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S Niesert

Publications and source records attributed to S Niesert.

17 recordsLinked to original sources
PubMed1992

[Differential diagnosis of seizures in the peripartal period].

Seizures remain an important cause of maternal morbidity and mortality during pregnancy and the puerperium. Encouraged by some cases treated in our clinic (9 cases have been observed between 29. 12. 1989 and 22.5. 1991), the management of differential diagnosis in seizures are discussed in this article. Despite all possibilities of using technical apparatus for investigations, case history and clinical examination remain the basics of diagnosis with regard to paroxysm. EEG is an important, noninvasive method for judgement of cerebral function. It can be carried out continuously as a bedside-test and is extremely helpful in the differential diagnosis of eclampsia versus epilepsia. With a view to substantial defects as a possible convulsant factor, visualised examination procedures, e.g. cranial computed tomography (CCT) and magnetic resonance imaging (MRI) are available. Especially MRI has advantages in the diagnostic procedure. It could help to find the cause of cerebral structure defects and to clear the question of aetiology. Thus, a specific therapeutic procedure might become possible.

Adult↗
PubMed1991

[Pregnancy following organ transplantation].

Pregnancies following organ transplantation are high-risk pregnancies for mother and fetus. There are many reports concerning pregnancies following renal transplantation whereas only few reports are published about pregnancies in recipients of liver, heart and bone marrow transplants. During the pregnancy after kidney transplantation pregnancy-induced hypertension can develop or the renal function can decrease. Risks for the fetus are prematurity, growth retardation and prenatal infections. A higher incidence of complications for mother and fetus is observed in patients with renal insufficiency or severe hypertension prior to conception. The risks can be reduced by an intradisciplinary cooperation of gynecologist, transplant specialist and paediatrician. The paediatrician. The experiences with pregnancies in women after organ transplantations in the Medical School of Hannover are analyzed and compared with the reports in the literature. The management of these patients is described on current state of knowledge.

Female↗
PubMed1990

[GnRH analogs in gynecology. Possibilities for therapeutic use].

Gonadotropin releasing hormone (GnRH) agonists are synthetic peptide analogues of the natural gonadotropin releasing hormone with a stronger and more prolonged effect than the natural GnRH. Repeated administration of GnRH agonists induces pituitary desensitization followed by a decrease in gonadotropin secretion and estradiol synthesis. Thus reversible hypogonadotropic hypogonadism is produced. Consequently, estrogen-dependent diseases can be treated successfully with GnRH analogues. The therapeutic results obtained in patients with endometriosis, leiomyoma, pubertas praecox, and metastatic breast cancer are discussed. Furthermore the contraceptive properties of GnRH analogues, and combination treatment with HMG to induce ovulation is reviewed.

Female↗
PubMed1990

[Twin pregnancy after liver transplantation].

Orthotopic liver transplantation was performed in a 29-year-old woman because of increasing decompensation of HBs-antigen positive post-hepatitic cirrhosis. Postoperatively she developed a mild rejection reaction and diabetes mellitus. Thirteen months after the transplant she conceived twins. This high risk pregnancy was complicated by a febrile viral infection with purulent tracheobronchitis at 9 weeks and a threatened abortion at 11 weeks. At 33 weeks there was a sudden drop in haemoglobin due to a minor uterine rupture which necessitated cesarean section. The female infants--of development in keeping with the dates--showed no clinical or ultrasound evidence of any malformations. Apart from initial difficulties--asphyxia (second twin), fluctuating glucose and calcium levels, an episode of neonatal jaundice which required phototherapy, reluctance to suck and hypotonia--the further development of both twins proceeded normally. The maternal diabetes disappeared after delivery, HBs-antigen remained negative and the HBs-antibody titre rose. The patient has remained in good condition, both mentally and physically.

Abortion, Threatened↗
PubMed1990

[Pregnancy following liver transplantation and during immunosuppression with cyclosporine].

Orthotopic liver transplantation had been performed in 1983 in a now 40-year-old woman in the terminal stage of posthepatitis liver cirrhosis with recurrent oesophageal bleedings and precoma from complete liver-cell failure. She became pregnant in 1988 while under immunosuppression with cyclosporin (2.1-2.7 mg/kg body-weight) and prednisolone (5 or 7.5 mg daily in rotation). Pregnancy proceeded without complication and there were no side effects from cyclosporin. After premature membrane rupture in the 39th week of pregnancy uterine inertia developed during oxytocin stimulation of contractions, and caesarean section was performed. The female infant was normally developed without any malformations. Liver, kidney and adrenal functions were normal, as was haemopoiesis. But possible late sequelae of cyclosporin treatment in the child cannot as yet be assessed because of the short follow-up.

Abnormalities, Drug-Induced↗
PubMed1989

[Puerperal thyroid gland dysfunction in healthy patients].

Elevated thyroid antibodies (AB) have been described in clinically healthy women indicating a postpartum thyroid dysfunction. We evaluated the incidence of the postpartum thyroid dysfunction in Hannover, FRG. 121 women were examined 1-5 days pp and 2-4 months later; 76 were restudied 5-7 months pp. Every time T3, T4, TSH, TBG, microsomal AB and thyroglobulin AB were determined. Six patients showed increased TAB and 10 increased MAB titers. Severe clinical symptoms were not complained. In some patients these elevated titers turned to normal subsequently. Further studies must evaluate the prognosis of this disease.

Adolescent↗
PubMed1989

Inactivation of prostaglandins in human decidua vera (parietalis) tissue: substrate specificity of prostaglandin dehydrogenase.

Prostaglandin dehydrogenase catalyzes the initial reaction in the inactivation of prostaglandin E2 and F2 alpha. To address the potential importance of this enzyme in regulating the tissue levels of active prostaglandins, we evaluated the kinetic properties of prostaglandin dehydrogenase in uterine decidua vera tissue of women. Specifically, we characterized the enzyme activity under optimal in vitro conditions in cytosolic fractions of uterine decidua vera tissue obtained at term and compared the substrate and cosubstrate specificities of prostaglandin dehydrogenase in cytosolic fractions of decidual tissues. The incubation conditions were optimized with either prostaglandin E2 or F2 alpha and nicotinamide-adenine dinucleotide or nicotinamide-adenine dinucleotide phosphate as substrates to ensure linearity of product formation with time of incubation and protein concentration. The apparent Michaelis-Menten constant of nicotinamide-adenine dinucleotide-dependent prostaglandin dehydrogenase for prostaglandin E2 was 5.5 mumol/L. The apparent Michaelis-Menten constant of nicotinamide-adenine dinucleotide phosphate-dependent prostaglandin dehydrogenase for prostaglandin F2 alpha was 15 mumol/L. Prostaglandin E2 serves as a better substrate for prostaglandin dehydrogenase than does prostaglandin F2 alpha, irrespective of the cosubstrate. In cytosolic fractions of decidual tissues, the specific activity (apparent Vmax) of nicotinamide-adenine dinucleotide-dependent prostaglandin dehydrogenase was greater than that of nicotinamide-adenine dinucleotide phosphate-dependent prostaglandin dehydrogenase. In addition, we found that in decidual tissue obtained before or after the onset of labor, the specific activity of prostaglandin dehydrogenase varied widely. In tissues obtained after delivery by cesarean section, no significant differences were apparent in the specific activity of the enzyme before (9.3 to 125.8 nmol/min/mg protein) and after (27.8 to 103.4 nmol/min/mg protein) the onset of labor. In cytosolic fractions of decidual tissue obtained after vaginal delivery, the specific activity of nicotinamide-adenine dinucleotide-dependent prostaglandin dehydrogenase ranged from undetectable levels to 38.4 nmol/min/mg protein. We speculate that nicotinamide-adenine dinucleotide-dependent prostaglandin dehydrogenase in decidua serves to regulate the levels of bioactive prostaglandins in decidua vera tissue and the amounts of prostaglandins (and metabolites) produced in decidua or fetal membranes that reach myometrium and fetal membranes and enter maternal blood and amniotic fluid.

Cesarean Section↗
PubMed1989

[Pregnancies following kidney transplantation and in immunosuppression with cyclosporin A].

From 1984 to 1987, offspring from six renal transplant-patients were delivered in the Department of Obstetrics and Gynaecology of the Medical School of Hannover. The patients received cyclosporine and cortisone as an immunosuppressive therapy during the pregnancies. All pregnancies ended with live births; in two cases, a caesarean section was performed. Serious congenital malformations of the newborns were not observed, only two newborns being small. In the blood of the newborns, the cyclosporine concentrations were between 85 and 65% of the maternal blood levels. In two patients, the kidney functions deteriorated significantly during and after pregnancy. An increase in blood pressure or a hypertonic crisis, however, did not occur.

Adult↗
PubMed1989

[Detection of cyclosporin A in breast milk--is breast feeding contraindicated?].

Cyclosporin A (CyA) was measured simultaneous in breast milk and maternal and fetal blood with a new monoclonal specific radioimmunoassay in a patient who was treated with Cyclosporin A during pregnancy because of kidney transplantation. CyA-levels in breast milk were 15 to 90% higher than in maternal blood. In case of breast feeding a child would take up less than 5 percent of an immunosuppressive dose. However, we would recommend ablactation because of the toxicity and the unknown side effects of CyA for the child's immunologic system.

Adult↗
PubMed1988

[Disorders of liver function, thrombopenia and hemolysis in a special clinical form of hypertension in pregnancy (the so-called HELLP syndrome)].

The so called HELLP syndrome is a severe complication of pregnancy-induced hypertension, characterized by haemolysis (H), elevated liver enzymes (EL) and low platelet counts (LP). The data of 37 patients with a HELLP syndrome are presented. In addition to the clinical symptoms of pregnancy-induced hypertension, 21 patients suffered from abdominal pain and 5 patients from icterus. Thrombocytopenia, haemolysis and elevated liver enzymes were observed in every case. In 28 of the patients a Caesarean section was performed to prevent further deterioration of the disease. Three patients died post partum as a consequence of severe complications. In five pregnancies intrauterine deaths were observed. The results of this retrospective study confirm the great risk for both the mother and the foetus, if pregnancy-induced hypertension is complicated by a so called HELLP syndrome.

Adult↗
PubMed1987

[Amniocentesis in the 2d trimenon: comparison of 2 technics].

The results of 1245 amniocenteses performed by the "free hand needle" technique and ultrasonic control are discussed. The use of ultrasonic control showed a much lower incidence of blood-stained amnionic fluid as well as a decreased number of repeated punctures of the amnion. The abortion rate was almost the same in both groups. According to our experience ultrasonic controlled puncture seems to be more reliable in terms of safety and success.

Abortion, Spontaneous↗
PubMed1986

The effect of fetal urine on arachidonic acid metabolism in human amnion cells in monolayer culture.

Human amnion cells in primary monolayer culture were used as a model system to evaluate the regulation of arachidonic acid metabolism and prostaglandin E2 production in amnion. Amnion cells were incubated with carbon 14-labeled arachidonic acid, and after various times the distribution of radiolabeled arachidonic acid in the lipids of these cells were determined. After incubation for 72 hours, 91% of the total radiolabeled arachidonic acid incorporated into cellular lipids was present in glycerophospholipids, and 9% was present in neutral lipids. The formation of [14C]prostaglandin E2 from [14C]arachidonic acid was maximal after 8 hours. In these studies the effect of human fetal urine on arachidonic acid metabolism in these cells was investigated (the production of prostaglandin E2 by amnion cells is increased by treatment with fetal urine). In cells incubated with [14C]arachidonic acid in the incubation medium, treatment with fetal urine for 4 hours caused a threefold to fourfold increase in [14C]prostaglandin E2 production, yet there were no detectable differences in the content of [14C]arachidonic acid in specific glycerophospholipids or neutral lipids of the cells after such treatment. In other studies, amnion cells were preincubated for 72 hours with [14C]arachidonic acid, and thereafter the cells were treated with fetal urine for 24 hours. With fetal urine treatment the amount of [14C]arachidonic acid in triacylglycerols decreased significantly compared with that in nontreated cells, but the formation of [14C]prostaglandin E2 was not increased. Thus we suggest that in response to fetal urine, prostaglandin E2 is formed from arachidonic acid that is released from a highly specific, stimulus-sensitive lipid pool or else from arachidonic acid that is derived from extracellular sources.

Amnion↗
PubMed1986

[Neurofibromatosis and pregnancy].

A case of neurofibromatosis (Recklinghausen's disease) in pregnancy in a 29-year-old patient is reported. The woman has had two uncomplicated pregnancies and deliveries. The lesions of the neurofibromatosis did not change during the course of the pregnancy. However, based on the few published cases it is necessary to pay attention to hypertension or an exacerbation of the neurofibromatosis.

Adult↗
PubMedDate not supplied

[Acute fatty liver of pregnancy].

Liver diseases in pregnancy can occur as a complication of gestation or independently. Acute fatty liver of pregnancy is a rare disease of unknown etiology specifically associated to gestation. The frequency is increased in the first pregnancy, in the last trimester and in multiple pregnancies. Because of the high maternal and perinatal mortality early diagnosis is necessary for prompt termination of pregnancy. This case report is intended to facilitate the differentiation between acute fatty liver of pregnancy and other liver diseases in pregnancy. The differential diagnoses include preeclampsia, HELLP syndrome, intrahepatic cholestasis of pregnancy and acute viral hepatitis.

Acute Disease↗
PubMedDate not supplied

[Postpartum thyroid gland dysfunction--a prospective study].

In a prospective study the postpartum thyroid function was investigated in 120 healthy women in the department of obstetrics and gynecology of the Medical School Hannover. A physical examination was performed in the first week after delivery and two to five and five to eleven months later. Additionally blood was drawn for the determination of thyroid hormones, thyroid autoantibodies and thyroid-stimulating hormone. In 10% of the patients pathological titers for thyroid microsomal autoantibodies and thyroglobulin autoantibodies were found, in 2.5% pathological concentrations of thyroid hormones. In none of these patients clinical symptoms of thyroid dysfunction could be found. After delivery a immunologically mediated thyroid disease should be considered in patients with clinical symptoms. Then the thyroid function needs to be investigated.

Adolescent↗