PubMed Health⌕ Search

Biomedical subjects

W Rath

Publications and source records attributed to W Rath.

At least 19 recordsLinked to original sources
PubMed2006

[Grey-scale texture analysis of the cervix in pregnancy].

AIM: The measurement of the length of the cervix is just a method of routine, but the analysis of the grey-scale texture of the cervix represents a method poorly evaluated to date which may have the scope of improving the prediction of premature birth. Before it can be used for clinical purposes, the method must be standardised. METHODS: 66 patients were examined endosonographically. The analysis was done both visually and automatically, using a commercially available software. Inside a ROI (region of interest), we calculated the mean of the histogram, and homogeneity as well as contrast of the co-occurrence matrix of the grey-scale values. The influence of ultrasound wave propagation as well as location, extension and sound angle of the ROI were examined, and the results of the analysis performed by man and machine were compared. Additionally, we compared the textures of the inner and outer cervical os as well as the anterior and posterior lip of the cervix. RESULTS: As homogeneity and contrast were significantly influenced by the propagation of ultrasound waves, we developed a new angle-independent parameter combining the results of the 45 degrees and the 90 degrees calculation. Small changes in location, extension and sound angle of the ROI did not influence our results significantly. The texture analysis performed by the software was significantly better than the one performed by the examiner. The maximum of brightness was detected in the region of the internal os/anterior lip. Contrast as well as homogeneity showed significant differences between all parts of the cervix. CONCLUSION: The analysis of the grey-scale texture of the cervix can deliver clinically relevant results in the prediction of premature birth. The external influence on sound wave propagation as well as different locations inside the cervix must be taken into consideration.

Cervix Uteri↗
PubMed2006

Intrahepatic cholestasis of pregnancy: the severe form is associated with common variants of the hepatobiliary phospholipid transporter ABCB4 gene.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is characterised by troublesome maternal pruritus, raised serum bile acid levels and increased fetal risk. Mutations of the ABCB4 gene encoding the hepatobiliary phospholipid transporter have been identified in a small proportion of patients with cholestasis of pregnancy. In a recent prospective study on 693 patients with cholestasis of pregnancy, a cut-off level for serum bile acid (> or =40 micromol/l) was determined for increased risk of fetal complications. OBJECTIVES: To investigate whether common combinations of polymorphic alleles (haplotypes) of the genes encoding the hepatobiliary ATP-binding cassette (ABC) transporters for phospholipids (ABCB4) and bile acids (ABCB11) were associated with this severe form of cholestasis of pregnancy. METHODS: For genetic analysis, 52 women with bile acid levels > or =40 micromol/l (called cases) and 52 unaffected women (called controls) matched for age, parity and geographical residence were studied. Gene variants tagging common ABCB4 and ABCB11 haplotypes were genotyped and haplotype distributions were compared between cases and controls by permutation testing. RESULTS: In contrast with ABCB11 haplotypes, ABCB4 haplotypes differed between the two groups (p = 0.019), showing that the severe form of cholestasis of pregnancy is associated with the ABCB4 gene variants. Specifically, haplotype ABCB4_5 occurred more often in cases, whereas haplotypes ABCB4_3 and ABCB4_7 were more common in controls. These associations were reflected by different frequencies of at-risk alleles of the two tagging polymorphisms (c.711A: odds ratio (OR) 2.27, p = 0.04; deletion intron 5: OR 14.68, p = 0.012). CONCLUSION: Variants of ABCB4 represent genetic risk factors for the severe form of ICP in Sweden.

ATP Binding Cassette Transporter, Subfamily B↗
PubMed2006

Family stability during childhood and the risk to develop hypertensive diseases in pregnancy.

BACKGROUND: Parental care giving, divorce and death are associated with physical health as an adult. AIM: To investigate whether the structure of the nuclear family during childhood shows any correlation with the development of hypertensive diseases in pregnancy as an adult. STUDY DESIGN: Self-administered questionnaires were sent to 2600 women with hypertensive diseases in pregnancy and to 1484 controls. SUBJECTS: After confirmation of the diagnosis data from 842 patients and 623 control women were evaluated. OUTCOME MEASURES: Type, number and involvement of different caregivers, parental separation, parental death. RESULTS: In both groups parental separation and parental death were found equally often. In all age groups during childhood fathers were involved significantly less often in care giving when women with hypertensive disorders in pregnancy were compared to control women (1st-3rd year 23.4%/17%, <0.0001; 4th-10th year 25.7%/19.3%, <0.0001; 11th-18th year 30.1%/23.9%, <0.0001). The total number of caregivers involved was significantly higher in patients. CONCLUSIONS: The quality of parental care giving, i.e. the involvement of fathers and the total number of caregivers correlate with the risk to develop HDP. Further research is needed to specify underlying mechanisms and the relevant factors of the parent-child relationship.

Adult↗
PubMed2006

[Drug-induced labour--more than just a decision by the obstetrician?].

The induction of labour ist the most frequently indicated measure in obstetrics. In this way a better perinatal result for both mother and infant should be expected than from a wait-and-see policy. In addition, the induction of labour should make vaginal delivery possible and thus spare the mother from the trauma of a Caesarean section. Today obstetrics is positioned in a field of tension between medical indications, the maternal wish for recognition of her sovereign right of decision, confirmed knowledge from evidence-based medicine and other paramedical influences. From the point of view of the clinical obstetrician the individual medical situation is all important, whereby the dynamics of the primary pathology, possibilities for its treatment, particular risks of induction of labour, and the success of a vaginal delivery have to be taken into consideration. A main principle is the more elective ist the induction of labour the more comprehensively must the patient be informed about the risks and benefits of the procedure. Current results about the most frequent indications for the induction of labour reveal a low strength of evidence. This is particularly valid for the increasingly more frequent problem of induction of labour after a previous Caesarean section. In the author's opinion the obstetrician should employ all his/her clinical skill and experience (in the sense of good clinical practice) in the risk-adapted decision making with regard to the induction of labour, especially in cases of previous Caesarean operations and not--a priori--follow the mode to "trendy Caesareanism". In this way, obstetrics will remain a domain demanding individual skill and ability from the future generations of responsible obstetrician and will not degenerate to solely a "surgical performance".

Decision Making↗
PubMed2006

Childhood sexual abuse (CSA) experiences: an underestimated factor in perinatal care.

BACKGROUND: Childhood sexual abuse can have several negative consequences on pregnancy, birth, and the early neonatal period. However, most obstetricians are not aware if their patients have a history of childhood sexual abuse. We therefore investigated childhood sexual abuse experiences in 226 women three to eight months after delivery of a healthy child. METHODS: 415 women were approached to answer a self-administered questionnaire including obstetrical questions and questions focusing on abuse experiences. 320 women agreed to participate, 226 (69.1% of the women fulfilling inclusion criteria) of which returned a completed questionnaire. Sexual abuse was explored using a modified version of a questionnaire developed by Wyatt. The complete questionnaire was designed in cooperation with the German "Frauennotruf", a society providing care for victims of sexual abuse. RESULTS: The prevalence of childhood sexual abuse was a minimum of 11.5% and a maximum of 14.6% if women who were not sure about such experiences during their childhood were included. Another 1.3% of the women had experienced sexual abuse as an adult. Lifetime sexual abuse prevalence was 12.8% and 15.9%, respectively. Of the women with an experience of childhood sexual abuse, 42.3% mentioned an ongoing abuse situation for at least six months. CONCLUSIONS: As approximately every 9th woman presenting for obstetrical care has experienced childhood sexual abuse, and as those experiences may have a negative impact on fetal and maternal well-being, adequate counseling models should be offered to victims of sexual abuse.

Adolescent↗
PubMed2005

Contractile reactivity of human myometrium in isolated non-pregnant uteri.

BACKGROUND: Perfusion of the isolated uterus has been shown to be a feasible experimental system for studies of the human endometrium and myometrium. Utilizing our established experimental perfusion model we perfused 20 uteri for 27 h and investigated the contractile reactivity of the myometrium in response to 17beta-estradiol (E2) and oxytocin (OT). METHODS: Uteri of group A (n = 4) were stimulated with OT; group B (n = 4) was treated continuously with E2; group C (n = 4) received both E2 and OT for 27 h; group D (n = 4) was perfused for 27 h with E2 with the addition of OT for the last 3 h of the experiment; group E (n = 4) as control group remained without any treatment. The pressure and duration of uterine contractions were recorded during the entire perfusion period using intramural and endoluminal pressure catheters. RESULTS: Compared to the other treatment groups and controls, the most effective myometrial activity was achieved in group D during the OT stimulation period. No relevant myometrial activity was detected in the control group. CONCLUSIONS: Continuous E2 treatment, with the addition of OT for the last 3 h of the 27 h perfusion period, led to the most pronounced uterotonic effects in the presented experimental condition.

Estradiol↗
PubMed2005

Is cervical dilatation during parturition at term associated with apoptosis?

AIMS: Cellular turnover may be involved in remodeling of the cervix during parturition. Therefore, the number and localization of apoptotic and proliferating cells during cervical dilatation at term were determined. METHODS: Biopsy specimens from the lower uterine segment of 36 women undergoing cesarean section with a cervical dilatation of < 2 cm (n = 10), 2- < 4 cm (n = 9), 4-6 cm (n = 8), and > 6 cm (n = 9) were examined for nuclear fragmentation by the TUNEL assay, and for cell survival by the apoptosis-blocking bcl-2. Proliferation was marked by Ki-67, epithelial cells by cytokeratin and leukocytes by CD 45. For quantification of apoptotic and proliferating cells, eight random fields of each specimen stained for TUNEL or Ki-67 were blindly counted by two investigators. For statistical evaluation, 90% confidence intervals based on a Poisson distribution were used; groups with non-overlapping intervals were considered significantly different. RESULTS: Apoptotic cells were found exclusively within the stromal compartment, while bcl-2 was expressed in epithelial cells and leukocytes. Proliferating cells were of stromal and epithelial origin. The number of apoptotic as well as proliferating cells ranged from 0 to 2 cells per high-power field (median number 0) in all groups. The confidence intervals were overlapping for all groups, showing no statistical difference between them. CONCLUSION: Apoptosis does not seem to play a decisive role in the process of cervical dilatation during parturition at term.

Apoptosis↗
PubMed2005

Increased soluble VCAM-1 serum levels in preeclampsia are not correlated to urinary excretion or circadian blood pressure rhythm.

OBJECTIVE: Soluble vascular cell adhesion molecule-1 (VCAM-1) is known to be elevated in serum of patients with preeclampsia, but there are no data available on the significance of urinary VCAM-1 excretion in preeclampsia. The aim of our study was to uncover possible circadian rhythms of VCAM-1 plasma levels and urinary VCAM-1 excretion in uncomplicated and hypertensive pregnancies and to ascertain their relation to blood pressure. STUDY DESIGN: A total of 10 normotensive and 10 preeclamptic pregnant women were included in this study. Venous blood was collected hourly, and urine samples were taken every 2 h over a period of 24 h. VCAM-1 levels were determined by ELISA. We compared these results with the circadian blood pressure rhythm. RESULTS: The median VCAM-1 plasma levels were significantly (P < 0.01) increased in preeclamptic patients (851.5 ng/mL) in comparison to normotensive pregnant women (659.3 ng/mL) without any circadian rhythm being apparent; however, the urinary excretion of VCAM-1 showed a typical circadian rhythm, with a higher excretion rate during daytime. CONCLUSION: For the first time we have demonstrated that urinary VCAM-1 excretion in pregnancy shows a circadian rhythm without correlation to plasma levels or the circadian blood pressure rhythm. In contrast, VCAM-1 serum levels did not show a diurnal rhythm. We assume that VCAM-1 serum levels do not correlate with systemic blood pressure or urinary excretion.

Adult↗
PubMed2005

Fetal hemorheology in normal pregnancy and severe preeclampsia.

Hemorheological parameters were determined in 45 pairs of mothers with severe preeclampsia and their newborns in comparison with 45 women with uncomplicated pregnancies and their newborns. In both groups we investigated red cell deformability, the plasma viscosity, the red cell aggregation (during stasis and low flow), the macromolecules fibrinogen and factor VIIIR:Ag (VWF), and the blood count parameters hemoglobin, hematocrit, white cells, platelets, reticulocytes, MCV, MCHC. Cholesterol and triglycerides were correlated to the parameter of red cell deformability measured as red cell elongation. We found a significant lower plasma viscosity, red cell aggregation, fibrinogen, cholesterol, triglycerides and VWF in cord blood with a close association between plasma viscosity and fibrinogen (r = 0.56, p = 0.001). The red cell deformability measured as red cell elongation was statistically higher in the cord blood compared to the mothers and associated with a higher MCV. In contrast the MCHC values remained unchanged. Hematocrit and hemoglobin in the cord blood were higher than in the mothers. The incidence of fetal hyperviscosity-polycytemia syndrome in women with severe preeclampsia was between 4.7% and 4.9%. An elevated red cell aggregation was found in 2.8% (stasis) and 4.8% (low flow state), respectively. We conclude that in fetal blood the higher hematocrit and the presence of larger red cells do not cause impaired fetal hemorheology.

Blood Platelets↗
PubMed2004

Analysis of local complications following explantation of silicone breast implants.

A study was undertaken to analyse local complications in patients with breast implants and the total number of implant-related interventions when silicone breast implants were explanted. We studied 53 patients who had received breast implants for cosmetic augmentation or breast reconstruction following surgery for breast cancer at the time of explantation. The clinical records of all these patients were analysed, and clinical information on reason for implantation, implant properties, number and kind of implant-related interventions and reason for explantation was elicited. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture, loss of implant integrity, haematoma or seroma, infection of the implant site, extrusion or wound dehiscence, and dissatisfaction with the result. The mean numbers of implant-related operations were 3.1 in patients who had undergone breast reconstruction and 2.3 in patients who had cosmetic augmentation (P < 0.03). We found a total of 35 complications in 28 patients, 21 patients (75%) each had one complication, five patients (18%) had two and two patients (7%) had three complications. A significantly higher incidence of early complications in patients who had undergone breast reconstruction (P < 0.03) marks the difference from complications in the cosmetic group, most of which arose after a longer time (P < 0.02). A complication analysis is presented. At the time of explantation, 78% of the patients decided to have a new implant, while 12% requested permanent removal of the implant without replacement. In the present study we saw no patients with connective tissue or other autoimmune disorders. When breast reconstruction or augmentation with silicone devices is considered, patients must be informed of the possible complications and of the potential choices in later implant-related revision surgery.

Adult↗
PubMed2004

[Treatment of severe preeclampsia and HELLP syndrome].

Severe preeclampsia and HELLP syndrome are still one of the leading causes of maternal and perinatal morbidity and mortality. The current definitions of the diseases should be considered before treatment. The timely allocation to a perinatal center and an intensive monitoring of mother and child after admission are mandatory for successful management of these patients. The aim of therapy is immediate stabilization of the mother's condition by means of anticonvulsive prophylaxis with intravenous magnesium sulphate, well-controlled reduction of blood pressure by the administration of urapidil or nifedipine, controlled volume expansion and an adequate treatment of coagulation disorders by giving fresh frozen plasma (not heparin). Immediate delivery is the method of choice in cases of severe preeclampsia/HELLP syndrome > or = 34 weeks' gestations; we prefer cesarean section in patients with an unripe cervix and the full-blown picture of HELLP syndrome. In patients < 34 weeks' gestation expectant management is generally possible under intensive monitoring of the mother and the fetus. Maternal and fetal indications for immediate termination of pregnancy should be considered carefully. The systemic application of corticosteroids is a promising approach to prolong pregnancy. During the past decade the increasing awareness of obstetricians and other disciplines have led to a significant reduction of maternal mortality (< 1 %) and perinatal mortality (9.4-16.2 %) in cases of HELLP syndrome, in particular in the West European countries.

Female↗
PubMed2004

[Analysis of Foetal Heart Rate Data using Complex Software: Comparison of Recurrence Plot of Foetal Heart Rate with the Course of Pregnancy -].

BACKGROUND: Is it useful to further analyse foetal heart rate to improve the prediction of pregnancy complications? The analysis of the foetal heart rate is usually based on the variability of the heart rate, i. e. the more variable the heart rate presents - except a decrease - the better the condition of the foetus is. The same concept is applied in our own analysis which differs only in the presentation of the data. MATERIAL AND METHODS: We analysed 25 non-stress-tests from unselected third trimester pregnancies using sophisticated software. The recurrence plot (RP) is able to rearrange data from foetal heart rate monitoring in order to make the heart rate variability visible. We developed criteria for a normal and an abnormal test result describing the structure of the diagram to predict an uneventful and a high-risk pregnancy, respectively. RESULTS: 11 out of 11 patients with uneventful course and outcome of pregnancy showed a coarse and blurred RP pattern. 12 out of 14 (86 %) patients developing either intrauterine growth retardation or preeclampsia and requiring caesarean section because of foetal heart rate abnormalities showed a fine and clear RP pattern. CONCLUSIONS: Our preliminary results show that it makes sense to further evaluate foetal heart rate variability in order to predict pregnancy complications. Computer programs including the algorithms needed (calculation of the recurrence plot) are not expensive and easy to handle. A widespread use of these programs represents the basis requirement for large controlled clinical trials.

Analysis of Variance↗
PubMed2004

[Primary diagnosis of hormone-secreting pituitary adenoma during pregnancy and after birth -- a rare occurrence].

About seven to ten percent of all brain tumours are neoplasias of the pituitary gland. Pituitary gland tumours can cause different clinical symptoms often making it difficult to come to the correct diagnosis. They can lead to severe complications such as hypopituitarism with secondary hypogonadism, hypothyroidism, and adrenocortical insufficiency, compression of the optic tract or obstructive hydrocephalus. We report on two patients with hormone-secreting pituitary tumours that were unknown prior to pregnancy. The first woman suffered from a growth hormone-producing pituitary adenoma, causing persistent headaches after birth. The second woman showed a significant loss of vision and visual field defects in the 32nd week of gestation, caused by a prolactin-producing pituitary tumour.

Adult↗
PubMed2004

In vitro analysis of modified surfaces of silicone breast implants.

BACKGROUND: Although silicone breast implants are well tolerated, local complications such as capsular contracture occur because of insufficient integration with surrounding tissues. In this study, cell behaviour on hydrophilized silicone breast implant foils was analysed qualitatively and quantitatively under in vitro conditions in order to provoke the desired responses in a defined environment. METHODS: Silicone breast implant foils with different surface modifications were tested after 24 hours, 5 days and 7 days. The following modifications of silicone implant foils were tested: Unmodified silicone, silicone after-graft polymerisation for polyacrylic acid (pAAc), silicone-pAAc-fibronectin adsorptive, silicone-pAAC-fibronectin covalent, positive and negative controls. Experiments were conducted using cell culture with murine mouse fibroblasts L-929. Cytotoxicity assays were carried out in direct and indirect contact with cells grown on the material. For the viability test and qualitative analysis of cell proliferation on different foils, both fluoresceine-diacetate and ethidiumbromide were used and in addition the morphologic description of hemalaun-stained cells were used. Quantitative cell analysis was carried out using XTT after resuspension. RESULTS: Toxic influence on cell cultures could be excluded for coated and uncoated surfaces in contact with dissolved biomaterials. Unmodified silicone surfaces showed poor cell growth in direct contact. We found a gradual improvement of cell morphology, with the spread and proliferation depending on the type of surface modification. Better results were achieved with covalently coupled fibronectin and GRGDS than with pAAc. CONCLUSION: Covalent immobilisation of hydrophobic silicone rubber can improve the initial cell-biomaterial interactions that are required to aid the successful development of tissue-like structures.

Biocompatible Materials↗
PubMed2004

Hemorheological changes in women with severe preeclampsia.

The objective of this study was to determine the differences of hemorheological parameters in association to haematological tests in patients with severe preeclampsia (blood pressure (diastolic) > 100 mm Hg, blood pressure (systolic) > 180 mm Hg and proteinuria > 3 g/24 h). Blood samples of 45 primigravidas by hospital admission were studied. The control group were 45 pregnant women--age and weight matched--with normal blood pressure and without obstetric complications. We measured red cell aggregation (stasis, low shear), red cell elongation with the ectacytometer, blood cell indices (Hct, Hbg, MCV, MCHC, reticulocytes, white cells, platelets), fibrinogen haptoglobin and factor VIIIR:Ag, cholesterol and triclycerides. In comparison between patients with severe preeclampsia and normal pregnant women we found statistically elevated values of hematocrit, hemoglobin, red cell aggregation (stasis, low shear rate), MVC and factor VIIIR:Ag. Non-significant changes were observed in values of plasma viscosity, white cells, platelets, haptoglobin, MCHC, reticulocytes, triglycerides and cholesterol. The red cell deformability measured as cell elongation was statistically reduced by high shear stress application in patients with severe preeclampsia. Our results suggest that hemorheological parameters play an important role in severe preeclampsia, especially at microcirculatory regions with high shear stress such as intervillous space of placenta.

Adult↗
PubMed2003

Expression of adhesion molecules in the lower uterine segment during term and preterm parturition.

Term and preterm cervical ripening and dilatation have similarities with an inflammatory reaction. Since cell adhesion molecules are involved in this process, investigations on the expression of intercellular adhesion molecule-1, endothelial leukocyte adhesion molecule-1, vascular cell adhesion molecule-1, and platelet endothelial cell adhesion molecule in the lower uterine segment and in vitro experiments on human umbilical vein endothelial cells were performed. In addition, current reports on expression of endothelial adhesion molecules by the uterine cervix were summarized. Cell adhesion molecule expression by lower uterine segment and uterine cervix in term and preterm parturition was measured using immunohistochemistry, enzyme immunoassay, and Northern blot analysis. Regulation of adhesion molecule expression was evaluated in vitro by indirect immunofluorescence and flow cytometry using human umbilical vein endothelial cells. Investigations in term parturition revealed that intercellular adhesion molecule-1, endothelial leukocyte adhesion molecule-1, and vascular cell adhesion molecule-1 expression increases during parturition. In preterm labor, the expression of endothelial leukocyte adhesion molecule-1 and intercellular adhesion molecule-1 in the lower uterine segment increased. Expression of platelet endothelial cell adhesion molecule did not change in term and preterm parturition. Expression of adhesion molecules was localized mainly on lower uterine segment vascular endothelial cells and to a smaller extent on leukocytes. In vitro experiments showed that expression of adhesion molecules by human umbilical vein endothelial cells can be stimulated by tumor necrosis factor-alpha, 17beta-estradiol, prostaglandin E(2), and the antigestagen onapristone. Progesterone exerted no stimulatory effect. Cervical ripening and dilatation during term and preterm parturition are associated with an increased expression of endothelial cell adhesion molecules by lower uterine segment and uterine cervix. The expression can be modulated by pro-inflammatory cytokines, sex hormones, and prostaglandin E(2). Mechanisms controlling the extravasation of leukocytes may play a fundamental role in term and preterm parturition.

Cell Adhesion Molecules↗
PubMed2002

Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery.

PURPOSE: Disturbance of anal continence is a well-known problem after vaginal delivery. However, only few and incongruent data on the incidence and pathogenesis of postpartum incontinence are available. This study examined the effects of vaginal delivery on anal continence prospectively. METHODS: In 42 unselected women anal vector manometry and endoanal ultrasonography were performed, and pudendal nerve terminal motor latency (PNTML) and rectal sensibility were measured in the 32th week of pregnancy and 6 weeks after delivery. Continence was evaluated according to the Kelly-Holschneider score. Patients with occult sphincter defects were additionally followed-up 12 weeks after vaginal delivery. To exclude any effect of pregnancy alone ten patients with elective cesarian section served as controls. RESULTS: Overall continence after vaginal delivery did not differ significantly from that before delivery, there was a significant reduction in postpartum anal squeeze and resting pressures in all patients. Obstetric tears of grade III or IV occurred in 9% of the patients. Endosonography revealed occult lesions of the internal and external anal sphincter in an additional 19% of women who clinically seemed to have an intact sphincter. Manometric results and continence in these women did not differ significantly from those with intact sphincter and remained unchanged after 12 weeks. PNTML and rectal sensibility were not affected by vaginal delivery. After cesarian section there were no changes in continence, anal pressures, rectal sensibility, or PNTML. CONCLUSIONS: Vaginal delivery leads to direct mechanical trauma to the anal sphincters, while stretch and distension of the pudendal nerve seem to be of minor importance. Only endoanal ultrasonography is suitable for detection of occult sphincter lesions.

Adult↗