Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system.

AIM: Most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced left ventricular ejection fraction (LVEF >35%). Periodic repolarization dynamics (PRD) and deceleration capacity (DC) are novel ECG-based markers related to sympathetic and vagal cardiac autonomic nervous system activity. Here, we test the combination of PRD and DC to predict risk in post-infarction patients with LVEF >35%. METHODS AND RESULTS: We included 823 survivors of acute MI with LVEF >35%, aged ≤80years and in sinus rhythm. PRD and DC were obtained from 30-min ECG-recordings within the second week after index infarction and dichotomized at established cut-off values of ≥5.75deg2 and ≤2.5ms, respectively. Patients were classified as having normal (CAF 0), partly abnormal (DC or PRD abnormal; CAF 1) or abnormal cardiac autonomic function (DC and PRD abnormal; CAF 2). Primary endpoint was 5-year all-cause mortality. Within the first 5years of follow-up, 51 patients died (6.2%). PRD and DC effectively stratified patients into low-risk (CAF 0; n=562), intermediate-risk (CAF 1; n=193) and high-risk patients (CAF 2; n=68) with cumulative 5-year mortality rates of 2.9%, 9.4% and 25.2%, respectively (p<0.001). On multivariable analyses, CAF was independent from established risk factors (GRACE-score, diabetes mellitus, mean heart rate, heart rate variability). Addition of CAF significantly improved the model (increase of C-statistics from 0.732 (0.651-0.812) to 0.777 (0.703-0.850), p=0.047; continuous NRI (0.400, 95% CI 0.230-0.560, p<0.001); IDI (0.056, 95% CI 0.022-0.122, p<0.001)). CONCLUSION: CAF identifies new high-risk post-MI patients with LVEF >35% which might benefit from prophylactic strategies.

Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in the treatment of locally advanced adenocarcinoma or adenosquamous carcinoma of the cervix uteri.

The optimal treatment of women with locally advanced adenocarcinoma or adenosquamous carcinoma of the cervix uteri is still undefined. We report a series of four consecutive patients with locally advanced adeno- or adenosquamous carcinomas of the uterine cervix (FIGO Stages IB-IIIB) treated by concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by one to four cycles of consolidation chemotherapy with the same drug combination. After completion of this treatment all patients showed complete clinical remission. Now, after a median follow-up of 40 (range: 13.5-61) months all patients still present with no evidence of disease. Despite the low number of patients in this series we may conclude that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy with the same drug combination is an efficacious treatment of patients with locally advanced adeno- or adenosquamous carcinomas of the cervix uteri.

Long-lasting complete remission of a patient with cervical cancer FIGO IVB treated by concomitant chemobrachyradiotherapy with ifosfamide and cisplatin and consolidation chemotherapy--a case report.

The treatment of women with already metastasized cervical cancer at initial diagnosis represents a challenge to gynecologic oncologists. We report on a 63-year-old patient with locally advanced squamous cell carcinoma of the cervix uteri with an isolated metastasis to the left ovary. Following treatment with concomitant chemoradiotherapy with ifosfamide and cisplatin and three cycles of consolidation chemotherapy with the same drug combination a complete clinical remission could be documented. At present, 35 months after her disease was diagnosed, she is still without any evidence of disease. The very promising outcome of this patient might suggest that combined chemoradiation which is the standard treatment of locally advanced cervical cancer is justified as well in the metastatic setting, provided the metastatic lesion is covered within the usual radiation field.

Current state-of-the-art of concomitant chemoradiation in cervical carcinomas.

Despite screening programs, cervical carcinoma remains a major health problem throughout the world. Until recently pelvic radiation has been the standard therapy for advanced disease with overall five-year survival rates of 50%. Recently, five randomized trials demonstrated a significant survival advantage for the concomitant administration of radiotherapy and cisplatin-based chemotherapy. Although the trials vary somewhat in terms of stage of disease, dose of radiation, and schedule of radiation and cisplatin, they all demonstrated a significant survival benefit for the combined approach. Congruent to these findings are results from a meta-analysis based on the data from 19 trials with 4,580 randomized patients. The absolute increase in progression-free and overall survival was 16% and 12%, respectively. Contrary to these findings is the result of the National Cancer Institute of Canada (NCCI) trial. Despite that result cisplatin-based concomitant chemoradiotherapy has become the standard treatment of locally advanced cervical cancer.

[Pregnancy-saving measures in premature rupture of fetal membranes in the 22nd week of pregnancy]. / Schwangerschaftserhaltende Massnahmen bei vorzeitigem Blasensprung in der 22. SSW.

The obstetric-perinatologic problems raised by premature rupturing of the membranes in the 22nd gestational week is presented in the form of a case report from the Perinatal Centre of the University of Cologne. By close ultrasonic monitoring of the course of development, measurement of parameters of inflammation and administration of prophylactic antibiotics pregnancy could be prolonged by 9 weeks with good fetal outcome.

[Lactate dehydrogenase isoenzymes in patients with HELLP syndrome]. / Lactatdehydrogenase-Isoenzyme bei Patientinnen mit HELLP-Syndrom.

Lactate dehydrogenase (LDH) isoenzymes were serially measured in nine patients with HELLP syndrome during 01. 01. 1994-31. 01. 1995; at the time of the maxima of the total LDH we observed in 8/9 cases an absolute and relative maximum of LDH isoenzyme 5, that predominantly originates from the liver and from skeleton muscles, with coincident relative decrease of LDH isoenzymes 1 and 2, which are the predominant forms in heart muscle and erythrocytes. Therefore, total LDH can not be used as a marker of intravascular hemolysis in HELLP syndrome. The most sensitive marker for the hemolytic component of HELLP syndrome is the measurement of haptoglobin which should be included in laboratory screening in all cases with suspected HELLP syndrome.

[Isolated ovarian metastasis of primary gallbladder carcinoma with estrogen and androgen production]. / Isolierte Ovarialmetastase eines primären Gallenblasenkarzinoms mit Ostrogen- und Androgenproduktion.

The rare case of an isolated ovarian metastasis of a primary adenocarcinoma of the gallbladder is reported: the ovarian metastasis was associated with androgen and estrogen production. The differential diagnoses are discussed.

[Experiences with definitive contraception--results of a follow-up study of sterilized women]. / Erfahrungen mit der definitiven Kontrazeption--Ergebnisse einer Follow-up-Untersuchung sterilisierter Frauen.

Within the framework of a retrospective analysis, 96 patients who had undergone sterilisation at the Department of Gynaecology at the University of Cologne between 1988 and 1991, had been questioned as to whether they were content about their former decision in favour of a definitive contraception. At present, 94% of these women fully agreed with their former decision. The circumstances influencing the decision for sterilisation before the operation i.e. age, number of children, motivation, situation between partners, date of operation and medical consultation - were compared to those of a number of sterilised women seeking refertilization. We want to stress the importance of a sufficiently long decision process, accompanied by individual medical consultation.

[Obstetric prognostic factors of newborn infants with very low birth weight (< or = 1,500 gram) with reference to survival rate and early childhood development]. / Geburtshilfliche Prognosefaktoren bei Frühgeborenen sehr niedrigen Geburtsgewichts (< or = 1500 Gramm) hinsichtlich Uberlebensraten und frühkindlicher Entwicklung.

Prognostic factors influencing survival in 235 very low birthweight prematures (< or = 1500 g) born between 1986 and 15.11. 1993 at the Department of Obstetrics and Gynaecology, University Hospital of Cologne, were retrospectively evaluated. Chromosomal anomalies and severe congenital malformations were excluded. Of 180 singletons 84 were classified as appropriate-for-gestational-age (AGA) and 96 as small-for-gestational-age (SGA). By interrogating the attending paediatricians data regarding the early development of 62/65 surviving singletons born between 1986 to 1990 were recorded (follow-up rate 95%). Survival was significantly correlated to singleton pregnancy (p < 0.05), female sex (p = 0.001) and in the AGA-prematures to prenatal corticoid prophylaxis. With similar mean birthweight SGA-singletons showed a three weeks higher mean gestational age; the mortality showed an inverse correlation to birthweight and gestational age being 11% higher in the AGA-group compared with the SGA-group (32% versus 21%). At the age of between 11 months and 6 years severe handicaps and developmental retardations were found more often in previous AGA-prematures (6/26) than in previous SGA-prematures (4/36); type and degree of later handicap were not correlated to birthweight. According to our results survival rates of very low birthweight prematures are strongly influenced by singleton pregnancy, by fetal sex, by gestational age and in the AGA-group by prenatal corticoid prophylaxis; mortality shows an inverted correlation to birthweight and gestational age, whereas the later prognosis of survivors does not seem to be influenced by birthweight or gestational age.

[Spontaneous remission of HELLP syndrome in the 36th week of pregnancy with uterus duplex]. / Spontanremission eines HELLP-Syndroms in der 36.SSW bei Uterus duplex.

We report on a case of an HELLP syndrome in the 36th week of gestation in a primigravida with known uterus duplex cum vagina duplice, which under intensive medical control showed a spontaneous decrease of the elevated liver enzymes and normalisation of platelet count. 12 days after the occurrence of the HELLP syndrome, a Caesarean section was performed because of PROM and breech presentation of the foetus.

A case of HELLP syndrome at 23 weeks' gestation.

We report a case of the HELLP syndrome at 23 weeks' gestation. Prolongation of pregnancy until the fetus was viable was not possible.

Prenatal expectations and fears in pregnant women.

The aim of this study was to extend the medical knowledge of the prenatal expectations and wishes of pregnant women with respect to themselves, their partners and the maternity ward selected for the approaching birth, and also of the anxieties arising in this connection. In summary, our study shows that the desire to experience birth in the most natural, undisturbed and unmanipulated form possible is reiterated frequently, but is relativized by the intense need to be reassured of the safety of the unborn child. Fears experienced before the birth were focused accordingly on the condition of the child, although 25% of the women questioned acknowledged a marked fear of helplessness and failure. The obstetric team were expected to offer, as far as possible, the continuous personal supervision of a doctor and a midwife who were prepared to allow the patient the responsibility of being involved in obstetric decisions.

[Mortality and prognosis of premature infants of very low birth weight (500-1,500 g) in relation to degree of maturity]. / Mortalität und Prognose von Frühgeborenen sehr niedrigen Geburtsgewichts (500-1,500 g) in Abhängigkeit vom Reifegrad.

In a retrospective study we analysed the influence of intrauterine growth retardation on mortality and early prognosis of 136 liveborn singletons of very low birthweight (VLBW) born between 1986 to 1992 at the Department of Obstetrics and Gynecology of the University Hospital of Cologne. The main causes of premature delivery in the appropriate-for-gestational-age (AGA)-group were premature rupture of membranes with an incidence of 73% and in the small-for-gestational-age (SGA)-group the pregnancy induced hypertension with an incidence of 44%. With a similar mean birth weight (1,009 g vs. 1,115 g) the SGA-prematures showed a three weeks higher mean gestational age (31.3 vs. 28.3 weeks). The mortality was 10% higher in the AGA-group than in the SGA-group (30% vs 20%); as regards the whole study group the mortality showed an inverse correlation to birthweight. In the age between 11 months and 6 years severe handicaps and developmental retardations were found more often within the previous AGA-prematures with an incidence of 23% (6/26) than within the previous SGA-prematures with an incidence of 11% (4/36); the incidence and severeness of later handicap were not dependent on birthweight. Accordingly to our results mortality and early prognosis of VLBW-prematures seem to be dependent on gestational age; whereas the mortality showed an inverse correlation to birthweight, the early prognosis did not.

[Prolongation of a primary twin pregnancy to the 31st week of pregnancy by surgical extraction of the 1st twin in the 17th week of pregnancy for umbilical cord prolapse]. / Prolongation einer primären Geminigravidität bis zur 31.SSW nach operativer Extraktion des I. Zwillings in der 17.SSW wegen Nabelschnurvorfall.

A 24-year-old woman with a twin pregnancy had a premature rupture of membranes (PROM) of the first foetus in the 16th gestational week (gw). After 9 days the umbilical cord prolapsed. In the 17th gw the foetus was extracted by vaginal hysterotomy, because of an inferior anterior wall placenta. The patient remained hospitalised receiving tocolysis, lung maturation induction and prophylactic antibiosis. The pregnancy could be prolonged for 109 days after PROM and 99 days after the extraction of the first twin. The second child was born in the 31st gw by Caesarean section, following uncontrollable labour.

Reduced productivity in adult yellowfever mosquito (Diptera: Culicidae) populations.

Male and female Aedes aegypti (L.) mosquitoes of the laboratory strain ROCK were irradiated with 130 mw of argon 514.5 nm laser microbeams for 0.04, 0.25, 0.4, and 0.5 s, respectively. Egg production, percentage hatch, and productivity (average number of adults surviving after 3 wk) were used to assess mutagenic effects. Mortality was high for males in all laser radiation groups and increased with time of exposure. Except for the group treated for 0.25 s, significant reductions in total F1 progeny also were demonstrated for all other experimentals when male parents were exposed to laser radiation. Females showed a high mortality when subjected to 0.4- and 0.5-s laser radiation. No F1 progeny were produced when parental females were exposed for 0.25, 0.4, and 0.5 s. Numbers of F1 progeny from females exposed to 0.04 s of laser radiation were significantly reduced. A comparison of weekly mean number of progeny showed that the important differences in productivity occurred during the first and second week, respectively, when either male or female adult parents were subjected to laser radiation.

[Electronic data processing of the patient record for computer-assisted evaluation of pregnancy and labor]. / EDV-gerechtes Krankenblatt zur computergestützten Auswertung von Schwangerschaft und Geburt.

This article describes an EDP-adequate data collection system which can also be used in the conventional way. The relational data base system used is PROFESSIONAL ORACLE, Revision 5.1.; the requisite hardware consists of 3 IBM-AT-compatible personal computers with a main storage comprising 4 MB, system MS/PC-DOS, and a hard disk of at least 20 MB. The standardized case history compiles the user to collect the data carefully and completely. Besides formulating research problems the system automatically prepares the discharge report. By means of statistical analysis a continuous internal quality assessment was realized.

Severe intra-uterine growth retardation: obstetrical management and follow up studies in children born between 1970 and 1985.

Peri- and postnatal data of 263 children with severe intra-uterine growth retardation (IUGR) born between 1970-75 (n = 145) and between 1976-85 (n = 118) are presented. The incidence of premature delivery in IUGR patients rose from 15% (1970-75) to 34% (1976-85). The rate of perinatal asphyxia in premature children with IUGR decreased from 64% during 1970-75 to 45% during 1976-85. Perinatal mortality in preterm SFD babies was higher in 1976-85 (20%) than in 1970-75 (14%), due to an 8-fold higher incidence of very low birth weight (less than or equal to 1000 g) SFD babies. Without this high-risk group perinatal mortality ranged between 2 and 3% in both groups. The incidence of deliveries by Cesarean section increased from 19 to 45% while vaginal deliveries decreased from 73 to 52% during 1976-85 compared with the 1970-75 age group. Follow up studies were carried out in 63 patients (1970-75) and in 41 patients (1976-85). Deficits of body height and weight persisted in one third of the patients, being severe in 10-20%. Infantile developmental milestones were retarded in 22-32%. Neurologic sequelae mostly of a mild degree were seen in 29% (1970-75) and 37% (1976-85). Psychologic testing showed abnormalities in 38% of the older age group, using the Göttinger Formreproduktionstest and in 21% of the younger age group, where the Denver Developmental Screening Test was performed. EEG investigations demonstrated unspecific abnormalities of a mild to moderate degree in one third of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Child development following severe intrauterine growth retardation--results of follow-up studies]. / Die kindliche Entwicklung nach schwerer intrauteriner Wachstumsretardierung--Ergebnisse von Follow-up-Studien.

94 prenatally severely dystrophic newborn (year of birth: 1970 to 1982) of the Department of Gynaecology of the University of Cologne were catamnestically investigated when they 2 to 12 years of age; follow-up examinations were performed by paediatricians, neurologists, EEG specialists and by test psychology. In more than one-half of the children followed up in this manner delays in early childhood development were seen; there were no conspicuous differences between the two groups (classified according to years of birth). On comparing the age brackets 1970-1975 and 1976-1982 about one-third of the children in both groups presented at follow-up clearly evident signs of retarded growth. In 32% of the children born between 1970 and 1975 mostly mild neurological deficits or slight impairments of nerve function were observed, whereas in the 1976-1982 group this figure was 26%. The incidence of cerebral pareses was 7% and 9%, respectively. Disturbances of fine motor response were most frequently seen. Mild to moderate EEG changes occurred in both patient groups at about the same rate of incidence (34% and 32% respectively); one child in each group presented with definitely pathological electroencephalographic findings. Pathological test psychology results were seen in 38% (1970-1975) and 21% (1976-1982) of the followed-up children; the tests employed were the Göttingen form reproduction test in children born between 1970 and 1975 and the Denver development test in the younger children born between 1976 and 1982.(ABSTRACT TRUNCATED AT 250 WORDS)