Biomedical subjects
Publications and source records attributed to M Meyenburg.
Chinese hamster ovary cells were treated with ultrasound from a fetal pulse detector (Eucotone, Siemens) operated at 10 mW/cm2 and 2.2 MHz. The frequencies of structural chromosomal aberrations and of sister chromatid exchanges were not increased by the treatment. There was no indication of single-strand breaks induced by ultrasound in the G2 phase of the cell cycle.
The results of 552 amniocenteses during the second trimester of pregnancy are reported. The amniocentesis were carried out under direct ultra-sonographic control. Six abnormal karyotypes were found and the pregnancies were terminated. Three spontaneous abortions due to intra-uterine infection following amniocentesis occurred. There were no maternal complications and no fetal injuries. 430 amniotic fluids were tested bacteriologically. Two samples showed E-coli and two samples grew staph epidermidis. The IGM values of 148 newborns with previous amniocentesis showed the same values as the IGM in newborns without amniocentesis during the pregnancy. Fetal monitoring prior and following the amniocentesis showed a temporary increase in uterine motility in 25% of the cases. Our observations and the review of the literature convinced us that complications of amniocentesis in the second trimester are rare. However, when complications occur the fetus and the pregnant woman are a serious risk. The fetal wastage caused by second trimester amniocentesis is approximately 0.5 to 1%. Therefore the patients must be informed about the risks very carefully prior to a second trimester amniocentesis.
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The prenatal diagnosis of omphalocele is reported. The characteristic signs in the ultra-sound scan were a small trunk, an angulation of the spine and mass adjacent to the absomen of the fetus. By x-ray amniography the ultra-sound findings were confirmed at further abnormalities outlined. The alpha fetal protein levels in the maternal serum and in the amniotic fluid are markedly elevated.
The localization of uterine devices by ultra-sound techniques was investigated. Seven different types of intra-uterine contraceptive devices were checked under immersion in water and in the uterus of 585 wearers of I.U.D.'s. The quality of the ultra-sound pictures is mostly determined by the type of intra-uterine device. Under optimal conditions the investigated types of I.U.D.'s produced standard ultra-sound pictures which permitted their identification. The evaluation of the localization of the intra-uterine contraceptive devices in the uterus was reasonably accurate. At first the classification of normal localization, lower segment localization and cervical localization was used, and this was later enlarged by the measurement of the distance between the uterine fundus and the end of the device closest to the fundus. It was possible to estimate the contraceptive efficiency with these measurements. In 486 cases (83%) the intra-uterine device was found in normal position. In 24 (4.1%) of the cases removal and repeat insertion of the device was suggested. In 18 (3.1%) cases the device was not localized despite normal intra-uterine localization.
During the past eight years ultra-sound scans were carried out on 281 patients with the suspicion of ectopic pregnancy. Diagnostic criteria were established which were designed to minimize false negative results. In 52 cases the clinical suspicion was confirmed by operation. In 46 of these patients ultra-sound signs of ectopic pregnancy were present. Six ectopic pregnancies were not recognized by ultra-sonographies. 73 patients were suspicious of ectopic pregnancy but did not show ectopic pregnancy. The high rate of ultra-sound misinterpretation in ectopic pregnancy is due to the variability of ectopic pregnancy, abortions of intra-uterine pregnancies, abnormalities of the uterus, and adnexal tumours of other etiology. Negative ultra-sound findings do not rule out an ectopic pregnancy since a number of cases with the clinical suspicion of ectopic pregnancy show intact intra-uterine pregnancies. Ultrasonography is a valuable additional diagnostic method in suspected cases of ectopic pregnancy.
The article explains a method for measuring the adhesivity between the anterior part of the foetus and the suction bulb of the vacuum extractor described by Malmström (1). The cover plate of the suction bulb, which is fitted with an expanding measuring strip, is used for reading off the measurements. This enables a quantitative recording of the pressure existing between the foetal part and the truss which corresponds very closely with the adhesivity of the suction bulb to the anterior part of the foetus. The device allows control and recording by means of an instrument with indicator and scale and a recording device. In this manner, vacuum extraction can be subjected to continuous control, thus rendering this obstetric procedure safer and easier.
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1. This report relates our experiences with 63 external versions of random breech or transverse presentations in cranial presentation between the 35th and 40th week of pregnancy p.m. using tocolytica. Only 22 of the 63 versions were successful when only tocolytica were administered. In 17 cases from a total of 34 the external version was successful under subsequent general anasthesia. 2. Of these 39, in whose case an external version of the foetus was successful, there were only two caesarian deliveries. The number of caesarian sections in the case of breech presentation on the other hand totalled, in the year the present investigation was carried out, 62%. By external version the number of caesarian sections performed on those women whose external version was successful was indirectly reduced twelve-fold. 3. It was not possible to turn 24 of the total of 63 foetuses - either by tocolytica or under general anaesthesia. The following factors - partly in combination - were responsible for this: 10 tendencies to contraction; 9 cases of a relatively narrow amniotic cavity: 3 cases of adiposity of the abdominal wall; 3 dorso-anterior or -posterior presentations; one case of "extended legs"; one relatively broad amniotic cavity. 4. An external version can cause damage to the placenta: a) in the case of 6 out of 22 women under obervation foetomaternal transfusion was detected. b) In once case materno-foetel transfusion with polyglobulism of the new-born was suspected. c) In one case a premature partial abruption of the placenta had to be assumed. The danger of damage to the placenta is especially great when the placenta is located next to the anterior wall of the uterus. 5. In 40% of the cases a brief deceleration of the foetal heart-frequency occurred immediately after the external version. Two cases were observed in which the foetal heart-frequency remained low over a period of several minutes. 6. In 5 out of the total of 63 cases a caesarian section was performed after the external version because of the danger of intra-uterine asphyxia. There were 4 cases of chronic insufficiency of the placenta and one of premature abruption of the placenta. 7. Suggestions are made concerning the future selection of breech presentations for external versions.
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Via examinations by ultrasonic sectional view during the course of pregnancy, the growth of the placenta was followed in 52 pregnant women. When a pathologic location of the placenta could be excluded during the first examination in the second trimester (26 cases), secondary development of a pathologic insertion was not observed. In 26 cases in which a pathological location of the placenta could be established before the 20th gestation week, a cranial shift in the caudal placenta border of up to 8 cm could be established in 19 cases. A pathological location of the placenta diagnosed in the second trimester can disappear. The shape of the uterus and the alterations in the spacial relationship between placenta and internal os uteri were caused by the development and stretching of the lower segment of the uterus. The vaginal hemorrhages in the second trimester caused by a low placental insertion (13 cases) stopped (with the exception of 2 cases) at the latest after the 6th month of pregnancy. The definitive establishment of a placenta pravia before the 5th-6th month of pregnancy is virtually impossible sonographically.
Human lymphocytes as well as Chinese hamster ovary cells were sonicated with either a fetal pulse detector (Siemens, Eucotone) or a compound scanner (Kretz, Combison 4100) at diagnostic energy levels. In one experimental series the cells were treated in the G1-phase of the cell cycle, in the other during late S-phase. The frequency of sister chromatid exchanges was determined in the metaphase chromosomes of the following mitosis. No significant increase in the frequency of SCEs per cell was observed as compared with the controls.
Involution of the uterus was observed in 77 puerperae by B-scan ultrasonography. In most cases the examinations were carried out several times on different days. Of all uterine dimensions (extension, circumferences, areal dimensions, volume index) the length proved particularly suitable for evaluating the involution. The other parameters offered no advantages. The findings covered 60 examinations following spontaneous labor and 137 following cesarean section. In both groups involution was completed by the 6th to 7th week after parturition. On the basis of mean values the course of involution was identical in the two groups, although there was considerable individual scatter. These findings, which do not correlate to the usual palpation findings in daily fundus checks on puerperae, may be explained by the different position of the uterus. Following spontaneous labor there is pronounced anteversion of the uterus and it is located lower. Following cesarean section it adopts a more extended position causing the fundus to be higher on palpation. It was also found that daily intramuscular injection of Syntocinon following cesarean sections has no measurable influence on the rate of involution.