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Biomedical subjects

R von Hugo

Publications and source records attributed to R von Hugo.

At least 19 recordsLinked to original sources
PubMed1996

[Autonomic hyperreflexia, pregnancy and delivery in para-tetraplegia. The obstetric anesthesiologic viewpoint on a case].

Although still rare, pregnancy and delivery in women with spinal cord injuries is becoming more frequent (Table 2). In 85%-90% of patients with lesions above T6 symptoms of autonomic hyperreflexia (Table 1), especially paroxysmal and excessive increases in arterial blood pressure, may occur. In anaesthetising a 31-year-old paraplegic primigravida with a complete transverse spinal lesion at T4 for an elective caesarean section, no indication of hypertonic cardiovascular dysregulation either intra- or postoperatively was observed after repeated epidural administration of bupivacaine. Distinct intraoperative spasticity of the abdominal wall muscles was, however, not influenced by the dosages selected.

Adult↗
PubMed1994

[The Kartagener syndrome].

A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility. Kartagener's syndrome is a rare disorder involving the combination of situs inversus, bronchiectasis and sinusitis. A dynein deficiency leads to ciliary dyskinesia. When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind: ascertainment of the preoperative pulmonary status, antibiotic coverage, recognition of dextrocardia, necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis. Anticholinergic and antitussive medications are relatively contraindicated, as are nasal tubes. In the present case an intubation anaesthesia with thiopental, nitrous oxide, enflurane and succinylcholine was carried out; cefoxitin was administered for antibiotic treatment, and the patient made an uneventful recovery.

Adult↗
PubMed1993

[Hereditary prolonged QT interval (Romano Ward syndrome) in obstetric management].

In the Romano-Ward syndrome, an inherited form of abnormally prolonged QT duration is a matter for concern. The frequency-corrected QTc value in the ECG amounts to more than 0.44 s. Persons suffering from Romano-Ward syndrome are vitally endangered by attacks of arrhythmia, syncope and cardiac arrest which are triggered or aggravated by stress or certain drugs. In obstetrical anaesthesia, attention should be paid to the foetus, which, due to the genetic dominance, will have a 50% probability of suffering from the disorder. A 28-year-old para I was admitted with cervical dilation on her predetermined date of delivery. Romano-Ward syndrome had been diagnosed 10 years earlier. The patient had been free of complaints and had received no treatment. Due to cephalopelvic disproportion and the cardiac syndrome, a primary Caesarean section was performed. The QTc values were pathologically prolonged (0.47 s; 0.48-0.63 s) during the pre- and intraoperative period. Haemodynamic irregularities did not occur in the perioperative period. The newborn was vital (3.830 g; 50 cm; Apgar scores 10/10/10; umbilical cord pH 7.29). Directly postpartum isolated supraventricular extra systoles occurred, and the QTc duration increased to 0.51 s.

Adult↗
PubMed1992

Radical surgical procedure improves survival time in patients with recurrent ovarian cancer.

BACKGROUND: There is plenty of evidence that survival time associated with advanced ovarian cancer is predominantly related to the amount of residual tumor after primary operation. However, there are only few and inconclusive reports concerning the effect of second debulking procedures on survival time after relapse. METHODS: To evaluate the effect of radical second operation, 30 patients with clinically diagnosed relapses had second operations after a median recurrence-free interval of 16 months. Considerable efforts were made to resect all tumor tissue. Complete resection was achieved in 14 of 39 (47%) patients, and residual tumors smaller than 2 cm remained in 12 (40%) patients. In 19 (63%) patients, intestinal resections were necessary. Operation time, blood units needed, hospital stay, and complication rates were comparable to those associated with primary debulking procedures. RESULTS: Survival time after second operation was closely correlated with the residual tumor remaining after second surgical procedure and also with the length of the recurrence-free interval. Patients with complete resections had significantly longer survival times than those with residual tumors of less than 2 cm (median, 29 months versus 9 months; P = 0.004). Patients with a recurrence-free interval of more than 12 months had a longer survival time than those with a shorter disease-free time (median, 29 months versus 8 months; P = 0.002). Postoperative treatment also was shown to influence survival time, whereas grade of the tumor (P = 0.74), age of the patient (P = 0.87), and initial FIGO stage (P = 0.58) had no influence on survival time after second operation. Multivariate analysis (Cox regression) revealed that residual tumor after second surgical procedure (relative risk, 4.7) was the most important independent variable predicting survival time after second surgical procedure. Recurrence-free interval (relative risk, 2.7) and postoperative (second-line) treatment (relative risk, 3.0) were equally potent variables. Residual tumor after primary operation, was almost significant (P = 0.06) in the univariate analysis, but was canceled in the multivariate setting by the recurrence-free interval. Again, FIGO stage, grade of the tumor, and patient age had no predictive value. CONCLUSIONS: The authors conclude that radical surgical procedure can prolong survival times in patients with recurrent ovarian cancer. Patients who had a complete resection of cancer tissue in the primary operation or those who experienced a disease-free interval of more than 12 months after primary operation are most likely to benefit from second operation in recurrent ovarian cancer. Radical surgical procedure should be offered to these patients to enhance efficacy of second-line chemotherapy, which is of limited value in bulky recurrent disease.

Adult↗
PubMed1992

[Hereditary prolonged QT interval (Romano-Ward syndrome) in a female patient with non-elective cesarean section].

In the Romano-Ward syndrome, an inherited form of abnormally prolonged QT duration is the matter of concern. The frequency-corrected QTc value in the ECG amounts to more than 0.44 s (upper mean value: 0.44 s). Persons suffering from Romano-Ward syndrome are vitally endangered by attacks of arrhythmia, syncope, and cardiac arrest that are triggered or aggravated by stress or certain drugs. In obstetrical anesthesia, attention should be paid to the fetus, which, due to the genetic dominance, will have a 50% probability of having the disorder. A 28-year-old para I was admitted with cervical dilation on her predetermined date of delivery. Romano-Ward syndrome had been diagnosed 10 years earlier; the patient had been free of complaints and had received no treatment. Due to cephalopelvic disproportion and the cardiac syndrome, a primary cesarean section was performed. Following premedication and provision of a beta-blocker, defibrillator, and drugs for resuscitation, intubation anesthesia with methohexital, nitrous oxide, enflurane, and succinylcholine was carried out. The QTc values were pathologically prolonged (0.47 s; 0.48-063 s) during the pre- and intraoperative period. Hemodynamic irregularities did not occur in the perioperative period. The newborn was vital (3,830 g, 50 cm; Apgar scores 10/10/10; umbilical cord pH 7.29). Directly postpartum isolated supraventricular extrasystoles occurred, and the QTc duration increased to 0.51 s. Simultaneous registration of the ECG and phonocardiogram showed premature occurrence of the second cardiac sound, which is typical of Romano-Ward syndrome.

Adult↗
PubMed1991

Thromboembolism in gynecologic oncology.

The risk of thrombo-embolic complications increases in surgical gynaecological oncology as a consequence of difficult and long-lasting interventions. In gynaecologic operations without any drug prophylaxis thrombosis has been reported by 24-29%, whereas in operations of progressed oncological findings thrombo-embolic complications arise in almost every second case. Such complications have to be taken seriously due to difficulty treatable sequelae (post-thrombic syndrome) and due to potentially lethal pulmonary embolism. Furthermore, they are important causes of postoperative early mortality. Diagnosis of a deep thrombosis is insecure even for experienced clinicians. We have various diagnostical means at our disposal, such as phlebography, sounding and 125-iodine-fibrinogen-testing. Differentiated drug medication for the prevention and therapy of thrombo-embolism is definitely indicated. There are also different kinds of physical and drug-aided means, which can be applied according to the individual situation.

Coumarins↗
PubMed1989

[Septic ovarian vein thrombosis--diagnosis and therapy].

Septic ovarian vein thrombosis is commonly the sequela of puerperal purulent endomyometritis. The incidence has been reported to be 1 in 600-6000 deliveries. The predominant location is the right ovarian vein according to the puerperal uterine drainage. The diagnostic and therapeutic experience in 9 cases is described. The leading symptoms were abdominal pain localized at the psoatic muscle and a tender, barrel-shaped tumor. Ultrasound and computed tomography (CT) added in the correct preoperative diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course; in complicated cases surgical intervention becomes mandatory.

Endometritis↗
PubMed1988

[Puerperal ovarian vein thrombophlebitis--a rare puerperal complication].

Puerperal ovarian vein thrombosis (POVT) commonly results from purulent necrotic endomyometritis. The incidence is published to be 1 in 600 deliveries, however, according to own data, the incidence is at least 10 times less frequent. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain localized anteriorly to the psoatic muscle and a tender, barrel shaped unilateral tumor. Discrepancy between the grave clinical picture and the insignificant findings on gyn. examination is common. Ultrasound and computed tomography frequently add in the correct diagnosis. Antibiotic therapy and anticoagulation are recommended in an uneventful course. If clinical improvement is delayed despite non-invasive treatment, surgical intervention with resection of the involved veins and all septic foci becomes mandatory. Despite non-invasive and invasive treatment, pulmonary emboli or septic complication refractory to therapy may contribute to mortality. Therefore POVT should always be included in the differential diagnosis of those patients presenting with a variable fever curve or an unexplained septic course following delivery or miscarriage.

Adult↗
PubMed1988

[Acute abdomen in gynecology].

The aim of the present study is, to describe the morbidity and mortality of 196 patients with an acute abdominal condition who underwent surgery at the Department of Gynecology and Obstetrics of the TU Munich between 1982 and 1986. This is a percentage of 2.7 of all 7,167 operations carried out during this period. 118 of these patients had an extrauterine pregnancy and were therefore excluded from the study. The second group of 79 patients, mostly with inflammatory diseases, were analyzed. In most of these cases the acute abdominal condition was caused by a tuboovarian abscess (48.1%), followed by peritonitis because of a bowel-disease (11.4%). 6 patients suffered from an abscessing endometritis due to a caesarean section with sepsis in 5 cases. A generalized peritonitis occurred in 5 cases and was treated with a planned relaparatomy with lavage. 63% of the patients had no complications within 28 days after operation, 13% developed a subileus; in 7% a relaparatomy was necessary. 6% of the patients had problems of wound-healing. One patient with stomach-cancer died 3 weeks after the operation because of a fulminant lung-embolism. Thus the mortality rate was 1.5%. A further 27% were treated at the intensive care-unit and 18% needed artificial respiration. The average postoperative period of hospitalisation was 15 days. In comparison, patients with elective operations remained 13 days. The morbidity and mortality of patients due to surgery of an acute abdominal condition was relatively small; postoperative complications could be well treated in all cases and is probably the result of a positive and early indication for surgical intervention.

Abdomen, Acute↗
PubMed1986

[A test for the detection of fibrin in the plasma].

The article reports on measurements of D dimer, a terminal plasmic lysis product of crosslinked fibrin, with an enzyme immunoassay (ELISA) employing recently developed specific monoclonal antibodies. Due to its sensitivity the test can be used on plasma samples. The D dimer concentrations in patients with deep vein thrombosis diagnosed by laboratory apparatus were significantly increased compared to a control group; in one patient with additional pulmonary embolism, the level was even higher. Moderately elevated concentrations of D dimer were observed in the hypercoagulable state of pregnancy, puerperium and during the postoperative course. This reduces the specificity of the test with regard to the recognition of thromboembolic episodes under these conditions. Obstetric patients with disseminated intravascular coagulation (DIC) showed excessively increased levels of D dimer. Hence, a marker function with regard to the recognition of thromboembolic disease can be attributed to the D dimer; the diagnosis of DIC can be confirmed if very high concentrations are detected.

Adult↗