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Biomedical subjects

R Osmers

Publications and source records attributed to R Osmers.

At least 19 recordsLinked to original sources
PubMed2003

[Primary malignant melanoma of the uterine cervix. Report of two cases and review of the literature].

The manifestation of a malignant melanoma in the uterus is very rare, more often it is the result of metastasis rather than a primary tumor. A malignant melanoma at this site can originate either from melanocytic elements within the cervical epithelium or from the cervical stroma. We report on two cases of primary malignant melanoma of the uterine cervix and compare them with other cases from the literature.

Adult↗
PubMed2003

Pregnancy in congenital cardiac disease: an increasing challenge for cardiologists and obstetricians -- a prospective multicenter study.

OBJECTIVES: Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed. RESULTS: Initially all women were in Functional Class I or II. Worsening during pregnancy occurred in 25.5% (n=27), mainly during the second and third trimester. Significant problems due to bleeding, hypertension, rhythm disturbances, endocarditis, liver congestion, increasing cyanosis or death, occurred in 11.3%. Twelve per cent of deliveries were premature. Five women had therapeutic abortion, nine spontaneous abortions, nine preterm births, and one intrauterine death. Seventy-nine per cent (n=85) delivered spontaneously; 21.3% (n=23) had caesarean section. Of the 111 live born children, 5.4% (n=6) had a CCD. CONCLUSIONS: Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.

Adolescent↗
PubMed2001

Complete karyotype discrepancy between placental and fetal cells in a case of ring chromosome 18.

A case of complete karyotype discrepancy between cultured chorionic villi and amniotic in addition to fetal cells is reported. Ring chromosome 18 and monosomy 18 mosaicism was detected after amniocentesis. The pregnancy was terminated in the 23rd gestational week. Cytogenetic analysis of cultured umbilical cord tissue after termination confirmed the finding of ring chromosome 18/monosomy 18 mosaicism. In cultured umbilical blood lymphocytes monosomic cells 45,-18 were not detected and the karyotype was 46,XY,r(18). In contrast, short-term and long-term cultured chorionic villi showed a normal male karyotype of 46,XY. Ultrasonographic examination revealed amniotic band syndrome and scoliosis in the caudal region of the spine.

Abortion, Induced↗
PubMed2001

Androblastoma of the ovary: clinical, diagnostic and histopathologic features.

Androblastomas of Sertoli-Leydig cell tumors of the ovaries are classified into the group of sex cord stromal tumors and represent an extremely rare form of tumor (0.2% of all ovarian tumors) in women. Their malignant potential is lower than that of epithelial ovarian cancer. They cause signs of virilization, although these are not obligatory. In many cases secondary amenorrhea is the only symptom of the disease. This leads to an intensive search for the source of the disorder. Frequently only the elevated production of androgens gives a preoperative clue to the tumor type. The recommendation to include the measurement of androgen levels in the routine diagnosis of secondary amenorrhea must therefore be endorsed. The tumors are usually sonographically identifiable; in differential diagnosis, hyperandrogenemia of other origins (e.g., Cushing's disease, adrenal hyperplasia, pituitary adenoma, other causes of ovarian and adrenal androgen hypersecretion, intersexuality, medically induced androgenization) have to be ruled out. In view of the good prognosis, the therapy of choice consists simply in adnexectomy of the affected side. With regular measurement of serum androgen levels an effective control of the course of the disorder is possible. A conclusive pathological diagnosis is difficult as heterologous tumors and mixed tumors exist and, furthermore, other tumor types are capable of imitating Sertoli-Leydig cell tumors.

Androgens↗
PubMed1999

Pulsatile vs. continuous parenteral tocolysis: comparison of side effects.

Bolus tocolysis has been developed to reduce the dose of fenoterol compared to continuous tocolysis. Whereas the high efficacy of pulsatile application of fenoterol has been shown, the proof of reduced side effects is still lacking. A total of 59 patients with preterm labor were divided in three groups: (1) continuous tocolysis and oral application of magnesium (n=19), (2) continuous tocolysis and parenteral application of magnesium (n=20), (3) pulsatile tocolysis (bolus tocolysis) and oral application of magnesium (n=20). Heart rate, systolic and diastolic blood pressure, serum K+ and serum Mg++ were quantified before tocolysis and after 2, 8 and 24 h. Beta-blockers and water balance were recorded over 24 h. Subjective side effects were quantified using a questionnaire with scales graduated covering palpitations, tremor, diaphoresis, thirst, precardialgia and nausea/vomiting. The analysis of the data revealed significantly fewer side effects concerning heart rate, plasma K+ level and the subjective side effects among patients treated with bolus tocolysis than among those treated with continuous tocolysis. Between the latter two groups, no significant difference was found. Concerning blood pressure and need for beta-blockers, no significant differences were found between the three groups. The results of the present study show that especially the side effects subjectively found to be disagreeable by the patients are reduced by pulsatile tocolysis, whereas other side effects show only slight differences between the study groups.

Adrenergic beta-Antagonists↗
PubMed1998

Monoclonal antibodies in solid tumours: approaches to therapy with emphasis on gynaecological cancer.

Monoclonal antibodies have progressed from the laboratory to the clinic. Although recognised in diagnosis there are still problems as far as their therapeutic use is concerned. This review looks at the history, principles of active specific immunotherapy, clinical experience with monoclonal antibodies in therapy of solid tumours, in particular the development of new bispecific monoclonal antibodies, and trials in ovarian, breast and colorectal cancer. Immunoconjugates, linked with radionuclides and cytotoxic drugs, indicate future developments. Conditions for successful therapy, especially with adjuvants in patients with small tumour residues, are also described.

Antibodies, Bispecific↗
PubMed1998

Sonomorphology of endometriotic cysts.

OBJECTIVE: The aim of the study was to evaluate prospectively the sonomorphological feature of histologically verified endometriotic cysts. METHODS: Transvaginal sonography was performed in 122 patients. Age distribution of the patients, and size and sonomorphology of the lesions were analyzed. RESULTS: Eighty-one percent of the endometriotic cysts occurred in patients between 31 and 50 years old with a peak of 29% between 31 and 35 years. Most of the cysts (81%) ranged between 30 and 59 mm in diameter. Forty-three percent of the endometriotic cysts were observed as monolocular cysts with internal echoes. More than half of the findings were observed to be multilocular, partially without any internal echos, partially even with solid parts or purely solid. CONCLUSION: The so-called 'typically' monolocular smooth-walled endometriotic cyst with internal echoes was only found in 43% of the cases. However, data from the literature show that one cannot assume even this special entity to represent endometriomas. Regarding all monolocular cysts with homogeneous internal echoes, one has to be aware of a great amount of functional cysts and a non-calculable residual risk of malignancy.

Adult↗
PubMed1998

Activated protein C resistance and factor V Leiden in patients with hemolysis, elevated liver enzymes, low platelets syndrome.

OBJECTIVE: Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is characterized by a distinct activation of the coagulation system. A mutation of the gene coding for coagulation Factor V (Factor V Leiden) has been identified as the most frequent risk factor for thrombosis. To identify risk factors for HELLP syndrome, we determined coagulation parameters and the Factor V Leiden mutation in women who previously had developed HELLP syndrome. METHODS: Coagulation parameters (activated protein C resistance, antithrombin, protein C, protein S) were determined in 21 women 6 months to 9 years after they had developed HELLP syndrome in the third trimester. In addition, these women were analyzed for the presence of the Factor V Leiden mutation. RESULTS: Of these analyzed women, 33% (seven of 21) had an activated protein C resistance (activated protein C ratio less than 2.0). Another 38% of the women had subnormal activated protein C ratios (2.0-2.3). Only 57% of the women with an activated protein C resistance were identified as heterozygous carriers of the Factor V Leiden mutation (four of seven). CONCLUSION: Women with HELLP syndrome have a higher incidence of Factor V Leiden mutations. This increased incidence does not, however, account fully for the increased frequency of activated protein C resistance in these patients.

Adult↗
PubMed1998

3D Color Power Angio imaging: a new method to assess intracervical vascularization in benign and pathological conditions.

It is well known that angiogenesis is a fundamental event in the growth of tumors as well as in physiological conditions. In an ongoing prospective study involving eight women, we investigated the microvasculature within the cervix by the use of 3D Color Power Angio imaging. The ultrasound equipment was used in conjunction with specialized software providing high-resolution '3D-Angiomode'. The system provides the ability to visualize blood flow in small vessels that are undetectable by conventional color Doppler techniques and also to study the architecture and determine the number of blood vessels. Comparison of the vessels in the normal cervix with those in the cervix affected by carcinoma or bacterial or viral infection demonstrated that, in malignant tissue, there is a chaotic network of tortuous vessels traversing the tumor mass, whereas, in benign tissue or tissue that is inflamed as a result of infection, the course of the vessels has a regular structure.

Cervix Uteri↗
PubMed1998

Changes in plasma elastase during pregnancy and sub partu.

Elastase is produced and released by polymorphonuclear leukocytes (PNMs) during inflammatory processes. Thus, elastase is assumed to be a sensitive marker of infections similar to the well-established C-reactive protein (CRP). It is deactivated predominantly in tissues by alpha1-proteinase inhibitor which forms stable complexes with the elastase molecule (EAPI) that can be detected for several hours. Premature rupture of membranes is often correlated with an early increase in elastase, occurring earlier than the increase in leukocyte count or CRP. Elastase might be a sensitive marker of beginning amnion infection syndrome after premature rupture of membranes. For the present study, plasma EAPI levels of 335 healthy pregnant women as well as 47 healthy nonpregnant pre- and postmenopausal women were analyzed. No significant differences were found in the latter group or in pregnant women until the beginning of labor. Women at the beginning of labor but without rupture of membranes showed a significant increase in plasma EAPI from 97.7 to 338.3 ng/ml (p < 0.001). With opening of the os uteri to more than 2 cm, elastase concentrations decreased to values comparable to those before the beginning of labor (p < 0.001). The use of elastase as a marker for a rupture of membranes or beginning amnion infection syndrome as suggested by a number of studies might need some restriction. As a consequence, serial monitoring of plasma elastase to detect a persisting increase might give more reliable results. The increase in plasma elastase during beginning of labor may be explained by the role of PMNs in the physiology of delivery. However, serial monitoring to detect a persisting increase in plasma EAPI may be more helpful.

C-Reactive Protein↗
PubMed1998

[Soluble adhesion molecules in patients with pre-eclampsia].

Plasma concentrations of the circulating adhesion molecules ICAM-1 (CD54), VCAM-1 (CD106) were determined in 31 women with pre-eclampsia, 9 women with HELLP syndrome, and 13 women with transient pregnancy induced hypertension (PIH). Data were compared with a control group of 157 healthy pregnant women of the same gestational age. Furthermore, concentrations of circulating E-selectin (CD62E), P-selectin (CD62P), and PECAM-1 (CD31) were determined in a subpopulation of 17 women with pre-eclampsia. Plasma concentrations of circulating ICAM-1, VCAM-1, E-selectin, and PECAM-1 were significantly elevated in women with pre-eclampsia compared to healthy control pregnant women. Circulating ICAM-1 and VCAM-1 levels were also significantly elevated in the pre-eclampsia group compared to women with PIH. Concentrations of circulating P-selectin varied strongly in all experimental groups (SD > 70% of the mean), most likely reflecting various degrees of thrombocyte degranulation in the individual samples. Finally, longitudinal profiles of cICAM-1 and cVCAM-1 concentrations were determined in 123 healthy pregnant women between the 16th and the 42nd week of gestation. This analysis identified cICAM-1 and cVCAM-1 as tightly regulated plasma parameters that varied in a small concentration range. Concentrations of cICAM-1 and cVCAM-1 did not vary during pregnancy and the determined concentrations corresponded to the reported reference levels of nonpregnant individuals.

Adult↗
PubMed1996

Fibronectin in the plasma during pregnancy and parturition.

Fibronectin can be detected in the plasma and the extracellular matrix of the uterus of pregnant women. Studies so far have compared individual observations, whilst serial investigations during pregnancy, and during and after parturition have not been carried out. Plasma fibronectin levels were measured in 153 women with healthy pregnancies in relation to the gestational age. During parturition, blood was taken from the inception of labor through to parturition, and on the 1st, 3rd, and 5th days after parturition. The investigations of the plasma fibronectin level in pregnant women show constant concentrations up to the 35th week of pregnancy. From the 36th week onward the fibronectin rises significantly before dropping to the initial values at the start of labor. The elevated fibronectin concentration in the last 4 weeks before delivery could be explained both by renewed, elevated synthesis in the uterus and placenta as well as by lower consumption. The decline in the fibronectin level with the onset of labor could be caused by an elevated enzymatic induction in the uteroplacental unit in connection with the start of parturition.

Adolescent↗
PubMed1995

Magnesium and calcium concentration in the pregnant and non-pregnant myometrium.

OBJECTIVES: To investigate the effect of labor on the magnesium and calcium concentrations in the human myometrium and to compare them with the concentrations in the non-pregnant uterus. METHOD: Samples of the isthmic part of the uterus were taken from 42 patients not in labor, 31 patients in regular labor during a cesarean section, and 37 premenopausal patients on whom a hysterectomy was performed. RESULTS: (i) The magnesium concentration dropped significantly during labor; (ii) the calcium concentration in the tissue showed no significant changes during labor; (iii) the magnesium and calcium concentrations were significantly higher during pregnancy; (iv) the distribution of electrolytes in the myometrium differed significantly in the corpus, isthmus and cervix uteri. CONCLUSIONS: The electrolyte concentration in the myometrium depends on the place of removal. A low magnesium concentration in the pregnant human myometrium could be a cause of premature labor.

Calcium↗
PubMed1995

Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio.

In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.

Ascitic Fluid↗
PubMed1995

[Comparative study of maternal side effects of various forms of intravenous therapy with fenoterol in premature labor].

OBJECTIVE: The aim of the present study was to compare different regimes of intravenous fenoterol tocolysis concerning their side effects. METHODS: A total of 59 patients with intravenous tocolysis due to preterm labor has been studied. They were chronologically alternating and thus randomly stratified into three groups: (a) continuous i.v.-tocolysis and oral application of magnesium sulfate (b) continuous i.v-tocolysis and i.v.-application of magnesium sulfate (c) pulsatile i.v.-application of fenoterol (bolus tocolysis) and oral application of magnesium sulfate. For all groups, heart rate, systolic and diastolic blood pressure, need for beta-blockers, K+, water balance over 24 hours as well as different subjective side effects were quantified. RESULTS: The side effects were found to be significantly less among patients treated with bolus tocolysis and they were also found to be slightly less in continuous tocolysis with i.v.- application of magnesium compared to continuous tocolysis with oral Mg2+ substitution; however, the difference between the two groups treated with continuous tocolysis was not significant. CONCLUSION: The present results suggest that bolus tocolysis shows significantly less side effects compared to the continuous tocolysis and thus it should be favored in clinical practise.

Administration, Oral↗
PubMed1995

[Reaction of umbilical cord arteries to PGF2 alpha and glycerol trinitrate during the first days post partum].

OBJECTIVE: Are there changes in the reactivity of umbilical cord arteries within the first day after parturition? METHODS: Groups of rings made from umbilical cord arteries were investigated by a force transducer for their reactions to PGF2 alpha and glycerol trinitrate after 1, 6, 12 and 24 hours after parturition. RESULTS: PGF2 alpha induces vasoconstriction, glycerol trinitrate vasodilatation of the umbilical cord arteries. The quantity of these reactions remains the same at each of the investigation times. But the standard deviation decreases 12 and 24 hours after parturition. CONCLUSIONS: There is an increase of the reproducibility of these investigations in the second half of the first day after parturition. The higher standard deviation in the first 6 hours after parturition may be caused by endogenous autacoids.

Autacoids↗