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Biomedical subjects

D Mink

Publications and source records attributed to D Mink.

At least 19 recordsLinked to original sources
PubMed2001

Transient bilateral osteoporosis of the hip in pregnancy. A case report and review of the literature.

Osteoporosis of the hip is a rare complication of pregnancy, the diagnosis of which can only be determined by radiologic means. Differentiation between osteonecrosis and osteoporosis remains problematic in some cases. Magnetic resonance imaging was reported as useful for the diagnosis of osteoporosis. Treatment of osteoporosis of the hip in pregnancy should be conservative including physical therapy, restricted weight bearing and analgetic therapy. We report an unusual case of bilateral transient osteoporosis of the hip in pregnancy.

Adult↗
PubMed2001

The immunolocalization of Bcl-2 in human term placenta.

PURPOSE: To study the immunolocalization of the Bcl-2 protein in formalin-fixed placental tissue collected from uncomplicated term pregnancies. METHODS: A total of 19 human term placentas of 38-41 weeks' gestation, 11 obtained from spontaneous deliveries and eight from elective caesarean sections prior to labour were included. Sections were incubated with an antibody to the Bcl-2 protein and light microscopy was used to evaluate Bcl-2 staining. RESULTS: The anti-apoptotic Bcl-2 protein was expressed diffusely throughout the cytoplasm of the syncytiotrophoblast with much less intensive staining in cytotrophoblast and mesenchymal cells. Bcl-2 expression was reduced or lost in areas of syncytial sprouts. No differences in Bcl-2 staining were observed between placentas obtained after spontaneous deliveries and those collected before the onset of labour after elective caesarean section. CONCLUSION: Expression of the anti-apoptotic Bcl-2 protein in human term placenta does not seem to be influenced by parturition. Additionally, Bcl-2 expression might be an important factor in the regulation of apoptosis in the human trophoblast and thus in maintaining placental function during gestation.

Female↗
PubMed2000

Uterine rupture in pregnancy subsequent to previous laparoscopic electromyolysis. Case report and review of the literature.

Reports about uterine rupture in pregnancy subsequent to previous laparoscopic surgery are not frequent. This may be due to the lack of long term follow up of patients who had undergone this surgery rather than the rarity of this complication. A case of uterine rupture subsequent to laparoscopic myomectomy is reported. An increasing rate of the occurrence of this complication is reviewed in current literature, thus reiterating the need for more stringent selection criteria for patients who benefit from this surgical technique.

Adult↗
PubMed2000

Neonatal nucleated red blood cell counts in small-for-gestational-age fetuses: relationship to fetoplacental Doppler studies.

OBJECTIVE: To study the influence of pathologic umbilical and middle cerebral artery and uterine artery Doppler studies on the nucleated red blood cell count in small-for-gestational-age (SGA) fetuses. MATERIALS AND METHODS: Cord blood was prospectively collected during a 18-month period. 80 SGA fetuses (fetal abdominal circumference < 5th percentile) with Doppler ultrasound of the umbilical, the middle cerebral artery and both uterine arteries were enrolled in the study. SGA fetuses with normal Doppler flow velocity waveforms were allocated to group 1 (n = 23). Group 2 (n = 13) were fetuses with abnormal umbilical Doppler studies and group 3 (n = 44) were fetuses with both, pathologic umbilical and uterine artery Doppler studies. 2 fetuses in group 3 showed evidence of brain sparing, 3 fetuses presented absent-end-diastolic flow in the umbilical artery. Outcome measures included nucleated red blood cell count, Apgar scores, arterial pH and arterial base excess, venous pH, birth weight, gestational age at delivery, mode of delivery, rate of neonatal intensive care unit admission and length of stay in the neonatal intensive care unit. RESULTS: Highest nucleated red blood cell counts with lowest birth weight and gestational age were found in group 3. Decelerations of the fetal heart rate were more frequent in study group 3 and caesarean section for fetal indication was performed more often in this group. Those fetuses had to be transfered more often to the neonatal intensive care unit than fetuses of the other study groups. There was a tendency in group 3 towards lower arterial pH values and arterial base excess values. Fetuses with absent-end-diastolic flow in the umbilical artery presented highest nucleated red blood cell counts. CONCLUSION: In SGA fetuses increasing Doppler pathology seems to be correlated with increasing nucleated red blood cell count post-partum. Pathologic uterine artery flow results might have an additional impact on the number of nucleated red blood cells at birth.

Apgar Score↗
PubMed2000

Postpartum ovarian vein thrombosis.

OBJECTIVE: Ovarian vein thrombosis (OVT) is known as a rare but serious postpartum complication. The condition is often clinically not distinguishable from endometritis, appendicitis or pyelonephritis. OVT may cause sepsis, septic pulmonary thromboembolism, and thrombosis of the inferior vena cava and the renal veins, and is potentially fatal. The objective of this study was to report the clinical findings and outcome of two patients with diagnosed ovarian vein thrombosis after delivery managed at this institution. METHOD: Two patients fit the study criteria of documented ovarian vein thrombosis after delivery. An imaging diagnosis (CT) of ovarian vein thrombosis was required for final study inclusion. RESULTS: We present two patients with ovarian vein thrombosis. The symptoms of one patient disappeared two days after beginning heparin and antibiotic therapy. The control-CT 93 days after the diagnosis of POVT showed unsuspected ovarian veins. The other patient suffered from POVT 13 days after spontaneous delivery. Because of lethal embolisms she died during the operation for embolectomy. CONCLUSION: On the basis of our series and other recent series, OVT may likely be more common than previously thought and may become clinically apparent only when complicated by infection, expansion of the thrombus or pulmonary embolism. POVT is a potentially fatal condition most commonly seen as a complication of pelvic surgery or inflammatory disease.

Adult↗
PubMed2000

Nucleated red blood cell count and doppler ultrasound in low- and high-risk pregnancies.

OBJECTIVE: The aim of this study was to evaluate the influence of circulatory deterioration in small-for-gestational-age fetuses (SGA) on the nucleated red blood cell count (NRBC). PATIENTS AND METHODS: During a 12-month period 194 patients with a complete NRBC count post-partum were enrolled in the study. Using pulsed wave colour Doppler ultrasound we recorded blood flow velocity waveforms from both uterine arteries and from the umbilical artery and/or from the fetal aorta. Patients were assigned to seven groups according to the results of the Doppler examination. Mean outcome measures were birthweight, gestational age at delivery, NRBC count, incidence of preeclampsia or SGA and need of neonatal intensive care. RESULTS: Significantly higher nucleated red blood cell counts than in all other groups were found in cases with abnormal Doppler findings in both uterine arteries and the umbilical artery and/or fetal aorta (p<0.001). These newborns had significantly lower birth weights (p<0.01, p<0.001), lower gestational age (p<0.001), an increased likelihood of caesarean section for clinical signs of fetal distress (p<0.001) and had to be transfered more frequently to the neonatal intensive care unit (p<0.01, p<0.001). CONCLUSION: Patients with abnormal Doppler velocimetry waveforms of the uterine arteries in the presence of an abnormal umbilical artery or fetal aorta Doppler findings have a high risk of prematurity, preeclampsia or delivering a small-for-gestational-age newborn. Fetal response to uteroplacental insufficiency may lead to elevated nucleated red blood cells in the fetal blood. This fact might help to discriminate the small-for-gestational-age fetus who is growth-retarded and suffers from chronic placental insufficiency from the small but healthy fetus.

Birth Weight↗
PubMed1999

Carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer.

The fourth case of heterologous mesodermal tumour of the uterine corpus, that developed, years following tamoxifen therapy for breast cancer in a postmenopausal woman with no previous pelvic irradiation, is presented with coincidental endometriosis and endometrial intraepithelial carcinoma. This coincidence after tamoxifen treatment appears to be an indication for the possible carcinogenic potency of tamoxifen.

Aged↗
PubMed1999

Expression of transglutaminase K in normal cervix tissue and cervix carcinomas.

The localization and expression of transglutaminase K has been investigated immunohistochemically in normal cervix tissue (n = 15) and in cervix carcinomas (n = 23). The distribution of the transglutaminase K was compared with the staining patterns of cytokeratin 10, Ki-67, p53, and oestrogen and progesterone receptors in these tumours. Weak to strong membrane-bound immunoreactivity for transglutaminase K was detected in almost all cervix carcinomas analyzed. The immunostaining was heterogeneous, with visual differences between individual tumour cells. 66.7% of normal cervix tissues revealed no immunoreactivity for the transglutaminase K. In normal cervix tissue, the immunoreactivity was confined to upper cervix layers, predominantly to the superficial and intermediate cell layers. The intensity of both the immunostaining and the number of transglutaminase K-positive cells were upregulated in cervix carcinomas as compared to normal cervix tissue. When the coexpressions of transglutaminase K with markers of proliferation and differentiation were analyzed, no statistically significant correlation was found. Our findings indicate that (1) transglutaminase K is upregulated at the protein level in cervix carcinomas as compared to normal cervix tissue; (2) upregulation of the transglutaminase K in cervix carcinoma is not exclusively induced by alterations of epithelial differentiation or proliferation, but by different, unknown mechanisms; and (3) upregulation of transglutaminase K in cervix carcinomas may play an important role for the regulation of tumour invasive properties by modulating cell-cell interactions.

Biomarkers↗
PubMed1999

Maternal and neonatal outcome of twin pregnancies complicated by single fetal death.

OBJECTIVE: To study the maternal and neonatal outcome of twin pregnancies complicated by the intrauterine death of one fetus after 20 weeks of gestation. DESIGN: Retrospective, observational study of 7 twin pregnancies out of 185 twin pregnancies with the diagnosis of a single intrauterine death over a 5-years period in a university hospital. RESULTS: The incidence of single fetal death in twin gestation after 20 weeks was 3.8% in the study population with a high incidence of intrauterine growth retardation (IUGR) of the remaining fetus and preeclampsia in the further course of pregnancy. The incidence of preterm delivery was 71% with a mean gestational age of 33.0 +/- 1.0 weeks. The median interval from diagnosis of single fetal death to delivery was 10.2 +/- 4.1 days (range 1-28 days). 5 of 7 (71%) cases were delivered by cesarean section for standard obstetrical reasons. Neither perinatal nor neonatal death of the remaining twin were observed. Two cases of neurologic injury were diagnosed after delivery by ultrasound and MRI. No maternal coagulopathy related to single fetal death occurred. CONCLUSION: Expectant management of single fetal death in twin pregnancies might be advisible under close surveillance of both, mother and the surviving fetus.

Adult↗
PubMed1999

Nucleated red blood cells in cord blood of singleton term and post-term neonates.

OBJECTIVE: This study aims to determine if nucleated red blood cells are elevated in pregnancies that continue beyond 289 days of gestation. STUDY DESIGN: Cord blood was prospectively collected from term and post-term singleton gestations from August 1 to December 31, 1998. Umbilical artery nucleated red blood cells were counted per 100 white blood cells. The comparison was made between pregnancies ending at 261-289 days (37.1-41.2 weeks) of gestation and those ending after 289 days (> or = 41.3 weeks) of gestation. RESULTS: Cord blood from 304 cases was obtained and evaluated for nucleated red blood cells per 100 white blood cells. The mean value of nucleated red blood cells per 100 white blood cells in the post-term neonate group was significantly higher than in the term neonate group (median 6.5, range 0-24 vs. median 3.7, range 0-14; p < 0.05). The values did not vary by fetal presentation, mode or duration of delivery. Neonatal outcome was comparable between both study groups. CONCLUSION: In post-term gestation after 289 days nucleated red blood cells in cord blood are significantly increased. These results point towards a different fetal oxygenation in post-term pregnancies beyond 289 days of gestation and support the current practice of very close testing of fetal well-being under those circumstances.

Apgar Score↗
PubMed1999

Immunohistochemical detection of apoptosis in the human term and post-term placenta.

PURPOSE: To study the incidence of apoptosis in human term and post-term placenta and to determine its presence in different areas of placentas of uncomplicated pregnancies. METHODS: A total of 15 placentas, 8 obtained from spontaneous deliveries and elective caesarean sections at term (37-41 weeks of pregnancy) and 7 from spontaneous deliveries and elective caesarean sections post-term (> 41 weeks of pregnancy) were included in this study. Apoptosis was identified by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling method (TUNEL, Boehringer, Mannheim, Germany) in paraffin-embedded sections. RESULTS: Apoptosis was predominantly detected in trophoblast and stromal tissue. There were no significant differences in the incidence of apoptosis in different parts of placental tissue. A significant increase of apoptosis was seen in both trophoblast and stromal cells of post-term placentas (p < 0.05; p < 0.005). CONCLUSIONS: Apoptosis could be detected in the human term and post-term placenta, with increasing incidence in post-term placental tissue, suggesting a possible role of apoptosis in the mechanism of parturition and placental senescence.

Adult↗
PubMed1999

Immunohistochemical evaluation of apoptosis in placentae from normal and intrauterine growth-restricted pregnancies.

OBJECTIVE: To investigate the extent of apoptosis within the human placenta in tissues from normotensive term pregnancies and those complicated by intrauterine growth-restriction (IUGR). METHODS: A total of 18 placentas, 10 obtained from uncomplicated term gestations and 8 from intrauterine growth restricted fetuses were included in this study. Apoptosis was identified using a terminal deoxynucleotidyl transferase-mediated deoxyuridine triophosphate nick end-labeling technique (TUNEL, Boehringer, Mannheim, Germany) in paraffin-embedded sections. RESULTS: Apoptosis was predominantly detected in the villous trophoblast and stromal tissue. There were no differences in the incidence of apoptosis in different parts of the same placenta. The apoptotic index in placental tissue from uncomplicated pregnancies was 0.93 +/- 0.12. Significantly more apoptotic nuclei were detected in the placental tissue from IUGR gestation (4.2 +/- 2.96, p < 0.01). CONCLUSION: These results might point toward a possible role of apoptosis in the pathophysiology of intrauterine growth-restriction.

Adolescent↗
PubMed1998

Tamoxifen and proliferation of vaginal and cervical epithelium in postmenopausal women with breast cancer.

OBJECTIVE: The estrogenic effect of tamoxifen on vaginal and cervical epithelium in postmenopausal women with breast cancer is evaluated. STUDY DESIGN: The tamoxifen group consisted of 92 postmenopausal breast cancer patients, the control group I of 30 postmenopausal women with breast cancer receiving no endocrine therapy and the control group II of 40 postmenopausal women without primary breast cancer taking no hormones. We determined the maturation index and the incidence of endocervical cell hyperplasia and metaplasia in cervical and vaginal smears. RESULTS: The maturation index increased under tamoxifen within the first 24 months from 0.4011 before taking tamoxifen (n=56) to 0.6039 (n=138, P<0.0001). The maturation index in the group treated with tamoxifen was statistically significantly higher (P<0.0001) than in the control groups (control group I: 0.3975, P<0.0001; control group II: 0.4102, P<0.0001). Under therapy with tamoxifen endocervical cell hyperplasia (P=0.00156) and metaplasia (P=0.00123) appeared significantly more often. CONCLUSION: An apparent increase not only of the incidence of endocervical cell hyperplasia and metaplasia but also of the maturation of the vaginal epithelium caused by the estrogenic effect of tamoxifen could be demonstrated.

Aged↗
PubMed1998

Immunohistochemical analysis of 1,25-dihydroxyvitamin D3 receptor in cervical carcinoma.

The immunohistochemical localization and expression of 1,25-dihydroxyvitamin D3 receptors (VDR) has been investigated in normal human cervical tissue (n = 15) and in cervical carcinomas (n = 23). VDR immunoreactivity (monoclonal antibody 9A7gamma) was compared with the staining patterns of transglutaminase K, cytokeratin 10 and Ki-67 in these tumours. Moderate to strong nuclear immunoreactivity for VDR was detected in almost all cervical carcinomas analysed. VDR staining was homogeneous, with no visual differences between individual tumour cells. Some 60% of normal cervical tissues revealed weak immunoreactivity for VDR. In normal cervical tissue, nuclear VDR staining was confined to the lower cervical layers, predominantly to the basal cell layer. Both the intensity of VDR immunostaining and the number of VDR-positive cells were up-regulated in cervical carcinomas compared with normal cervical tissue. No visual correlation was found for the coexpression of VDR with markers of proliferation and differentiation. Our findings indicate that: (1) cervical tissue may be a new target organ for therapeutically applied vitamin D analogues; (2) VDR is up-regulated at the protein level in cervical carcinomas compared with normal cervical tissue; (3) up-regulation of VDR in cervical carcinoma is induced not exclusively by alterations in epithelial differentiation or proliferation, but by different, unknown mechanisms; and (4) calcitriol and new vitamin D analogues exerting fewer calcaemic side-effects may be promising new drugs for the treatment or chemoprevention of metastasizing cervical carcinomas as well as of cervical precancerous lesions.

Adenocarcinoma↗
PubMed1998

Ultrasonography of the endometrium and endometrial pathology under tamoxifen treatment.

PURPOSE: The estrogenic effects of tamoxifen on the endometrium and the vaginal epithelium are evaluated. METHOD: 211 postmenopausal women were examined (tamoxifen group: 176 estrogen-receptor positive breast cancer patients; control group I: 35 estrogen-receptor negative breast cancer patients; control group II: 50 women without breast cancer taking no hormones). We determined the endometrial thickness and the maturation index (MI). Person's chi-square-test and the t-test for independent samples were used. RESULTS: In the tamoxifen group, the mean endometrial thickness and the MI were significantly higher (p<0.0001) than in the control groups. No evidence of correlation in duration of tamoxifen intake and endometrial thickness was found (Pearson's correlation coefficient: 0.4773; p=0.0001). The maturation index significantly (p<0.0001) increased under tamoxifen therapy. There was no correlation in the maturation index and endometrial thickness (Pearson's correlation coefficient: 0.1649; p=0.169). The histological clarification (N=47; endometrial thickness greater than 8 mm) revealed 3 neoplasms, 9 endometrial polyps, 2 glandular-cystic hyperplasias and in 32 cases atrophic endometrium. CONCLUSION: An apparent increase of endometrial thickness and the maturation of the vaginal epithelium caused by the estrogenic effect of tamoxifen was demonstrated.

Aged↗
PubMed1998

[Uterine leiomyosarcoma with subsequent pregnancy].

Leiomyosarcoma are malignant tumors showing smooth muscle differentiation, they are rare, representing only about 25 percent of all uterine sarcomas and mixed malignant tumors and slightly more than 1 percent of all corporeal malignant tumors. Usually they arise in postmenopausal women and are not known to be related to the known risk factors for endometrial carcinoma (nulliparity, obesity, diabetes mellitus, hypertension, etc.) or carcinosarcoma (prior radiation therapy). They may occur in uteri that also bear typical benign leiomyomas, but leiomyosarcoma rarely can be proven to have arisen in or from benign leiomyomas. We report on two premenopausal women with leiomyosarcoma--out of totally 31 cases in our clinic from 1975-1995 who got pregnant after surgical treatment preserving the uterus. The patients are alive without evidence of disease 3 and 6 years after surgical resection.

Abortion, Incomplete↗