[Effect of noninvasive first trimester diagnosis on indications and results of chorion villi sampling]. / Einfluss der nicht invasiven Ersttrimester-Diagnostik auf Indikationen und Ergebnisse der Chorionzottenbiopsien.

AIM: In this explorative study it should be evaluated how the introduction of non invasive first trimester diagnosis (nuchal translucency measurement, Combined Test, first trimester ultrasound screening) has influenced the indications and cytogenetic results of chorion villi samplings. MATERIALS AND METHODS: Between 1989 and 2008 3337 pregnancies with CVS between 11 and 14 weeks of gestation were examined retrospectively. They were divided in two groups: CVS 1989 - 2001 before introduction of non invasive first trimester diagnosis (n = 1698) and CVS 2002 - 2008 after introducing non invasive testing at the end of 2001 (n = 1639). In both groups the indications for CVS (maternal age, sonographic findings, past history, maternal anxiety, and abnormal results of the Combined Test only in the second group) and the cytogenetic results were evaluated. RESULTS: In the first group (1989 - 2001, n = 1698) 85,6% (n = 1454) of all CVS were performed because of maternal age and only 3% (n = 51) due to sonographic findings. In the second group (2002 - 2008, n = 1639) there was a distinct increase of sonographic findings leading to CVS (33,9%, n = 555) with a clear decrease of maternal age to 37,9% (n = 621). Abnormal cytogenetic results were found in 10,5% (n = 172) in the second group, in the first group only in 4,5% (n = 76), respectively. The parameter with the highest rate of chromosomal disorders was fetal hydrops (66,1%), follwed by hygroma colli (48,2%), malformations (12,9%) and increased nuchal translucency (11,2%). Regarding maternal age alone the rate of abnormal chromosomes was 3,1%. CONCLUSIONS: It could be shown that non invasive first trimester diagnosis has lead to a more specific indication for invasive fetal testing (sonographic findings 33,9 vs. 3%, maternal age 37,9 vs. 85,6%) with a higher rate of chromosomal disorder in this group (10,5 vs. 4,5%).

Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures.

OBJECTIVE: Valvuloplasty of the fetal aortic valve has the potential to prevent progression of critical aortic stenosis (AS) to hypoplastic left heart syndrome (HLHS). The aim of the study was to assess 24 aortic valvuloplasties regarding indications, success rate, procedure-related risks and outcome. METHODS: Between January 2001 and December 2009 we performed 24 aortic valvuloplasties in 23 fetuses with critical AS at a median gestational age of 26 + 4 (range, 21 + 3 to 32 + 5) weeks by a transabdominal ultrasound-guided approach. Four fetuses had hydrops as a late sign of heart failure. RESULTS: In 16/24 procedures (66.7%) corresponding to 16/23 fetuses (69.6%) the procedures were technically successful, with one intrauterine death in this group. After an initial learning curve, success rate improved to 78.6% (11 of the last 14 interventions were successful). In 10 out of the 15 (66.7%) successfully-treated and liveborn fetuses a biventricular circulation could be achieved postnatally. All four fetuses with hydrops had successful interventions, hydrops disappearing within 5 weeks. In 8/24 interventions (33.3%) the aortic valve could not be treated successfully, with intrauterine fetal death in two of these cases. In one fetus a repeat procedure was successful. All surviving fetuses with unsuccessful (n = 5) or no (n = 5) procedure performed developed HLHS until delivery. CONCLUSIONS: Fetal aortic valvuloplasty could be performed successfully in selected fetuses with critical AS and evolving HLHS, with a biventricular outcome in two thirds of the patients. Safety and success rate were dependent on patient selection and the level of experience of the whole interventional team. In fetuses with AS and hydrops, aortic valvuloplasty could reverse end-stage heart failure and hydrops and ensure fetal survival.

[Protection for noise-induced hearing loss using active hearing protection systems]. / Schutz vor Lärmschwerhörigkeit durch aktive Gehörschutzsysteme.

Though noise induced hearing loss is no longer the most frequent occupational disease in the Federal Republic of Germany, the environmental pollution by the product "noise" in our technical and industrialized world has not been reduced. On the contrary, the situation is worsened by the rising influence of leisure noise. To avoid occupational hearing loss, the "Noise Injury Prevention Code" issued by the insurers would demand wearing personal ear protection, e.g. ear plugs, if ambient noise levels are above 85 dB(A). But there are working places in which such equipment would have precisely the adverse effect, because one of the reasons for possible damage to hearing is radio communication. In military aircraft cockpits for example noise exposure measurements showed ambient noise levels above 90 dB(A) during regular flight service nearly all the time. To be able to understand radio traffic in spite of the noisy environment, the headphone volume must be raised above the noise of the engines. The use of ear plugs can only be of limited value. Whereas pilots with normal hearing show only little impairment of speech intelligibility, those with noise-induced hearing losses show substantial impairment that varies in proportion to their hearing loss. Communication abilities may be drastically reduced which may compromise the reliability of radio traffic. To avoid compromising air security one has to demand a noise protection system which allows to reduce ambient noise levels without disturbing speech intelligibility in the inevitable radio communication. Nowadays active noise cancelling (ANC) systems by electronic compensation in different ways provide effective protection against noise induced hearing loss.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electronic noise compensation for improving speech discrimination in airplane pilots]. / Elektronische Lärmkompensation zur Verbesserung des Sprachverständnisses bei Luftfahrzeugführern.

Noise exposure measurements were performed in pilots of the Federal Navy during realistic flight situations. The ambient noise levels during regular flight service were maintained at levels nearly all the time above 90 dB. To avoid occupational hearing loss, the "Noise Injury Prevention Code" issued by the insurers would demand wearing personal ear protection, e.g. ear plugs. But such equipment in the aircraft cockpit would have precisely the opposite effect, because one of the reasons for possible damage to hearing is radio communication. To be able to understand radio traffic in spite of the noisy environment, headphone volume must be raised above the noise of the engines. The use of ear plugs can be of only limited value. Whereas pilots with normal hearing show only little impairment of speech intelligibility, those with noise-induced hearing loss show substantial impairment that varies in proportion to their hearing loss. Communication abilities may be drastically reduced which may compromise the reliability of radio traffic. Cockpit noise has its maximum intensity around 125 Hz and flight helmets and ear defenders are not very effective in low frequency ranges. Sennheiser electronic KG developed an active noise compensation circuit, which makes use of the "anti noise" principle. Here the outside noises picked up by two microphones integrated into the headset are processed electronically in such a way that they largely neutralise the original noise. It had to be made sure that the radio traffic signal was not also compensated and that the signal to noise ratio was clearly increased.(ABSTRACT TRUNCATED AT 250 WORDS)

[Circadian neuroendocrinologic profile in patients with multiple drug abuse]. / Polytoxikomane Patienten im neuroendokrinologischen Tagesprofil.

13 cases of politoxicomania that had undergone stationary treatment and, at the time of observation, were in rehabilitation, comprised the case load of this study. They were compared with 10 test persons in good state of health. In order to obtain circadine hormone profiles for melatonine, cortisol, human growth hormones (HGH) and thyroid stimulating hormones (TSH), blood samples were taken every hour from 6 pm until 7 am the following morning. The test cycle commenced with obtainment of a biochemical blood profile and a drug-oriented urine analysis. The cases were assorted into three therapy groups: Group 1: complete abstinence. Group 2: no hard drug intake. Group 3: acute relapse after a prolonged period of abstinence. This categorization (i.e. abstinence, soft or hard drug intake) was clearly mirrored by significant differences in the hormone profiles: the group of "abstinents" showed remarkably higher melatonine and cortisole levels than the acute relapsive cases. HGH and TSH profiles showed partly pathological levels which appeared unrelated, however, to the incidence of abstinence, or the manner of drug intake. Compared to the healthy control group, the test cases showed an increase of liver enzymes (Gamma-GT, SGOT, SGPT and LDH) but there was no marked difference between the 3 user categories themselves. The pathological neuroendocrine findings identified in test patients after a long period of abstinence are indicative of changes possibly based on genetic disposition rather than on abusive habits. The issue of self-inflicted damage, therefore, becomes a questionable one.