Biomedical subjects

E M Grischke

Publications and source records attributed to E M Grischke.

At least 19 recordsLinked to original sources

PubMed1992

[B-streptococci in obstetrics--risks and consequences of maternal colonization and neonatal contamination].

2,373 mothers and their newborn were studied during two years with respect to B streptococci colonisation or contamination. Bacteriological, vaginal and anal smears were taken from mothers at the beginning of parturition, as well as the amnion and the aspirated stomach contents of the newborn, employing, in each case, conventional culture methods and a latex agglutination test as a rapid testing method. Smears from the ears were also taken from the newborn for bacteriological examination. The vertical transmission and its possible influencing variables were examined in 1,328 mother/child pairs of the first observation year. Surface contamination of the newborn was confirmed in 10% in at least one smear. In the group of mothers with B streptococci colonisation, the amnion showed the highest rate of contamination (43%), followed by the aspirated stomach contents (26%) and the ear smears (taken from each side separately) with 28% and 30% respectively. Vertical transmission was decisively influenced by vaginal maternal colonisation (50% of the cases resulting in contamination of newborn), whereas anal colonisation, if it was the only site of colonisation, resulted in contamination of newborn in only 32% of the cases. The rate of contamination of newborn dropped significantly from 50% to 20% after intrapartal antibiotic prophylaxis, the latter appearing to be meaningful only after at least 6 hours of exposure. In this group, the surface contamination could be reduced from 61% to 8%. A group of newborn suffering from early onset of sepsis (0.4%), was compared with a group of 13 newborn at risk of infection (0.9%) with established surface contamination and clinical or laboratory chemistry confirmation of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Ampicillin↗

PubMed1992

[Ultrasound diagnosis of blood flow in benign and malignant breast tumors].

Malignant tumours can be differentiated from the benign ones by their vascular blood supply. We employed three methods to analyse the blood flow: the angiodynograph, the duplex system, and the continuous-wave Doppler method, and measured the blood flow in 151 patients on the preoperative day. Histology revealed a malignoma in 92 cases and a benign tumour in 59 cases. It was found, that in more than 90% of the malignomas, a high blood flow was identified in or around the tumour by means of the colour method (angiodynography), which could be quantified by the pulsed-wave Doppler. A significantly lower blood flow was evident in the benign tumours with a markedly increased resistance index (by 80%) established by means of the pulsed-wave Doppler. Continuous-wave (CW) Doppler showed a significantly higher blood flow with almost all malignomas in the entire breast, than was the case with benign changes. Our studies showed, that the enhanced blood flow in and around malignant tumours can be visualised by means of update technology, angiodynography being particularly suitable for demonstrating the flow by the B-mode. Quantification, however, is, at present, only possible by employing the duplex method with pulsed-wave Doppler. CW Doppler is suitable only for blood flow diagnosis of the entire organ, but it requires great precision of working method and is time consuming; tumour blood flow cannot be visualised on-target by this method.

Blood Flow Velocity↗

PubMed1992

[Doppler ultrasound study of breast tumors using color Doppler ultrasound, duplex ultrasound and the CW Doppler ultrasound].

The preoperative examinations by doppler-sonography of 83 patients with tumors of the breast are presented. The examinations are done with newest technique: duplex-sonography in slow-flow-technique (AI 3200, Dornier); colour-sonography in MEM-technique (AI 5200, Dornier) and synchronical colour-doppler++ (Quantum 2000, Siemens) and CW-doppler-sonography (Vasocope 3, Kranzbühler). There is a markable difference between the side of carcinoma and the normal side as well as pre- and postmenopausal patients. No difference is shown in cases of benign tumors and the normal side. The increasing blood flow of a malignant tumor is showed in changing the doppler parameters (A/B-ratio and resistance-index) and in the doppler wave form. The number of vessels found in or around a tumor is not a good criteria to find malignant diseases, the best criteria is the difference between sides of the mamma.

Blood Flow Velocity↗

PubMed1991

Urodynamic assessment and lateral urethrocystography. A comparison of two diagnostic procedures for female urinary incontinence.

We compared urodynamic findings and results of lateral urethrocystography in 84 case. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly greater increase in the normal axis of urethral inclination was noted in patients with a urodynamic diagnosis of stress incontinence than in patients with urge incontinence or for normal urodynamic findings. Lateral urethrocystography vis-à-vis urodynamic assessment proved to be a method having high sensitivity (91%) but low specificity. These two methods supply different but complementary data. Together with the patients' medical history, the assessment of their complaints, clinical vaginal examination, and clinical stress test, they offer valuable information for an efficient therapeutic concept.

Adult↗

PubMed1990

Ifosfamide combination chemotherapy in advanced breast cancer.

The objective of our clinical studies was to develop an effective combination chemotherapy regimen (CHT) with acceptable side effects, consisting of the two most potent drugs used as single agents in breast cancer. We tested the combination of an anthracycline, epirubicin (A) at 70 mg/m2 i.v. on day 1 or (B) at 120 mg/m2 i.v. on day 1 with an alkylating drug ifosfamide (IFO), (C) at 2.5 g/m2 in an i.v. infusion given over 4 h on days 1-3 or (D) at 5 g/m2 in a 24-h i.v. infusion given on day 1. Courses were repeated every 4 weeks. The combinations were given as first-line therapy as follows: CHT (A, C) in six cases and CHT (B, C) in five cases of advanced breast carcinoma, and CHT (B, D) in seven patients with primary inflammatory breast cancer. Due to side effects (e.g., stomatitis, mental disturbances) and applicability, CHT regimen (B, D) was preferred. Responses (12/18) occurred 1-3 cycles earlier than those previously achieved using the conventional epirubicin/cyclophosphamide CHT. We conclude that 5 g/m2 IFO given i.v. over 24 h with uroprotection (mesna) in a two-drug regimen is an effective dose with tolerable toxicity. Alopecia was seen in all cases. However, according to our experience, myelotoxicity is the dose-limiting factor for both of these drugs.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

[Urodynamics and the lateral cystogram: value for incontinence diagnosis].

We compared urodynamic findings and results of lateral cystourethrography in 82 patients with incontinence. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly higher increase of the posterior urethrovesicular angle was noted in patients with a urodynamic stress incontinence than in patients with urge incontinence or those with normal urodynamic findings. Lateral cystourethrography as compared to urodynamic assessment, proved to be a method with high sensitivity (91%) but little specificity. These two methods supply different but complementary data. Together with history, assessment of patients' complaints, clinical vaginal examination, and clinical stress test they offer valuable information for an efficient therapeutic concept.

Adult↗

PubMed1990

[Abruptio placentae].

Neither the frequency nor the clinical pattern of abruptio placentae have changed significantly in the past years. In a retrospective study (1979-1988) we found a frequency of 0.55%, that means one abruptio placentae in every 182 births. Important and significant factors which could be correlated with the abruptio placentae were: premature labour, vaginal bleeding and gestosis. The case histories show a high rate of abortions and interruptions (24.3%) of pregnancy, as well as premature rupture of membranes (15.4%) and multiple pregnancies. Ultrasound furnished valuable diagnostic criteria in only 7.7% of the cases. A high rate of breech presentation (1/5 of all cases) is seen in combination with premature birth (37% less than or equal to 33 weeks of gestation). Half of the patients showed disturbances of coagulation. The high rate of perinatal mortality (12%) is related to the prematurity on the one hand and too late diagnosis of abruptio placentae.

Abruptio Placentae↗

PubMed1990

[A rapid test procedure for the detection of B streptococci in the perinatal period].

At the Hospital of the Department of Gynaecology of the University of Heidelberg, a latex agglutination test (Strep B Patho Dx Test) was applied after extraction of antigens from amniotic fluid and gastric aspirate, parallel to the routine screening programme (vaginal and anal swabs) for maternal colonization with B streptococci. The latex agglutination test was applied in 1336 cases. Maternal vaginal colonization was detected in 14%, anal colonization in 17% of the cases. A comparison of the results obtained with the latex agglutination test and with conventional bacteriological procedures (no gradual bacteriology, incubation 48 hours) showed antigen identification in amniotic fluid in 54%, respectively 24%. In gastric aspirates a B streptococcal contamination was detected by bacteriology in 40% of cases, by the rapid latex agglutination test in 22%. If no streptococci were found in the mother, amniotic fluid or gastric aspirates were contaminated in 4% or 6%, respectively (agglutination test or bacteriology, respectively). With a sensitivity of approximately 50% and a specificity of 98%, the latex agglutination test proved superior to routine bacteriology. All clinically contaminated newborn (positive blood specimens) were clearly identified by this test. With this new latex agglutination test, a procedure is now available to detect B streptococcal contamination in newborns within less than half an hour, thus an intra- or postpartal antibiotic therapy can be applied early.

Anal Canal↗

PubMed1990

[Therapy of ascites with tumor necrosis factor in ovarian cancer].

The biotechnological production of human recombinant tumour necrosis factor (rHuTNF) makes this drug available for clinical application. This endogenous compound exhibits tumouricidal activity and regulatory functions within the immune system. 20 out of 23 (87%) patients with refractory recurrent malignant ascites from ovarian cancer were successfully treated in a phase-I and II-study. The production of ascites was either completely suppressed or reduced to a minimum for at least 4 weeks after maximally three intraperitoneal (i.p.) applications. Two of the three non-responders were mucinous carcinomas. In the phase-I study the evaluation of a maximal tolerable dose was not possible due to the rapid therapeutic success at low doses of TNF. The effective dosage was 0.08-0.14 mg TNF/m2 given i.p. Side effects which occurred 2 to 24 hours after the application of TNF were flue-like symptoms combined with general malaise. The side effects were not dose related. All concomitant signs and symptoms could be minimized by prophylactic or therapeutic application of indometacine, paracetamol or pethidine. This applied especially for the typical early phase cytokine side effects e.g. chills and febrile temperatures. The side effects were not dose related. The i.p. treatment with rHuTNF appears to be a novel practicable and effective method for palliation in patients with recurrent ascites even in multiple pretreated patients.

Adenocarcinoma, Mucinous↗

PubMed1989

[Perineal sonography and roentgenologic procedures within the scope of diagnosis of female urinary incontinence].

Parallel to the traditional lateral cystogram with chain, perineal sonography as was employed as avisual procedure on 50 patients, who presented themselves at our clinic for urodynamic screening for clinical incontinence. The sonographic procedure, performed without introduction of a catheter into the urethra, the urinary bladder, urethra and symphysis as well as vagina and rectum can be visually represented in sagittal section through the minor pelvis. A comparison with traditional x-ray findings, showed a good correlation at 96%. In relation to predictive value, perineal sonography may thus be considered a "true" alternative to radiology. With increasing experience (approx 2-3 months), the sagittal view being unfamiliar at the beginning, perineal sonography proves a simple and quick screening method, which is easy to reproduce.

Female↗

PubMed1988

[Ultrasonography in the primary diagnosis and follow up of ovarian tumors].

Preoperative sonographic data in 317 patients who underwent surgery at the University Women's Clinic Heidelberg for an ovarian tumour during a 6 years' observation period, were compared with the results of clinical examination. The prognostic value of both techniques was examined, by relating the findings (as to tumour size, demarcation from the uterus) to the postoperative histological or cytological diagnosis. In the 214 cases of benign and 103 of malignant ovarian tumours a correct diagnosis was provided by ultrasound in 88% and 74% respectively. Thus significantly more often than by clinical examination alone (p less than 0.001 for benign and p less than 0.01 for malignant tumours). The sonographic findings in 49 patients during follow-up after surgery for ovarian carcinoma and polychemotherapy were checked by a second look laparotomy. The detection rate of tumour progression, recurrence, residual tumour or remission was of 98%.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

[Transposition and myocutaneous island flaps in primary or secondary locoregional surgical therapy of breast cancer].

New plastic surgical reconstruction techniques can today make a major contribution to locoregional therapy in breast cancer cases. The present paper reports on indications for and experience gathered in primary and secondary therapy with transposition (medial-pedicled thoracoepigastric) and myocutaneous island flaps (lower transversal rectus and latissimus dorsi) at the University Gynecological Clinic of Heidelberg between October 1981 and June 1987. Thirty-nine patients were treated using these techniques. Altogether nine rectus, 13 latissimus dorsi, and 21 thoracoepigastric flaps were used; in 16 cases for primary treatment with T4 tumors and in 27 cases for secondary treatment. In view of the rate of complications and recurrences seen, the indication must be established strictly and individually according to the location of the defect, the anatomic situation, and the prognosis for the patient. Today, the use of these plastic surgery techniques should lie in the hands of experienced surgeons and be an integral part of the treatment of primary advanced breast carcinomas or large locoregional recurrences.

Adult↗

PubMed1988

[Length of the cervix in the 2d and 3d trimester: vaginal study versus measurement by perineal scan--an improved indication guide for cerclage?].

In a study made at the Department of Gynaecology of the University of Heidelberg, the cervical length, as measured by vaginal examination, was compared in 100 impatients between the 16th and 40th week of pregnancy with a special ultrasonic examination method termed "perineal scan". Examination results can be considerably simplified, corrected and, above all, increased in objectivity through the use of perineal scan. As a result, in 53 patients in which, clinically, a definite shortening of the cervix was apparent (portio-length 0.5-1 cm), 12 cases (23%) were found by sonography to exhibit a normal finding with a cervical length greater than or equal to 3 cm. Conversely, from 47 patients with either clinically normal findings or clinically minimal cervical shortening (portio-length 1.5-2 cm), 25 cases (53%) were established as pathological by ultrasonic methods (cervical length less than 3 cm). The superior objectivity of the results obtained by perineal scan when compared to vaginal examination could be statistically established, primarily through the number of premature births occurring during the further course of pregnancy. The incidence of premature births was not significantly increased in clinically established cervical shortening of less than 1.5 cm, whereas a significant result was obtained if sonography revealed cervical shortening below 2.5 cm (p less than 0.01). Perineal scan is however also recommended for controlling therapeutic success of tocolytic treatment and for confirming and/or detecting premature rupture of the foetal membranes, as well as in cases of suspected cervical insufficiency or incompetent cervix.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

[Significance of the examination position in urodynamic assessment of female urinary incontinence].

The present paper describes a test center which permits urodynamics tests with the patient in various positions, such as lithotomy position (A), supine position with outstretched legs (B) and, by continuously raising the patient, upright position (C). The results of a comparative investigation show the influence of these different examination positions on urodynamic parameters, in particular the functional length of the urethra and maximum urethra closing pressure at rest. Urodynamic tests on 40 patients with urinary incontinence showed that there is a significant increase in the functional length of the urethra when the patient is in lithotomy position (A) as compared to lying with outstretched legs (B), and that it is once again significantly reduced when the patient is raised to upright position. Maximum urethra closing pressure at rest drops significantly when the patient is repositioned from lithotomy (A) to supine (B) position, and once again rises significantly when she is raised to the upright (C) as compared to the supine (B) position. In the light of the changes described, which cause major changes in the form of the urethra pressure profile, it makes sense to perform urodynamic measurements in at least two different positions. The authors recommend the supine position with outstretched legs (B), as it appears more physiological than the lithotomy position (A), and measurement in the upright position (C). The importance of positioning with regard to the diagnostic information value in determining the cause of urinary incontinence is discussed.

Adult↗

PubMed1987

[Acute hydramnios in the 2d half of pregnancy].

95 patients were prospectively examined from 1982-1986 in a diagnostic programme. These patients showed a clinically and ultrasonically established acute hydramnios during the second half of their pregnancy period. Possible important causes of an acute hydramnios can be confirmed or excluded via on-target sonography; at the same time, a diabetic condition must be excluded and the amniotic fluid must be examined to exclude acute viral or specific bacterial infections. In 8 cases (8%) we found that the mother had diabetes mellitus requiring insulin, the hydramnios being the main pointer towards the metabolic disturbance. Gestation diabetes was confirmed in 23 patients (25%) on the basis of the polyhydramnios. Chromosomal anomalies were seen in 12 eucyeses (13%) and in 2 polycyeses. In 8 pregnancies (8%) we found a pattern of non-immunological hydrops fetalis with pleural effusions and ascites. In three patients (3%) there was an immunological hydrops fetalis with polyserositis within an Rh incompatibility pattern. Severe foetal malformations associated with a normal karyotype were sonographically found in 12 pregnancies--encyeses and twins--(12%). Cardiac disturbances (tachyarrhythmia) resulted in polyhydramnios in 8 cases of eucyesis (8%). Finally, 10 cases only remained unclarified (11%). 14 cases (15%) had twin pregnancy. In this connection we observed on the average an earlier onset of acute hydramnios (27 weeks) compared with the eucyeses (on the average during the 30th week). Timely and adequate treatment may become possible if we know the aetiology of the acute hydramnios, especially in cases of diabetes mellitus and gestation diabetes, as well as in certain foetal malfunctions, such as e.g. pleural effusions and generalised hydrops fetalis and disturbances of cardiac rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1987

Treatment of bacterial infections of the female urinary tract by immunization of the patients.

In an open comparative study 400 patients with urinary tract infections were randomly allocated to two treatment groups. In 202 patients an immune stimulation against uropathogenic bacteria was produced with a new preparation, SolcoUrovac, and only in exceptional cases with pronounced symptomatology was antibiotic therapy given, while in the control group (n = 198) all patients were treated with nitrofurantoin or with another appropriate antibiotic, according to the antibiogram. In the subsequent 12-month observation period 28 infections occurred in 23 patients of the immune-stimulated group and 84 in 47 patients of the control group. This difference is statistically significant (p less than or equal to 0.001). The preventive effect of the SolcoUrovac therapy was particularly impressive in patients with recurrent urinary tract infections. Thirty-two patients from each group with similar case histories, as matched pairs, were evaluated separately. The relapse rate in the 12-month observation period amounted to 2 re-infections in the group treated with immunotherapy and to 29 in the control group. All side-effects were recorded. No adverse effects were observed in pregnant women or in their offspring.

Bacterial Infections↗

PubMed1987

Urinary tract infections in women. Current unsatisfactory situation and prospects of a new therapeutic concept.

The prevalence, pathogenesis and clinical aspects of bacterial infections of the female urinary tract are described and the efficacy of therapies used at present is discussed. Based on a retrospective compilation of data on 142 female patients with urinary tract infections, the pathogen spectrum is defined and the therapeutic results achievable with antibiotics are quantified. In uncomplicated urinary tract infections a cure rate of 73% was achieved. In 12% of the cases the infection persisted, and relapses or re-infections occurred in 15% of the cases. The high proportion of unsatisfactory clinical results justifies the search for new treatment methods. The body's own infection defence mechanisms are discussed and the possibility of stimulating the local immune reaction in the urinary tract is presented as a possible future therapeutic measure.

Anti-Bacterial Agents↗

PubMed1986

[A new study method: the perineal scan in obstetrics and gynecology].

For gynecological/obstetrical ultrasound examination the abdominal wall constituted the first and for a long time the only acoustical window that could be used to visualize the female reproductive organs. Only recently transvaginal/transrectal endosonography has opened new approaches in this diagnostic field. Apart from the above-mentioned procedures, the female perineum can be regarded as a useful window to demonstrate the cervix uteri, the bladder and the urethra. At the Universitäts-Frauenklinik Heidelberg this examination procedure was used since June, 1985, to evaluate its clinical reliability in obstetrics and gynecology.

Female↗