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Biomedical subjects

R Boos

Publications and source records attributed to R Boos.

At least 19 recordsLinked to original sources
PubMed1991

[Discolored amniotic fluid--results of prenatal diagnosis and clinical significance].

7000 pregnancies were analysed after genetic amniocentesis in respect of the further course and results of prenatal diagnosis (observation period 1975-1988). In 3.1% (217 cases) samples of amniotic fluid were discoloured. Vaginal haemorrhages prior to amniocentesis were recorded with significantly higher incidence (18%) in patients with discoloured amniotic fluid than in a control group (n = 217) with normal colour of the amniotic fluid (4.6%) (p less than 0.001). Miscarriages and chromosome anomalies occurred more often in the study group (3.7%/2.8%, control group: 0.9%/1.8%, n.s.). The risk of miscarriages was increased in cases with sanguineous amniotic fluid if the amniotic fluid alpha-fetoprotein values were enhanced at the same time. Significant differences were observed in respect of the incidence of foetal malformations in patients with discoloured amniotic fluid (7.8%) and in the control group (2.3%) (p less than 0.01). Borderline or definitely pathological amniotic fluid AFP concentrations were found often if the amniotic fluid was discoloured (6.9%, control group 3.2%). If discoloured amniotic fluid was sampled, foetal malformations should be excluded sonographically. In 82% of all cases with discoloured amniotic fluid and foetal malformations pathological sonographic findings and/or enhanced MS-AFP values were recorded even prior to amniocentesis.

Amniocentesis↗
PubMed1991

[Comparison of perineal sonography and abdominal ultrasound examination in placenta praevia].

This study describes a comparison between two different ultrasound methods used to localize a low-lying placenta or a placenta previa. The methods implemented were the abdominal ultrasound and the so-called "perineal scan", an ultrasound examination of the female urogenital tract, which is performed by using the perineum as an acoustic window. Between 1985 and 1988, 84 patients, suspected of having a low-lying placenta, were examined by perineal scanning. In all these cases it was possible to compare the results with those of abdominal ultrasound examinations documented in the patient's records. The "perineal scan"-examinations were performed "blind", i.e., without knowledge of the results of prior abdominal ultrasound. Abdominal sonography was performed by a different examiner using the full-bladder-technique. Perineal scanning was done a short time after voiding. The results showed considerable and significant (p less than 0.001) discrepancies between the two methods; perineal scanning more often demonstrated higher grade diagnoses (27 patients, 32%) than vice versa (9 patients, 11%). These differences may be at least partially explained by the influence of bladder distension. Probably a full bladder produces false negative results more often than previously suspected. An analysis of pregnancy outcome yielded positive predictive values of 78% (abdominal ultrasound) and 86% (perineal scanning). Perineal scanning therefore seems to provide an uncomplicated and reliable means to verify an abdominal placenta localisation.

Cesarean Section↗
PubMed1991

[Pathologic Doppler flow findings and cardiotocography results].

Of 1950 pregnant patients (2870 Doppler ultrasound measurements) we observed, in a study group with highly abnormal Doppler-flow findings (n = 66, Feb. 1990), a correlation of Doppler flow and FHR-recordings. Among these 66 patients we retained 60 (91%) in the hospital. They had at least 2 FHR-recordings a day. The results of Doppler flow measurements in the fetal aorta and umbilical artery correlated well with diagnosis of IUGR. The comparison of the overall results of both fetal vessels did not indicate any significant difference. In 21% of all patients with highly abnormal Doppler flow findings, was no abnormal FHR record until delivery. 26% already showed an abnormal non-stress test before the first pathological Doppler assessment, in 44% abnormal FHR-recordings were observed later than the first abnormal Doppler flow finding in the course of pregnancy. The median interval was 13.5 days in cases with increased Doppler flow parameters but with detectable end-diastolic blood flow and was reduced to 8 days in cases with absent end-diastolic blood flow. In 9% of all cases, abnormal results were found with both methods on the same day. In 32% we observed a reproducible notch in Doppler flow velocimetry of uteroplacental vessels. The rate of congenital malformations was 14%. Thus abnormal Doppler flow signals can be estimated as "early" prognostic criterias for a compromised fetus at risk.

Birth Weight↗
PubMed1991

[Doppler ultrasonography--perinatal data in cases with end-diastolic block and reverse flow].

In 50 cases with an end-diastolic zero flow or reverse flow all antenatal and perinatal abnormalities have been recorded. The fetal outcome was registered. The percentage of highly dystrophic newborns (percentile less than 5) was 88%. The perinatal mortality counted up to 16% and the percentage of congenital malformations (including chromosomal anomalies) was 12%. A reverse flow was registered in 4 cases. The perinatal mortality of those cases with reverse flow was 100%. In approx. one-quarter of those pregnancies and in 50% of the perinatally deceased newborns, there were no pathological or suspicious changes in the antepartal and/or subpartal CTG-recordings. The Duplex sonographical diagnosis of an end-diastolic zero flow/reverse flow, has a highly positive predictive value, whereas its sensitivity is low. It can be regarded as a very helpful parameter in clinical diagnosis, particularly as it is independent of borderline values. The correct choice of the high-pass wall filter (50-100 Hz) is important.

Adult↗
PubMed1990

Actions of excitatory amino acids on brisk ganglion cells in the cat retina.

1. Retinal ganglion cell activity was recorded extracellularly in the intact cat eye. We examined the effects of iontophoretically applied glutamate (GLU), aspartate (ASP), and the specific agonists kainate (KA), quisqualate (QQ), (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA), and N-methyl-D-aspartate (NMDA) on the spontaneous and light-driven activity of ganglion cells. 2. ASP and GLU increased the spontaneous as well as the light-driven activity of all brisk cell types. The effects of the two drugs were very similar. The activity of most cells remained at a constant increased level during prolonged application of these drugs. 3. KA also excited all brisk ganglion cell classes and caused effects very similar to those of GLU and ASP but was effective at a much lower concentration. In general, brisk ganglion cells responded most vigorously to KA application. 4. QQ excited approximately 50% of all ON-X and OFF-X cells encountered, the other 50% of the X cells and all Y cells were inhibited during QQ-application. This inhibition was quite likely due to the stimulation of glycinergic and GABAergic interneurons, because it was reduced or abolished during application of the respective antagonists strychnine and bicuculline. All ganglion cells apparently received either direct or indirect excitatory input from QQ receptors, which can be revealed by blocking the inhibitory interneurons. 5. The major actions of QQ on the discharge rate of ganglion cells are mimicked by AMPA. Hence, the actions of QQ are likely to be mediated by the "classical" QQ-receptor, ion-channel complex rather than by the recently described type of QQ-receptor that is coupled to a second messenger system. 6. NMDA excited ON-X, OFF-X, and OFF-Y cells but inhibited ON-Y cells. Excitatory and inhibitory NMDA effects could be blocked by the specific NMDA-receptor antagonists D(-)-2-amino-7-phosphono-heptanoate (AP-7) or 3-((+/-)-2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP). If the GABAergic transmission was blocked by bicuculline, the NMDA-induced inhibition of ON-Y cells was abolished. We conclude that NMDA activates GABAergic interneurons that in turn reduce the activity of ON-Y cells.

Amino Acids↗
PubMed1989

[Nedocromil sodium therapy in asthma patients. Therapeutic effect in addition to treatment with oral theophylline and inhaled bronchodilator agents].

131 asthmatics aged 12-65 years, who still had symptoms despite inhaled or oral bronchodilators, were included in this double-blind group comparative study involving nedocromil sodium (2 puffs of 2 mg each twice daily) and placebo (2 puffs twice daily). The study was carried out at 8 centers over six weeks. Under nedocromil sodium, cough, dyspnea and severity of attacks were reduced significantly. Overall patient assessment also clearly favoured the active substance. Nedocromil sodium was also superior to placebo in terms of the improvement of lung function (FEV1, FVC and PEFR). 26 patients complained of unusual symptoms (12 under nedocromil sodium, 14 under placebo). Nedocromil sodium proved to be an effective, safe and well-tolerated drug in the antiinflammatory long-term treatment of reversible obstructive airways disease.

Administration, Inhalation↗
PubMed1989

Twin pregnancy in the right horn of a uterus didelphys: a case report.

A rare case of a twin pregnancy occurring in the right horn of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. The occasional diagnosis of this uterine anomaly was made after the pregnancy was detected. Both embryos, with cardiac actions which proved the viability of the gestation from the very early stage of pregnancy, were detected by transvaginal ultrasonography. Two male infants were delivered by Cesarean section in the 34th week. The importance of the transvaginal sonography and the handling of the case during this high-risk pregnancy are reported.

Adult↗
PubMed1989

Three years' experience with large ovarian cysts diagnosed in utero.

Thirteen fetuses with abdominal cystic tumors were diagnosed by routine prenatal ultrasonography between the 28th and 36th week of gestation. Postnatal ultrasonography of the full-term newborns confirmed the findings. Laparotomies were performed in all cases except one. Patients who were operated on had large ovarian pseudocysts with volumes between 24 and 120 cc. In seven patients (54%), the cysts arose from the left ovary; this included four cases in which the postnatal ultrasound was interpreted as showing the cysts in the right abdomen. Very thin cystic walls threatening perforation were found in 91%. In 33%, we found salpingotorsion on the affected side. Small contralateral ovarian cysts were found in 66% of the patients. One infant required resection of 30 cm of necrotic jejunum because adhesions to the cyst had caused bowel volvulus. Histology of the cysts showed hemorrhage and calcifications, but ovarian stroma was absent in all but one patient. Serum estradiol-17 beta, progesterone follicle-stimulating hormone, and luteinizing hormone were normal in all cases, and similar levels were found in the cyst fluid. These results show that large abdominal cystic masses in full-term infant girls with normal gonadotrophin levels and normal serum estradiol-17 beta and progesterone levels are very likely to require surgery; this is in contrast to preterm neonates with elevated gonadotrophins who can be treated with medroxyprogesterone acetate in the absence of clinical signs necessitating surgery.

Female↗
PubMed1988

[Ultrasonography in the primary diagnosis and follow up of ovarian tumors].

Preoperative sonographic data in 317 patients who underwent surgery at the University Women's Clinic Heidelberg for an ovarian tumour during a 6 years' observation period, were compared with the results of clinical examination. The prognostic value of both techniques was examined, by relating the findings (as to tumour size, demarcation from the uterus) to the postoperative histological or cytological diagnosis. In the 214 cases of benign and 103 of malignant ovarian tumours a correct diagnosis was provided by ultrasound in 88% and 74% respectively. Thus significantly more often than by clinical examination alone (p less than 0.001 for benign and p less than 0.01 for malignant tumours). The sonographic findings in 49 patients during follow-up after surgery for ovarian carcinoma and polychemotherapy were checked by a second look laparotomy. The detection rate of tumour progression, recurrence, residual tumour or remission was of 98%.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Behavior of fetal position in the 2d half of pregnancy in labor with breech and vertex presentations].

In a retrospective analysis, presentation behavior during pregnancy of 501 infants with breech presentation at birth was compared with that of a control population (n = 520) with vertex presentation at birth. Since the fetus usually changes position frequently during the sonographic examination prior to the 20th week of pregnancy, and since its presentation behavior is generally unstable, presentation of the fetus was only determined sonographically from this point onward. In both populations it was found in 40% of the cases that the fetus remained in either breech or vertex presentation up to birth; and in both populations there was one change of position to the definitive presentation at birth in 44% of the cases (before the 33rd week of pregnancy in 95%). Seventeen percent of the infants born from breech presentation and 15% of those born from vertex presentation changed position several times during pregnancy. The stability of presentation behavior during pregnancy of infants with breech presentation at birth was similar to that of infants with vertex presentation. At about the 32nd week of pregnancy, 90% of the fetuses in both breech and vertex presentation had assumed their final presentation prior to birth. Even when breech presentation is found between the 33rd and 36th week of pregnancy there is still a 54% probability of a change to vertex presentation at birth. In contrast, the probability of the fetus turning from vertex to breech presentation at birth in this period of pregnancy is only 0.4%.

Amniotic Fluid↗
PubMed1986

[Sonographic evaluation of the quantity of amniotic fluid. II. Oligohydramnios--significance for the course of pregnancy and labor].

3,274 pregnant women were examined sonographically in this study, with particular emphasis on the quantity of amniotic fluid present. In 8% of the patients a reduced amount of amniotic fluid was seen. If the largest pocket of amniotic fluid was less than 2 cm that particular case was classified as oligohydramnios. If the largest pocket of amniotic fluid was between 2 cm and 3 cm, it was assumed to be in the lower standard range. These cases were compared with a randomly selected control group with normal amounts of amniotic fluid, in respect of the occurrence of complications during gestation and delivery and of the incidence of fetal malformations. Patients with reduced amounts of amniotic fluid showed signs and symptoms of gestosis more often (p less than 0.001) and delivered more often before the 36th week of pregnancy (p less than 0.001) and growth-retarded children (p less than 0.001) than women with standard amounts of amniotic fluid. The incidence rate of Caesarean section was 42%, and hence far above the standard level (p less than 0.001). In oligohydramnios, 13% (p less than 0.001) of the children had severe fetal malformation, whereas, with an amount of amniotic fluid in the lower standard range, only 5.5% (not significant) showed severe foetal malformation. The stated sonographic criteria are suitable as an objective measure for quantifying the amount of amniotic fluid.

Adult↗
PubMed1986

[Pathological insertion of the placenta after the 20th week of pregnancy--its importance in the course of pregnancy and delivery].

The present paper reports on the results of sonographic diagnosis of a pathologic insertion of the placenta after the 20th week of pregnancy and its importance with regard to the course of pregnancy and birth. The conversion of a primarily pathologic placental insertion to a "normal" insertion at term depends on the severity of the placental insertion disorder and the date of diagnosis. The frequency of pathologic insertions after the 20th week of pregnancy amounted to 4.2% of the patients examined. The rate of conversion from pathologic to normal placental insertion was 91%, if marginal/partial and total placenta previa are accepted as definitive diagnoses at term. The insertion remained unchanged up to term in approximately 90% of the cases in which total placenta previa was sonographically diagnosed. The sonographic diagnosis of "pathologic insertion of the placenta" after the 20th week of pregnancy is associated with severe complications in the subsequent course of pregnancy and birth. There is a significant cluster of vaginal hemorrhage in the last trimester of pregnancy; cesarean deliveries are common; there are more cases of transfer to pediatric clinics, and the incidence of retarded fetal growth and perinatal mortality is higher. The present authors believe that where the diagnosis of placenta previa has been confirmed sonographically, prophylactic measures and, in the last resort, a planned cesarean delivery can contribute to a reduction in maternal morbidity and also to a decrease in perinatal morbidity and mortality.

Abortion, Spontaneous↗
PubMed1986

[Diagnosis of holoprosencephaly with cyclopia in the fetus].

The typical ultrasound findings in cases of fetal holoprosencephaly with hypotelorism and cyclopia are explained with reference to a case history. Hypotelorism was confirmed by measurement of the distance between the orbits of the fetus.

Abnormalities, Multiple↗
PubMed1985

Fetal behavioural states and controlled sound stimulation.

The aim of this study was to investigate responses of human fetuses near term (37-42 wks) (increase/decrease of fetal heart rate and/or fetal motility) to acoustic stimuli. The study group consisted of 43 patients and the control group of 27 patients. Polygraphic recordings of 5 different fetal variables were carried out synchronously for the categorization of the actual fetal behavioural state according to Nijhuis et al. (Nijhuis, J.G., Prechtl, H.F.R., Martin, C.B., Jr. and Bots, R.S.A.M. (1982): Early Hum. Dev., 6, 177-195). Controlled acoustic stimulation was performed either with sine wave tone (2 kHz, 120 dB and 5 s duration) or modulated sine wave tone (0.5-2 kHz, 'sawtooth' modulation, 120 dB and 5 s duration). An additional group of patients received 'sham' stimulation. Overall 84 acoustic stimulations have been carried out. In 26 out of 84 stimulations (30%) a fetal response could be observed within 5 s after acoustic stimulation. In general, there were far fewer fetal responses in sleep states than in states of wakefulness. Whereas in state 1 F only 1 out of 28 acoustic stimulations was followed by an immediate fetal response, more responses were observed in state 2 F. An obvious increase in fetal reactivity to acoustic stimulation was noted in states of wakefulness (states 3 F and 4 F). Comparison between the true and sham stimulations revealed a relatively high level of spontaneous fetal activity (high variation of fetal heart rate and fetal motility) present in states 2 F and 4 F. This must be taken into account in all assessments of fetal responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗
PubMed1985

[Sonographic diagnosis of severe fetal malformations].

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗
PubMed1985

[Diagnosis of benign and malignant ovarian tumors].

The present paper reports on the value of gynecological-clinical examinations and preoperative ultrasonography in the diagnosis of benign and malignant ovarian tumors. Out of a group of 42 patients, in all of whom "ovarian cyst" had only been diagnosed clinically, 14% were not found to be suffering from this condition at surgery. In a comparison of preoperative gynecological-clinical and ultrasonographic findings (in 68 patients) it proved possible to determine the side on which the tumor was localized, its actual size, the extent to which it was delimited from the uterus, and its consistency (whether solid or cystic) significantly better by ultrasonography (p less than 0,01). However, the results of this study indicate that 2% of the cases diagnosed ultrasonographically as "benign ovarian tumor/ovarian cyst" are likely to be ovarian carcinomas. In the group of patients with malignant ovarian tumors also (42 patients), there was a significant difference in the preoperative diagnosis "suspected ovarian carcinoma". On the basis of clinical findings it was only diagnosed in 45%, while it was found in 74% by ultrasonography (p less than 0,01). In 3 cases with ovarian carcinoma there was no pathologic palpation finding, and in only one other case was a "suspected ovarian cyst" diagnosed. By means of ultrasonography, on the other hand, all of the cases of ovarian carcinoma were classified either as "ovarian carcinoma" or as "cystic-solid/complex abdominal tumor". The most frequent diagnoses on the basis of the sonographic scan (approx. 90%) were cystic-solid ovarian tumors, followed by cystic-ventriculated ovarian tumors with solid portions and finally solid ovarian tumors with only a few cystic portions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗