Biomedical subjects
Publications and source records attributed to U Gethmann.
Complications during a pregnancy caused by a gastric balloon as a weight reduction device are presented. We refer about a patient in the 35th week of pregnancy who suffered with abdominal cramping. She was studied for hours before the decision for a laparotomy and cesarean section was made. Just before starting, a gastric balloon which was implanted in the early pregnancy for loss of body weight was expelled and the patient was healthy.
Rare haemorrhagic disorders cause a lot of diagnostic and therapeutic problems to the obstetrician. By means of a pregnancy course and a birth process a report is given on the physiological drop of the factor XIII serum concentration and its difficult clinical interpretation. This paper presents pathophysiology, symptoms, complications and treatment of factor XIII deficiency in pregnancy.
A radioimmunoassay for the determination of progesterone in saliva using a 125J-labelled progesterone derivate has been developed. The assay is characterized by the excellent sensitivity of 3.12 pg progesterone/ml. During the menstrual cycle of normal women the biphasic rhythm of progesterone in saliva could not been clearly demonstrated. In the follicle phase high peaks of progesterone have been shown and even in the luteal phase individual low values have been observed. The circadian rhythms of progesterone in saliva are characterized by irregular oscillations. The saliva flow rate is not responsible for the progesterone concentration. The measurement of progesterone in serum seems to be more useful in the diagnosis of sterility.
A case of ovarian pregnancy after gamete transfer (GIFT) is reported in a 33-year old women who, after intensive stimulation therapy, experienced a right tubal pregnancy in one cycle and an ovarian pregnancy on the left side in the next. The incidence of ovarian pregnancies seems to have been increasing during the past years, comprising 3.3% of all extrauterine pregnancies. This may be influenced by the possibilities of sterility therapy today. Clinical presentation, possible pathogenesis, diagnostic steps and preferred management are described. The use of transvaginal sonography has improved the diagnosis of ectopic pregnancies and should be routinely used leading to an early diagnosis and organ-preserving therapy. This case report is intended to assist and promote the sensitivity towards an early diagnosis of this rare form of ectopic pregnancy.
The particulars of 78 patients with fetal demise of the last 14 years were evaluated retrospectively. The most important reason of fetal death was hypoxaemia or anoxaemia. 31 patients were delivered by cesarean section or had spontaneous uterine contractions. Induction of 47 abortions were started with oxytocin or prostaglandins. Within 12 hours 54% of the oxytocin and 67% of the prostaglandin group succeeded in spontaneous delivery. In both groups there were 5 management failure of therapy, so that alternative medication or a cesarean section lead to delivery.
A rare case of a struma ovarii and carcinoid of the ovary is presented. In comparison with 21 reported cases, the tumor was unilateral and showed no metastatic spread. The treatment of this primary ovarian tumor with low malignant potential, was bilateral salpingo-oophorectomy and hysterectomy. Long-term follow up is advisable.
Primary cultures of pituitary cells from adult female rats were exposed to increasing concentrations (10(-13) to 10(-6)M) of selected prostaglandins (PGE2, PGF2 alpha, PGI2, 6-keto-PGF1 alpha, and sulproston). The release of luteinizing hormone (LH) by the pituicytes was monitored. In a second series of experiments, pituitary cells were treated with prostaglandins as described above and additionally challenged with a submaximal stimulus of gonadotrophin-releasing hormone (GnRH; 10(-9) M). The spontaneous LH-release in all prostaglandin treated cultures did not differ from the controls. When stimulated with 10(-9) M GnRH, the LH-release increased approx. six-fold in all cultures, with no difference between prostaglandin treated cells and the respective controls. Thus, the prostaglandins tested - at least at concentrations less than or equal to 10(-6) M - have neither a direct positive or negative effect on pituitary LH-release, nor do they enhance or decrease the LH-releasing effect of GnRH. These prostaglandins are probably not involved in the cellular regulation of LH-release by the pituicyte.
Retrospectively we have compared the efficacy, the immediate complications, and the side effects during termination of 727 first trimester pregnancies with and without preoperative cervical dilatation by sulprostone. All these patients had been admitted to the Frauenklinik der Medizinischen Hochschule L ubeck for legal abortion; 365 of them got a single intramuscular injection of 500 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 4% Hegar less than 6); 81 patients got a single intramuscular-intracervical injection of 25 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 16% Hegar less than 6); in 281 patients evacuation of the uterus was carried out in dilating the cervix mechanically. This route without preoperative dilatation by the prostaglandin analogue sulprostone gave the highest rate of complications. Only in regard to a complete evacuation of the uterus a single intramuscular-intracervical injection of sulprostone resulted in a diminution of the complications. However, a single intramuscular injection of 500 micrograms sulprostone prior to vacuum aspiration offered a practical, effective and relatively side-effect free method of cervical dilatation.
We studied the action of catecholestrogens on prostaglandin and LH release by female rat pituitaries superfused in vitro. Their actions were compared to those of estradiol (E2) at the same concentration (10(-6) M). By comparison with E2 the action of 2-OHE2 was only the same on total PGE2 release. 4-OHE2-17 beta stimulated LH like E2 but the values for PGD2 and PGE2 were about 20-30% lower. However, the release of 6-keto-PGF1 alpha was about 35% higher. 4-OHE2-17 alpha had no comparable action on PG release but stimulated a significant LH release. There was no action on TxB2 in any case.
In ten of 12 patients with non-progressive hirsutism a pathologic pattern of androgens was assessed by hormone determinations. Using a new test procedure increased androgen production could be tentatively associated with an impaired function of either ovaries or adrenals. Androgen-producing tumors could be excluded. With differential therapy (progestins, estrogens, corticosteroids, antiandrogens) pathologic androgen serum levels subsided already prior to antiandrogen medication. Definite clinical success was, however, observed only it antiandrogen therapy. As long-term therapy a low-dose antiandrogen-estrogen combination proved valuable.
Osmotic minipumps containing low doses of either 4-hydroxyoestradiol or 2-hydroxyoestradiol2) were sc implanted for 152 h (6 1/3 day) into immature male and female rats. At the end of the test period the animals were killed and the uterine weight, the vaginal opening, the gonadotrophin serum levels and the gonadal weight monitored. The following results were obtained: 1) a significant increase in the uterine weight and a consistent vaginal opening were observed after 4-hydroxyoestradiol but not after 2-hydroxyoestradiol treatment, 2) LH-levels increased after 2-hydroxyestradiol but not after 4-hydroxyoestradiol; the increase was, however, not significant, 3) FSH-levels and gonadal weights were lowered by 4-hydroxyoestradiol treatment in male animals only; 2-hydroxyoestradiol had not effect on FSH-levels in both sexes, 4) in no instance an antioestrogenic effect of either catecholoestrogen was observed. It is concluded that 4-hydroxyoestrogens - using the above paradigm - have a significant importance on uterine growth and vaginal opening but (on day 6) no role of LH-release, whereas 2-hydroxyoestrogens may increase LH levels (on day 6) but are nearly ineffective with respect to peripheral parameters.
In 34 risk pregnancies with 34 hypotrophic newborns we determined during the second half of pregnancy the 24-hour urinary total oestrogens, unconjugated oestriol and total oestriol in the serum. By means of graphical evaluation of the pathological ranges in relation to the normal ranges (degree of overlapping) we investigated the relative clinical relevance. In respect of hypotrophy the ratio of dU-total oestrogens: S-unconjugated oestriol: S-total oestriol = 14:2:1. The considerable superiority of diagnosis based on urine in transverse assessment results in a statistically significant time gain of 4 weeks compared with the two serum parameters.
1. The fetal contribution to PGFM levels is smaller than supposed. 2. The highest levels of PGFM found at placental separation seem to indicate the decidual origin of PGs which enter the maternal organism via the open uterine veins. This assumption is supported by low levels during the postpartum period when contractions are nearly as strong as during labor, but the uterine veins are closed. 3. There is no evidence that obstetrical factors are correlated to PGFM levels.
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First clinical results are reported of a new prostaglandin-E2-derivative (16-phenoxy-prostaglandin-E2-methylsulfonylamide = SHB 286) as abortifacient using the extraamniotic route of application. Upon investigation in animals this prostaglandin-E2-derivative proved to be more tissue-selective and more potent in inducing abortion than the naturally occurring prostaglandins. Prostaglandin SHB 286(50 or 100 microgram) was applicated to 31 patients for legal abortion and to 7 patients with a missed abortion. The mean instillation-abortion time was 14.2 and 13.7 h respectively. 96% of the patients had a complete or incomplete abortion after 24 hours. Severe local or systemic side effects did not occur and the patients did not need any further medication.
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Serum, cord blood and amniotic fluid beta2-microglobulin contents were measured from normal pregnancies complicated by EPH gestosis, Rh immunisation and pathological serum levels of HPL and alpha1-fetoprotein. We found no changes in high risk pregnancies from normal serum levels. beta2-microglobulin seems to be no parameter in managing complicated pregnancies and fetal growth retardation.