Biomedical subjects

I Hösli

Publications and source records attributed to I Hösli.

At least 19 recordsLinked to original sources

PubMed2006

[Recent advances in prenatal diagnostics].

During the last years, technical improvements have increased the possibilities in prenatal ultrasound. During the eighties and nineties, fetal malformations were increasingly detected and specified. Since a few years, the measurement of the fetal nuchal translucency between 11 and 14 weeks of gestation has been implemented to calculate the individual risk, in combination with most recent biochemical markers. Today, the sonographic measurement of the nuchal translucency is regarded as a valuable screening tool for chromosomal anomalies in prenatal medicine. Beside standardized examinations, a profound information and counseling of the pregnant women should be emphasized. With the improvement of the specific maternal risk calculation, using the sonographic measurement of the nuchal translucency, the biochemical markers and the maternal age, unnecessary invasive examinations may be prevented and their overall number can significantly be reduced. The same trend is seen in the whole field of prenatal medicine, illustrated by the detection of the fetal rhesus D status from the maternal blood and the use of Doppler ultrasound in the management of fetal anemia.

Fetal Diseases↗

PubMed2006

Surgical management of renal cell carcinoma during the second trimester of pregnancy.

Renal cell carcinoma is rarely diagnosed during pregnancy and its management represents a real challenge. Pregnancy demands special consideration in terms of diagnostic evaluation and management, particularly during the second trimester. We report a patient undergoing left radical nephrectomy using a thoracoretroperitoneal approach at 22 weeks' gestation. Histological analysis revealed a pT2R0G2 chromophobic renal cell carcinoma. Furthermore, we review the sparse literature available.

Adult↗

PubMed2006

Ropivacaine versus bupivacaine 0.125% with fentanyl 1 microg/ml for epidural labour analgesia: is daily practice more important than pharmaceutical choice?

UNLABELLED: Ropivacaine might be superior to bupivcaine for epidural labour analgesia because it appears to induce less lower extremity motor blockade. The clinical relevance of this difference is not yet clear. METHODS: In a double-blind randomised trial bupivacaine and ropivacaine each at 0.125% with 1 microg/ml fentanyl were compared for epidural labour analgesia. This study was performed in two university hospitals. RESULTS: Sixty-three nulliparous women with singleton pregnancies at term were included. There were no differences between bupivacaine and ropivacaine as far as motor blockade, analgesic outcome, mode of delivery and neonatal outcome are concerned. However, the clinical management of epidural analgesia differed significantly between the two institutions involved. Parturients of one institution had their epidural catheter placed earlier, needed less top-up medication, and had more successful mobilisations, when compared to the other institution. CONCLUSIONS: Institutional clinical practice can be significantly different. Pharmacological differences between bupivacaine and ropivacaine at 0.125% with 1 microg/ml fentanyl seem to be less important than differences between institutions in terms of clinical practice.

Adjuvants, Anesthesia↗

PubMed2005

Water birth: is the water an additional reservoir for group B streptococcus?

OBJECTIVE: Water birth became popular in the last years, despite the fact that many questions like the risk of infection for the newborn remain unanswered. Group B streptococcal (GBS) infections in the newborn remain a challenge in obstetrics and neonatology. METHOD: We conducted a prospective trial to study the impact of water birth on the colonization rate of the bath water and, more importantly, the GBS-colonization rate of the newborn. RESULT: After water birth the bath water was significantly more often colonized with GBS than after immersion followed by a delivery in bed. The newborns, however, showed no difference in GBS colonization and there was even a trend towards less GBS colonization of the newborn after a water delivery. CONCLUSION: Regarding GBS colonization of the newborn during water birth there might be a wash out effect, which protects the children during the delivery.

Baths↗

PubMed2005

[Uterine gas gangrene through clostridium perfringens sepsis after uterus rupture postpartum].

Anaerobic infections with Clostridium perfringens (CP) occur rarely but are associated with considerable maternal mortality. We report the case of a patient who developed uterine gas gangrene postpartum and discuss the management of this infection. A 28-year-old patient, GII, PII with history of Caesarean in 2002, delivered a healthy girl per vacuum extraction. Postpartally she presented with an acute abdomen and a laparotomy was performed. The uterotomy suture was intact but a parametrane tear had to be resutured. 36 hours later the patient's condition worsened quickly. Cellulitis was diagnosed and after receiving the results of the wound swabs (CP positive) from the uterus and haematoma, tazobactam and clindamycin were administered. Her condition continued to deteriorate and gaseous gangrene was seen with unilateral extension to the abdomen reaching as far as the axilla cranially and to the thigh caudally. Due to the extensive infection it was necessary to perform a hysterectomy, necrosis removal and splitting of the fascia followed by several debridements and leaving the wound open in order to avoid anaerobic conditions. The patient was discharged after 21 days. She developed a post-traumatic syndrome with severe depression. Clostridium perfringens is ubiquitous and is found vaginally in ca. 1 - 10 % of healthy women and usually does not cause a serious infection. Under the right conditions it can cause an endometritis leading to sepsis. Early recognition and interdisciplinary treatment are of extreme importance. In this case the surgical treatment through hysterectomy combined with targeted antibiotic therapy, ultimately saved the patient's life.

Adult↗

PubMed2003

[The two elements air and water. Introduction to the main topic "water birth"].

Alternative birth methods such as deliveries 'under water' are part of a new concept of individualized obstetrics. Two recent studies from Austria and Switzerland confirm that water deliveries offer a safe and comfortable alternative to deliveries 'in bed' in low-risk pregnancies. The retrospective or prospective observational studies, however, are not randomized studies. Equal results can only be obtained if clear guidelines are worked out and strictly obeyed.

Adult↗

PubMed2003

[Pros and cons of water birth].

Women choose more and more often to deliver in water and expect the hospital to offer this method of giving birth. If we critically look at the data in the literature, we can conclude that it is safe to offer water delivery to any woman who belongs to a low-risk population. However, we have to add that no prospective randomized studies on this topic have been published so far. Thus, women may deliver in water if they wish, but the professionals working in the delivery room have to follow the guidelines and the usual safety standards of the particular clinic in order to avoid any unnecessary risks.

Apgar Score↗

PubMed2002

[Current aspects of labor induction].

Induction of labor is one of the most important means for therapeutic intervention in modern obstetrics. The aim of labor induction is to achieve a better perinatal result for mother and baby as compared to expectative management. Different methods for induction include administration of oxytocin or prostaglandins, amniotomy, and mechanical means of cervical dilatation. The success of the labor induction depends primarily on the readiness of the uterus to go into labor, and the method used for induction. If the cervical ripeness is very advanced, induction with amniotomy and oxytocin seems beneficial. However if the cervix is not yet ready, intravaginal or intracervical prostaglandins are more promising. Until recently, prostaglandins E2 are used in the first line. Now, the prostaglandin E1-analogon misoprostol is also increasingly used. As a rule, induction of labor should be performed as an inpatient procedure in order to be able to provide the surveillance for maternal and fetal safety.

Critical Pathways↗

PubMed2002

[Ultrasound cervix measurement].

The sonographic assessment of cervical length is a well established method for pregnant women with an increased risk of preterm delivery. Even in asymptomatic patients, but with specific risks for preterm delivery, a selected screening has become successful. Up to now a screening in the general population is not recommended, as the sensitivity and specificity in this group are quite low. Therapeutic interventions or preventions are more efficient and under objective criteria with the use of cervical length measurement. The further development will be a combination of sonographic, biophysical and biochemical markers. This includes the multiple causes for preterm delivery and pronounces the central role of sonographic assessment of the zervix. For induction of labour at term the results of cervical length assessment are promising. The interval between priming and delivery and the success rate for a vaginal delivery within 24 hours can be predicted more precisely. It optimises the organisation of a busy delivery unit and motivates the pregnant woman.

Cervix Uteri↗

PubMed2001

Fanconi anemia associated with increased nuchal translucency detected by first-trimester ultrasound.

Increased nuchal translucency between 10 and 14 weeks of gestation has now been established as a marker for chromosomal defects in several large-scale studies. In addition, a growing number of structural defects and some rare genetic syndromes have been identified in association with this marker. We describe a case of a fetus with increased nuchal translucency at 12 weeks of gestation, in which second-trimester evaluation by ultrasound showed an enlarged cisterna magna, a ventricular septal defect and moderate signs of dysmorphia. Karyotyping by chorionic villus sampling revealed a high rate of chromosomal breaks. The diagnosis of Fanconi anemia with early onset was confirmed following the development of severe postnatal anemia 2 months after birth.

Abnormalities, Multiple↗

PubMed2001

Two case reports of rare fetal tumors: an indication for surface rendering?

Fetal tumors are rare and can be difficult to diagnose in utero. This report describes one case of an extrarenal rhabdoid tumor and one case of a giant congenital melanocytic nevus. Both presented with moderate polyhydramnios and were prenatally detected at 31 weeks of gestation with two-dimensional ultrasound. The application of the surface mode of three-dimensional ultrasound improved the visualization of these tumors especially for the parents and the multidisciplinary team. Three-dimensional sonography proved to be a valuable addition to the prenatal armamentarium for the evaluation of these fetal tumors although it is not mandatory for their assessment and clinical management.

Adult↗

PubMed2001

[Use of 3-dimensional ultrasound for assessment of intrauterine device position].

AIM OF THE STUDY: The purpose of our prospective study was to assess the accuracy of measuring and visualizing different types of IUDs with three dimensional ultrasound (3D) and two dimensional ultrasound (2D). METHODS: Ultrasound investigation was carried out in 147 patients 6 weeks after insertion of the IUD; in 127 cases a copper IUD was inserted, in 20 cases a Levonorgestrel-containing (LNG) IUD. Correct measurement was defined as the distance between top of the IUD and inner endometrium as well as IUD and myometrium (fundus) in the longitudinal plane (2D) plus the frontal plane (3D). The possibility to visualize the complete IUD was evaluated in the frontal plane and in the transparent mode after volume rendering. RESULTS: The distance measurement between copper IUD and myometrium or endometrium with 2D and 3D did not differ significantly (19.54 mm +/- 6.13 vs. 19.48 +/- 6.39, 5.58 +/- 4.57 vs. 5.21 +/- 4.57). There was no difference in the distance between LNG IUD and myometrium between the two ultrasound investigations (17.75 +/- 3.70 vs. 16.80 +/- 4.65), whereas the distance between LNG IUD and endometrium was significantly different (5.00 +/- 2.81 vs. 4.30 +/- 3.06, p = 0.03). The imaging of the LNG IUD was very clear with the 3D facilities, especially in the transparent mode. Furthermore, congenital anomalies of the uterus, like an arcuate uterus, were clearly detectable in the frontal plane (3D). CONCLUSION: Distance measurement can be obtained equal as well by 2D or 3D ultrasound. The 3D ultrasound offers the advantage of better visualization of LNG IUD and the assessment of anomalies of the uterine cavity.

Adolescent↗

PubMed2001

Birth as a multidimensional experience: comparison of the English- and German-language versions of Salmon's Item List.

Results concerning satisfaction with the birth experience in different trials are difficult to compare, owing to a lack of internationally used research scales. Salmon's Item List (SIL) is easy-to-handle and would therefore be very helpful for research as well as for obstetric clinic quality control. Two hundred and fifty-one patients were investigated using a German-language version of SIL (SIL-ger); the statistical evaluation was carried out by means of a principal components analysis. Principal components analysis revealed two major findings: (1) as stated by other authors the birth experience is multidimensional, each aspect influencing the others in a non-linear way; (2) in addition to Salmon's dimensions (i.e. postnatal 'fulfillment', intranatal 'physical discomfort' and intranatal 'emotional distress') another postnatal dimension labeled 'negative emotional experience' was detected. Not only are intranatal experiences multidimensional, but so too are evaluative feelings afterwards. In addition to fulfillment, as developed by Salmon, a dimension of negative emotional experience needs to be taken into account. This dimension does not correlate in a linear way with fulfillment. It is appropriate to use SIL in research. Before using it for purposes of clinical quality control, however, larger samples need to be evaluated in order to prove the stability of the factor structure.

Cross-Cultural Comparison↗

PubMed2000

Prenatal diagnosis of a partial trisomy 19q.

Phenotypic anomalies due to a genetic imbalance of chromosome 19 have been reported in very rare postnatal cases. Here a case of partial trisomy 19 diagnosed prenatally by ultrasonography and cytogenetic analysis is presented. Detailed evaluation by sonography showed major anomalies which could be correlated to the typical appearance of this chromosomal anomaly. Termination of pregnancy at 21 weeks of gestation was performed, and the prenatal diagnosis was confirmed postnatally by autopsy. The syndrome in this case was caused by a duplication of the long arm of chromosome 19 (46,XY, dup(19) (q13.1-->qter).

Adult↗

PubMed2000

Complications of lost needle after suture of vaginal tear following delivery.

We present a case of a lost broken needle during repair of a vaginal tear following delivery. The woman was not informed at that time. Only twenty years later a pelvic X-ray visualised the fragment by chance. From that day on she complained about lower abdominal chronic pain and insisted on a hysterectomy. The case considers moving of foreign bodies and as a cause of chronic pain and relates to open information even 20 years later.

Adult↗

PubMed2000

Inv(11)(p13p15) and myf-3(MyoD1) in a malignant extrarenal rhabdoid tumor of a premature newborn.

We present a premature newborn of 32 wk of gestation with a congenital malignant extrarenal rhabdoid tumor (MERT) on the right shoulder with generalized metastases. Standard histologic, immunohistochemical, molecular and cytogenetic methods were used in the evaluation of diagnostic material. Biopsy of a skin lesion showed the histologic features of a malignant rhabdoid tumor. Cytogenetic analysis of the tumor cells revealed an inv(11)(p13p15) and additionally, an increased expression of myf-3 (myogenic determination factor, MyoD1) and PAX3 was detected. These results suggest an origin of the neoplasm derived from a pluripotent cell with the potential of myogenic differentiation. Tumor suppressor genes located on chromosome 11p13 and 11p15 may play an important role for malignant rhabdoid tumor development and progression.

Adult↗

PubMed1999

[Malignant pheochromocytoma in the 17th week of gestation].

INTRODUCTION: Pheochromocytoma during pregnancy is rare and represents a high risk for mother and fetus. Due to the variable clinical presentation it may be mistaken for preeclampsia. CASE: A 34-year-old primipara with hypertension up to 240/120 mmHg. After diagnosis of a pheochromocytoma its resection together with lymph node metastasis in the 17th week of gestation was performed. CONCLUSION: The definitive diagnosis is confirmed by elevation of serum catecholamines and their metabolites in a 24-h urine collection. Localization during pregnancy can be made by ultrasound and MRI. The definitive treatment is surgical removal after administration of adrenergic blockers. If discovered later in pregnancy, delivery by elective caesarean section followed by tumor resection is recommended. Since about 10 % of pheochromocytomas are malignant, postpartum screening is required to detect and treat extraadrenal or metastatic tumors by MIBG scintigraphy, chemotherapy or surgical procedures.

Adrenal Gland Neoplasms↗

PubMed1999

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial.

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.

Administration, Oral↗