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Biomedical subjects

E Merz

Publications and source records attributed to E Merz.

At least 37 records · Page 2Linked to original sources
PubMed2000

Value of the electronic scalpel (cut mode) in the evaluation of the fetal face.

OBJECTIVES: To evaluate the improvement of image quality and diagnostic value of fetal face examinations using the electric scalpel. METHODS: A total of 232 cases were examined. The fetuses were separated into two groups: Group A, including normal fetuses (n = 152) and Group B, fetuses with facial pathology (n = 80). The fetuses were divided into eight subgroups according to gestational age (9-12 weeks, 13-16 weeks, 17-20 weeks, 21-24 weeks, 25-28 weeks, 29-32 weeks, 33-36 weeks and 37-40 weeks). RESULTS: The number of cutting steps for the improvement of image quality ranged from 1 to 9 (mean value 3) in the group of normal fetuses and from 1 to 10 (mean value 3) in the group of fetuses with facial pathology. In the group of normal fetuses, superior image quality improvement was achieved in 68.4% of cases, moderate improvement in 28.9% and poor improvement in 2.6%. In the group of fetuses with facial pathology, high image quality improvement was obtained in 72.5% of cases, moderate improvement in 25.0% and insufficient improvement in 2.5%. There were no differences among the eight subgroups in the number of steps required relating to gestational age. CONCLUSIONS: The use of the electronic scalpel was associated with diagnostic improvement in 71.1% of cases in the group of normal fetuses, and in 75.0% in the group of fetuses with facial pathology.

Face↗
PubMed2000

Age-related reference ranges for fetal foot length.

AIM: The aim of this study was to establish age-dependent reference ranges for fetal foot length with gestation as well as for the femur/foot length ratio, based on a mathematical growth model. METHOD: In a prospective cross-sectional study of 610 pregnancies with sonographically confirmed gestational age (< 12 weeks' gestation), fetal biometry was performed in addition to measurements of fetal foot length between 12 and 42 completed weeks of gestation. Reference ranges for the fetal foot and for the femur/foot length ratio were constructed with an overall coverage of 90% of the measured data, using a previously established method of determining reference bands for growth parameters. RESULTS: Foot length was noted to level off slightly up to 24 weeks of gestation and it continued in a nearly linear fashion thereafter. The femur/foot length ratio was associated with a mean value of approximately 1 up to 24 weeks of gestation, falling to below 1 after this time point to a value of 0.85 at 41 weeks' gestation. The comparison of the reference ranges established in this study with anatomic and sonographic reference ranges for the fetal foot demonstrates good conformity with the anatomic reference range published by Streeter as early as 1920, and a large degree of conformity with the sonographic reference range developed by Mercer and co-workers. CONCLUSION: The proposed statistical approach offers reliable reference ranges for the fetal foot and for the femur/foot-ratio as well.

Cross-Sectional Studies↗
PubMed2000

Reference values of ductus venosus flow velocities and calculated waveform indices.

In recent years, investigations of the venous vascular system have become increasingly important in the assessment of fetal myocardial function. The aim of the present Doppler ultrasound study was to establish both new reference ranges for blood flow velocity during the different phases of the cardiac cycle (S, SD, D, a) and various calculated indices ((S-a)/S, (S-a)/V(mean), (S-a)D, S/D, a/S, S/a) for the ductus venosus. Pulsed-wave colour Doppler was used in this prospective cross-sectional study to examine 696 women with low-risk pregnancies during the period from 14 to 41 weeks' gestation. Reference curves were constructed for the individual measuring parameters based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square principle. A significant increase in blood flow velocity from 48 cm/s to 65.8 cm/s was observed during ventricular systole (=S) from 14 to 41 week's gestation. Similarly, increases in blood flow velocity were recorded during the endsystolic phase (=SD) (35.5 cm/s to 50.7 cm/s during early ventricular diastole (=D) (41.7 cm/s to 58 cm/s, p=0.0001) and atrial contraction (=a) (11.2 cm/s to 35 cm/s, p=0.0001), as well as for intensity-weighted mean velocity (30 cm/s to 48.3 cm/s). The venous indices were associated with significant decreases in the individual parameters with increasing gestational age: (S-a)/S from 0.77 to 0.47, (S-a)/V(mean) from 1.21 to 0.67, (S-a)/D from 0.89 to 0.54, S/a from 4.5 to 1.99. A significant increase from 0.23 to 0.53 was observed only for the quotient a/S. There were no changes in the S/D quotient (from 1.15 to 1.13). Regarding intra-observer reliability, more favourable results were obtained for calculated indices than for measurements of absolute blood flow velocities. At constant measuring conditions, the reference ranges established by this study for blood flow velocities and calculated indices in the ductus venosus may serve as the basis for Doppler ultrasound follow-up in a normal patient population as well as for the diagnosis of fetal myocardial insufficiency of hypoxic and congestive origin.

Adolescent↗
PubMed2000

[Diagnosis and therapy of leg and pelvic deep vein thrombosis in pregnancy].

OBJECTIVE: To establish differences in the management of acute thrombosis in the deep venous system associated with pregnancy in patients undergoing thrombectomy and in patients receiving heparin therapy. MATERIALS AND METHODS: From 1984 to 1995 the course of pregnancy was assessed retrospectively in 26 patients with acute deep vein thrombosis. Thirteen patients underwent thrombectomy with establishment of an arteriovenous fistula and 13 patients received conservative treatment with heparin therapy. In addition to the assessment of clinical symptoms, signs of thrombosis, diagnoses established with imaging techniques and of laboratory parameters, early complications and obstetric data obtained in surgically and conservatively treated patients were compared. RESULTS: The incidence of deep vein thrombosis in the 26 patients (median age 28 years) was 0.21%. In 53.8% of the cases the occurrence of thrombosis was observed in the second trimester (median: 27.5 weeks of gestation). The presence of risk factors was demonstrated in 58% of cases. The most frequently reported symptoms were swelling of the affected leg (88.5%) and pain (61.5%). A marked predilection for the left leg was recorded in 88% of cases. In contrast to phlebography, twice the number of sonographic studies were performed. The comparison of both therapeutic regimes showed a three-fold increase in the rate of early complications in patients after thrombectomy. The rate of recurrent thrombosis in these patients was 58.3% compared to a recurrence rate of 15.4% in patients undergoing heparin therapy. CONCLUSIONS: Recurrent thrombosis and pulmonary embolism represent the most frequent complications associated with thrombosis in the deep venous system during pregnancy. Although currently there is a lack of conclusive data on the development of postthrombotic syndrome, heparin therapy appears to be associated with fewer maternal risks. Interdisciplinary cooperation is urgently needed.

Adult↗
PubMed1999

Prenatal sonographic chest and lung measurements for predicting severe pulmonary hypoplasia.

UNLABELLED: Pulmonary hypoplasia was diagnosed sonographically in 32 fetuses from 20 to 33 weeks of gestation. In addition to standard biometry, transverse thoracic diameter (TTD), sagittal thoracic diameter (TSD), thoracic circumference (TC) and lung diameter (LD) were measured in all cases and compared with known nomograms. The fetuses were divided into five groups according to the main sonographic findings: group 1-skeletal dysplasia; group 2-renal agenesis; group 3-diaphragmatic hernia; group 4-hydrothorax; and group 5-others. Severe pulmonary hypoplasia (PH) was diagnosed prenatally in all cases on the basis of LD measurements. In 17 (53.1 per cent) out of 32 cases TTD was below the 5th percentile while lower TSD measurements were recorded in 15 (46.8 per cent) fetuses. A thorax circumference below the 5th percentile for the respective gestational age was found in 15 cases (46.8 per cent) and a decreased LD/TC ratio in 25 cases (78.1 per cent). In 13 out of 32 fetuses pulmonary hypoplasia was diagnosed before, and in 19 cases after 24 weeks of gestation. Pulmonary hypoplasia was confirmed by autopsy in all cases. CONCLUSION: pulmonary hypoplasia can be sonographically detected before 24 weeks of gestation. In cases of skeletal dysplasia and renal agenesis pulmonary hypoplasia can be diagnosed by chest and lung measurements, whereas in diaphragmatic hernia and hydrothorax diagnosis of pulmonary hypoplasia is possible only by lung measurement.

Bone Diseases, Developmental↗
PubMed1999

Ovarian endometrioid-like yolk sac tumor treated by surgery alone, with recurrence at 12 years.

We describe the case of a stage Ia endometrioid-like yolk sac tumor (YST) of the ovary, which was originally misdiagnosed as a malignant struma ovarii and not treated with adjuvant chemotherapy. After 12 years, a contralateral dermoid cyst was excised along with a small omental nodule of partially necrotic and calcified endometrioid-like YST. No tumor was detected in several other biopsy specimens, and a peritoneal lavage was negative for tumor cells. Since there was no evidence of remaining tumor and the serum alpha-fetoprotein (AFP) level was normal after the second operation, the patient was followed. Serial serum AFP levels remained normal for 4 months. At a second-look laparotomy after 4 months, a small tumor nodule was removed from the cul-de-sac. Postoperatively, the patient received three cycles of BEP chemotherapy. The long disease-free interval after the first operation in spite of the presence of occult spread to the omentum and to the pouch of Douglas in this case indicates that some endometrioid-like YSTs may have an indolent course. The present case underscores the importance of careful surgical staging and of long-term follow-up in cases of primitive germ cell tumors of the ovary.

Adult↗
PubMed1999

Membrane particle distribution in the sternal epithelia of the terrestrial isopod Porcellio scaber latr. (Crustacea, oniscidea) during CaCO(3) deposit formation and resorption, a freeze-etch analysis.

The anterior sternal epithelium of terrestrial isopods transports cuticular Ca(2+) to and from large sternal CaCO(3) deposits. We analyzed the anterior and posterior sternal epithelium by the means of the freeze-etch technique and measured the size distribution and density of intramembrane particles (IMPs) during three different molting stages. At least three IMP size classes around 4.5, 7.7, and 9.4 nm can be distinguished on the P-face of the apical and basolateral plasma membrane. An additional size class of around 12.8 nm is restricted to the apical compartment. In the anterior sternal epithelium, the density of these large particles changes by a factor of 1.9 during the molt cycle, suggesting a role in CaCO(3) formation and/or resorption. The density of the smaller IMPs rises transiently by a factor of 1.3 in the posterior sternal epithelium only. The IMP density of the basolateral plasma membrane increases significantly by a factor of 1.4 and 1.3 in the anterior and posterior sternal epithelia, respectively. The results indicate that increases in the IMP density contribute to the differentiation to an increased transport activity during the cyclic enlargements of the plasma membrane surface area in the anterior sternal epithelium.

Animals↗
PubMed1999

Congenital diaphragmatic hernia: ultrasonic measurement of fetal lungs to predict pulmonary hypoplasia.

OBJECTIVE: The purpose of this study was to assess the value of biometric lung measurements for the prediction of severe fetal pulmonary hypoplasia in congenital diaphragmatic hernia and to determine whether a correlation between lung measurements and autopsy findings or neonatal outcome could be established. DESIGN: Prospective study, between 1991 and 1997. SUBJECTS: Nineteen fetuses with congenital diaphragmatic hernia. METHODS: In addition to standard biometry, sonographic measurement of the transverse thoracic diameter, sagittal thoracic diameter, fetal lung diameters at the level of the four-chamber view and lung/thoracic circumference ratio were performed. These were compared with the standard curves defined by Merz and colleagues. Autopsy examinations were performed to determine lung weight, lung weight/body weight ratio and radial alveolar count. RESULTS: Five fetuses (26%) were terminated before 24 weeks of gestation. All of these fetuses had lung measurement values below the 5th centile. Eleven of 14 fetuses (78.6%) with pulmonary hypoplasia diagnosed after 24 weeks of gestation died postnatally. The mortality rate was 70% (7/10) in the fetuses without associated anomalies. The sonographic diagnosis of fetal pulmonary hypoplasia was made in all fetuses who died postnatally. All fetuses with a lung diameter/thoracic circumference ratio below 0.09 died. Three fetuses, which had values within the normal range, survived. In contrast, measurements of the bony thorax (transverse and sagittal thoracic diameters, thoracic circumference) did not provide an indication of the presence of fetal pulmonary hypoplasia. Pulmonary hypoplasia was confirmed at autopsy in all fetuses on the basis of lung weight, lung/body weight ratio or radial alveolar count. Concomitant with pulmonary hypoplasia was polyhydramnios in ten fetuses (71.4%), mediastinal shift in 11 fetuses (78.6%), intrathoracic herniated stomach in six fetuses (42.9%) and associated malformations in four fetuses (28.6%). Postnatal mortality for these conditions was 80%, 78.6%, 100% and 100%, respectively. Postnatal mortality was 75%, 70% and 100% in the fetuses with an isolated diaphragmatic hernia. CONCLUSION: The results of this investigation suggest that the assessment of fetal lung diameter and the use of the lung diameter/thoracic circumference ratio are further useful prognostic parameters in the management of congenital diaphragmatic hernia.

Biometry↗
PubMed1999

A new sonomorphologic scoring-system (Mainz score) for the assessment of ovarian tumors using transvaginal ultrasonography. Part II: A comparison between the scoring-system and the assessment by an experienced sonographer in postmenopausal women.

OBJECTIVE: The early and accurate detection of ovarian carcinomas continues to pose a problem. To what degree can the evaluation of a maximum number of sonographic tumor markers on the basis of a newly developed 10-item score improve the preoperative assessment of adnexal tumors in postmenopausal women? MATERIALS AND METHODS: In a prospective study 195 postmenopausal women with an adnexal tumor were examined by transvaginal sonography. A score allowing the evaluation of 10 sonographic markers was used to predict the adnexal tumor status: 1. Total tumor structure, 2. tumor border, 3. wall thickness, 4. inner echoes in cystic component, 5. septa, 6. shape of echocomplex or of the completely solid tumor, 7. echogenicity of the echocomplex or of the completely solid tumor, 8. acoustic phenomena behind tumor, 9. ascites, 10. detection of liver metastases/peritoneal carcinosis. The different markers were rated on a scale from 0 to 2 points depending upon the degree of expression observed for the individual characteristics. The total score obtained after addition of the point number recorded for each marker served as the basis for the assessment of the sonographic tumor status. The adnexal tumor was then assessed by a second sonographer to confirm the validity of the score. After having been informed of all clinical parameters, this sonographer evaluated the preoperative tumor status assessment based on his previous experience. The preoperative tumor status assessment according to the score as well as that by the experienced sonographer were compared postoperatively with the results of the histological diagnosis. RESULTS: All assessment criteria of the score with the exception of septal thickness showed p-values of < 0.05, thus demonstrating a statistically significant correlation between score point numbers and histological findings. A suitable scoring threshold for the sonographic differentiation between malignant and benign adnexal tumors was determined at > or = 10 points at a sensitivity of 96.8% and a specificity of 91.2%, a positive predictive value of 91.2% and a negative predictive value of 96.9%. Ninety of 93 malignant and 93 of 102 benign tumors were accurately identified. Compared with the tumor status assessment by the experienced sonographer, the score offers a clear advantage in the evaluation of ambiguous cases. In 24 of 38 neoplasms whose tumor status could not be determined definitely by the experienced sonographer, the accurate tumor status could be established on the basis of the score. Using the score a problem continues to exist, however, for a small number of false-positive assessments of benign tumors, which occurred in particular for dermoid cysts and fibromas. CONCLUSION: The 10-item score provides even an inexperienced ultrasound sonographer with a valuable tool allowing the assessment of the tumor status of postmenopausal adnexal tumors with a high degree of diagnostic accuracy. For the experienced sonographer the score represents, in particular in the case of indistinct ultrasound findings, a refined and improved method for the prediction of tumor status.

Adult↗
PubMed1998

Evaluation of different transvaginal sonographic diagnostic parameters in women with postmenopausal bleeding.

OBJECTIVE: To determine whether the accuracy of transvaginal sonography to detect endometrial pathology is enhanced by assessing endometrial morphology and the regularity of the endometrial border in addition to measurement of endometrial thickness in women with postmenopausal bleeding. DESIGN AND METHODS: A total of 159 women with postmenopausal bleeding were included in a prospective study performed at the Clinic of Obstetrics and Gynecology, University of Mainz. The results obtained on transvaginal sonographic assessment of the endometrium were compared with the histological evaluation of the operative endometrial specimen. RESULTS: A cut-off level for endometrial thickness of 5 mm had a sensitivity of 94%, specificity of 48% and positive and negative predictive values of 69% and 87%, respectively for the presence of endometrial pathology. Assessment of the regularity of the endometrial border showed a sensitivity of 75%, specificity of 66% and positive and negative predictive values of 73% and 69%, respectively. For the third sonographic parameter, endometrial morphology, the sensitivity was 82%, specificity 64%, the positive predictive value 73% and the negative predictive value 74%. The combined consideration of the three sonographic parameters showed a sensitivity of 97%, specificity of 65%, and positive and negative predictive values of 80% and 94%, respectively. CONCLUSION: The combined evaluation of endometrial thickness, endometrial morphology and the endometrial border enhances the accuracy of transvaginal sonography to detect endometrial pathology in women with postmenopausal bleeding, thus facilitating the decision regarding further diagnostic and therapeutic measures.

Endometrial Neoplasms↗
PubMed1998

[Does maternal obesity increase the risk of fetal abnormalities? Analysis of 20,248 newborn infants of the Mainz Birth Register for detecting congenital abnormalities].

AIM: To investigate the risk of congenital malformations for newborn of obese women (BMI > or = 30) compared with women of average prepregnancy weight. METHODS: We performed a prospective, population-based case-control study of 20,248 newborn born in the city of Mainz. A total of 1,451 infants (cases) with and 8,088 without congenital malformations (controls) were analysed. The relative risks of associations between obesity and malformations were calculated as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The prevalence of malformations in children of obese mothers is 11.1% and thus approximately 4% higher than those of the total study population. There is a significant odds ratio for major malformations (OR 1.3; KI 1.0-1.7). Statistically significant associations were calculated for malformations of the internal urogenital system (OR 1.7; 1.1-2.8), the eyes (OR 5.0; 1.3-20.0) and for orofacial clefts (OR 1.7; 1.1-2.8). Among the specific malformations the highest associations occurred for encephalocele (OR 7.3; 1.1-50.6), common truncus arteriosus (OR 6.3; 1.6-24.8) and Potter sequence (OR 6.3; 1.6-24.8). Adjustment for confounding factors (e.g. maternal diabetes mellitus and age) did not change the odds ratios. CONCLUSIONS: Our data demonstrate that newborn of obese mothers are at an increased risk for malformations. An adequate prenatal examination of these pregnancies should include ultrasound screening by specially trained ultrasonographers in tertiary units (DEGUM II/DEGUM III) and serum alpha-fetoprotein measurements. Public health campaigns for prevention are advised.

Body Mass Index↗