Two types of health care systems and their influence on the introduction of perinatal care: an epidemiological twin model in Berlin from 1950 to 1990.

Objectives: When perinatal medicine emerged as a new medical discipline in the 1960s, Berlin was as one of the world's leading centers. During that time, the city was separated into two parts, each fostering its own health care system. After the destruction of the Berlin Wall, it was possible to speak with the citizens of East Berlin and to access their database systems.

GFAP gene expression is altered in young rats following developmental low level lead exposure.

The astroglia cytoskeletal element, glial fibrillary acid protein GFAP, is a generally accepted sensitive indicator for neurotoxic effects in the mature brain. We used GFAP RNA as a marker for molecular biological changes in rat brain related to chronic low level lead exposure during the developmental period. Brains in the third week of postnatal life, following a continuous prenatal and postnatal exposure to lead of low dose were investigated.

Superimposing positive end-expiratory pressure during partial liquid ventilation in experimental lung injury.

This study was undertaken to determine the effects of superimposing incremental levels of positive end-expiratory pressure (PEEP) during partial liquid ventilation (PLV) on gas exchange, respiratory mechanics and morphological changes in experimental acute lung injury (ALI). In a prospective trial, six pigs weighing 30+/-5 kg (mean+/-SD) were tracheotomized, submitted to pressure-controlled mechanical ventilation (pc-CMV) and depleted of surfactant by lung lavage. Animals were then mechanically ventilated with three levels of PEEP: 0.

[Factors modifying postoperative astigmatism after no-stitch cataract surgery].

Background: One of the main advantages of the no-stitch technique in cataract surgery is that induced astigmatism occurs less frequently than with any other procedure and stabilizes within a very short time postoperatively. The resultant high wound strength enabled us to alter the incision parameters in an attempt to identify those which influenced postoperative astigmatism, the ultimate goal being to improve the prognosis of the expected astigmatism. Since the influence of tunnel width and incision length and shape were well known, we investigated the influence of incision depth and site and that of various parameters in a prospective randomized and controlled clinical trial.

The onset of inter-human contacts: longitudinal ultrasound observations in early twin pregnancies.

Twin pregnancies provide us with the opportunity to observe first reactions towards touch in utero, and this study illustrates the onset and development of these contacts. Forty women with twin pregnancies volunteered to take part in this study, 25 of whom (five monochorionic, 20 dichorionic pairs) fulfilled the inclusion criteria. Between 8 and 12 weeks' gestation, ultrasound examinations were performed transvaginally, and from 13 weeks onwards transabdominally, at weekly intervals.

Seroprevalence of Lyme borreliosis in forestry workers from Brandenburg, Germany.

In 1992 blood samples were taken from 630 forestry workers in the state of Brandenburg, Germany, and an inquiry about tick bites and possible symptoms of Lyme borreliosis carried out in order to determine the seroprevalence of the disease. To estimate the rate of seroconversion within six months, 406 of the individuals were investigated a second time. IgG and IgM antibodies against Borrelia burgdorferi were detected in serum using an indirect immunofluorescence assay (IFA) and an immunoblot assay (IBA).

Hepatic venous catheterization in patients undergoing positive end-expiratory pressure ventilation after OLT: technique and clinical impact.

The objective of this study was to determine the feasibility and clinical impact of hepatic venous oxygenation monitoring in patients undergoing positive end-expiratory pressure (PEEP) ventilation after OLT. The design comprised a prospective study using repeated-measures design, within an intensive-care unit for liver-transplanted patients in a university hospital. Sixteen consecutive adult patients undergoing orthotopic liver transplantation were enrolled.

From biochemical to biophysical placental function tests in fetal surveillance.

Radioimmunoassays of human placental lactogen and estriol levels in the maternal plasma, ultrasound biometry of the abdominal diameter (AD), pulsed Doppler measurements of uteroplacental arteries, the common carotid artery (CCA), and the umbilical artery (UA) and fetal heart rate monitoring were simultaneously performed in 219 risk pregnancies from 26 weeks' onward at regular intervals. The prognostic value of all tests to predict small for gestational age infants (SGA) and fetal distress was evaluated simultaneously. Receiver operator characteristic allowed the simultaneous comparison of all methods: The AD was most predictive for early detection of SGA, even more than uteroplacental blood flow.

Prediction of fetal distress and poor outcome in prolonged pregnancy using Doppler ultrasound and fetal heart rate monitoring combined with stress tests (II).

Postterm pregnancies of more than 290 completed gestational days (n = 110) were simultaneously supervised after admission by pulsed Doppler ultrasound of the common carotid and the umbilical arteries, nonstress and contraction stress tests (NST/CST) and vibroacoustic stimulation tests (VAST). The results of these tests were blinded for the clinicians. Further decision making was based mainly on fetal heart rate (FHR) monitoring.

Evaluation of the fetal assessment score in pregnancies at risk for intrauterine hypoxia.

Objective: Our purpose was to define the diagnostic value of a new fetal assessment score that is based on each of the components of the Apgar score.

Study Design: A fetal assessment score was established to study the main fetal vital functions: (1) cardiovascular (heart rate, color of the skin in the Apgar score), now based on fetal heart rate patterns and Doppler assessment of fetal blood flow redistribution, (2) fetal respiratory (quality of breathing in the Apgar score), now based on Doppler assessment of uteroplacental perfusion, and (3) neuromuscular function (tone and reflexes in the Apgar score), now based on fetal tone and response to external stimuli. The fetal assessment score was used in the study of 110 postdate pregnancies and 103 small-for-gestational-age infants and was compared with the traditional biophysical profile score in the prediction of perinatal outcome.

Prediction of fetal distress and poor outcome in intrauterine growth retardation--a comparison of fetal heart rate monitoring combined with stress tests and Doppler ultrasound.

One hundred and three intrauterine growth retardation (IUGR) pregnancies were scheduled for pulsed Doppler ultrasound of the common carotid and the umbilical artery, nonstress and contraction stress tests (NST/CST) as well as vibroacoustic stimulation tests (VAST). The last examinations < 3 days before birth were compared by receiver-operator characteristics: Results of the resistance indices of fetal common carotid/umbilical artery and NST were more predictive of later fetal distress during labour, compared to CST and VAST (p < 0.001/< 0.

Comparison of the prognostic value of pulsed Doppler blood flow parameters to predict SGA and fetal distress.

A total of 219 women with complicated pregnancies had Doppler assessment of uteroplacental arteries, the umbilical artery, the fetal common carotid artery and the descending thoracic aorta to determine the prognostic value of Doppler examinations to predict the birth of a small-for-gestational-age (SGA) infant with or without fetal distress. Preliminary reproducibility studies showed that the resistance index, pulsatility index and intensity weighted flow velocity had the lowest coefficients of variation. Data on the systolic/diastolic ratio and mean blood flow volume were, therefore, not considered for further evaluation.

Lifetime prolongation in voluntary alcohol-consuming rats (SHR) treated with clofibrate.

Clofibrate affects lipid and alcohol as well as drug and eicosanoid metabolism. Spontaneous hypertensive rats (SHR) further increase their high voluntary alcohol consumption during clofibrate feeding. The interaction of alcohol and clofibrate was studied in two long-term trials.

The geriatric patient in surgery. Experience with patients over the age of 85 years.

Between 1982 and 1989 hospitalized treatment was applied to 615 patients aged between 85 and 101 years. The average age was 88.8 years.

[The elderly surgical patient. Experiences with patients over 85].

Hospitalised treatment was applied to 326 patients aged between 85 and 101 years, between 1982 and 1987. Operations were performed on 215 of them. The surgical lethality amounted to 16.

Design of a new pulse duplicator system for prosthetic heart valves.

This paper discusses results of a computer simulation for designing a new pulse duplicator system for mechanical heart valves. The design objective of the system is to obtain a compact, efficient pulse duplicator system capable of accurately measuring the volume flow rate across a valve. The volume flow rate is determined as the derivative of the volume displacement of an actuator piston which directly drives the fluid.

[Controlling of artificial blood pumps after total heart replacement - an example of disregulation (author's transl)].

This is a report on the special regulation problem of the left blood pump after replacement of the natural heart by incorporated extracorporally driven blood pumps in an animal experiment. The consequence of the peripheral self-regulation on the transporting capacity of the bloodpumps considering the driving pressure and the systemic pressure losses has been investigated. Two possible controlling principles and the respective fields of application are discussed on the example of a lung oedema.

[Observation in 10 calves with a survival time of more than 100 hours after total heart replacement (author's transl)].

It is reported on 10 calves surviving total artificial heart replacement more than 100 hours. Pneumatically driven double-chambered blood pumps made of silastic were implanted. During the experiments an increase of the right atrial pressure as well as a rise of the perfusion volumes (CO) and of the blood volumes could be found regularly.