Biomedical subjects
Publications and source records attributed to P Husslein.
The injection of different substances into early, unruptured tubal pregnancies is increasingly advocated. In this study, fertility was evaluated after treatment of tubal pregnancy by means of prostaglandins. The overall tubal patency rate was 86.4% and 14 of 20 patients (70%) could subsequently achieve pregnancy.
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The incidence of tubal pregnancy has been increasing in recent years. The improvement in diagnostic procedures leads to an early detection of tubal pregnancies. As a result, conservative treatment modalities are more feasible today. In this study, we compared the treatment of tubal pregnancy by means of locally applied prostaglandin with pelviscopic surgery. 75 patients with an early tubal pregnancy were included in each group. The comparison between the two groups showed, that prostaglandin treatment has a higher failure rate, than treatment by pelviscopic surgery. However, postoperative fertility indicated better results in the prostaglandin treated patients.
In the present study, plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) concentrations were measured in 46 patients admitted for preterm labour. Gestational age ranged from 20-34 weeks. Samples were collected 12 hours before and after initiation of tocolysis. Patients with a premature rupture of the membranes and/or intra-amniotic infection were excluded in this study. There was a significant difference in the oxytocin (p = 0.05) and PGFM levels (p = 0.007, after 12 hours: p = 0.004) between a control group without preterm labour and women with preterm labour. No differences were seen between the successfully treated (delivery more than 5 days after start of tocolysis) and the failure group. There was no significantly different increase or decrease in PGFM and Oxytocin plasma levels between treatment failures and successfully treated patients.
In recent years, the requirements of society towards the quality of research have increased. Especially in the perspective of European integration, ethical and conceptual problems have to be revisited. Clinical research is alimented by technical development and the results of fundamental and pharmacological research. The obligation of converting the most recent knowledge into conventional treatment is the driving force of development. Clinical research is fraught with multiple risks, mainly the risks incurred by patients enrolled in clinical studies, and the risks of drawing erroneous conclusions from badly designed studies. This is the reason why the organization of clinical studies must satisfy the highest quality standards. Prospective randomized double-blind studies are doubtless the best design although they usually involve the difficult problem of patient information. As concerns publications, the picture may be distorted. Thus all the studies should be published exhaustively. Clinical research is thus a great challenge from both the intellectual and the ethical points of view.
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Since ectopic pregnancy may terminate in spontaneous recovery we compared treatment by means of prostaglandin (PG) application with expectant management in laparoscopically verified tubal gestations. Twelve patients received local and systemic PG, 4 patients were treated with sodium chloride and in 7 patients laparoscopy was discontinued without medical therapy. The comparison between the PG group and the placebo groups revealed a highly significant difference with regard to a subsequent necessary surgical intervention and hospitalisation. Expectant management may only be recommended in very selected cases, whereas PG treatment seems to produce favourable results in cases of early tubal pregnancy.
A closure of the parietal and visceral peritoneum has always been thought to be a necessary measure in gynaecological surgery to avoid postoperative ascending infections or adhesion formation with the risk of a consequent ileus. Based on good experience in radical gynaecological surgery and the opinion of many authors, who consider the closure by means of sutures as the real cause for adhesion formation, we omitted the closure of the visceral peritoneum in abdominal hysterectomies. We performed 80 such procedures and analyzed them with regard to their postoperative course. We found a strikingly low rate of postoperative fever, no signs of infection of the wound and not a single case of postoperative ileus. We therefore believe, that omitting the closure of the visceral peritoneum entails notable advantages, that should be confirmed by follow-up studies.
.6 mg trichosanthin, a drug which is frequently used for midtrimester abortion in China, was applied laparoscopically in a case of tubal pregnancy. No side effects occurred and beta-human chorionic gonadotropin decreased within several days.
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683 women were assessed in the present study. All study participants were subjected to an overall clinical examination before and after a 4-month regimen of a low-dose norgestimate-containing combination oral contraceptive (Cileste); in addition, their subjective well-being was investigated by an appropriate questionnaire. 63.3% of the study participants rated drug tolerance as 'very good' and 23.0% rated it as 'good' at evaluation in the 4th cycle. Between the first and second evaluation, we observed a significant improvement of the depressive mood and of skin and hair problems. Women with skin and hair problems often suffer from 'severe dysmenorrhea'. This difference was statistically significant only at the first evaluation (i.e. before the combined norgestimate regimen) and was not observed in the 4th cycle (i.e. during the Cileste regimen), while the incidence of menstrual disturbances was generally found to decrease.
Survey about the newer methods of treatment of tubal pregnancy using methotrexate and prostaglandins. This individualizing therapy has the advantage of avoiding laparotomy.
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A major cause of concern with respect to local prostaglandin (PG) E2 application is uterine hyperstimulation. The purpose of the present study was to evaluate the incidence of hyperstimulation and the possibility of treating this complication. A total of 181 cases were registered in two obstetric centres over a 51-month period. The rates of hyperstimulation were 7.3% in the group receiving intravaginal PG E 2 tablets (3 mg), 2.9% with intravaginal gel (2.5 mg), and 0.5% with intracervical gel (0.5 mg). In 178 cases (98.3%) the infusion of a beta-2 adrenergic drug (hexoprenaline or terbutaline) led, without adverse effects, to the rapid resolution of the alarming findings. Caesarean section was necessary in 3 patients. Depressed Apgar scores and an umbilical artery pH less than 7.20 were uncommon and, indeed, no more frequent than in PG E 2-treated cases without hyperstimulation. We conclude that uterine hyperstimulation is uncommon after low-dose PG E 2 therapy and is usually rapidly reversible, without apparent untoward intrapartum or neonatal effects.
The incidence of tubal pregnancy has increased markedly over the past years. Reasons for this are increased infections of and operations on the tubes and also improved diagnosis of the condition. The development of sensitive pregnancy tests, a constant improvement in ultrasound, introduction of laparoscopy and last, but not least, an increase in the degree of awareness amongst the general public have led to a much earlier diagnosis of tubal pregnancies. Therefore, it is possible to treat tubal pregnancies in a more conservative fashion operatively but also medically.