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Biomedical subjects

K T Schneider

Publications and source records attributed to K T Schneider.

At least 19 recordsLinked to original sources
PubMed2006

[Acute ovarian vein thrombosis in the third trimestre].

BACKGROUND: Ovarian vein thrombosis is a known complication in the peri- and postpartum phase. Its incidence is documented as 1:600 to 1:2000. Concerning ovarian vein thrombosis in earlier stages of pregnancy there are only very few case reports. CASE REPORT: We report on a woman in her third pregnancy who presented with acute abdominal pain in the 27th week of gestation. After a long car drive she felt an acute pain in the upper right abdomen which moved down to the right lower abdomen. On admission the obstetrical examination showed no pathology. There were no contractions. Clinical and sonographic examination could not reveal the cause of the pain. As adequate analgesia failed to relieve the pain, an explorative laparotomy was performed. It showed a dilated right ovarian vein of 3 cm diameter with a thrombus reaching the confluence to the vena cava. The ovarian vessels were resected and the adnectomy on the right side performed. Anticoagulation was initiated. There were no complications during the postoperative course. The pregnancy proceeded normally. After 10 days the patient could be dismissed in good condition. Laboratory diagnostic showed an deficiency in protein C. At 39 weeks of gestation a planned caesarean section was performed without any complications.

Acute Disease↗
PubMed2005

[Quality measurement between illusion and reality--is the quality of medical care measurable?].

The current implementation of external quality assurance focuses on identical, albeit simple univariate procedures. This approach proves to be inefficient, exhibiting low specificity. Definitions of performance indicators were classified by the local steering committee and applied to Bavarian obstetric data augmented with multivariate and confidence interval analyses as well as statistical simulations. A highly selected group of units with multivariate extreme values was audited. Blind application of federal regimes without further in-depth analysis of concomitant data is inefficient and may lead to wrong conclusions. Exclusive univariate analyses of performance indicators are not enough. Multivariate analyses have a higher specificity. Classification reveals an imbalance in the indicator set with respect to varying degrees of coverage as well as a bias towards outcome. Deficiencies in the organisational processes crucial for quality of care are often only revealed by dedicated cause and effect analyses within the hospital, thus constituting an essential prerequisite for desired changes in health care policies. It is unlikely that mere publication of performance indicators in the impending quality report will generate lucidity in spite of abundant structure. The installation of standardised programmes with identical computation rules may appear convincing as long as no doubt is cast upon the efficacy of the performance indicators in respect to their intended usage as well as upon the expected feedback effects. The experience so far however teaches us that these elements may be essential yet although not sufficient.

Benchmarking↗
PubMed2005

Prenatal constriction of the fetal ductus arteriosus--related to maternal pain medication?

Physiological fetal circulation requires patency of the ductus arteriosus. As gestation proceeds, the sensitivity of the ductus to dilating prostaglandins diminishes. The sensitivity to constricting agents like PGE-synthetase inhibitors, present in many analgetics, however, increases. Fetuses affected by an antenatal constriction of the ductus arteriosus (DC) may present with different signs of cardiac failure including dilated right ventricle, tricuspid regurgitation and abnormal venous Doppler. We report on four cases with prenatal DC, presenting at 34, 35, 36 and 37 weeks of gestation. They were referred to fetal echocardiography because of abnormal routine echo scans with unexplained signs of right heart decompensation. Three patients were medicated during pregnancy with either aspirin (low dose), metamizole or ibuprofen. One patient did not take any drugs, especially no pain medication drug in pregnancy. Immediate delivery was performed in all cases. The neonates were in a good condition; echocardiography showed different degrees of right heart hypertrophy which disappeared in all infants by the age of 3 months except in case 2. Unexplained fetal right heart decompensation requires detailed echocardiographic evaluation of the ductus arteriosus and a sophisticated medical history with regard to analgesics. In contrast to ibuprofen and high-dose aspirin, metamizole and low-dose aspirin have not yet been reported as possible agents constricting the fetal arterial duct. In any suspected context, early delivery as in our cases may save babies life. Any application of non-steroidal anti-inflammatory drugs in pregnancy requires close fetal follow-up due to their potentially life-threatening effect.

Analgesics, Non-Narcotic↗
PubMed2005

[Private umbilical cord blood banking does not reduce the number of samples for scientific stem cell research].

OBJECTIVE: Private umbilical cord blood (UCB) banking after delivery has increased over the last decade. For adult/somatic stem cell research UCB is an essential source of stem cells and researchers question if the number of UCB samples for research might be reduced by private banking. METHODS: A survey among seven private blood banks in Germany and analysis and comparison of the number of UCB samples donated for research within the STEMMAT project with private blood banking were performed from 03/2003 to 06/2005 at the Frauenklinik (OB/GYN), Technical University Munich, Germany. RESULTS: Within 27.5 months 1,551 UCB samples were collected for research purposes; the effective recruitment rate was higher than expectations at an effective 66.2 %. Private UCB banking [n = 24] was distributed among three cord blood banks [n = 16, 6 and 4]. The rate of private blood banking was 0.99 % for all deliveries, thus reducing the effective rate for research purpose by only 1.5 %. CONCLUSION: Under the assumption of active and successful recruitment of scientific UCB samples, private blood banking does not significantly reduce this rate and therefore is a negligible rival in the competition for sufficient numbers of UCB samples for research.

Blood Banks↗
PubMed2004

[Interdisciplinary management of pregnant women with connective tissue diseases].

Connective tissue diseases affect frequently women during the childbearing period. As fertility is not considerably reduced in these patients, monitoring and treatment of a pregnant patient is a complex clinical setting that requires an intensive cooperation between gynecologists, rheumatologists and pediatricians. In this article, a 4-point-program for the clinical management of these patients is presented that addresses specifically the problems inherent with the identification of patients with connective tissue diseases, preconceptional diagnostics as well as monitoring and treatment during pregnancy and the postpartal period. Clinical aspects that are intensively discussed include immunosuppressive therapy during pregnancy, the management of antiphospholipid antibody-dependent problems and the prophylaxis and treatment options for congenital heart block.

Antiphospholipid Syndrome↗
PubMed2004

[Pregnancy-associated femoral nerve affection].

BACKGROUND: Common neuropathies during pregnancy are carpal tunnel syndrome or peripheral facial paralysis. However, there is little information about femoral nerve affection during pregnancy. CASE REPORT: We report on a female at 30 weeks of gestation, complaining of pain in hips and thighs and gait difficulty. Pregnancy was normally developed. Neurological examination showed a bilateral weakness in both quadriceps and iliopsoas muscles combined with soreness in hips and thighs, without deficits of sensibility. Laboratory findings and results of a lumbar punction were normal. Pelvic ultrasound and an MRI scan of the spine and pelvis showed no mass or disc prolaps. Neuromyographic evaluation bilaterally revealed acute signs of denervation of the muscles innervated by femoral nerve. Caesarean section was performed at 32 gestational weeks, as pain was unbearable and refractory to treatment with even opiates. Post partum, pain relieved immediately, and after weeks of physiotherapy, complete remission was achieved. CONCLUSION: This unusual manifestation of a neuropathy in pregnancy could be due to pressure on the femoral nerve. The patients' anxiety can be eliminated, as the described cases in literature show an excellent prognosis. However, the severity of symptoms can lead us to necessity of premature delivery.

Female↗
PubMed2002

Distribution and unspecific protein binding of the xenoestrogens bisphenol A and daidzein.

Physiological toxicokinetic (PT) models are used to simulate tissue burdens by chemicals in animals and humans. A prerequisite for a PT model is the knowledge of the chemical's distribution among tissues. This depends on the blood flow and also on the free fraction of the substance and its tissue:blood partition coefficients. In the present study we determined partition coefficients in human tissues at 37 degrees C for the two selected xenoestrogens bisphenol A (BA) and daidzein (DA), and their unspecific binding to human serum proteins. Partition coefficients were obtained by incubating blood containing BA or DA with each of the following tissues: brain, liver, kidney, muscle, fat, placenta, mammary gland, and adrenal gland. Blood samples were analysed by HPLC. For BA and DA, all partition coefficients in non-adipose tissues were similar (average values: BA 1.4, DA 1.2). However, the lipophilic properties of both compounds diverge distinctly. Fat:blood partition coefficients were 3.3 (BA) and 0.3 (DA). These values indicate that with the exception of fat both compounds are distributed almost equally among tissues. In dialysis experiments, the unspecific binding of BA and DA with human serum proteins was measured by HPLC. For BA, the total concentration of binding sites and the apparent dissociation constant were calculated as 2000 and 100 nmol/ml, respectively. Because of the limited solubility of DA, only the ratio of the bound to the free DA concentration could be determined and was found to be 7.2. These values indicate that at low concentrations only small percentages of about 5% (BA) and 12% (DA) are as unbound free fractions in plasma. Since only the unbound fraction can bind to the estrogen receptor, binding to serum proteins represents a mechanism that limits the biological response in target tissues.

Animals↗
PubMed2001

Screening for trisomy 21 by fetal nuchal translucency and maternal age: a multicenter project in Germany, Austria and Switzerland.

OBJECTIVE: To examine the effectiveness of screening for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation in Germany, Austria and Switzerland. METHODS: This was a multicenter study of screening for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation. All the sonographers involved in the study had received The Fetal Medicine Foundation Certificate of Competence in the 10-14-week scan. Fetal nuchal translucency thickness and crown-rump length were measured in 23 805 singleton pregnancies with live fetuses. In each case the risk for trisomy 21 was estimated on the basis of maternal age and fetal nuchal translucency thickness for crown-rump length with the use of The Fetal Medicine Foundation's software. The distribution of estimated risk was determined and the sensitivity and false-positive rate for a risk cut-off of 1 in 300 was calculated. RESULTS: Fetal nuchal translucency thickness was successfully measured in all 23 805 pregnancies and outcome was available in 21 959. The median maternal age was 33 (range 15-49) years and in 7935 (36.1%) the age was 35 years or greater. The median gestation at screening was 12 (10-14) weeks and the median fetal crown-rump length was 61 (range 38-84) mm. The estimated risk for trisomy 21 based on maternal age and fetal nuchal translucency thickness for crown-rump length was 1 in 300 or greater in 13.0% (2800 of 21 475) normal pregnancies, in 87.6% (184 of 210) of those with trisomy 21 and in 87.2% (239 of 274) with other chromosomal defects. CONCLUSIONS: In Germany, Austria and Switzerland the results of screening for chromosomal defects by measurement of fetal nuchal translucency thickness, in centers with appropriately qualified sonographers and using The Fetal Medicine Foundation's software, are similar to those reported in the UK using the same methodology.

Austria↗
PubMed2000

Combined transvaginal B-mode and color Doppler sonography for differential diagnosis of ovarian tumors: results of a multivariate logistic regression analysis.

OBJECTIVE: Transvaginal sonography is limited in its ability to assess early stage cancers of the ovary as well as in distinguishing benign processes. As a method for characterization of tumor vascularization, color-coded Doppler sonography may be able to improve the diagnostic accuracy of B-mode sonography. METHODS: Preoperative transvaginal B-mode and Doppler sonography was performed in 63 patients with unclear adnexal lesions prior to operation. Using multiple logistic regression, the independent variables of each procedure were selected and combined to yield a diagnostic flow chart. The diagnostic accuracy of this decision matrix was tested on 257 patients with unclear adnexal tumors. RESULTS: In the 63 adnexal tumors investigated, the diagnostic impact of isolated sonomorphological assessment with evidence of a "solid area" was 78%. Using Doppler sonography, the best discrimination was achieved by displaying the vascular distribution ("central vascularization"). Combining these independent significant variables of the two procedures raised the diagnostic accuracy to 90% (sensitivity 86%, specificity 93%). The validity achieved by this combination was confirmed by the independent application of this method to the 257 adnexal tumors with unclear malignancy status (diagnostic accuracy 93%, sensitivity 92%, specificity 94%). CONCLUSIONS: The combination of sonography and Doppler sonography achieves high and reproducible diagnostic accuracy in preoperative malignancy status assessment of adnexal tumors. The additional use of Doppler sonography can thus provide significant aid both for differential diagnostics of adnexal lesions and for the choice of surgical route in the case of an existing indication for operative therapy.

Adnexal Diseases↗
PubMed2000

[Contraception in patients with congenital heart defects].

The number of women with congenital cardiac disease, who mature into adulthood is increasing. Unfortunately, there are no prospective data published about the relative risk of different forms of contraception for these patients. Most women with congenital cardiac disease can safely use oral contraceptives, especially low-estrogen combination or progestin-only preparations, with the exception of those, who are at particular risk because of thromboembolic complications (especially in cyanosis, pulmonary hypertension, Eisenmenger reaction, rhythm disturbances), fluid retention (especially in reduced ventricular function and congestive heart failure), arterial hypertension (important in coarctation), infectious complications (endocarditis) or hyperlipidemia. Oral contraceptives should be avoided in patients at increased risk for thromboembolic events. Intrauterine devices are very effective, have no metabolic side effects and merely carry a small risk of endocarditis. Newer devices containing progesterone only may put the patients at a still smaller risk. Contraceptive subdermal implants (e.g. levonorgestrel) are used with good results in the United States for patients with contraindications to estrogen-containing oral contraceptives and may well become more widely accepted in patients in Germany in the coming years. Barrier methods can be used, but have a higher failure rate, which may be unacceptable in patients at risk (e.g. Eisenmenger's). Especially in Eisenmenger's, permanent sterilisation should be advised.

Adolescent↗
PubMed2000

An examination of the nature and correlates of ethnic harassment experiences in multiple contexts.

The authors examined the nature and correlates of ethnic harassment experiences in 4 predominantly Hispanic samples of working men and women (N = 575) using a newly developed scale. Confirmatory factor analyses supported a 2-factor structure for the Ethnic Harassment Experiences scale (i.e., verbal ethnic harassment and exclusion due to ethnicity). Most experiences of ethnic harassment in the workplace during the previous 24 months included verbal ethnic harassment (i.e., ethnic slurs, derogatory ethnic comments, or ethnic jokes). It was also found that participants who experienced verbal ethnic harassment and exclusion reported negative correlates that could not be attributed to affective disposition. For some correlates, those who experienced low levels of verbal harassment and high levels of exclusion were more negatively affected than others, perhaps as a result of the attributional ambiguity of the situation.

Adult↗
PubMed1999

Assertiveness predicts threat and challenge reactions to potential stress among women.

In this study assertiveness as a moderator of stress reactions among women was examined. Specifically, the experimenters examined how high and low assertive women cognitively appraised, affectively and physiologically responded to, and behaviorally coped with the stress of giving an impromptu speech. High assertive women appraised the speech stressor as challenging, whereas low assertive women appraised the stressor as threatening. High assertive women also had a challenge pattern of autonomic response during the task, compared with the threat response of low assertive women. Afterward, the high assertive women reported experiencing less stress and negative emotion and greater positive emotion than did the low assertive women. Overall, the high assertive women's stress-related reactions indicated challenge, whereas the low assertive women's reactions indicated threat (see J. Tomaka, J. Blascovich, R. M. Kelsey, & C. L. Leitten, 1993).

Analysis of Variance↗
PubMed1997

Angiogenin plasma levels during pregnancy.

OBJECTIVE: Our purpose was to determine the levels in plasma of angiogenin in healthy pregnant women and to examine whether there are differences between uncomplicated pregnancies and patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets, preeclampsia-eclampsia, and highly pathologic Doppler flow findings without additional complications. STUDY DESIGN: Angiogenin was measured with a novel enzyme-linked immunosorbent assay. A case control and observational study was conducted in 68 healthy women from the tenth to fortieth weeks of pregnancy and in 18 patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets, 21 with preeclampsia/eclampsia and 13 with highly pathologic Doppler flow findings at admission for delivery. RESULTS: Between the tenth and fortieth weeks of uncomplicated pregnancy angiogenin plasma levels rose from 150 to 250 ng/ml (significant correlation). In patients with highly pathologic Doppler flow findings angiogenin is significantly reduced compared with healthy pregnant matched pairs (150 vs 219 ng/ml, p < 0.01). CONCLUSION: Rising plasma angiogenin levels in pregnancy may reflect persisting placental transformation and remodeling processes: in patients with highly pathologic Doppler flow findings these processes are disturbed and thus placental function is impaired.

Adult↗