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Biomedical subjects

A Rempen

Publications and source records attributed to A Rempen.

At least 19 recordsLinked to original sources
PubMed2005

Feto-amniotic shunting -- experience of six centres.

AIM: Foeto-amniotic shunting is an ultrasound-guided, therapeutic intervention for drainage of persistent intracavital fluid retention in severely affected foetuses with a high risk of mortality. In order to weigh up the comparatively high risk of intervention against the possible benefit, we evaluated the value of different indications, the complication rate and the time span of drains in situ. PATIENTS AND METHODS: We made a survey of all level III ultrasound centres of German-speaking countries from 1993 to 2001. Six level III centres returned the questionnaire: forty-seven foeto-amniotic shunting procedures were performed in 30 foetuses [megacystis in 18 foetuses (three of these with urinary ascites), hydrothorax in eight foetuses, hydronephrosis in two foetuses, cystic adenomatoid malformation of the lung in one foetus, ovarian cyst in one foetus]. RESULTS: The median gestational age at time of shunting was 23.5 (range 16 - 33) weeks, at time of delivery 35 (range 23 - 41) weeks. The median time span of drains in situ was 19 (range 0 - 170) days. Altogether 18 of 30 foetuses (60 %) had a benefit of foeto-amniotic shunting. CONCLUSION: The best possible selection of pregnancies which might profit from foeto-amniotic shunting is required. The decisive criteria are the underlying defect as well as the severity and progression of the disorder.

Amniotic Fluid↗
PubMed1999

Prenatal diagnosis in a family with severe type I plasminogen deficiency, ligneous conjunctivitis and congenital hydrocephalus.

Severe type I plasminogen deficiency may cause severe ligneous conjunctivitis, a rare and unusual form of chronic pseudo-membranous conjunctivitis that usually starts in early infancy, but also pseudo-membranous lesions of other mucous membranes in the mouth, nasopharynx, trachea and female genital tract, and in rare cases congenital occlusive hydrocephalus. The index patient, the daughter of a consanguineous marriage, had suffered from severe ligneous conjunctivitis and had died from decompensated congenital hydrocephalus despite numerous shunt revisions. She was found to be homozygous for a non-sense mutation in exon 15 of the plasminogen gene (Trp597->Stop). In her next pregnancy, the mother asked for prenatal diagnosis of the plasminogen deficiency. Chorionic villus biopsy was performed at 12 weeks of gestation. DNA analysis of the plasminogen gene by PCR and single-strand conformation polymorphism (SSCP) revealed that the fetus exhibited an identical heterozygous band pattern as observed in the healthy mother. Therefore, the fetus was heterozygous for the Trp597->Stop mutation in plasminogen exon 15. In addition, the fetus was found to be male by cytogenetic analysis and by multiplex PCR analysis using two polymorphic X-chromosomal markers (DXS424, HPRT). These findings excluded the possibility of contamination by maternal DNA. It was concluded that the fetus was not at risk for ligneous conjunctivitis and its associated complications. After the birth of a healthy boy, plasminogen functional activity was shown to be 38 per cent. DNA analysis confirmed prenatal molecular genetic results.

Adult↗
PubMed1998

Fetal lung volumetry by three-dimensional ultrasound.

The aim of this study was to establish a method for determination of fetal lung volume by three-dimensional ultrasound. The thoraces of a total of 113 fetuses (singleton pregnancies, 11-41 weeks of gestation without any signs of malformation or oligohydramnios) were examined by three-dimensional ultrasound. Volumetric evaluation of each lung was performed in each of three perpendicular planes (six measurements in total). There were significant differences in all three measurements between the left and right lungs. Especially in the second and third trimesters, measurement of the frontal and the sagittal planes was sometimes prevented by poor imaging conditions. The scan volume was always too small for fetuses above 34 weeks. With these problems considered, nomograms of fetal lung volume for the left and the right lung were calculated. Lung volumes in the present study showed good correlation with published autopsy findings. Three-dimensional ultrasonographic volumetry is a useful method for determining fetal lung volume and may have a role to play in the detection of pulmonary hypoplasia.

Female↗
PubMed1998

Successful abdominal delivery in a woman with sonographic diagnosis of diffuse cavernous hemangioma of the uterus.

Diffuse hemangioma of the pregnant uterus is a serious lesion. We report the first case of a successful cesarean section at term following expectant management of pregnancy in a patient with presumed isolated diffuse cavernous hemangioma of the uterus and protein S deficiency. The sonographic diagnosis and clinical management of this condition is described. The presented successful pregnancy underlines that, under close surveillance, consideration should be given to a conservative approach to this sonographic finding during pregnancy, as even an abdominal delivery does not imply hysterectomy inevitably.

Adult↗
PubMed1998

The shape of the endometrium evaluated with three-dimensional ultrasound: an additional predictor of extrauterine pregnancy.

The objective of this prospective follow-up study was to evaluate the potential utility of three-dimensional (3D) ultrasound to differentiate intrauterine from extrauterine gestations. Fifty-four pregnancies with a gestational age <10 weeks and with an intrauterine gestational sac <5 mm in diameter formed the study group. The configuration of the endometrium in the frontal plane of the uterus was correlated to eventual pregnancy outcome. After exclusion of three patients with a poor 3D-image quality the endometrial shape was asymmetrical with regard to the median longitudinal axis of the uterus in 84% of intrauterine pregnancies, whereas the endometrium showed a symmetry in the frontal plane in 90% of extrauterine pregnancies (P = 0.0000001). Intrauterine fluid accumulation may distort the uterine cavity, thus being responsible for false-positive as well as false-negative results. The evaluation of the endometrial shape in the frontal plane appears to be a useful additional means to distinguish intrauterine from extrauterine pregnancies, especially when a gestational sac is not clearly demonstrated with conventional ultrasound.

Abortion, Spontaneous↗
PubMed1996

Laparoscopic assistance at vaginal hysterectomy: a literature review.

38 literature reports of laparoscopic assistance in a total of 2,275 vaginal hysterectomies were reviewed. Operation times varied from 28 to 430 minutes. The mean conversion rate to laparotomy was 3.1%. The main reasons encountered were poor access (1.9%), heavy bleeding (0.7%) and organ injury (0.3%). Post-operative complications necessitating a secondary procedure occurred in 1.6% including hernia at trocar site (0.4%), urinary tract or intestinal lesions (0.5%) and delayed hemorrhage (0.6%).

Female↗
PubMed1996

Longitudinal observations of human chorionic gonadotropin in serum following surgery for ectopic pregnancy.

In order to study the disappearance of human chorionic gonadotropin (hCG) in serum after surgery for ectopic pregnancy and to facilitate the postoperative follow-up of hCG decline serial hCG serum concentrations were analysed in 189 women with an uneventful postoperative course and in 4 patients with persistent trophoblast. A double logarithmic transformation of hCG concentrations resulted in a linear relationship of the individual hormonal decline versus the postoperative time (r2 = 0.990). The decrease of hCG levels was independent from the type of surgery or gestational age. The calculated half life of hCG steadily increased with rising time interval after surgery. A nomogram of hCG decrease was constructed using the regression lines of the individual sequential hormone concentrations. The nomogram enabled the detection of active residual trophoblast within one week after surgery before serious complications occur. Our scheme requires only three hCG tests to be performed before surgery, and on day 2 and 7.

Adult↗
PubMed1996

Experience with laparoscopic assistance in vaginal hysterectomy.

OBJECTIVE: To determine safety and usefulness of laparoscopy intended to convert an abdominal into a vaginal hysterectomy. STUDY DESIGN: Forty-seven consecutive hysterectomies are retrospectively analyzed in which laparoscopy was used to accomplish a vaginal instead of an abdominal procedure which would have been performed without endoscopic surgery. RESULTS: In four patients the operation had to be converted to laparotomy due to difficult access (n = 3) or heavy bleeding (n = 1). Operation time declined during the study period, thus highlighting the importance of experience with laparoscopic technics. Major complications such as injuries of adjacent organs or delayed haemorrhage requiring a second intervention were not encountered. CONCLUSIONS: Laparoscopy in hysterectomy seems to be a valuable method to avoid laparotomy. In the future, guidelines to determine the route of surgery are to be established which include those conditions in which laparoscopy in addition to vaginal hysterectomy implies a benefit for the patient.

Adult↗
PubMed1996

Transvaginal ultrasonography of pelvic masses: evaluation of B-mode technique and Doppler ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate pelvic masses by B-mode and Doppler ultrasonography for identification of ovarian malignancies. STUDY DESIGN: A previously described scoring system for pelvic masses was applied in 310 women, and the lesions were classified into four groups according to the ultrasonographic structure. Pulsatility index values of vessels within the tumor and the contralateral ovary and of both uterine arteries were determined. RESULTS: A total of 259 masses were benign and 51 were malignant. The scoring system and classification into morphologic groups revealed similar sensitivity, specificity, and positive and negative predictive values. Intratumoral and opposite ovarian blood flow and ipsilateral and contralateral uterine blood flow did not differ in benign and malignant masses except in cases of benign lesions in postmenopausal women. In malignant lesions a lower pulsatility index (0.94 +/- 0.4) was measured than in benign lesions (1.06 +/- 0.4, p < 0.05), although a remarkable overlap was found. CONCLUSION: The results suggest that further refinement of assessment of pelvic masses with Doppler ultrasonography is needed.

Adnexal Diseases↗
PubMed1996

[Premature termination of pregnancy in the 2nd and 3rd trimester. Serial administration of 1 mg gemeprost vaginal suppositories versus intravenous sulproston].

Comparison of 1 mg Gemeprost-Vaginal Suppositories Serial Application versus Sulproston i.v.: Three different regimens for the termination of second and third trimester pregnancies by the use of prostaglandins (PG) were compared in a retrospective analysis. In group A (n = 16) terminations were attempted by continuous i.v. Infusion of Sulproston 9 hours after administration of a 3 mg-PGE2-vaginal tablet overnight. In group B (n = 22), i.v. Sulproston was started 2 hours after priming with 1 mg Gemeprost-vaginal suppositories. The outcome of these two regimens was compared with that of repeated administration of 1 mg Gemeprost-vaginal suppositories at 6-hourly intervals (group C, n = 25). In each group. If uterine contractions failed to appear after one day, the treatment was discontinued for a sleep rest over night and then resumed. Genetic disorders or fetal malformations were the most frequent reasons for termination. Patients with intrauterine fetal demise, rupture of the membranes, preterm labour or a ripe cervix (Bishop Score > 3) were excluded. Median time intervals from induction to abortion were 33 hours in group A and 23 hours in each Group B and C. The rate of fetal expulsions within 12, 24 and 36 hours in groups B and C were similar. Women of parity > or = 1 showed significantly shorter intervals than nulliparae in groups A and C. Only one woman (in group A) failed to expel after induction, in four other cases (in groups A and B) complications (local thrombophlebitis, bronchospasm) were noted. The serial administration of 1 mg Gemeprost-vaginal suppositories at 5-hourly intervals showed fewer side effects and seems to be as efficient as sulproston i.v. after cervical ripening.

Abortifacient Agents, Nonsteroidal↗
PubMed1996

[Diagnostic value of color Doppler ultrasound in addition to B-image ultrasound in predicting underweight newborn infants].

In 74 pregnancies suspected for a small-for-gestational age (SGA) fetus by ultrasound measurement of the abdominal circumference, Doppler measurements of the fetal aorta and umbilical artery were performed. The renal and middle cerebral arteries were studied by color flow mapping. 47 infants were indeed growth retarded. The resistance- (RI) and pulsatility-indices (PI) of all vessels and their ratios were calculated. The superior parameter evaluated by receiver operating characteristic was the ratio of the PI of the middle cerebral artery in comparison to the PI of the umbilical artery at a threshold value of 1.6. An additional diagnostic value of Doppler sonography was only seen in cases of normal amniotic fluid volume and fetal symmetry, but not in cases of oligohydramnion and fetal asymmetry.

Brain↗
PubMed1995

Color flow mapping of the middle cerebral artery in 23 hydrocephalic fetuses.

Color flow mapping was performed on 23 fetuses with hydrocephaly. The measurements on the middle cerebral artery posed no problem. We found end-diastolic frequencies in all cases. The pulsatility-indices were raised in only 4 cases. Color Doppler sonography gave no extra information about diagnosis or prognosis.

Blood Flow Velocity↗
PubMed1995

[Transvaginal ultrasound of the endometrium in postmenopause].

We checked on the validation of vaginal ultrasound parameters to detect endometrial neoplasma by apposing the histological and sonographical data of 232 patients with postmenopausal bleeding. An endometrial height of more than 4 mm proved a good preliminary fact to screen for pathological findings (sensitivity: 94.9% for endometrial cancer and 84% for benign and malignant neoplastic lesions). The low specificity (53%) of this threshold value can be increased by including morphological parameters like inhomogeneous structure, irregular demarcation and lack of an endometrial middle echo. When screening postmenopausal women by transvaginal sonography these must be taken into account particularly with younger patients whose menopause occurred only recently. Until the age of sixty, respectively until 5 years after menopause, 50 to 70% endometrial proliferation must be taken into account causing an endometrial height of more than 4 mm in ultrasound. Therefore, before starting invasive diagnostics, one should confirm the postmenopausal state of asymptomatic patients without additional sonographical criteria and exclude other reasons for endometrial proliferation.

Aged↗
PubMed1995

[Introduction of laparoscopic surgery in extrauterine pregnancy].

Top evaluate laparoscopic surgery in extrauterine pregnancy, the period from 1990-1993 was analysed, and the first 44 operations including only one laparoscopy (2%), were compared with the following 70 operations with 60 laparoscopic procedures (86%). Except for a younger mean gestational age in the second interval, both groups showed no differences in the history and preoperative findings. During the second period, however, the intraoperative blood loss was smaller and the rate of conservative procedures was higher. Operation times and complication rates were not different. But in laparoscopy, duration of the procedure significantly decreased with advancing experience. Postoperative hospital stay was half as long in the second group. Subsequent procedures were necessary in 3% of 61 laparoscopies due to adhesion ileus and persistent trophoblast, respectively. Persistent pregnancy was seen in 2% of 42 conservative laparoscopies. Laparotomy due to failed laparoscopy was done in 2 of 63 patients (3%) with bleeding complications. Laparoscopy in the hand of the experienced surgeon is a suitable method to treat ectopic pregnancy and allows also organ preservation.

Adult↗