis for this disorder.

Adolescent↗