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Biomedical subjects

A Wischnik

Publications and source records attributed to A Wischnik.

At least 19 recordsLinked to original sources
PubMed1992

[Fetal outcome of premature infants less than 1,500 g birth weight with special reference to surfactant requirements].

The objective of our study was to examine therapeutic success within a study group of 108 premature babies weighing less than 1500 g at birth. The foetal outcome was divided according to intrauterine betamethasone administration, method of birth and surfactant requirement. 59 of the babies did not require a surfactant factor, because within 12 hours it was possible, to reduce respiration to an O2 partial pressure of 20%. In 49 of the premature babies, this was not possible, and therefore, surfactant substitution was required, whereby this subject group was divided into surfactant responders and surfactant non-responders. In addition, we examined the influence of the method of birth on later survival and the occurrence of intraventricular haemorrhages in the children. A noticeably higher survival rate was determined in 81% of the children, born via Caesarean section, compared with 63% of premature babies, born via vaginal delivery. Likewise, detectable intraventricular haemorrhages (IVH) were significantly lower amongst premature babies delivered via Caesarean section (25%) than those delivered vaginally (37.5%). A considerable improvement in survival rates and a reduction in IVH was achieved by means of completed lung maturation with betamethasone (16 mg in 48 hours). 62% of premature infants with completed prepartal lung maturity did not require the administration of a surfactant due to the favourable respiratory situation. However, for those cases, where it was no longer possible to conduct lung maturation, only 46% did not require surfactant substitution. Therefore, it would appear advisable, to delay the delivery of premature babies weighing less than 1500 g in order to carry out lung maturity treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

[Struma carcinoid tumor within a dermoid cyst as an incidental finding in cesarean section].

A 25-year-old primigravida with breech presentation was admitted near term. During Caesarean section, a dermoid cyst of the right ovary was detected. The dermoid cyst was enucleated, preserving a plum-sized ovary. Histology revealed a strumal carcinoid within the excised dermoid cyst. From the histological point of view it was classified as a tumour of low malignancy. The clinical study provided no evidence of any metastases. On the 14th postoperative day the patient could be discharged from hospital subject to close aftercare control.

Adult↗
PubMed1992

[Do the obstetrically relevant bony pelvic measurements change? A retrospective analysis of computed tomographic pelvic x-rays].

The important dimensions of pelvimetry were evaluated from 467 CT studies of the pelvis by trigonometric deduction. The age of the women was between 18 and 88 years. In addition to the diameters, which are routinely used for pelvimetry, transverse and sagittal diameters, pelvic angles and areas of pelvic planes were calculated. On condition that the pelvic dimensions do not depend on age the parameters can be regarded as representative of sexual maturity. 5 parameters showed highly significant and 7 parameters showed significant differences between the age-classes 1901-1920 and 1950-1971. An increase of pelvic dimensions (1950-1971) was found at the planes of the pelvic inlet and outlet in contrast to the dimensions of the pelvic center. The results confirm the importance of the bispinous diameter for pelvimetry as well as the demand for a revision of the standard values of the first half of the century.

Adolescent↗
PubMed1992

[Magnetic resonance tomography as the basis for biomechanical analysis. The simulation of the birth process as an example of the expanded information potentials of segmental imaging procedures].

A method is presented that enables the use of (static) informations from magnetic resonance imaging (MRI) for (dynamic) biomechanical analysis. Using a specially developed software MRI pixel matrices are colour-coded and--according to the principle of same density--line data are created. After sectional attribution of the resulting polygons a three-dimensional mesh of so-called finite elements is created which can then be used in deformation analysis. This method is exemplified by a project dealing with the simulation of birth mechanics, which is finally aimed at validating the results from radiologic pelvimetry. First analyses show that even under foetal head moulding conditions, being considered as normal, such sensitive structures as the cerebellum, brain stem as well as the ventricles with the plexus chorioidei are to be found within the maximum isobars within a range of 104-140 N(10.6-14.3 kp).

Adult↗
PubMed1989

The excretion of ketorolac tromethamine into breast milk after multiple oral dosing.

We have studied the transfer of the analgesic ketorolac tromethamine into breast milk in ten women aged between 22 and 35 years. Ketorolac administration was started between 2 and 6 days after delivery. The breast milk was not fed to the infant because of maternal antibiotic use (6 patients) or because of jaundice of the baby. 10 mg of ketorolac was given four times daily for two days. Plasma and milk samples were collected on the two dosing days and on the first day after dosing. The plasma and milk were assayed for ketorolac concentrations by HPLC: the quantification limits were 10 ng.ml-1 and 5 ng.ml-1 respectively. The maternal plasma concentrations were within established ranges for ketorolac. In four patients the concentration of ketorolac in the milk was never above 5 ng.ml-1. At 2 h after dosing on both Days 1 and 2 there were quantifiable concentrations of ketorolac in the milk. The range was 5.2 ng.ml-1 to 7.9 ng.ml-1. The ratio of breast milk: plasma concentrations of ketorolac ranged from 0.015 to 0.037. The maximum potential amount of ketorolac that an infant may be exposed to daily could range from 3.16 mg to 7.9 mg, assuming a consumption of between 400 ml and 1 l of breast milk. On a weight-adjusted basis this is equivalent to between 0.16% and 0.40% of the total daily maternal dose.

Administration, Oral↗
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

[Obstetric pelvimetry using digital image intensifier radiography].

Obstetric pelvimetry can be performed by digital image intensifier radiography using very low exposure doses. Comparative measurements show a reduction of the entrance dose to 5% of conventional respectively 15% of high speed film-screen radiography. Phantom measurements have shown an accuracy of +/- 5 mm. In 30 patients the transverse diameter of the pelvic entrance, of the interspinous and of the intertuberous level as well as the sagittal diameter of the pelvic entrance and outlet were measured. Pelvimetry is indicated for the early recognition of certain risks if anamnestic (previous Caesarean section), clinical (eg. external pelvimetry) or fetometric features indicate the evidence of disproportion. As a radiological method the image intensifier radiography appears particularly recommendable in respect of its low exposure dose and the possibility of interactive measurements with subsequent documentation of the diameters and values.

Female↗
PubMed1988

[Elimination of nalbuphine in human milk].

In order to examine the pharmacokinetics and excretion of nalbuphine (Nubain 20) in breast milk, patients suffering from postpartum pain were given a single dose of 20 mg nalbuphine intramuscularly. During a 24-h period, the total amount of nalbuphine excreted in the breast milk was 2.3 micrograms (mean value), which is equivalent to 0.012% of the dosage. The mean milk/plasma quotient was calculated using the AUC from the milk and plasma time curves at 1.2:1. An oral intake of 2.3 micrograms nalbuphine would not show any measurable plasma concentrations in the neonate. Adverse opioid reactions, e.g. respiratory depression are not to be expected even if one assumes a lack of glucuronide production in the neonate.

Adult↗
PubMed1985

[Visualization of the uterine fundus in intrauterine sonography].

Intrauterine sonography (hysterosonography) is useful for visualising malignant processes in the myometrium. Since normally no sound-wave source is available for beaming the sound waves in strictly anterograde direction, the authors examined which sections of the fundus of the uterus cannot be assessed, and discussed the possibilities of reducing the area and also the importance of the inaccessible region. It was found that normally a satisfactory assessment would be possible in clinical routine even in the region of the fundus by the combined shifting of the geometrical axis of the sound waves and the use of transducers from which the sound waves emanate in anterograde direction at an angle of 135 degrees.

Female↗
PubMedDate not supplied

Risk-benefit assessment of tocolytic drugs.

beta 2-Mimetics are the principal agents used for myometrial relaxation. As all the available drugs also have beta 1-stimulant effects, the various side effects (cardiovascular, pulmonary and metabolic) require a critical consideration of the clinical indications, thorough supervision and combined therapeutic concepts. With regard to clinical indications, 'prophylactic tocolysis' frequently turns out to be unnecessary, as does the treatment of physiological uterine contractions during pregnacy which have no effect on the cervix. The benefit of tocolysis must be seen not so much in a reduction of preterm labour but in enabling the obstetrician and neonatologist to optimise the handling of the premature baby, e.g. by allowing lung maturation or by enabling the patient to reach a centre for perinatal medicine before the birth. Labour-dependent fetal distress situations during birth at term can also be managed successfully. Supervision involves thorough control of both mother (especially of cardiovascular and metabolic parameters, electrolyte and water balance) and fetus (cardiotocography, fetometry) in order to decide individually when possible benefits are outweighed by maternal or fetal risks. Combination of beta 2-mimetic treatment with magnesium therapy reduces the beta-mimetic dosage required, has a cardioprotective action, and reduces the development of drug tolerance and the risk of lung oedema. This combination, therefore, should become routine in tocolytic therapy. If further protection against cardiovascular and risk of lung oedema is required, administration of beta 1-blockers is advisable.

Female↗
PubMedDate not supplied

[Does the "fatty pelvis" exist? Quantitative computer tomography studies].

50 Patients weighing between 45 and 114 kg underwent standardized computed tomography of the pelvis. Fat compartments from inside and outside of the small pelvis were assessed quantitatively by means of tracing the fat tissue borders and planimetry. Fat compartments within the small pelvis showed a rather weak correlation with body weight and the so called Rohrer-Index as a weight/height-Index, correlations with the latter being slightly better. From the fat compartments within the single levels the functional reduction of birth channel diameters caused by fat tissue was calculated for. The weight/height-index dependent increase of space demand within the birth channel was rather pronounced at the pelvic brim becoming slighter when reaching mid-pelvis or even pelvic outlet. Hence, the common assumption can no longer be maintained, that adiposity necessarily causes soft tissue dystokia due to larger fat compartments within the small pelvis.

Adipose Tissue↗
PubMedDate not supplied

[Changes in pelvic anatomy in 8 decades--computerized tomography study of obstetrically relevant pelvic measurements].

An increasing proportion of obstetric operative procedures due to cephalopelvic disproportion gave raise to the question, whether there has been a change in pelvic anatomy during the past decades. In a retrospective evaluation of 467 computerized pelvic tomograms of patients aged between 18 and 88 years relevant parameters of pelvic proportion were determined. As these parameters are not subject to age-conditioned changes, the values may be viewed as representative for the time of patients' birth or fertility period respectively. Changes in pelvic anatomy turned out to be complex: The transverse elliptic shape of pelvic inlet changed into sagittal elliptic form, the pelvic midplane is contracted progressively, sacral concavity is reduced. Obviously, this obstetrically adverse development is influenced by the fact, that unfavourable pelvic conformation can be transmitted more intensively by the generous indication for cesarean section. This development is contrasted by the circumstance of fetal acceleration. Therefore, an increase in cephalopelvic disproportion has to be expected. For the sake of a safe obstetrical management in these situations the generous use of ante partum pelvimetric diagnosis seems to be advisable.

Adolescent↗
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↗