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Biomedical subjects

M Oettinger

Publications and source records attributed to M Oettinger.

At least 19 recordsLinked to original sources
PubMed1999

Creatine kinase as a biochemical marker in diagnosis of placenta increta and percreta.

We describe 1 case of placenta increta and 1 of placenta percreta, both associated with elevated maternal serum creatine kinase concentration. In patients with placenta previa and ultrasonographic findings of an abnormally adherent placenta, an unexplained elevation in maternal serum creatine kinase level should alert the clinician to the possibility of placenta increta or placenta percreta, with an attendant increase in maternal morbidity.

Adult↗
PubMed1999

Acute adrenal insufficiency during pregnancy and puerperium: case report and literature review.

UNLABELLED: Acute adrenal dysfunction during pregnancy is rare. Nevertheless, adrenal insufficiency can present as an adrenal crisis, and may be life threatening. There is a wide range of clinical symptoms and signs, and the differential diagnosis is challenging. A full adrenal and pituitary evaluation, both structural and hormonal, must be performed to reach the correct diagnosis, and appropriate treatment must not be delayed. A case is presented of acute adrenal insufficiency that occurred 24 hours after a cesarean delivery. The initial symptoms included hypoglycemic seizures and coma. The workup, both hormonal and structural, revealed isolated adrenocorticotrophic hormone deficiency. This considers this case and reviews the differential diagnosis, diagnostic workup, and the treatment of adrenal dysfunction in pregnancy and the puerperium, as well as the obstetric outcome in women suffering from this disorder. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.

Adrenal Insufficiency↗
PubMed1997

Progesterone levels in preterm labor are not affected by ritodrin treatment.

Several in vitro studies reported on increased levels of progesterone secretion from placental tissue. This was not tested in vivo. To study the issue we examined progesterone levels in women presenting with premature labor before treatment, and 24 h and 48 h after beginning ritodrin treatment. A control group consisted of women treated with indomethacin for preterm labor. There were 13 women in the ritodrin group and 12 in the control group. The mean concentration of progesterone in the ritodrin group was 161.7 +/- 74.2, 132 +/- 50.2 and 145 +/- 49.8 ng/ml before treatment, and 24 and 48 h after ritodrin treatment, respectively. The mean progesterone concentration of the group treated with indomethacin was 129 +/- 45.6, 132 +/- 49.5 and 138.6 +/- 53.5 ng/ml before treatment, and 24 and 48 h after treatment, respectively. There were no statistically significant differences between the groups or within each group before and after treatment. Ritodrin treatment does not affect progesterone levels in vivo as demonstrated by in vitro studies.

Administration, Rectal↗
PubMed1997

Evidence that women with a history of cesarean section can deliver twins safely.

OBJECTIVE: To determine whether a trial of labor is safe in twin pregnancies after one previous cesarean section. STUDY DESIGN: Retrospective analysis of all cases of multiple pregnancies after cesarean section during the years 1970-1993, including twin gestations after one cesarean section. RESULTS: Forty-six cases of multiple gestations were found, 36 of which were eligible for the study presented herein. Fifteen women (41.7%) were denied trial of labor. Twenty-one women (58.3%) were allowed trial of labor, 17 (80.9%) of whom were delivered vaginally and four (19.1%) by a repeated cesarean section. The group of trial of labor was compared to the group of elective cesarean section. Hospitalization period was 4.4 +/- 1.9 days and 8.0 +/- 2.6 days in the trial of labor group and elective cesarean section group, respectively (p<0.01). Blood transfusions required were 9.5% and 26.6% in both groups, respectively (NS). Puerperal infections were 9.5% in the trial of labor group, compared to 46.6% in the elective cesarean section group (NS). No scar dehiscence occurred in either groups. There were no statistically significant differences in age, parity, gestational age at delivery, mean newborn weight, Apgar score at one and five minutes, Neonatal Intensive Care Unit admission and mean Neonatal Intensive Care Unit stay. CONCLUSIONS: Vaginal delivery in twin gestation after one previous cesarean section may be considered in appropriate cases. A large multicentral randomized prospective study may further confirm this conclusion.

Adult↗
PubMed1996

Role of the karyopherin pathway in human immunodeficiency virus type 1 nuclear import.

The interaction of the human immunodeficiency virus type 1 (HIV-1) nucleoprotein complex with the cell nuclear import machinery is necessary for viral replication in macrophages and for the establishment of infection in quiescent T lymphocytes. The karyophilic properties of two viral proteins, matrix (MA) and Vpr, are keys to this process. Here, we show that an early step of HIV-1 nuclear import is the recognition of the MA nuclear localization signal (NLS) by Rch1, a member of the karyopherin-alpha family. Furthermore, we demonstrate that an N-terminally truncated form of Rch1 which binds MA but fails to localize to the nucleus efficiently blocks MA- but not Vpr-mediated HIV-1 nuclear import. Correspondingly, NLS peptide inhibits the nuclear migration of MA but not that of Vpr and prevents the infection of terminally differentiated macrophages by vpr-defective virus but not wild-type virus. These results are consistent with a model in which Rch1 or another member of the karyopherin-alpha family, through the recognition of the MA NLS, participates in docking the HIV-1 nucleoprotein complex at the nuclear pore. In addition, our data suggest that Vpr governs HIV-1 nuclear import through a distinct pathway.

Amino Acid Sequence↗
PubMed1996

Anaphylactic shock during hysteroscopy using Hyskon solution: case report and review of adverse reactions and their treatment.

Dextran 70 (Hyskon) solution, as many other substances, is in current use as distension medium during hysteroscopy. The advantages of Hyskon solution are its nonconductivity and immiscibility with blood, allowing good visibility during operative hysteroscopy. Adverse reactions to Hyskon are mainly attributable to the drug's antigenic properties and include severe anaphylactic reactions and fatalities. We report a case of anaphylactic shock during hysteroscopy using Hyskon solution as the distension medium, review the adverse reactions of Hyskon and summarize the treatment modalities used to decrease the incidence of the rare but serious adverse reactions with its use.

Adrenal Cortex Hormones↗
PubMed1995

Does the electrocardiographic pattern of "anteroseptal" myocardial infarction correlate with the anatomic location of myocardial injury?

The current electrocardiographic (ECG) definition of anteroseptal acute myocardial infarction (AMI) is a Q wave or QS wave > 0.03 second in leads V1 to V3, with or without involvement of lead V4. To verify whether there is a correlation between the ECG pattern of anteroseptal AMI and the location of an AMI, we compared ECG, echocardiographic, and cardiac catheterization findings of 80 patients who fit the traditional definition of anteroseptal AMI. We found that 48 of 52 patients (92%) who presented with ST elevation in leads V1 to V3 had an anteroapical infarct and a normal septum. The culprit narrowing was more frequently found (in 85% of patients) in the mid to distal left anterior descending artery. We conclude that there is no correlation and that the ECG pattern traditionally termed anteroseptal AMI should be called an anteroapical AMI; the term anteroseptal AMI should be defined as extensive anterior wall AMI associated with diffuse ST changes involving the anterior, lateral, and occasionally, inferior leads.

Aged↗
PubMed1995

Is removal of the tube mandatory after coagulation in ectopic pregnancies.

Laparoscopic treatment of ectopic pregnancy is gaining wide acceptance. We report a new simple laparoscopic technique involving grasping the tube with forceps and coagulating on both sides of the ectopic pregnancy site, leaving the fertilized ovum in situ. This method is suitable for multiparous women and women who request tubal sterilization. Sixteen patients (mean age 32.6 +/- 4.4 years) were treated by using this method. The mean duration of hospitalization was 1.94 +/- 1.12 days. No complications occurred.

Adult↗
PubMed1995

Beta-HCG concentration in peritoneal fluid and serum in ectopic and intrauterine pregnancy.

OBJECTIVE: To evaluate the significance of beta-HCG levels in peritoneal fluid and serum in the diagnosis of ectopic pregnancy. STUDY DESIGN SETTING: Obstetrics and Gynecology department of a regional general hospital. SUBJECTS: Sixty-two women who presented with a differential diagnosis of ectopic pregnancy vs. nonviable intrauterine pregnancy. INTERVENTIONS: All patients underwent D & C and culdocentesis. beta-HCG was measured in simultaneously obtained peritoneal fluid (PF) and serum (S), and the PF/S ratio calculated. RESULTS: Twenty-three patients had an ectopic pregnancy (Group I). All 23 had higher beta-HCG concentrations in the PF than in the serum, with a mean PF/S ratio of 19.1 +/- 16.9. Twenty-four patients had an intrauterine pregnancy (Group II). The beta-HCG levels in the PF and serum were similar (mean PF/S 1.1 +/- 0.2). The difference in PF/S ratio between groups I and II was statistically significant (p < 0.001). CONCLUSION: The measurement of beta-HCG in peritoneal fluid and serum is a useful diagnostic tool in differentiating ectopic from intrauterine pregnancy.

Ascitic Fluid↗
PubMed1994

Acceptability and skin reactions to transdermal estrogen replacement therapy in relation to climate.

The acceptability and skin reaction of Estraderm Transdermal Therapeutic Systems as a function of climatic variability were examined in various zones which alter considerably in their temperature and humidity. An open, noncomparative prospective study was carried out in four institutional out-patient menopausal clinics in varying climatic areas. Eighty symptomatic postmenopausal patients without previous estrogen replacement were examined. Estraderm T.T.S. 50 was applied twice weekly in four weekly cycles. Norethisterone-acetate tablets (1 mg), were taken orally for 12 consecutive days. Using a questionnaire, the subjects were asked about the efficacy of the treatment on postmenopausal symptoms, the adhesiveness and tolerability. The results were matched with the meteorological conditions. The duration of the study was 6 months. Acceptability of Estraderm T.T.S. is high (78.7%). Discontinuation of treatment was found in 21.3% of the study group. The main reason for discontinuation is due to skin reactions which occurred in 14 of the 80 patients (17.5%). Meteorological conditions in this study did not influence the rate of skin reactions. No difference in acceptability of the treatment was found in relation to the mean temperature and mean humidity as registered in the dry desert and the humid coastal areas.

Administration, Cutaneous↗
PubMed1994

Tubal anastomosis in the rat using the tissue adhesive cyanoacrylate (Histoacryl).

n-Butyl-2-cyanoacrylate (Histoacryl) is said to be as effective as microsurgery for tubal anastomosis. In a prospective controlled study at the regional teaching hospital research laboratories, 40 female laboratory rats underwent laparotomy, with ligation of the uterine horns, and reanastomosis by microsurgery or cyanoacrylate tissue adhesive. Main outcome measures were patency of uterine horns following anastomosis, histologic examination of anastomotic sites and pregnancy rate following anastomosis by each of the two methods. Patency rates were 100% with both methods of anastomosis, although foreign-body granulomas were more prominent in horns anastomosed by microsurgery. When cyanoacrylate was used on one horn and the contralateral horn ligated, a 90% pregnancy rate was achieved; when microsurgery was used, the pregnancy rate was 80%. In microsurgically anastomosed tubes there was a longer narrow segment, resulting in a lower number of embryos per rat. Cyanoacrylate tissue adhesive is successful in tubal reanastomosis and has certain advantages over classical microsurgical techniques: fewer foreign-body granulomas occur; there is less narrowing of the uterine horn; less skill is required in its use.

Anastomosis, Surgical↗
PubMed1994

Betamethasone and intrauterine fetal death.

Three cases of intrauterine fetal death occurring shortly (within 24 h) after betamethasone administration are described. Two of the women were diabetic, and the third had secondary infertility due to hyperprolactinemia. None of the stillborns had evidence of gross malformations. In view of the fact that infants born prematurely now have a better chance of survival in intensive-care units than in previous years, we believe that for certain high-risk mothers, the policy of betamethasone administration for preventing respiratory distress syndrome in premature babies must be revised.

Adult↗
PubMed1993

Is cesarean section necessary for delivery of a breech first twin?

Eighty-two pregnancies involving a breech first twin were retrospectively analyzed over two study periods during which the cesarean section rates were 20.9 and 94.9%, respectively. The neonatal and maternal morbidity in both study periods was compared. There were no neonatal deaths during either study period and no cases of interlocking twins among patients delivered vaginally. Neonatal morbidity was unrelated to the mode of delivery. The incidence of maternal fever was, however, significantly higher in the cesarean section group compared with the vaginal delivery group (p < 0.001). Our study suggests that vaginal delivery of selected twin gestations with a breech first twin should be an alternative to cesarean delivery.

Apgar Score↗