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Biomedical subjects

D Spitzer

Publications and source records attributed to D Spitzer.

At least 37 records · Page 2Linked to original sources
PubMed1995

The relationship between peak velocity in the fetal descending aorta and hematocrit in rhesus isoimmunization.

OBJECTIVE: To correlate the peak velocity in the fetal descending aorta, as measured by pulsed Doppler ultrasound, with fetal hematocrit values assessed by funipuncture in pregnancies complicated by rhesus isoimmunization. METHODS: One hundred twelve consecutive funipunctures were performed on 33 rhesus-negative gravidas of 21-36 weeks' gestation (median 30). Doppler flow, corrected for angle, was measured on the fetal descending aorta with pulsed Doppler equipment immediately before funipuncture. Differences between observed peak velocities and the calculated gestational age-dependent upper confidence limits (delta peak velocities) were compared with corresponding differences between observed hematocrits and the calculated lower confidence limits (delta hematocrits), and a regression analysis on the above paired difference values was performed. In addition, the correlation coefficient between delta peak velocities and delta hematocrits was calculated for the first procedure per pregnancy only. RESULTS: The mean peak aortic velocity of anemic fetuses was higher than that of unaffected fetuses (P < .001); delta peak aortic velocities correlated negatively with delta hematocrits (r = -0.66, P < .001). The correlation coefficient between delta peak aortic velocities and delta hematocrits for the first procedure peer pregnancy only was r = -0.72 (P < .001). Prediction of fetal anemia by Doppler using gestational age-dependent 95% confidence limits was possible with positive and negative predictive values of 73 and 66%, respectively. CONCLUSION: Peak aortic velocity, a noninvasive assessment of fetal anemia, may be used as an additional test for monitoring pregnancies complicated by rhesus isoimmunization. However, the limited predictive capacity hampers its clinical usefulness.

Anemia↗
PubMed1995

[Monitoring umbilical cord puncture and intravascular transfusions with Doppler ultrasound].

Complications of percutaneous umbilical blood samplings and intravascular transfusions can be detected rapidly, easily and efficiently by Doppler ultrasound and therefore the operator can react as early as possible. In addition to real-time sonography Doppler ultrasound allows for assessment of haemodynamical changes due to intravascular transfusions both on the venous and arterial side of umbilical perfusion. Because of immediate recognition of bradycardia and other fetal cardiac frequency alterations as well as increase of resistance to blood flow on the arterial side the operator can react promptly. On the venous side correct application of transfused volume is monitored continuously by changes of flow velocity waveforms during injection and allows to assess dislocation of the needle.

Blood Flow Velocity↗
PubMed1994

[Surgical secondary measures in unsuccessful prostaglandin treatment of tubal pregnancy].

As local drug treatment grew more common, the risk of persisting trophoblast remnants increased in tubal pregnancies treated in this way. We studied the secondary surgical measures in 52 patients, who had to undergo surgery for a second time after tubal pregnancy treated with prostaglandins. The indication for revision was arrived at 30 times on the basis of laboratory parameters (increasing or constant beta-HCG) (Group I). Reoperation had to be performed 22 times because of acute clinical symptoms (Group II). Laparotomy was performed 40 times, repelviscopy 12 times. In patients of Group I, the rate of rupture, that, had already occurred at the time of secondary surgery, was significantly smaller (p < 0.0001); in that case secondary surgery was significantly more often successful (p < 0.06) in preserving the tubes. In case of constant beta-HCG values 11 patients (50% of Group II) developed acute symptoms; another 7 patients (31.8%) also had to be reoperated on due to acute complaints, although the values were already clearly reduced. The study proves, that tubal pregnancies can be reoperated with preservation of the tubes even after unsuccessful prostaglandin therapy. The starting position for secondary surgery with preservation of the tubes is much better before acute clinical symptoms occur.

Adult↗
PubMed1994

[HELLP syndrome and manifestation of type I diabetes mellitus in pregnancy].

HELLP syndrome (haemolysis, elevated liver function tests and low platelets) is a multiorganic disease and has been described in combination with pre-eclampsia/eclampsia, but even without symptoms of gestosis. There are signs, that HELLP syndrome represents an "acute status of autoimmunity". Since immune mechanisms play a fundamental role together with other factors in the development of type I diabetes mellitus, a combination of autoimmune reactions could explain the development of type I diabetes during an altered immune status. We report on the course of a pregnancy complicated by HELLP syndrome, which developed type I diabetes mellitus in the same pregnancy. A subsequent pregnancy with adequate diabetes therapy was uncomplicated and without recurrence of HELLP syndrome.

Adult↗
PubMed1994

Three-dimensional ultrasound in obstetrics and gynaecology: technique, possibilities and limitations.

Three-dimensional (3D) ultrasound offers several options extending conventional two-dimensional scanning. Various imaging modes are available. Three perpendicular planes displayed simultaneously can be rotated and translated in order to obtain accurate sections and suitable views needed for diagnosis and geometric measurements. 3D ultrasound tomography combines the advantages of ultrasound, e.g. safety, simplicity of application and inexpensiveness, with the advantages of sequentially depictable sections in numerous rotatable and translatable sections. Surface rendering gives detailed plastic images if there are surrounding layers of different echogenicity allowing for the definition of a certain threshold. Transparent modes provide an imaging of structures with a higher echogenicity in the interior of the object. A combination of the two modes sequentially definable by the sonographer allows for the optimal viewing of structures. These imaging modes are innovative features which have to be evaluated for clinical applicability and usefulness. Digital documentation of whole volumes enables full evaluation without loss of information at a later point. 3D technology provides an enormous number of technical options which have to be evaluated for their diagnostic significance and limitations in obstetrics and gynaecology.

Female↗
PubMed1994

[Postpartum ovarian vein thrombophlebitis--case report].

Because of the low incidence and the lack of clinical symptomatology, puerperal ovarian vein thrombophlebitis has constituted a diagnostic problem now as ever, and diagnostic errors are frequent. With the help of US and CT, however, the chances of early detection have improved. On the 26-year old patient P. C. a section had to be performed in the 34th week of pregnancy because of premature rupture of the bag of waters. On the 7th postoperative day, the patient developed pyrexia inspite of antibiotic therapy. Sonographical examinated lead us to suspect a floating thrombus in the vena cava inferior. It was in the CT that the diagnosis of ovarian vein thrombosis was made for the first time. On the 13th day post partum a laparotomy and exstirpation of the v.ovarica dextra with removal of the thrombus plug from the v.cava inferior infrarenally was performed. Primarily, conservative treatment is given preference if the development is uncomplicated; operative sanitation is undertaken in case of difficulties only.

Adult↗
PubMed1994

[Breast metastasis in renal cell carcinoma].

The breast is an unusual site for metastatic extra-mammalian tumors, for instance for renal cell carcinoma. In the literature only few cases are reported. Our two cases show the possibility of different metastatic forms in hypernephroma after nephrectomy 5 and 6 years before.

Biopsy↗
PubMed1993

[Outcome after artificial amniotic fluid instillation in early oligohydramnios].

We report on the foetal outcome of 50 pregnancies with severe oligohydramnios in the second and early third trimesters in which artificial fluid instillation (AFI) had been performed. Through the AFI, rapid diagnosis was possible or was made easier or additional malformations were detected or could be excluded. The AFI-associated risk was an induction of labour and a possible iatrogenic rupture of membranes in 3/50 cases. A total of 47 pregnancies could be evaluated to the end, 37 ended in intrauterine death, spontaneous abortion or, in case of a diagnosed lethal malformation, in induced abortion. Ten babies were born alive, but within a period of six months 6 of them died. From the total group, 4 children (8%) are alive and healthy. Survivors are from pregnancies with PROM, with severe IUGR or from the group of idiopathic oligohydramnios. Twenty-seven foetuses had structural, chromosomal or functional anomalies (urogenital, intestinal, heart, skeletal, central nervous, complex malformations). Our data demonstrate a poor prognosis in case of early oligohydramnios. AFI enables early and correct diagnosis. It provides a better basis for counselling and managing of these pregnancies. The risk of AFI with possible induction of labour and iatrogenic rupture of membranes has to be considered both in indication and counselling. However, the risk is limited with regard to the very poor prognosis even without invasive diagnosis.

Abnormalities, Multiple↗
PubMed1993

[Does 3D sonography present new perspectives for gynecology and obstetrics?].

3D-sonography opens a new chapter of ultrasound-imaging. The aim of our study was, to summarise our preliminary experiences in the clinical application of this method. One-hundred and fifty patients were investigated with the use of transabdominal transducers. The scanning is performed after targeting the three-dimensional region by the volume box. The three planes are displayed simultaneously on the screen. Analysis can be performed on any possible plane within the stored volume (tomography). Surface imaging and transparent imaging can be calculated and displayed by a work-station. Three-dimensional ultrasound makes complete imaging and documentation of sonographically investigated structures feasible. The possibility of arbitrarily often repeatable systematic analyses without risk for the patient seems to be the more important advantage than statistical simultaneous imaging. Plastic imaging of structures, especially of foetuses, in the surface and transparent modes has been made possible for the first time. Biometry can also be measured in three dimensions (volumetry). Volume documentation provides the possibility of arbitrarily repeatable "real-time" scanning. By this means, any plane can be reanalyzed, remeasured and reassessed. This kind of documentation provides advantages in clinical, scientific, didactic and legal aspects. The first experiences with this new method seem to be promising. Further studies have to be conducted to evaluate the diagnostic significance of 3D-sonography in our field of specialisation.

Congenital Abnormalities↗
PubMed1992

[Comparison of results of daily blood pressure self-monitoring and general practice monitoring within the scope of a study assessing treatment of hypertension with quinapril].

24 hour blood pressure monitoring is a well established method in the field of antihypertensive research. Patients self recorded blood pressure values are an additional option to overcome the disadvantages of casual office readings--however they are not frequently used within intervention trials. To prove the usefulness of selfrecordings in clinical trials we investigated both selfrecordings taken twice a day and casual readings within intervals of 1 to 3 weeks, in this study on the efficacy and tolerability of the ACE-inhibitor Accupro. 108 hypertensive patients (grade WHO I to II) were included in this trial for ten weeks. Although blood pressures were measured by the patients using sphygmomanometers of the same type and the physicians, decisions to treat or to increase dosage were based on the patients' recordings only. Accupro was dispensed according to the package leaflet at a daily dosage of 5 mg up to 40 mg. In case of failing response to monotherapy, Accupro was combined with Diltiazem or with a diuretic. 7 patients discontinued the treatment due to mild adverse events, one did not cooperate. 82 of the remaining patients were treated effectively with Accupro monotherapy--60 (73%) got one dose daily, 22 (27%) 2 doses per day,--and in 18 patients a drug combination was required. Therapeutic response (RRd < or = 90 mm Hg) was gained within 86 of the 100 evaluable patients according to the doctors' and 83 according to the patients' records. In this respect the two methods used gave comparable overall results. This somewhat surprising fact is due to the design of the study, because treatment decisions were based on the selfrecordings only. Clinical trials based on selfrecordings are in some points preferable to casual office readings: As patients being normotensive at home should not be included into an interventional study, a change of dosage within this group is avoided. Additionally the compliance of a cooperative patient taking his blood pressure twice daily is at a high level. Measurements of each single patient may be evaluated statistically by time series-analysis regarding longterm distribution of blood pressure-values. Taking the means of selfrecordings over adequate time-intervals eliminates the influence of "outliers" (occasionally extremely high or low values) and also reduces the standard deviation compared to that of the casual readings. Research work based on self recordings provides more information and therefore more security for treatment decisions.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Achieving ideal esthetics in osseointegrated prostheses. Part II. The single unit.

There are several advantages to the CeraOne single-tooth abutment. It seats directly onto the fixture, forming a nonrotating joint. A new type of gold alloy screw that can be tightened to 32 N/cm is used. In addition, the restoration is constructed on a prefabricated ceramic cap onto which porcelain is directly baked. A case report illustrates the technique and the highly esthetic results of such single-tooth replacement.

Adolescent↗
PubMed1991

[The significance of computed tomography and ultrasound in the diagnosis of puerperal ovarian vein thrombophlebitis].

The diagnosis of puerperal ovarian venous thrombophlebitis (POVT) is problematic, not only because of the low and variable incidence (1:600-6000 births), but also because there are no characteristic clinical symptoms. So far, therefore in 80% of cases it has been diagnosed by exploratory laparatomy. Early non-invasive diagnostic procedures must be aimed at, because surgical intervention involves a high rate of complications and uncomplicated cases can be treated by conservative methods (broad-spectrum antibiotics and anti-coagulants). Several case reports refer to the possibility of recognizing POVT by real-time ultrasound (US) and computer tomography (CT). Two cases are described to illustrate this option for preoperative diagnosis by CT and US. A tubular, annular structure with ring enhancement after application of dye along the anatomical course of the ovarian vein seems to be characteristic for POVT.

Adult↗
PubMed1991

[Diagnosis of fetal thrombocyte count in relation to obstetric management of maternal idiopathic thrombocytic purpura (Werlhof disease)].

Beside maternal, fetal platelet count is the essential parameter for the decision about the obstetrical management in ITP-patients in pregnancy. Evaluation of fetal platelet count contains different problems. Using heparinised capillary tubes in fetal blood sampling procedure, platelet aggregation occurs and therefore false low platelet counts are found, by the commonly used method of conductivity measurement. A recently observed case is reported.

Adult↗