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Biomedical subjects

A Hettenbach

Publications and source records attributed to A Hettenbach.

At least 19 recordsLinked to original sources
PubMed1991

[Value of vaginal ultrasonography in noninvasive assessment of the endometrium of the postmenopausal uterus].

The endometrial carcinoma shows an increasing incidence and represents today the most frequent malignoma of the female pelvis. Until now all techniques of detection of this carcinoma or its precursors are invasive and thus are not suitable for screening investigations. Vaginosonography, as the first non-invasive diagnostic method, now supplies knowledge about the state of the endometrium. At the Gynaecological Department of the University of Homburg/Saar, West Germany, 221 patients had been preoperatively subjected to vaginosonography before they underwent surgery. Sonographical and histological findings corresponded in atrophic endometrium in 82%, in regular, perimenopausal endometrium in 91%, in endometrial polyps and hyperplasia of the endometrium in 56%, and in endometrial carcinoma in 79%. With regard to the detection of endometrial cancer, a specificity of 96%, a sensitivity of 93%, a positive predictive value of 79% and an accuracy of 96% were established. Thus, according to our experience, vaginosonography represents a valid, non-invasive diagnostical method as a suitable instrument for screening the endometrium.

Adult↗
PubMed1991

[Slit drainage versus Redon drainage in a clinical comparison--initial experiences with a new kind of wound drainage system].

In a prospective, randomised study we compared the clinical properties of the established Redon drain with a new type of drain called "slit drain". Both types of drains were examined regarding the amount of drained fluid, the time elapsing until removal of the drain, the frequency of occlusion of the lumen as well as the patient's pain and the required force at extraction of the drain. The statistical analysis showed both drains to have equal abilities in draining of fluid if they were used under vacuum conditions. If used as nonsuction drains, the new device was able to drain more fluid than the established type of drain (p less than 0.05). Statistically relevant advantages of the slit drain were seen in a lower rate of obstruction of the lumen, a higher amount of drained fluid (as non-suction device) as well as an easier and less painful extraction.

Breast Neoplasms↗
PubMed1989

[The "other induction"--experiences and consequences in 281 deliveries following intravaginal administration of PGE2 tablets].

186 patients have been included prospectively in a study, aimed at analysing the course of birth after induction with 3 mg PGE2-tablets given intravaginally. These data are compared with those gained from a retrospective analysis of 95 patients using a dose of 2 mg. The total of the births within our clinic in 1986/87 functions as controls. Although in every case there has been an urgent need for the termination of pregnancy and there have been also unfavourable cervix findings in the 3 mg group, no differences could be observed in comparison to the control group concerning duration of cervical dilatation and expulsion, as well as foetal outcome parameters. When comparing the 2 mg and 3 mg groups, a certain superiority of the 3 mg dosage could be noted, leading to the opinion, that trial dosages of less than 3 mg should be abandoned. C-section rate was lowest and spontaneous birth rate was highest in the 3 mg group as compared to the 2 mg and the control groups. Permanent CTG-monitoring was not necessary. CTG-controls after 2 and 6 hours proved to be sufficient. Uterine hyperstimulation occurred in 2.1% of cases in both groups. In every case, prompt antagonization by means of high dose betamimetic therapy could be achieved. Due to reducing maternal and foetal side effects, the maximal mobility of the mother after tablet application, as well as, for the smooth congruence of cervical ripening and labour induction, the clinical use of the 3 mg tablet is a modern alternative to the classic oxytocin induction.

Administration, Intravaginal↗
PubMed1989

[Fenoterol-induced lung edema during anesthesia in cesarean section].

Indications for anaesthetics and the beta-mimetic fenoterol, which is used to inhibit uterine contraction, are of interest for the anaesthesiologist because these drugs can be life-threatening. For this reason a case is presented showing the cardiopulmonary side effects connected with anaesthesia for Cesarean section. Detailed knowledge of the pharmacodynamics of this tocolytic is imperative to prevent avoidable errors during administration of anaesthesia.

Adult↗
PubMed1987

[Effect and side effects of oral morphine, lormetazepam and placebos as premedication].

In 60 patients undergoing a curettage in thiopentone induced inhalation anaesthesia with enflurane and N2O/O2 = 2:1, the effects of oral premedication (2 h before anaesthesia) with 30 mg morphine (MST 30) (n = 21), 1 mg lormetazepam (Noctamid) (n = 19) and placebo (n = 21) on psychological (anxiety, depression and asthenia), physiological (blood pressure, heart and respiratory rate) and pain parameters (visual analogue scale, analgesic consumption) were investigated. The study design was single blind, randomized. Before premedication the three groups did not differ in one parameter and so were comparable. MST 30 had a significantly better anxiolytic, Lormetazepam a significantly better antidepressive effect than the compared substance. There were no differences in blood pressure and heart rate. In contrast to lormetazepam and placebo after MST 30 there was no increase in the respiratory rate which can be explained by the anxiolytic stress reducing effect. There was no difference in peri- and intraoperative pain parameters, probably due to the type of surgery. Nausea and vomiting occurred more frequently after MST 30, but there was no significance. A higher rate was probably prevented by the application of transdermal scopolamine the day before surgery. The indication of analgesics (opiates) for premedication is discussed taking the controversy into account. The results of this study show that oral morphine (MST 30) has an anxiolytic effect, one of the most important effects a premedication should have. Further studies should investigate in which types of surgery the analgesic effect of MST 30 is peri- and intraoperatively relevant, so that advantages compared to e.g. Flunitrazepam, Midazolam or Lormetazepam in a higher dosage could be expected.

Administration, Oral↗
PubMed1987

[Conization of the uterine cervix. A study of 900 cases].

In the years 1968 till 1982, 900 conisations of uterine cervix were performed, 90% of which were diagnostic interventions. During the follow-up period, the mean age of the patients with carcinoma in situ decreased 4 years, the mean age from patients with microcarcinoma 3.2 years. In 64% the conisation was carried out due to a positive or suspekt smear. Conisations, performed during pregnancy, were not associated with any additional complications for mother or child. Taking a big conus resulted more often in a total extirpation of the neoplastic changes, without increasing the complication rate. The average hospital stay was 8.7 days. It was only prolonged in patients with secondary hemorrhage. 33% of all neoplastic changes were extirpated totally. In 85% of the women who had follow-up only after incomplete extirpation of the neoplasia by conisation, there was no recurrence. The rest did show the neoplasia again, often in a more serious way. The overall complication-rate was 7.4%.

Adolescent↗
PubMed1987

[Midazolam and pethidine/promethazine for intramuscular premedication].

The main reason for premedication is the reduction of preoperative stress. Despite the proven fact that benzodiazepines best reduce preoperative stress, combinations of opioids and neuroleptic drugs are preferred for premedication by many on reviewing the journal Der Anaesthesist. This double-blind study was performed to investigate midazolam and meperidine/promethazine for intramuscular premedication. Method. 60 patients undergoing minor gynecological surgery were randomly assigned to receive either 5-7.5 mg midazolam or 50-75 mg meperidine and 25-50 mg promethazine intramuscularly 30-90 min before surgery. Anxiety, depression, and asthenia were assessed by the patient before and after premedication but before induction of anesthesia using visual analogue scales and a nominal scale. Sedation was assessed by an observer. Heart rate and blood pressure were the physiological stress parameters. Parameters of acceptance and side effects were registered perioperatively. Results. Midazolam had a significantly better anxiolytic and antidepressive effect. There were no differences in the other parameters except for adverse effects. Meperidine/promethazine produced significantly more side-effects than midazolam. The parameters of acceptance assessed the day after surgery were comparable. Conclusions. We conclude from these results that anesthesiologists still premedicate with meperidine/promethazine because the patients accept this premedication very well when asked the day after surgery. Nevertheless, premedication with midazolam provides significantly better anxiolytic and antidepressive effects with significantly less side-effects. Therefore, midazolam should be preferred to meperidine/promethazine for intramuscular premedication.

Adolescent↗
PubMed1986

[Effects and side effects of transdermal scopolamine for premedication in general anesthesia in elderly patients].

Transdermal scopolamine has already proved an effective premedication to prevent postoperative nausea and vomiting. In a double-blind study, the effects and above all the side effects of TTS-scopolamine (TTS-s) and TTS-placebo (TTS-p) were investigated in elderly patients (greater than 50 years), who are particularly susceptible to adverse drug reactions. The 59 (out of 61) male and female patients who could finally be evaluated had to undergo long (1-6.3 hrs.) surgical or gynaecological interventions in general anaesthesia after premedication with benzodiazepines in the evening and in the morning. The operations were performed under intubation anaesthesia induced by barbiturate (3-5 mg/kg bw) or etomidate (0.2-0.3 mg/kg bw), together with enflurane (0.5-2.5 vol.%) or isoflurane (0.5-1.5 vol.%), N2O/O2 (2:1) and fentanyl (0.05-0.45 mg). Alcuronium or vecuronium were given for relaxation, pyridostigmine/atropine was administered for antagonisation. The patient groups did not differ significantly with regard to age (mean = 65 years vs. 63 years), sex, height, weight, concomitant diseases, method and duration of operation, method and duration of anaesthesia, postoperative antagonisation and analgesia. In patients under TTS-s postoperative nausea was less intensive and of shorter duration. In contrast to 7 patients of the placebo group (p less than 0.05), no case of vomiting could be observed in the TTS-s group. The efficacy of TTS-s was significantly better than that of TTS-p. TTS-s and TTS-p were both tolerated equally well. In both groups, the most frequent side effect was dryness of the mouth, but without any significant differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1985

[Cost-benefit studies of 2 equivalent forms of therapy in cervical cancer in the pretherapeutic T 1b stage].

Patients suffering from a collum carcinoma stage T 1b can be treated either by operation according to Wertheim and Meigs, or by radiotherapy. The results with regard to post operationem complications, five-year-survival and recidivation are equivalent in both methods. Therefore, an analysis of the indirect benefit and the costs of both therapies was performed. Surgery was superior to radiotherapy in all analysed dimensions of indirect benefit. Over and above this, expenses for an operation were 2.7 times lower than for radiotherapy.

Adult↗
PubMed1985

Carcinoma of the cervix stage T1b. A 15 years review of 256 cases.

256 patients of the years 1965-1979 who suffered from collum carcinoma stage T1b were reviewed. Most of the neoplasmas were squamous cell carcinoma (81%). By tumor screening only 21% of the carcinomas were detected. The treatment was in most of the cases a radical hysterectomy (Wertheim-Meigs). Postoperative radiotherapy was performed in cases of poor differentiated carcinoma of if lymphatic nodes had been occupied by the tumor. Thus only 43 patients had no radiotherapy. A 5 year-follow-up was possible in 151 cases. Women older than 40 year showed a better prognosis than younger women. Patients treated only by radiotherapy had a five year survival rate of 88%. No difference in prognosis was observed, if radiotherapy was additionally performed. There was no significant difference of severe complications in either forms of treatment.

Adult↗
PubMed1984

[Peridural morphine analgesia for the control of tumor-induced pain in gynecologic cancer patients].

22 gynecological patients suffering from considerable tumor pain in an advanced carcinoma stage had a continuous peridural anaesthesia. 18 patients reported a very good and 4 patients a sufficient analgesia. The average morphine dose per day was 14 mg. The indwelling catheters remained on an average 27 days in site. Side effects, which could be related to the morphine PDA, occurred in one case.

Catheters, Indwelling↗
PubMedDate not supplied

[Internal urinary diversion in complicated pregnancy-induced hydronephrosis].

In 14 women with sympthomatic hydronephrosis of pregnancy (calix diameter 1-2.6 cm) an internal urinary drainage was carried out during the second half of pregnancy. Retrograde stenting was performed following cystoscopy in all cases. Follow up examinations were taken weekly for the first two weeks and further on biweekly. Primary stenting was possible in 12 out of 14 cases and in 2 patients dilatation of the ureteral orifice was necessary. 11 out of 14 patients suffered from complications consisting of severe dysuria (9x), urinary tract infection (7x), persisting lumbar pain plus catheter lumen obstruction (6x each) as well as catheter dislocation (3x). Long term follow up showed that urinary tract obstruction was relieved by stenting in only 6 out of 14 patients. Sufficient urinary drainage by so called double-J-ureteral stents was achieved in less than half of the cases. Moreover, there was a complication rate of more than 75%. Taking these results into consideration, internal drainage of complicated pregnancy hydronephrosis needs careful evaluation.

Catheters, Indwelling↗
PubMedDate not supplied

[Pregnancy-induced changes in adrenergic receptors].

In the 24th and 26th week of pregnancy and also 6 weeks post partum, n = 32 pregnant women were evaluated for the concentration of adrenergic receptors on blood cells by radioligand binding assay and an isoprenaline stimulation of the beta-receptors. The concentrations of estradiol and progesterone in serum were also determined and nephrosonography was carried out. The stimulation and concentration of the beta-receptors were significantly higher during pregnancy than post partum. The alpha-receptors displayed contrary alterations: Here, the concentration evaluated during pregnancy was considerably lower. No connection was determined between the progesterone level in serum and the extent of the receptor alterations. However, one was found with the estrogen level and the dilatation of the upper urinary tract: Pregnant women with pronounced alterations above the median showed a distinct decrease of estradiol and a marked dilatation of the kidney collecting system. Alterations in the adrenergic receptors can therefore be determined during pregnancy. The extent of the receptor fluctuation is connected to the estradiol concentration in serum and the dilatation of smooth muscle hollow organs.

Dilatation, Pathologic↗
PubMedDate not supplied

[Effect of co-medication with magnesium sulfate in beta-mimetic tocolysis on parameters of water-electrolyte balance].

With 2 groups of 10 patients the influence of an additional therapy with 1 g magnesium sulfate/h during i.v. tocolysis with the betamimetic fenoterol (2 micrograms/min) upon parameters of water and electrolyte balance has been investigated. The whole of the magnesium administered during the 24 hours investigational period has been eliminated via the kidneys. Most probably due to a competition within the distal tubulus hypermagnesemia was associated with hypocalcemia and hypercalciuria, followed by a rise in parathyroid hormone. As PTH is able to compensate hypocalcemia not only by means of bone mobilisation but also by an increase in enteral Ca absorption, estimated losses of calcium are minimal. These may be neglected, as additional therapy with magnesium sulfate--besides the advantages yet known (cardioprotection, saving of betamimetic dosage, reduction of drug tolerance development)--reduces betamimetic induced water retention, thus significantly diminishing lung edema hazard during tocolytic therapy.

Adult↗
PubMedDate not supplied

[Lung function during tocolysis with beta-stimulators and beta-1-blockers].

The pulmonary function during pregnancy is foremost changed by the elevated diaphragm, which reduces the functional residual capacity. The lungs are less extended, so that the airway resistance increases. The application of a beta-mimetic drug for tocolytic therapy could reduce the airway resistance. Because an additional selective beta-1-blocking drug for cardioprotection could interfere with this effect, the pulmonary function in pregnancy during tocolytic therapy was investigated by body plethysmography in 20 woman of the third trimester of gravidity. There were no apparent differences in the pulmonary function in these woman when an additional selective beta-1-receptor blockade was performed. The airway resistance even diminished during the beta blockade. This unexpected result is probably due to an stabilizing effect of the betablocker on the body fluid and the permeability of capillary membranes during tocolytic therapy.

Adrenergic beta-Agonists↗