Marfan Syndrome Versus Bicuspid Aortic Valve Disease: Comparative Analysis of Obstetric Outcome and Pregnancy-Associated Immediate and Long-Term Aortic Complications.

Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years; p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.

Lectures based on cardinal symptoms in undergraduate medicine - effects of evaluation-based interventions on teaching large groups.

Despite critical voices lectures are still an important teaching format in current medical curricula. With the curricular reform at Hamburg Medical Faculty in the year 2004, all subject specific lectures were replaced by cardinal symptom oriented lectures (LSV) in the new clinical curriculum. LSVs are taught throughout all six thematic blocks in years three to five. Since regular student evaluations after each thematic block seemed to demand improvement of the LSVs, this study was carried out using evaluations of individual LSVs by the participating students and by trained auditors (final year students and academic staff). Based on these evaluations feedback containing the individual evaluation data was given in written form to the lecturers combined with information material on planning an LSV using modern didactic techniques. In a second evaluation period, the effects of this intervention were studied. Only small improvements in the LSVs' quality were noted regarding the level of marks achieved. When individual items were evaluated, especially the didactic quality, significant improvements were noticeable. Overall, on the basis of individual items students ranked the quality of the LSVs significantly higher than trained auditors during the first evaluation period. This effect was no longer seen after the second evaluation period. The inter rater reliability among the auditors was very good. This study shows that regular quality assurance is needed on the structural levels and for staff to accompany the process of embedding teaching formats into curricular concepts. Further investigation is needed to determine the adequate frequency of evaluation and the format of feedback to guarantee sustainable effects of the didactic quality of lectures.

A combination of umbilical artery PI and normalized blood flow volume in the umbilical vein: venous-arterial index for the prediction of fetal outcome.

OBJECTIVE: The objective was to assess the diagnostic power of the umbilical venous-arterial index (VAI) as a combination of the pulsatility index in the umbilical artery and the normalized blood flow volume in the umbilical vein for the prediction of poor fetal outcome. STUDY DESIGN: This was a prospective clinical study in which the umbilical artery PI (UAPI), the normalized umbilical vein blood volume flow rate (nUV; ml/min/kg estimated fetal body weight), the venous-arterial index (VAI; nUV/UAPI), and the pulsatility index (PI) in the umbilical artery (UA), uterine artery (utA), middle cerebral artery (MCA), and aorta were determined in 181 fetuses once (at between 17 and 41 weeks' gestation) during pregnancy using standard Doppler ultrasound equipment. A risk score based on the umbilical blood pH, the 1 min Apgar score, birth weight, duration of gestation, type of postpartum respiratory support, and referral to the pediatric department was used, and fetuses were assigned to a control or a pathological group accordingly. RESULTS: The incidence of compromised neonates was 18.2%. The sensitivity of the UAPI in predicting the poor neonatal outcome was 51.5%, of the nUV 54.5%, the MCA PI 39.4%, the PI in the utA 61.5%, and the notching in the utAa and the VAI was 57.6% and 69.7% respectively. CONCLUSION: A combination of the umbilical artery PI and the nUV as the VAI with a cut-off of 100 ml/min/kg can be used to predict fetal outcome.

[Is a reformation of the medical training worthwhile? The quality of the Hamburg curriculum under the old and the new board certification law]. / Lohnt sich eine Reform der klinischen Ausbildung? Die Qualität des Hamburger Curriculums unter der alten und der neuen Approbationsordnung im Vergleich.

This paper presents the results of the evaluation of a new undergraduate curriculum at the Medical Faculty of Hamburg University. This curriculum is based on the new law on medical board certification of 2002, and was tested for the first time in the summer term of 2004. The results were compared with those obtained under the previous law. The data show a substantial increase in student subjective learning effectiveness and satisfaction with the new program. The reasons discerned were the increased practice orientation of the program, the problem-oriented seminars, and the increased motivation of the teaching staff.