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C Sohn

Publications and source records attributed to C Sohn.

At least 19 recordsLinked to original sources
PubMed2000

Serum intercellular adhesion molecule-1 levels and histologic chorioamnionitis.

OBJECTIVE: To compare the diagnostic value of intercellular adhesion molecule (ICAM)-1 with that of C-reactive protein (CRP) and white blood cell (WBC) count for detecting histologic chorioamnionitis in serum of women with preterm labor. METHODS: Maternal blood was collected from 97 consecutive women admitted with preterm delivery before 37 weeks' gestation, and 50 women after normal term delivery (38-41 weeks' gestation). Intercellular adhesion molecule-1, CRP, and WBC count were measured before delivery. RESULTS: Histologic chorioamnionitis was diagnosed in 48 of 97 women (48%) who delivered preterm and in none who delivered at term. Maternal serum levels of ICAM-1 (median 169 ng/mL, range 94-510 ng/mL, P <.001), CRP (median 2.8 ng/mL, range 0.5-13.2 mg/dL, P <.001) and WBC count (12.6 x 10(3)/microL, range 6.4-30.6 x 10(3)/microL, P <.02) were statistically significantly higher in women with histologic chorioamnionitis than those without it (ICAM-1 median 70 ng/mL, range 23-107 ng/mL; CRP median 0.7 mg/dL, range 0.5-6.7 mg/dL; WBC count median 10.9 x 10(3)/microL, range 4.3-22.2 x 10(3)/microL). The sensitivity and specificity of maternal serum ICAM-1 (cutoff 106 ng/mL), CRP (cutoff 1.1 mg/dL), and WBC count (cutoff 11.8 x 10(3)/microL) for diagnosing histologic chorioamnionitis were 98.0% and 93.8%, 75.5% and 71.4%, and 63.3% and 61.2%, respectively. CONCLUSION: In women with preterm labor, ICAM-1 is a more reliable indicator of histologic chorioamnionitis than CRP or WBC count.

Adult↗
PubMed2000

[Current management of thromboembolism in pregnancy and puerperium].

Venous thromboembolism (VTE) remains the leading cause of maternal death. Today, various risk factors and conditions are known to increase the risk for VTE associated with pregnancy. Having identified the individual risk of a pregnant women, appropriate preventive measures can be taken. If VTE occurs during pregnancy, an appropriate immediate diagnostic work-up is essential in order to avoid further complications. For deep vein thrombosis (DVT) the diagnostic tool of choice is color-coded duplex-sonography, for pulmonary embolism (PE) perfusion/ventilation lung scan can be used. Integrating a detailed individual and family history, the presence of thrombophilia or other risk factors, a risk stratification can be undertaken. These risk categories are defined in the present paper and the appropriate treatment measures are described. As oral anticoagulants cross the placenta and may cause embryopathy in any trimester, oral anticoagulants should be avoided throughout pregnancy. Therefore, heparin is the anti-coagulant of choice for pregnant women, with low molecular weight heparins (LMWH) having distinctive pharmacological advantages over unfractionated heparins. Besides a potential for bleeding, the main side effects of heparin include heparin-induced thrombocytopenia which prompts for platelet monitoring, especially in the first weeks of heparin treatment, and, secondly, heparin-induced osteoporosis, which is a potential sequel of long-term heparin administration. Even though there are abundant reports in the literature on the use of LMWH in pregnant women, that show that they are safe and effective, LMWH are not specifically licensed for the use in pregnancy.

Anticoagulants↗
PubMed1999

Cytokine release from placental endothelial cells, a process associated with preterm labour in the absence of intrauterine infection.

There is currently a great deal of interest in the role that cytokines may play in the processes mediating preterm as well as normal term labour. In case of preterm delivery a cause-effect relationship between infection, uncontrollable preterm labour, and increased uterine cytokine concentrations is widely accepted, but there is considerable information that increased uterine cytokine release is also a condition in normal term labour and preterm labour not due to infection. Thereby, the exact cellular sources of cytokine production have not yet been identified. In the present study, the authors used immunohistochemical analysis to localize interleukin 1beta (IL-1beta) interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) immunoreactivity within trophoblastic villi and fetal membranes. In the absence of chorioamnionitis, uncontrollable preterm labour, and also normal term labour was associated with strong immunoreactivity for IL-1beta and IL-6 in the endothelial cells within trophoblastic villi. In contrast, preterm delivery accompanied by histologically confirmed chorioamnionitis, was not associated with increased expression of cytokine antigens within endothelial cells of the fetal vascular system, but strong cytokine activity was found in polymorphonuclear cells infiltrating the amniochorionic membranes. Therefore, the data suggest two well-defined subgroups among patients delivering preterm. Thereby, increased uterine cytokine concentrations may be realized in both groups, but the cellular sources of cytokine production may be different.

Adult↗
PubMed1999

Spontaneous labour at term is associated with fetal monocyte activation.

The aetiology of both term and preterm labour remains incompletely understood. Maternal infectious diseases as well as intra-uterine infections were shown to be a well established cause of uncontrollable preterm delivery, indicating that inflammatory reactions, regulated by maternal immunecompetent cells, are implicated in labour-promoting mechanisms. To investigate the possibility that the activation of the fetal immune system may be involved in labour induction, we examined cytokine production patterns of different cord blood cell populations obtained from neonates after spontaneous onset of normal term labour and vaginal delivery (n = 25), vaginal delivery but induced term labour (n = 17), and preterm delivery because of uncontrollable labour (n = 27, 20 patients received corticoid treatment for fetal lung maturation), in comparison with cells obtained from neonates after elective term caesarean delivery in the absence of labour (n = 15). Our results demonstrate that spontaneous term labour, but not induced term labour, was associated with significantly increased IL-6 production by myelomonocytic cell populations. Preterm delivery due to uncontrollable labour with resistance to tocolysis was not associated with increased IL-6 production by fetal myelomonocytic cells. Two-colour flow cytometry combined with intracellular cytokine staining was used to identify fetal monocytes as sources of labour-associated IL-6 release at term. We did not find any activation of cord blood T cells in association with spontaneous term or uncontrollable preterm labour. Therefore, fetal T cell responses may not cause monocyte activation. Our results suggest that increased release of IL-6 from fetal monocytes is involved in mechanisms promoting normal term, but not preterm labour, and that mechanisms inducing term and preterm labour are completely different.

Betamethasone↗
PubMed1999

Labour-associated expression of intercellular adhesion molecule-1 (ICAM-1) in placental endothelial cells indicates participation of immunological processes in parturition.

Inflammatory cytokines induce or upregulate de novo expression of cell adhesion molecules on endothelial and epithelial cells. In order to demonstrate inflammatory reactions within placental tissues in association with normal term as well as non-infection-induced preterm labour, the expression of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and endothelial leucocyte adhesion molecule-1 (ELAM-1) was examined by immunohistochemical methods in both trophoblastic villi (n=123) and umbilical cord (n=61). As a result, ICAM-1 immunoreactivity was exclusively localized in the endothelial cells of the fetal vascular system, while VCAM-1 and ELAM-1 were not detected. Whereas ICAM-1 was not expressed in early pregnancy (9-12 weeks of gestation), it could be weakly detected at the end of pregnancy in cases of elective caesarean delivery in the absence of labour, and was significantly more strongly expressed in cases of vaginal delivery after spontaneous onset of normal term labour. Significantly increased immunoreactivity of ICAM-1 within umbilical cord tissues was also found in association with uncontrollable preterm labour in the absence of intrauterine infection which was excluded after histological examination of fetal membranes, umbilical cord and chorionic plate. We conclude that ICAM-1 expression in the endothelium of the fetal vascular system is associated with the presence of labour and reflects participation of immune-inflammatory reactions in labour-promoting mechanisms.

Adult↗
PubMed1999

Early onset of breast carcinoma in African American women with poor prognostic factors.

The purpose of this study was to determine prognostic significance of age and race as independent variables and to see role of age at the onset of breast carcinoma. A retrospective study was conducted of African American and white women with breast cancer treated at SUNY-Health Science Center Brooklyn and Kings County Hospital Center from 1983 to 1993. The objective was to analyze the differences in patterns of disease onset, as related to age and prognostic factors. A total of 738 patients were analyzed for race-adjusted comparison of stage, grade, disease-free survival, and median survival. Age at the time of diagnosis was analyzed to conduct age-specific comparisons of African American (AA) and white patients. The multivariate analysis indicated that AA women develop breast cancer 10 years earlier than white women (p = 0.00001). Corrected by stage and grade, i.e., chi2 test for stage-by-stage and grade-by-grade analysis has revealed that the AA women present with higher stage (p = 0.009), increased number of positive nodes (p = 0.00007), and more estrogen receptor/ progesterone receptor-negative tumors (p = 0.005). Further studies are required to probe into the etiologic possibilities of this significant difference. The important contributing factors could be hormonal, genetic, environmental, and socioeconomic. Obesity and dietary factors also need to be evaluated. Further studies to explore genetic susceptibility by ploidy is recommended to explain this significant difference. We conclude that the onset of breast cancer among AA women occurs at a significantly younger age than in white women, and their prognostic factors are poorer.

Adult↗
PubMed1999

[Risk management in gynecology and obstetrics. Forensic questions in connection with operative gynecology and obstetrics].

Due to the avalanche-like increase of malpractice suits, it has become mandatory for doctors in hospitals and private practices to acquire a profound knowledge relating to modern management and to become familiar with the legal aspects of medical procedures. The article at hand reviews the standards of medical documentation and risk information within the scope of operative gynaecology and obstetrics and provides guidelines for a structured behaviour once an incident has occurred. The typical sources of complications are presented and strategies to avoid them are outlined: professional clinical management including the definition of competences for all therapists working together in a hospital. By observing these principles a professional medical level even in administrative respect is provided and thus enables an atmosphere of mutual confidence among doctors and patients.

Female↗
PubMed1998

Estimation of probability of malignancy using a logistic model combining physical examination, ultrasound, serum CA 125, and serum CA 72-4 in postmenopausal women with a pelvic mass: an international multicenter study.

BACKGROUND: To assess the differential diagnostic potential of physical examination, ultrasound, the serum CA 125 assay, and serum CA 72-4 assay, and the contribution of each parameter to a logistic model predicting the probability of malignancy in postmenopausal patients presenting with a pelvic mass. PATIENTS AND METHODS: In a multicenter, prospective study a total of 155 patients were evaluated preoperatively using a standard protocol for pelvic examination, transvaginal (occasionally additional abdominal) ultrasound, and serum CA 72-4 (cutoff level 3 U/ml) and CA 125 (cutoff level 35 U/ml). RESULTS: Fifty-nine malignant (39%) and 92 benign (61%) pelvic tumors were found in addition to 4 borderline tumors (3%). Forty-three patients appeared to have ovarian carcinoma, FIGO Stage III or IV in 28 cases. Borderline tumors were excluded from the statistical calculations. The diagnostic accuracy of each single parameter, i.e., pelvic examination, ultrasound, and serum CA 125 and CA 72-4 in discriminating between benign and malignant pelvic masses gave highly similar results (81, 76, 78, and 81% respectively). Best sensitivity was found in pelvic examination (92%); best specificity was found in CA 72-4 (93%). Using logistic regression analysis the power of pelvic examination appeared to be the most relevant (adjusted odds ratio 12.1), followed by ultrasound (odds ratio 9.7), serum CA 125 (odds ratio 5.0), and serum CA 72-4 (odds ratio 4.9). Age appeared to be nonpredictive. The logistic model gives a correct prediction in 87% of all cases. CONCLUSIONS: The addition of serum CA 72-4 to the combination of pelvic examination, ultrasound, and serum CA 125 leads to an improved discrimination between malignant and benign pelvic masses.

Aged↗
PubMed1998

[3-dimensional ultrasound in clinical diagnosis of meniscus lesions].

AIM: To compare the significance of the two-dimensional and three-dimensional sonography in the diagnosis of meniscal tears under clinical conditions. METHODS: Sixty menisci of knees with clinical symptoms (44 medial and 16 lateral menisci) were examined by an identical transducer in a two- and three-dimensional sonography technique. The findings were compared with the diagnosis made with subsequent arthroscopy. RESULTS: In the diagnosis of meniscal lesions the two- and three-dimensional sonography reached a sensitivity of 92% and 100% and a specificity of 83% and 88%, respectively. The positive predictive value of these methods was 58% and 67%. The negative predictive value was 98% and 100%. Because of the good results with the two-dimensional sonography, there were no statistically significant differences between both methods. The three-dimensional sonography, however, proved to be superior, to the two-dimensional sonography in the analysis of subgroups (medial and lateral menisci, menisci with and without clinical symptoms). The negative predictive value of the three-dimensional sonography was 100% for all of these subgroups. CONCLUSION: Although this study shows no significant difference in the results of two- and three-dimensional sonography, the analysis of subgroups displays a slightly improved significance for diagnosis of meniscal tears by three-dimensional sonography. The high negative predictive value shows that three-dimensional sonography, performed by an experienced examiner, may be useful to exclude meniscal tears. This result may help focus further cost-intensive or invasive examinations.

Adolescent↗
PubMed1998

Case report: prenatal diagnosis of diastrophic dysplasia by ultrasound at 21 weeks of gestation in a mother with massive obesity.

Routine prenatal ultrasound of a massively obese mother at 21 weeks of gestation revealed short-limb dwarfism in the fetus. The proportionate shortening of tubular bones of about 50 per cent of the normal length, the absence of thoracic dysplasia, and a normal head circumference narrowed the diagnosis down to a severe but non-lethal skeletal dysplasia. Ulnar deviation of the hands and talipes made diastrophic dysplasia the most likely differential diagnosis. At post-mortem clinical examination, the diagnosis of diastrophic dysplasia was clearly apparent due to highly specific 'hitch-hiker thumbs', similarly luxated big toes, facial dysmorphism, and a cleft palate. Retrospective re-evaluation of the prenatal ultrasound videos revealed the misplaced thumbs, which together with the ulnar deviation of the wrist and suspected talipes, led to the conclusion that the definitive diagnosis can be established prenatally, even in a mother with massive obesity.

Abortion, Induced↗
PubMed1997

Chemotherapy is a safe and effective initial therapy for infected malignant breast and chest wall ulcers.

BACKGROUND AND OBJECTIVES: Locally advanced breast cancers may form large, infected skin ulcers, which were traditionally treated with radiation therapy. Neoadjuvant chemotherapy is now standard treatment for locally advanced breast cancer. METHODS: The response of 33 patients with ulcerated breast cancer to primary chemotherapy was retrospectively analyzed. Antibiotics were not used in primary treatment. Tumor and ulcer responses were evaluated independently. RESULTS: Chemotherapy alone healed 18 of these ulcers. Neither responding nor refractory patients developed sepsis during this treatment. CONCLUSIONS: Chemotherapy is safe and effective treatment for patients with infected malignant breast ulcers and does not cause systemic sepsis.

Adult↗
PubMed1997

[3-dimensional sonography in the diagnosis of meniscal lesions. An experimental and clinical study].

There is no consensus regarding the clinical significance of conventional two-dimensional ultrasound in the diagnosis of meniscal tears of the knee. Three-dimensional ultrasound spatially reconstructs a transparent image of subsequent ultrasound scans. In an experimental study of 96 menisci, radial and oblique tears were detected more often by three-dimensional ultrasound. In a clinical study of 60 menisci the two- and three-dimensional ultrasound reached a sensitivity of 92% and 100%, a specificity of 83% and 88%, a positive predictive value of 58% and 67%, and a negative predictive value of 98% and 100%, respectively. Altogether, there was no statistically significant difference between both methods. The high negative predictive value, however, shows that the three-dimensional ultrasound may be a clinically relevant examination for special questions in the diagnostics of meniscal tears.

Adolescent↗
PubMed1997

[Diagnosis of blood flow in breast tumors with increased blood pressure. New possibility in tumor field diagnosis].

On the assumption that the architecture of blood vessels of malignant tumors, formed by neoangiogenesis, shows characteristics that are different from those of blood vessels of benign tumors or physiological findings, we have tried in the present study to investigate the behavior of these different vessels under increased blood pressure. Using a special stand, the same sonographic section could be stably maintained during an examination time of approx. 4 minutes. Using a new computer program, the color pixels of the employed Angio color technique were quantified and recorded as a function of the measured blood pressure. To increase blood pressure, the patient had to press a hand grip, which practically always caused a systolic blood pressure elevation of more than 15-20 mmHg. Seventy patients with sonographically detected breast tumors were examined; 54 (14 benign and 40 malignant tumors) could be included in the evaluation. We found four typical types of curves: Curve type 1 is associated with an instantaneous increase in blood flow with increased blood pressure, followed by a drop in the blood pressure, with a slow decrease in blood flow as the blood pressure drops (with 29 malignant and 3 benign tumors). Curve type 2 shows a continuous increase in blood flow-though somewhat delayed with respect to the rise in blood pressure-which is also observed when the blood pressure drops (exclusively benign tumors). In curve type 3, maximum blood flow is reached after the blood pressure maximum, and then the blood flow decreases (1 benign and 3 malignant tumors). Curve type 4 features decreased blood flow in spite of increased blood pressure (3 benign and 5 malignant tumors). The described quantification method, in combination with the stand, permits for the first time analysis of a tumor under increased blood pressure as to its blood flow behavior over time in an examination using a challenge test. Here one can find two distinctive curve types (types 1 and 2) that correlate mostly with malignant (type 1) or benign (type 2) breast tumors. Should this tendency be substantiated by additional large-scale studies, it would seem that a new ultrasonic possibility for differential diagnosis has been found.

Adult↗
PubMed1997

Sonographic blood flow measurements in malignant breast tumors. A potential new prognostic factor.

BACKGROUND: The aim of this study was to find a possible relationship between the biological behavior of carcinomas of the breast and sonographically detectable blood flow after first studies showed a correlation between blood flow and prognostic factors. METHOD: 259 patients with ductal invasive breast cancer were examined using MEM (i.e., the Maximum Entropy Method), a new sonographic blood flow measurement technique capable of discerning considerably slower blood flow velocities than Doppler sonography. Due to the lack of objective methods for quantifying the blood flow, the findings were divided into three classes dependent upon the visual color information obtained. The blood flow was correlated with the size of the tumor, lymph node and receptor status, ploidy and S-phase fraction. RESULTS: Most of the patients with small tumors, without lymph node metastases, with positive receptors, with a diploid genome, and with a low S-phase fraction belonged to the group with the lowest blood flow. CONCLUSION: The close relationship between the established prognostic factors and the sonographic blood flow measurements using MEM might be indicative of a new preoperative prognostic factor; this must, however, be confirmed by larger studies.

Blood Flow Velocity↗
PubMed1997

The sensitivity of new color systems in blood-flow diagnosis. The maximum entropy method and angio-color-comparative in vitro flow measurements to determine sensitivity.

BACKGROUND: Two new blood-flow-diagnosis techniques have recently been developed as supplements to the established color techniques: the MEM (maximum entropy method) technique and color flow amplitude (power Doppler). These are capable of representing blood flow in distinctly more slowly flowing areas than is possible with the conventional Doppler technique. METHODS: Both methods make use of the Doppler technique in part, yet analyze the reflected signal in a different manner, in so doing optimizing the relation between the noise and the signal. Measurements were obtained on two anatomic flow models to test the sensitivity of both techniques under slow flow conditions. RESULTS: The slowest flow the MEM technique was capable of recording was 0.5 mm/s, albeit utilizing a 5-MHz transducer for the MEM technique and a 10-MHz transducer for the angio technique. One may thus assume that the MEM technique would be still more sensitive when utilizing a 10-MHz transducer. The advantage of the MEM technique is its real-time flow representation: The angio technique requires a few seconds of acquisition time. This could have serious consequences during clinical utilization. Doppler sonography was merely capable of detecting a minimum flow velocity of 15 mm/s. The angio technique is less dependent on the angle during flow representation than the MEM technique. CONCLUSIONS: The distinctly higher sensitivity of these two new color techniques offers new possibilities in the clinical sector as far as the perfusion diagnosis of organs and tumors is concerned.

Angiography↗
PubMed1997

Telencephalosynapsis (synencephaly) and rhombencephalosynapsis with posterior fossa ventriculocele ('Dandy-Walker cyst'): an unusual aberrant syngenetic complex.

Agenesis of the cerebellar vermis (paleocerebellar agenesis) with fusion of the cerebellar hemispheres (rhombencephalosynapsis) is a rare malformation of the central nervous system (CNS). Its combination with synencephaly (telencephalosynapsis), telencephalic ventricular aplasia, aqueductal atresia and cystic fourth ventricle has not yet been described, as far as we know. Here, we report this combination in a 23-weeks' gestation male fetus who was aborted to a 24-year-old diabetic mother. In this fetus with cerebral and cerebellar hemispheric fusion, vermian agenesis was associated with a Dandy-Walker-like posterior fossa cyst, in spite of the fusion of the hypoplastic cerebellar hemispheres. The CNS malformations were further accompanied by dysmorphic facial stigmata such as unilateral atresia of the external ear, ocular hypertelorism and a broad nasal bridge. Preaxial polydactyly and contractures of the upper limbs were the only associated non-cranial abnormalities. Cytogenetic studies revealed a numerically and structurally normal male (46, XY). The malformation complex described in this fetus of a mother with antedating pregnancy diabetes appears to represent a previously undescribed aberrant syngenetic CNS phenotype, some basic teratogenetic aspects of which will be discussed in this paper.

Adult↗