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Bamberg C, Diehl W, Diemert A, Sehner S, Hecher K. Differentiation between TTTS Stages I vs II and III vs IV does not affect probability of double survival after laser therapy. Ultrasound Obstet Gynecol 2021; 58:201-206. [PMID: 32959919 DOI: 10.1002/uog.23131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare the perinatal outcome of monochorionic twin pregnancies with twin-twin transfusion syndrome (TTTS), according to the disease severity, defined using Quintero staging, after treatment with fetoscopic laser surgery. METHODS This was a single-center study of 1020 consecutive cases with severe TTTS, which were treated with fetoscopic laser surgery. During the study period from January 1995 to March 2013, the participants were included at a mean ± SD gestational age of 20.8 ± 2.2 weeks. Perinatal survival analysis, including the rates of double survival and survival of at least one fetus, was undertaken according to the Quintero staging system. For blockwise comparisons of data, the whole population was divided into five chronologically consecutive study subgroups of 200 patients in each of the first four subgroups and 220 in the last one. RESULTS For the entire study population with known outcome (n = 1019), the rate of pregnancy with double fetal survival was 69.0% (127/184) in Stage-I, 71.4% (257/360) in Stage-II, 55.4% (236/426) in Stage-III and 51.0% (25/49) in Stage-IV TTTS cases. At least one twin survived in 91.3% (168/184) of pregnancies with Stage-I, 89.7% (323/360) of those with Stage-II, 83.1% (354/426) of those with Stage-III and 77.6% (38/49) of those with Stage-IV TTTS. The rates of double survival and survival of at least one fetus were both significantly higher in Stage-II TTTS compared with those in Stage-III TTTS cases (P < 0.001 and P = 0.011, respectively). Survival rates between pregnancies with Stage-I vs Stage-II TTTS and between those with Stage-III vs Stage-IV TTTS were not significantly different. Therefore, we combined pregnancies with Stage-I or Stage-II TTTS, and those with Stage-III or Stage-IV TTTS. The double survival rate was 70.6% (384/544) in combined Stage-I and Stage-II vs 54.9% (261/475) in combined Stage-III and Stage-IV TTTS cases (P < 0.001). At least one twin survived in 90.3% (491/544) of pregnancies with Stage-I or Stage-II TTTS vs 82.5% (392/475) in those with Stage-III or Stage-IV TTTS (P < 0.001). The double survival rate increased between the first and the last consecutive study subgroups from 59.8% (55/92) to 75.0% (96/128) (adjusted odds ratio (aOR)linear trend , 1.26 (95% CI, 1.01-1.56); P = 0.037) in pregnancies with Stage-I or Stage-II TTTS and from 41.7% (45/108) to 62.0% (57/92) (aORlinear trend , 1.21 (95% CI, 0.98-1.50); P = 0.082) in those with Stage-III or Stage-IV TTTS. Double survival rate was the lowest for Stage-III cases in which the donor twin was affected by severely abnormal Doppler findings (45.4% (64/141)). CONCLUSIONS Double survival and survival of at least one fetus in monochorionic twin pregnancies with TTTS were related significantly to Quintero stage. However, our data show that the differentiation between Stages I vs II and Stages III vs IV does not have any significant prognostic implication for perinatal survival. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - W Diehl
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K. First-trimester intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol 2020; 55:47-49. [PMID: 31486133 DOI: 10.1002/uog.20860] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report the outcome of monochorionic twins with twin reversed arterial perfusion (TRAP) sequence following interstitial laser therapy in the first trimester. METHODS This was a retrospective cohort study of all consecutive cases of TRAP that underwent interstitial laser therapy at ≤ 14 + 3 weeks' gestation between January 2014 and April 2016. Interstitial laser treatment was performed under ultrasound guidance using a 400-nm Nd:YAG laser fiber. Hospital records were reviewed to ascertain perinatal survival and morbidity. RESULTS Twelve monochorionic twin pregnancies underwent interstitial laser treatment of the umbilical artery of the acardiac fetus, at a median gestational age of 13 + 5 (interquartile range (IQR), 13 + 4 to 14 + 0) weeks. In all cases, one treatment was sufficient to achieve complete interruption of the perfusion of the acardiac twin. There were no procedure-related complications during or within 48 h after the procedure. In one (8.3%) case, intrauterine death of the pump twin occurred 2 weeks after the intervention. All other cases (91.7%) resulted in a live birth at a median gestational age of 39 + 6 (IQR, 37 + 1 to 41 + 2) weeks and with a median birth weight of 3370 (IQR, 2980-3480) g. No neonatal mortality or serious morbidity occurred. CONCLUSIONS Our results support the use of interstitial laser therapy in the first trimester of pregnancy complicated by TRAP sequence, showing a live birth rate of 92%. The results of a randomized controlled trial, evaluating early vs late intervention in pregnancy with TRAP sequence, are awaited. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pasura L, Schwickert A, Henrich W, Bamberg C. Sonographische Evaluation des unteren Uterinsegments in einer Folgeschwangerschaft nach einfacher- oder doppelter Uterusverschlusstechnik bei der Sectio caesarea. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Pasura
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - A Schwickert
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - C Bamberg
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin, Hamburg, Deutschland
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Faensen A, Lehmann H, Metze B, Berns M, Hinkson L, Henrich W, Bührer C, Bamberg C. Differential association of prenatal blood flow patterns with death and neurodevelopmental retardation in preterm infants with intrauterine growth restriction. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Faensen
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - H Lehmann
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - B Metze
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - M Berns
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - L Hinkson
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - C Bührer
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - C Bamberg
- UKE, Geburtsmedizin, Hamburg, Deutschland
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Bamberg C, Diemert A, Glosemeyer P, Hecher K. Quantified discordant placental echogenicity in twin anemia-polycythemia sequence (TAPS) and middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol 2018; 52:373-377. [PMID: 28557152 DOI: 10.1002/uog.17535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/03/2017] [Accepted: 03/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To quantify sonographic placental echogenicity in twin anemia-polycythemia sequence (TAPS) and to correlate it with middle cerebral artery peak systolic velocity (MCA-PSV) measurements. METHODS We performed a retrospective search for consecutive TAPS cases between 16 and 36 weeks of gestation (MCA-PSV > 1.5 multiples of the median (MoM) in the anemic donor and < 1.0 MoM in the polycythemic recipient) in our database of monochorionic twin gestations from January 2007 until December 2016. In cases for which ultrasound images showing the donor's and the recipient's part of the placenta were available, echogenicity for both twins was quantified by image processing. MCA-PSV Doppler values of both fetuses were correlated to their respective placental echogenicity. Placental thickness of both twins was also measured. RESULTS Of 756 cases with MCA-PSV measurements identified from the database, 36 (4.8%) had TAPS; of these, 23 had TAPS combined with twin-twin transfusion syndrome and 13 showed isolated TAPS. Placental echogenicity could be quantified in 28 pregnancies. Mean ± SD placental echogenicity of donor twins was significantly higher than that of recipients (138.7 ± 22.8 vs 77.9 ± 37.0; P < 0.0001). Furthermore, a significant positive correlation was found between placental echogenicity and MCA-PSV MoM (R = 0.67, P < 0.0001). Mean placental thickness of donor twins (n = 20) was significantly higher than that of recipients (49.3 mm ± 13.4 vs 25.4 mm ± 10.1; P < 0.0001). CONCLUSIONS Echogenicity of the placental share in recipient and donor twins with TAPS correlates with MCA-PSV values. Quantification of sonographic placental echogenicity may help to determine the severity of TAPS in monochorionic twins. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bamberg C, Bujak V, Rodekamp E, Hinkson L, Kalache K, Henrich W. Longitudinale transvaginale sonographische Evaluation bezüglich Narben Pouch nach einschichtiger und zweischichtiger Uterusnaht bei Sectio caesarea – eine prospektiv randomisierte Studie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vitezica I, Heymann CV, Kaufner L, Koch C, Blaschke F, Dörner T, Berns M, Henrich W, Bamberg C. Sectio cesarea unter dualer Plättchenhemmung nach akutem Myokardinfarkt und Stenting im 2. Trimenon. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Noirez P, Thomasson R, Bamberg C, Djemai H, Desgorces F, Karim Z, Luquet S, Magnan C, Toussaint JF, Denis R. P052: Métabolisme énergétique, performance et récupération post-exercice dans un modèle murin (HFE-/-) de surcharge en fer. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henkelmann A, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cuerva MJ, Bamberg C, Tobias P, Gil MM, De La Calle M, Bartha JL. Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position. Ultrasound Obstet Gynecol 2014; 43:687-692. [PMID: 24265172 DOI: 10.1002/uog.13256] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the hypothesis that intrapartum ultrasound (ITU) measurements, including the angle of progression (AOP), progression distance (PD) and head direction (HD), can predict complicated forceps delivery in non-occiput posterior deliveries. METHODS In this prospective observational study, a single operator performed ITU on 30 patients with an indication for operative forceps delivery. Managing obstetricians were blinded to the results. ITU was performed just before blade application, between contractions and concurrently with contractions and active pushing. Forceps delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a subjective impression of a difficult or failed application; a third-degree or higher perineal tear; significant bleeding during the episiotomy repair; major tear; significant traumatic neonatal lesion. RESULTS Twenty-one forceps deliveries were classified as uncomplicated and nine were complicated. The strongest predictor of a complicated forceps delivery, calculated using the area under the receiver-operating characteristics curve (AUC), was the AOP between contractions (AOP1) (AUC = 98.9%). The best cut-off for predicting a difficult forceps delivery was an AOP1 of 138° (sensitivity = 85.7%, specificity = 100%). The best predictive model included both the AOP1 and the HD during a contraction with active pushing (HD2). CONCLUSION The sonographic parameters AOP and HD can be used to predict complicated operative forceps delivery in fetuses in non-occiput posterior position.
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Affiliation(s)
- M J Cuerva
- Department of Obstetrics, La Paz University Hospital, Madrid, Spain
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Weißhaupt K, Bamberg C, Schönborn I, Henrich W. Spontane Re-Uterusruptur im 2. Trimenon nach laparoskopischer Salpingektomie und Myomenukleation. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tucher EV, Siedentopf N, Siedentopf JP, Weichert A, Bamberg C, Dückelmann A, Henrich W. Inkarzerationen und Sacculationen bei Retroflexio uteri. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fazeli S, Bamberg C, Brauer M, Mayer B, Salama A, Hüsemann D, Hinkson L, Henrich W. Perinatales Management bei fetaler Anämie durch irreguläre Antikörper: 2 Fälle schwerer fetaler Anämie bei Alloimmunisierung durch Anti-cellano- Antikörper und Anti-Rh 17- Antikörper. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bamberg C, Pauly F, Niepraschk-von Dollen K, Mickley L, Henkelmann A, Kaufner L, Henrich W. Bestimmung des maternalen Faktor XIII Spiegels im Blutplasma zur Abschätzung des Blutungsrisikos unter der Geburt. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pauly F, Bamberg C, Mickley L, Niepraschk-von Dollen K, Henkelmann A, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bamberg C, Brauer M, Hinkson L, Longardt AC, Rothe K, Horn D, Bührer C, Henrich W. Dreidimensionale Ultraschall Darstellung einer schweren Makroglossie bei einem Feten mit Beckwith-Wiedemann-Syndrom. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Freese AL, Wehland M, Freese F, Kreutz R, Schulz A, Bamberg C, Rothermund L. Genetic Low Nephron Number Hypertension is Associated with Altered Expression of the Renin-Angiotensin System (RAS) During Nephrogenesis. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Golic M, Hinkson L, Bamberg C, Rodekamp E, Brauer M, Sarioglu N, Henrich W. Vasa praevia: risk-adapted modification of the conventional management--a retrospective study. Ultraschall Med 2013; 34:368-376. [PMID: 23023454 DOI: 10.1055/s-0032-1313167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Undiagnosed vasa praevia carries an imminent risk of fetal death and increases with IVF. When diagnosed, the question arises as to whether the conventional prenatal management of routine steroid administration for fetal lung maturation and elective caesarean section in week 35 is generally justified in face of the risks involved. We present a retrospective study of a risk-adapted modification of the conventional management of vasa praevia. MATERIAL AND METHODS We analysed 11 years of records involving 18 cases of antenatally diagnosed vasa praevia at our perinatal centre. Each case was managed by a risk-adapted modification of the conventional treatment where both, the steroid administration and the timing of delivery, were dependent on the patient history and clinical signs for preterm birth. RESULTS There were no lethal fetal, neonatal, or maternal complications. The earliest caesarean section took place at 34 weeks 1 day, the latest at 37 weeks 1 day, and in more than half of the cases at ≥ 36 weeks. CONCLUSION Steroid application is generally recommended for pregnancies before 34 weeks carrying a risk for preterm birth. Thus, retrospectively, none of our cases required steroid administration. This supports our protocol of not obligatorily administering steroids. Delaying the caesarean section up to two weeks beyond the conventionally recommended date of 35 weeks in 78% of our cases resulted in no complications. This justifies the suitability of determining the timing of delivery based on our individual patient assessment. In conclusion, the following recommendations for a risk-adapted management of vasa praevia can be made: 1. weekly evaluation of risk factors for preterm delivery; 2. steroid administration only at risk for preterm birth; 3. admission to hospital with full obstetric and neonatal care facilities between 32 and 34 weeks; 4. elective caesarean section between 35 and 37 weeks, risk-adapted.
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Affiliation(s)
- M Golic
- Klinik für Geburtsmedizin, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany.
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Engels T, Frei C, Chekerov R, Bamberg C, Neitzel H, Henrich W, Verlohren S. Schwere Hypertonie und Proteinurie in 19+2 SSW bei Triploidie mit Plazentahypertrophie sowie alobärer Holoprosenzephalie. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Güttler FV, Heinrich A, Rump J, de Bucourt M, Schnackenburg B, Bamberg C, Hamm B, Teichgräber UK. Magnetic resonance imaging of the active second stage of labour: proof of principle. Eur Radiol 2012; 22:2020-6. [PMID: 22549105 DOI: 10.1007/s00330-012-2455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/09/2012] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. MATERIALS AND METHODS Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. RESULTS Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CONCLUSION CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications.
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Affiliation(s)
- F V Güttler
- Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany.
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Güttler FV, Bamberg C, Heinrich A, Rump J, Schnackenburg B, de Bucourt M, Thomas A, Hamm B, Teichgräber U. Dokumentation der aktiven zweiten Phase der Geburt mittels MRT. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bamberg C, Fotopoulou C, Teichgraeber U, Henrich W, Dudenhausen JW, Kalache K. Die Bestimmung des Angle of progression am Termin: Ein Vergleich zwischen transperinealer Sonographie und offenen MRT. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rodekamp E, Nonnenmacher A, Henrich W, Beinder E, Bamberg C. Fetomaternal macrotransfusion – A case series. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bamberg C, Scheuermann S, Fotopoulou C, Slowinski T, Dückelmann A, Teichgräber U, Streitparth F, Henrich W, Dudenhausen JW, Kalache KD. Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Rodekamp E, Nonnenmacher A, Henrich W, Beinder E, Bamberg C. Fetomaternale Makrotransfusion – eine Fallserie. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Dückelmann AM, Michaelis SAM, Bamberg C, Dudenhausen JW, Kalache KD. Impact of intrapartal ultrasound to assess fetal head position and station on the type of obstetrical interventions at full cervical dilatation. J Matern Fetal Neonatal Med 2011; 25:484-8. [DOI: 10.3109/14767058.2011.587057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN, Streitparth F, Teichgräber U, Henrich W, Dudenhausen JW, Kalache KD. Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound. Ultrasound Obstet Gynecol 2011; 37:712-716. [PMID: 21308830 DOI: 10.1002/uog.8944] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term. METHODS Thirty-one pregnant women at full term with a fetus in the occipitoanterior position were enrolled. First, the distance between the leading part of the skull and the interspinal plane was obtained using an open MRI system with the patient in a supine position. Immediately after MRI, the angle of progression was obtained by transperineal ultrasound without changing the woman's posture. RESULTS There was a significant correlation between the angle of progression determined by transperineal sonography and the distance between the presenting fetal part and the level of the maternal ischial spines (y = - 0.51x + 60.8, r(2) = 0.38, P < 0.001). None of the fetal heads was engaged at the time of MRI and ultrasound examinations. CONCLUSIONS The present study demonstrated a predictable relationship between the angle of progression obtained by transperineal ultrasound and the traditional scale used to quantify fetal head descent. Based on our results, station 0 would correspond to a 120° angle of progression. However, this correlation is based on statistical assumptions only and has to be proven in future studies.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany
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Bamberg C, Felber S, Riepe G. Ischiadicuslähmung durch Aneurysma der A. profunda femoris. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1248450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dückelmann AM, Bamberg C, Michaelis SAM, Lange J, Nonnenmacher A, Dudenhausen JW, Kalache KD. Measurement of fetal head descent using the 'angle of progression' on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet Gynecol 2010; 35:216-222. [PMID: 20069668 DOI: 10.1002/uog.7521] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience. METHODS One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement. RESULTS In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93). CONCLUSIONS Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience.
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Affiliation(s)
- A M Dückelmann
- Department of Obstetrics, Charité University Hospital, Campus Benjamin Franklin and Campus Charité Mitte, Berlin, Germany
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Proquitte H, Freiberger O, Yilmaz S, Bamberg C, Degenhardt P, Roehr CC, Wauer RR, Schmalisch G. The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants. Eur Respir J 2009; 35:1072-8. [DOI: 10.1183/09031936.00058009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bamberg C, Vogt M, Dückelmann A, Streitbarth F, Teichgräber U, Dobinsky TN, Kalache KD, Dudenhausen JW. Höhenstandsdiagnostik am Termin – Ergebnisse von transperinealem Ultraschall und offenem MRT. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bamberg C, Vogt M, Röhr CC, Stangl V, Dudenhausen JW. Erfolgreiche systemische Lysetherapie nach massiver bds. Lungenarteriembolie im 3. Trimenon-Ein Fallbericht. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hartenstein S, Proquitté H, Bamberg C, Bauer S, Röhr CC. Neonatales Abstinenzsyndrom bei einem reifen Neugeborenen nach chronischer, intrauteriner Tramadolexposition – Eine Kausistik. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bamberg C, Linder M, Schaller G, Bollmann R, Dudenhausen JW, Kalache K. Proteomic Analyse mittels SELDI-TOF und proinflammatorische Zytokinbestimmung im Fruchtwasser des zweiten Trimenon – Identifikation subklinischer intrauteriner Inflammation und follow up hinsichtlich Frühgeburtlichkeit. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bamberg C, Schoser B, Tews S, Claus D. Rippling-muscle-Phänomen bei Thymitis-assoziierter Myasthenia gravis. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0028-1090127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bamberg C, Haase M, Budde K, Hocher B, Halle H, Hartung J. Intensivierte Hämodialyse während der Schwangerschaft-Fetale Überwachung und perinatales Outcome. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bamberg C, Mueller C, Tews D, Claus D. Tumoröse Verdickung des M. tensor fasciae latae als ungewöhnliche Manifestation einer Einschlusskörperchen-Myositis. Akt Neurol 2004. [DOI: 10.1055/s-2004-833422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jilek C, Bamberg C, Berkefeld J, Claus D. Progredientes Cauda-equina-Syndrom als Manifestation einer thorakalen duralen AV-Fistel. Akt Neurol 2004. [DOI: 10.1055/s-2004-833178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kalache KD, Bamberg C, Gagel K, Wauer R, Bollmann R. Beeinflussen die fetalen Atembewegungen die Entwässerung der fetalen Lunge in Terminnähe? Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-815183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bamberg C, Deschauer M, Tews S, Claus D. Mitochondriale DNA-Deletionen bei einer Patientin mit Koinzidenz einer myotonen Dystrophie Typ 2 (PROMM) und einer Myasthenia gravis. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Minocycline is an effective treatment of acne vulgaris, especially for inflammatory forms. Prescription rates have increased in recent years accompanied by a number of reports concerning drug-induced side effects. An otherwise healthy woman developed an erythema multiform-like rash and and toxic hepatic damage causing cholestatic jaundice following long-term minocycline use. Unusual cutaneous lipid deposition also developed. Minocycline-induced side effects are reviewed.
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Affiliation(s)
- C Bamberg
- Klinik und Poliklinik für Dermatologie und Venerologie der Universität Rostock
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Abstract
A 67-year-old man presented with cognitive deficits, status epilepticus, left hemiparesis, and severe lactic acidosis. Respiratory chain enzyme analysis of skeletal muscle revealed a defect in complex I activity, associated with a heteroplasmic C11777A mutation in the mitochondrial ND4 gene. This case is remarkable not only because of the late onset of symptoms, but because this mutation affects the identical ND4 codon as the G11778A mutation that causes Leber hereditary optic neuropathy.
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Affiliation(s)
- M Deschauer
- Department of Neurology, The Medical School, University of Newcastle upon Tyne, UK
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Seipelt M, Zerr I, Nau R, Mollenhauer B, Kropp S, Steinhoff BJ, Wilhelm-Gössling C, Bamberg C, Janzen RW, Berlit P, Manz F, Felgenhauer K, Poser S. Hashimoto's encephalitis as a differential diagnosis of Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry 1999; 66:172-6. [PMID: 10071095 PMCID: PMC1736201 DOI: 10.1136/jnnp.66.2.172] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES During an epidemiological study of Creutzfeldt-Jakob disease in Germany, Hashimoto's encephalitis was encountered as a differential diagnosis, which has not yet been described in this context. METHODS The symptoms and findings of seven patients who fulfilled the criteria for "possible" Creutzfeldt-Jakob disease are presented. RESULTS A Hashimoto's thyroiditis with antibodies against thyroglobulin or thyroid peroxidase, or both and a hypoechoic thyroid ultrasonogram were found in all cases. Analysis of CSF disclosed an increased leucocyte count in three patients, and a raised CSF:serum concentration ratio of albumin (QA1b) in four patients. The 14-3-3 protein, typical of Creutzfeldt-Jakob disease, could not be detected in any of our patients. No periodic sharp wave complexes, which are typical of Creutzfeldt-Jakob disease, were detected on EEG in any of the cases. By contrast with Creutzfeldt-Jakob disease, which leads to death within a few months, the patients with Hashimoto's encephalitis often recover quickly when treated adequately. All the patients improved after administration of corticosteroids. CONCLUSION The clinical symptomatology of both diseases may be very similar: dementia, myoclonus, ataxia, and personality change or psychotic phenomena are characteristic symptoms.
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Affiliation(s)
- M Seipelt
- Department of Neuroradiology, University Hospital, Göttingen, Germany
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Bamberg C, Janzen RW, Szabados M. [Long-term treatment with 7S immunoglobulins in myasthenia gravis. Preliminary clinical results]. Nervenarzt 1996; 67:327-32. [PMID: 8684513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
After initial high-dose intravenous 7S immunoglobulin therapy, six patients with seropositive myasthenia gravis received intermittent low-dose 7S immunoglobulins for at least 4-12 months. This treatment was started in five cases following an acute exacerbation of myasthenic symptoms (Oosterhuis class 3-4) and in one case because of marked clinical fluctuations (Oosterhuis class 3). In five of the six patients, there was a clinical response to the immunoglobulin therapy within 2 weeks, followed by marked long-standing improvement and stability of the clinical outcome. In four cases a decrease in the titer of acetylcholine receptor antibodies was noted in parallel. Our observations suggest an additional positive therapeutic effect of long-term, low-dose intravenous immunoglobulin therapy following the acute management of myasthenic exacerbations.
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Affiliation(s)
- C Bamberg
- Neurologische Klinik, Krankenhaus Nordwest, Frankfurt am Main
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Krauss A, Bamberg C. [Pulse frequency during labor in healthy persons and in patients with heart diseases or late toxemias]. Zentralbl Gynakol 1970; 92:1673-6. [PMID: 5531247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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