Biomedical subjects

C Sohn

Publications and source records attributed to C Sohn.

At least 127 records · Page 7Linked to original sources

PubMedDate not supplied

[Influence of antenatal acupuncture on cardiotocographic parameters and maternal circulation - a prospective study].

BACKGROUND: Acupuncture as a non-evidence-based therapy modality is widely used in obstetrics prior to and during delivery. Thus far, only few studies investigated the impact of acupuncture on obstetric surveillance parameters like cardiotocography. The aim of this study was to control the effect of clearly-defined acupuncture on CTG parameters. PATIENTS AND METHODS: 61 low-risk singleton pregnancies between 30 + 0 and 39 + 6 weeks of gestation were prospectively treated with acupuncture at GV 20 and ST 36 bilaterally for the purpose of maternal relaxation by the same investigator under CTG control. Before (Phase 1), during (Phase 2) and after (Phase 3) treatment the cardiotocogram was recorded. Controlled parameters of outcome were the Fisher score, uterine activity (Phase 1, 2, 3) and maternal blood pressure and pulse before (Phase 1) and after (Phase 2) administration of acupuncture. In a matched control group, 60 pregnant women were monitored by an identical scheme without application of acupuncture and the same outcome parameters were recorded. RESULTS: : The CTG analysis revealed a statistically significant increase of the Fisher score as well as uterine activity which tended to trace back to pretherapeutic initial values. The systolic maternal blood pressure was found to show a statistically significant decrease while diastolic blood pressure and pulse frequency remained unchanged. In the control group, the comparison of phase 1 vs. phase 2 showed a statistically significant increase of the Fischer score and uterine activity. During phase 3 the Fischer score further increased in contrast to a statistically significant slight reduction of uterine activity. Maternal systolic blood pressure measured at the end of phase 2 was found to be statistically reduced while diastolic blood pressure and pulse remained unchanged. The extent of the systolic blood pressure reduction was markedly higher in the acupuncture group as compared to the control group. CONCLUSIONS: Antenatal acupuncture as a reflex therapy for the purpose of maternal relaxation seems to exert an influence on short-term alterations of the fetal activity (transient increase in terms of Fischer score) with reversibly increased uterine activity as detected by cardiotocography. Also, a slight reduction of the maternal blood pressure seems to be effected. The phenomena recorded in the control group (relaxation without supportive acupuncture treatment) revealed to be partially concordant (reversibly increased uterine activity, mild maternal reduction of systolic blood pressure) and partially discordant (persisting increase of Fischer score) as compared with the acupuncture group. Acupuncture seems not only to have a psychological, but also a short-term somatic effect with direct influence on maternal and fetal circulation parameters. Other established surveillance parameters and different points of acupuncture should be studied to further elucidate the underlying interaction as well as the duration of this effect.

Acupuncture↗

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3D real-time imaging of the fetal heart.

OBJECTIVE: The aim of this study was to evaluate the clinical utility of a novel 3D scanner system for real-time 3D fetal echocardiography. METHOD: In a prospective study, 13 single, healthy 20- to 24-week-old fetuses were examined with conventional 2D and real-time 3D echocardiography. The visualization rates and imaging quality of standard cardiac views were compared between both methods. RESULTS: The visualization rates of standard cardiac planes were found to be slightly increased and more easily obtainable in 3D imaging whereas the image quality showed better results with conventional 2D echocardiography. CONCLUSION: Our data show that real-time 3D fetal echocardiography can be considered a useful tool in the evaluation of the fetal heart with the necessity for further refinement of the resolution quality

Echocardiography↗

PubMedDate not supplied

Evaluation of two-dimensional versus three-dimensional ultrasound in obstetric diagnostics: a prospective study.

OBJECTIVES: We aimed to find answers to the following questions: What are the technical and biological prerequisites for easily obtainable three-dimensional (3D) images? What are the visualization rates for various fetal organ systems? What is the potential for assessing fetal malformations? What are the psychological effects of 3D imaging on the expectant mothers? METHODS: Between January and June 1998, 433 pregnant women were prospectively examined with two-dimensional (2D) and 3D sonography. RESULTS: 3D visualization in healthy fetuses was inferior in quality to 2D visualization, which also accounted for the comparison of 3D imaging versus 2 D imaging among fetuses affected with malformations. In only 1 case did 3D imaging yield a slightly better description of the given malformation. This did not result in a different therapeutical approach. Concerning the psychological effect of 3D imaging, a marked approval of the 3D method was recorded. CONCLUSIONS: These results show that the image information acquired by 3D ultrasound technology is nearly always inferior to the image information obtained by conventional 2D imaging. 3D imaging can be useful for specific malformations under the condition that these examinations be performed in specific ultrasound departments. Thus, a clearly defined range of indications can be assigned to 3D imaging.

Congenital Abnormalities↗

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Treatment of the twin-twin transfusion syndrome: initial experience using laser-induced interstitial thermotherapy.

This paper describes our initial experience with laser-induced interstitial thermotherapy (LITT) for the treatment of the twin-twin transfusion syndrome (TTTS). This procedure was utilized in four pregnancies-three monochorionic twin pregnancies and one triplet pregnancy (20-26 weeks of gestation)-with severe TTTS with fetal dropsy, polyhydramnion of the acceptor, and anhydramnion of the donor. In vitro examinations of placental tissue had shown that laser coagulation can be monitored by sonography, hence we used this method for the first time in these four pregnancies. Blood vessels connecting the two umbilical cords were determined prior to the treatment using a new ultrasound color technique which is highly sensitive and capable of representing slow blood flow velocities. A 1.2 mm thick puncture needle was then directed to the shunt under on-line ultrasound control. All patients had an anterior wall placenta. The laser fiber was inserted via this thin needle. A coagulation time of 2-3 min was necessary at 3 W. In the one twin pregnancy the intrauterine fetal death of the smaller child occurred 10 weeks after LITT, the other child survived and is healthy. A cesarian section was necessary in another twin pregnancy 1 week after LITT due to the intrauterine death of the smaller child. In the third twin pregnancy, the donor, who had already had distinct bradycardia prior to the treatment, died immediately after LITT. The intrauterine fetal death of the donor in the triplet pregnancy occurred 3 days after LITT once the volume of amniotic fluid had basically returned to normal. The tragic intrauterine death of the uninvolved child occurred 13 weeks later as a result of umbilical cord strangulation, the surviving child is healthy. All four pregnancies were severe and advanced cases of TTTS with a very poor prognosis, leaving us with no other alternative to the described method of treatment. The instruments we used are a lot thinner than those utilized for fetoscopic laser treatment to date. Furthermore, it is not necessary to penetrate the amniotic sac in patients with an anterior wall placenta; intraplacental vessels can be coagulated, and the laser energy required for LITT is also much lower. In our opinion these advantages justify the utilization of LITT under more promising conditions than those described above.

Adult↗

PubMedDate not supplied

Isolated fetal choroid plexus cysts: not an indication for genetic diagnosis?

Offering invasive prenatal cytogenetic testing in cases of isolated choroid plexus cysts is controversial. To give a contribution to this discussion we recorded prospectively the course of 41 fetuses with cysts of the choroid plexus diagnosed in 4,326 pregnancies sonographically scanned in our center between January 1994 and August 1995. The fetuses were all in the 13th to 24th week of gestation, with an average of 19.3 weeks. Only 1 of these fetuses (with large bilateral choroid plexus cysts) had further sonographically visible malformations (renal and cardiac anomalies, malposition of the hands). 34 fetuses had bilateral and 7 one-sided plexus cysts. 38 of the 41 patients decided on invasive diagnosis; karyotyping was successful in all these cases. The complete follow-up until 5 days after birth is known in 38 fetuses, including 3 without genetic diagnosis. A chromosomal aberration was detectable only in 1 fetus (trisomy 18, this fetus had the additional malformations described above), the other fetuses all displaying neither chromosomal nor morphological abnormalities. All fetuses, excluding 1 (the pregnancy was terminated due to trisomy 18) were re-examined before the 25th week of gestation, plexus cysts only still being visible in 3 fetuses. By the 30th week of gestation in these 3 fetuses the cysts had also disappeared. Furthermore, 20 pregnancies with confirmed trisomy 18 diagnosed between 1990 and 1996 were analyzed retrospectively. In 19 cases heart defects had been detected by prenatal ultrasound, cervical hygroma being less common (6 cases) and other malformations still rarer. Choroid plexus cysts had, however, been seen only in the 1 case described above. There was no case of isolated choroid plexus cysts in this group. From our data and current literature we conclude that isolated choroid plexus cysts are not an absolute indication for fetal karyotyping. In our opinion a detailed ultrasound assessment to seek for further malformations in a specialized center would be necessary if fetal choroid plexus cysts have been diagnosed, and only if additional fetal malformations are indeed detectable a fetal karyotype should be recommended.

Adult↗

PubMedDate not supplied

Changes of serum HER2 status during clinical course of metastatic breast cancer patients.

BACKGROUND: Serum HER2 testing allows the determination of the real-time HER2 status of breast cancer patients. The aim of this investigation was to study (i) whether changes of serum HER2 status occur during the clinical course of breast cancer and (ii) to evaluate the prognostic significance of serum HER2 status, at the time of first diagnosis of primary breast cancer and at the onset of metastatic disease, for survival after relapse (SAR). MATERIALS AND METHODS: HER2 serum levels were retrospectively measured in 152 breast cancer patients at the time of first diagnosis of breast cancer and at the onset of metastatic disease by enzyme immunoassay. RESULTS: Twenty-seven out of 152 (18%) patients had elevated HER2 serum levels at the time of first diagnosis of breast cancer. In contrast, 56 out of 152 (37%) patients showed elevated serum HER2 levels when metastases were diagnosed. A change of serum HER2 status during clinical course was observed in 43 out of 152 (28%) patients. Serum HER2 status at the time of first diagnosis of breast cancer had no impact on survival after relapse (SAR) (p = 0.4). However, the median SAR for serum HER2-positive patients at the onset of metastatic disease was significantly shorter (8 months, 95% CI: 3-12) compared to patients serum HER2-negative at this time (18 months, 95% CI: 14-22) (p < 0.01). CONCLUSION: Serum HER2 status can change during the course of disease. Therefore, the serum HER2 status should be re-evaluated at the time of diagnosis of metastatic disease to optimize treatment decisions.

Breast Neoplasms↗

PubMedDate not supplied

[Ultrasound diagnosis of fetal lung maturity].

Until now, it has been possible to determine fetal pulmonary maturity only by amniocentesis. Since the functional changes of the fetal lung leading to maturity are also morphologically apparent, pulmonary maturity can be demonstrated sonographically. Obtaining a uniform value for maturity is a problem, since the position of the fetus, the mother's constitution and the instrument setting all influence assessment. The fetal liver was therefore used as a reference organ, since it is subject to the same influences. By frequency analysis of both organs and calculation of the ratio between the frequencies obtained, a mathematical value can be calculated by which pregnancies can be compared and which, as our studies showed, represents a measure of pulmonary maturity. This was documented in 348 patients. It was shown by amniocentesis in 32 patients and the postpartal condition of 25 premature births that a value of 1.11 for this ratio between lung and liver represents the borderline between pulmonary immaturity and maturity. Lower values indicate maturity. If these results are confirmed by further studies on larger groups of patients, it will in future be possible to determine fetal pulmonary maturity very easily and non-invasively.

Female↗

PubMedDate not supplied

[Comparison of duplex systems and simple Doppler equipment in obstetric diagnosis].

Duplex systems are normally used in obstretric Doppler sonography. The fact that these systems are technically complex and very costly to some extent contradicts the use of Doppler sonography as a screening method. This study examines whether simplex Doppler systems without tomographic imaging and not involving costly technology, such as frequency analysis, are as suitable for Doppler examination in pregnancy as the costly duplex systems. Examinations of 83 patients between GW 32 and 42 showed that both the umbilical and uterine arteries can be reliably identified using the simplex Doppler unit. A comparison of Doppler curves obtained with duplex and simplex Doppler systems showed that the two devices produced the same results. The Doppler curves were compared both as regards their geometry, according to the score described by Fendel et al. (1988), as well as on the basis of calculated parameters. The scores were correlated to delivery mode and birth weight. However, the fetal aorta cannot be reliably located with the simplex Doppler unit unless it has been tomographically imaged beforehand. Doppler examination of the umbilical and uterine arteries provides the best information for selection of high-risk pregnancies. It therefore appears sufficient to screen patients with the simplex Doppler described here and to perform more detailed diagnostic investigations with a duplex systems in the event of pathologic findings.

Blood Flow Velocity↗

PubMedDate not supplied

[Transvaginal sonography: the differential diagnostic significance of the secondary vitelline sac in early pregnancy].

In the study reported here, yolk sac size and vertex-breech length were determined by transvaginal sonography, in addition to other parameters relevant to early pregnancy. Vital pregnancy was found without abortion symptoms in 72 cases, and with these symptoms in 35 cases; in 29 cases a missed abortion was found. The secondary yolk sac, which was detectable and measurable in 95 of 107 vital early pregnancies, showed constant growth from the fifth (diameter 3.9 mm) to the twelfth completed gestational week p.m. (diameter 6.5 mm). From the tenth completed gestational week p.m. onward, the yolk sac was not always detectable. Of the yolks sacs in the group of missed abortions, seven were found to be too small and 15 rudimentary. The correlation coefficients determined between yolk sac size and gestational age on the one hand and vertex-breech length on the other indicate that there is a significant relationship between the development of the yolk sac and that of the embryo up to the tenth completed gestational week p.m. Where a normally developed secondary vitelline sac is sonographically detected up to the tenth gestational week, the prognosis may be regarded as good. However, any finding which deviates from the norm must be verified, and the prognosis must be considered poor even when a living embryo is detected.

Abortion, Missed↗

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[Doppler studies of arterial uterofetoplacental blood flow before and during labor].

The encouraging results obtained using pulsed Doppler sonography for antepartal diagnosis gave cause to use the method during labor. For this purpose a group with normal course of pregnancy was examined by Doppler sonography. This group was compared with a similar group examined by the same method at onset of labor with the cervix beginning to dilate, or with premature rupture. A comparison of the usual Doppler parameters, uterine arteries, umbilical artery and fetal aorta, recorded in contraction-free phases, showed no differences between the two groups. A third group was examined by Doppler sonography during labor with average or late cervix dilatation. In this case the Doppler parameters for the contraction phases were compared with those for the contraction-free phases. With adequate utero-placental supply during labor, the changes in the Doppler parameters for the uterine arteries due to contraction indicate a reduction in blood flow. The blood flow in the umbilical artery remains unaffected during normal labor. In the fetal aorta the blood flow velocity drops significantly due to contractions, while the peripheral resistance is unchanged. The elimination of the end-diastolic shift in frequency in the fetal aorta during labor indicates a fetal supply deficiency, as shown by Doppler measurements during birth in cases with pathologic cardiotokograms.

Aorta↗

PubMedDate not supplied

[The renal artery and uterine circulation in normal and toxemic pregnancies].

The renal and uterine arteries of 52 patients with normal course of pregnancy and 12 patients with EPH gestosis were examined by Doppler sonography between the 35th and 38th weeks of gestation post menstruationem. Doppler curves of renal arteries were recorded in a further 31 nonpregnant subjects. A significant difference in arterial vessel resistance was found between patients with normal course of pregnancy and those with EPH gestosis. There was also a significant difference in the circulation parameters in the renal vessels between patients with normal courses of pregnancy and the nonpregnant controls. However, there were no differences in this vessel segment between the patients with EPH gestosis and the nonpregnant controls. Among patients with EPH gestosis the renal increase in resistance was relatively more pronounced than the uterine increase. In addition to the calculated flow parameters there were also marked differences in the Doppler curves of these two groups. There is evidently a considerable increase in renal circulation in normal pregnancies. This is in agreement with findings described in the literature, obtained by invasive methods. On the other hand, a clear limitation of renal and uterine resistance was seen in the patients with EPH gestosis. This ties in with the well-known morphologic changes in the kidneys in cases of EPH gestosis. A larger patient sample will have to be studied to determine whether the renal vascular changes described here may represent an early sign of EPH gestosis. If this is confirmed it would make sense to include Doppler sonography of the renal vessels in routine diagnostic procedure.

Adult↗

PubMedDate not supplied

[Non-invasive diagnosis of pre- and postpartum urination disorders].

Postpartal disorders of urinary discharge due to birth trauma are frequently the cause of rising infections of the urinary tract during the puerperium. In diagnosis, noninvasive methods should be preferred. Bladder-emptying function was checked by means of uroflowmetry and sonographic measurement of residual urine in 83 patients at the Department of Gynecology and Obstetrics at the RWTH, Aachen, in the third trimester and post partum. A considerable restriction of urine flow was found both prepartally as well as on the third day post partum. In contrast, there was practically no disturbance of bladder emptying on the sixth day post partum. This function is restored more quickly in cases of cesarean section than in cases of vaginal delivery. As early as the third day post partum no further influence of subpartal analgesia could be demonstrated. The findings failed to show any difference between the group with vaginal/surgical delivery and that with spontaneous birth. Generous use of these noninvasive diagnostic methods to identify postpartal micturition disorders can be recommended.

Cesarean Section↗

PubMedDate not supplied

[Involution-induced changes in arterial uterine blood flow].

The change of resistance in the uterine arteries was studied in 20 patients showing a normal involution on five consecutive days. A uterine artery was examined by Doppler sonography, the Doppler profile evaluated, and the quotient, Fmean, resistance index, and pulsatility index were calculated from the systole and diastole. These parameters, which provided information on vascular resistance independently of the angle between the Doppler beam and the vessel, indicated a continuous increase during the puerperium; the differences in values for different days were significant. The changes in the Doppler profiles in the puerperial period pointed to an increasing vascular resistance. In one-half of the patients this was shown only by an increasing slope to the systolic peak, a sharp drop to early diastole, and a clear distinction between systole and diastole. In the other half of the patients the Doppler curves were like those found in pregnant patients with EPH gestosis. This indicated that the pathologic mechanisms leading to increased resistance in the uterine vessels were the same in both groups. One cause of this may be contraction and compression of the blood vessels, the other, and probably principal, cause was reduction of the vascular system due to histolysis, as in the puerperium, or insufficient development of the vascular system, as in EPH gestosis. That is to say, functional and morphological changes occur in both cases. No decrease in resistance in the uterine vascular bed was detected in cases of puerperial subinvolution of the uterus.

Adult↗

PubMedDate not supplied

[Initial studies of 3-dimensional imaging using ultrasound].

In the study reported here three-dimensional sonographic imaging of organs was achieved for the first time. To make this possible it was first necessary to ensure, by appropriate guidance of the probe, that the sequence of sonographic sections was coordinated in their spatial arrangement. This was accomplished by constructing a probe guide with which parallel sonographic sections could be demonstrated. The distance between these sections was known, so that with the aid of suitable computer programs three-dimensional reconstruction of a kidney examined in a water bath was possible. Since, however, due to the uneven surface of the body, it will hardly be possible to obtain parallel sonographic sections of an organ, a new solution had to be found to ensure the necessary coordinated sequence of sections. The solution lay in rotating the probe. A further device was constructed in which the probe could be rotated farther, by known angles, from section to section. The pivotal point was at the center of the probe tip. The computer knew the angular distance between these sections and reconstruction to a three-dimensional image was therefore possible. Prior the three-dimensional reconstruction the ultrasonographic sections had to be contoured, since only the surface of the organ was available for three-dimensional image construction. Three-dimensional imaging of an organ can be achieved on the one hand by binary representation and on the other with a continuous organ surface. The advantage of binary representation is that the original sonographic data are incorporated in the image-producing process without any computer manipulation; with a continuous surface the distance between the individual sections has to be interpolated.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Simulation↗

PubMedDate not supplied

[Changes in uterine circulation in relation to body position in pregnancy].

The present paper reports on studies to determine the influence of body position on uterine blood flow. In ten pregnant patients (around the 35th week of gestation), over 700 measurements of systolic/diastolic action in the uterine vessels were made by Doppler sonography with the patients in various positions: lying down, standing, and sitting on the couch and the balance-variable chair; from the relationship between the systolic and diastolic levels conclusions were then drawn about the uterine blood flow in various body positions. It was found that it was best when the patient was lying down or sitting on the special chair without angling the hips; in contrast, diastole was lower in relation to systole with the patient standing and sitting on the examination couch. This means an increase in resistance or a reduction in blood flow. It appears reasonable to conclude that sitting on the balance-variable chair can be recommended to pregnant patients with signs of deficient fetal blood supply, in addition to bedrest, which is customarily advised. Apart from this, it is wise to use Doppler sonography to establish the body position in which uterine blood flow is best.

Blood Flow Velocity↗

PubMedDate not supplied

[Comparative studies of the venous system of the arm and leg before and after delivery].

Venous occlusion plethysmographic measurements were performed on the legs of ten non-pregnant subjects on ten consecutive days, in order to demonstrate the reproducibility of this method. In the third trimester of gestation and on the seventh day post partum, venous occlusion plethysmographic studies and vein caliber measurements were performed on arms and legs of 20 patients. A significant reduction in leg vein diameter following delivery was found. There were no differences in the diameters of arm veins measured in the third trimester and post partum. The results of venous occlusion plethysmography, as an indicator of venous function, revealed no differences between the third trimester and post partum in either the arm or the leg. Since hormonal changes during gestation must affect the entire venous system, i.e., also the arms and legs, mechanical displacement of the blood drainage pathways by the gravid uterus is most probably responsible for the significant dilatation of leg veins in the third trimester. A displacement of the higher sections of the femoral vein was demonstrated by Doppler sonography. Increased distensibility of the veins in the third trimester, continuing post partum, is probably the measurable basis of the much higher incidence of varicosis among women who have had children. It appears possible to detect extreme dilatations of leg veins sonographically, and to counter the increased risk of thrombosis and perhaps also to reduce the risk of later varicosis by timely compression treatment.

Arm↗

PubMedDate not supplied

[Fetal functional atrioventricular blocks in pregnancies at risk].

Because antepartal and subpartal CTG monitoring is now widespread, fetal cardiac arrhythmias are being diagnosed ever more frequently. In a high-risk group of 148 pregnancies with placental insufficiency and preterm births, 14 CTGs manifested a rigid rectangular pattern, with alternating normal-frequency and slightly bradycardial cycles. The change in frequency occurred suddenly. All the children of the high-risk group were delivered by cesarean section and weighed less than 2500 g at birth. There is no description in the literature of similar CTG curves with sligthly bradycardial phases. However, there are some descriptions of cases of fetal AV blocks with severe bradycardias. These frequently occur in combination with fetal cardiac abnormalities and collagenoses of the mother. In the present authors' group these underlying conditions were not diagnosed. The fixed numerical ratio of the output frequency to slight bradycardia in the CTGs described here supports the tentative diagnosis of an atrioventricular conduction disorder, with relatively high conduction from the atrium to the ventricle. Since the arrhythmias did not continue in the newborns post partum it may be assumed that they were functional events. Birthweight, Apgar score, and the placental weight of the 14 births with the rectangular CTG curve described were lower than in the control group, i.e., the other 134 births. The CTG patterns described appear to have been caused by a chronic supply deficiency, resulting in functional AV conduction disorders. This CTG course should therefore be reason enough for intensive fetal monitoring.

Acid-Base Equilibrium↗

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[Laser in gynecology. Palliative laser treatment in genital and breast cancers].

Local, so-called incurable, recurrences of breast or genital cancers were as therapeutic challenge in the past. The authors undertook a pilot trial of laser treatment in 45 patients, as a palliative measure, in view of the serious psychological and physical problems experienced by these women constantly confronted by the presence of painful, visible and often ulcerated tumor lesions. CO2 and Nd:YAG lasers were used for tumor vaporisation and coagulation, the combined use of these two wavelengths providing the new study concept which emerged from this pilot trial.

Adult↗