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Hamburg, Germany

Krapp M.,Zentrum fur Endokrinologie | Baumann K.,Universitatsklinik Schleswig Holstein | Axt-Fliedner R.,Justus Liebig University | Gembruch U.,Universitatsklinikum Bochum | Weichert J.,Universitatsklinik Schleswig Holstein
Ultraschall in der Medizin | Year: 2011

Purpose: The aim of this study was the follow-up of children with a prenatal diagnosis of tachyarrhythmia up to an age of 5 years in order to assess the long-term outcome of these children. Materials and Methods: All fetuses diagnosed with prenatal tachyarrhythmia between April 1993 and June 2004 in the Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck were identified and the childrens parents and pediatricians were contacted for retrospective data on the childrens health. The data from the compulsory examinations (U1 U9) were used for analysis. Results: 49 cases (93 %) were enrolled in this study. 23 fetuses had supraventricular tachycardia (SVT), 10 had an atrial flutter (AF) and 16 had paroxysmal supraventricular tachycardia (pSVT). Intrauterine conversion into sinus rhythm was achieved in 41 of 44 treated fetuses (93 %). 17 of 48 cases showed tachyarrhythmia postnatally (35 %). 15 of these newborns were treated with antiarrhythmic medication between 4 days and 46 months. The follow-up rate in the 3 subgroups ranged from 78 100 %. At the time of the U 9 examination, 69 100 % of the children were healthy. During the examinations there was an increase in motor activity delay and language development delay with a maximum at U 5 and U 9, respectively. Conclusion: Overall, on the basis of the long-term follow-up of 49 children, we could show that prenatal tachyarrhythmia has a good prognosis. Increased motor activity and language development delay are important for patient counseling. Substantial cardiac and extracardiac anomalies are associated with an unfavorable outcome. © Georg Thieme Verlag KG Stuttgart - New York. Source


Nawroth F.,Zentrum fur Endokrinologie
Breast Care | Year: 2012

Purpose: Chemotherapy-induced amenorrhea is a serious concern for women undergoing cancer therapy. This prospective randomized trial evaluated the use of gonadotropin-releasing hormone (GnRH) analog triptorelin to preserve ovarian function in women treated with chemotherapy for early-stage breast cancer. Patients and Methods: Premenopausal women age 44 years or younger were randomly assigned to receive either triptorelin or no triptorelin during (neo)adjuvant chemotherapy and were further stratified by age (< 35, 35 to 39, > 39 years), estrogen receptor status, and chemotherapy regimen. Objectives included the resumption of menses and serial monitoring of follicle-stimulating hormone (FSH) and inhibin A and B levels. Results: Targeted for 124 patients with a planned 5-year follow-up, the trial was stopped for futility after 49 patients were enrolled (median age, 39 years; range, 21 to 43 years); 47 patients were treated according to assigned groups with four cycles of adriamycin plus cyclophosphamide alone or followed by four cycles of paclitaxel or six cycles of fluorouracil, epirubicin, and cyclophosphamide. Menstruation resumed in 19 (90%) of 21 patients in the control group and in 23 (88%) of 26 in the triptorelin group (P= .36). Menses at random assignment) in the control group had spontaneous pregnancies with term deliveries. FSH and inhibin B levels correlated with menstrual status. Conclusion: When stratified for age, estrogen receptor status, and treatment regimen, amenorrhea rates on triptorelin were comparable to those seen in the control group. returned after a median of 5.8 months (range, 1 to 19 months) after completion of chemotherapy in the triptorelin versus 5.0 months (range, 0 to 28 months) in the control arm (P= .58). Two patients (age 26 and 35 years at random assignment) in the control group had spontaneous pregnancies with term deliveries. FSH and inhibin B levels correlated with menstrual status. Conclusion: When stratified for age, estrogen receptor status, and treatment regimen, amenorrhea rates on triptorelin were comparable to those seen in the control group. © 2012 S. Karger GmbH, Freiburg. Source


Krapp M.,Zentrum fur Endokrinologie | Ludwig A.,Zentrum fur Endokrinologie | Axt-Fliedner R.,Justus Liebig University | Kreiselmaier P.,Zentrum fur Endokrinologie
Ultraschall in der Medizin | Year: 2011

Purpose: The objective of this study was to evaluate which cardiac planes and malformations can be visualized by first trimester fetal echocardiography during the daily routine in a prenatal medicine unit. Materials and Methods: From October 2007 to June 2009, all fetuses with a crown rump length between 45 and 84 mm were included in the study. The fetal echocardiographies were carried out by one examiner. The entire examination including fetal echocardiography was completed within a time interval of 30 minutes. When possible, the abdominal plane, 4-chamber view (CV), pulmonary veins, left ventricular outflow tract, 3-vessel view (3-VV) and the aortic arch were visualized by color Doppler and/or power Doppler sonography. Results: 690 fetuses were enrolled in the retrospective study. The abdominal plane, 4-CV, pulmonary veins, left ventricular outflow tract, 3-VV and the aortic arch were visualized in 99 %, 96 %, 23 %, 97 %, 98 % and 72 % of cases, respectively. During the study interval, 17 cardiac malformations were diagnosed. Outcome data were obtained in 92 % of the normal fetuses. 5 cardiac anomalies were diagnosed beyond the first trimester. Conclusion: The standard planes of fetal echocardiography can be displayed in the first trimester in the clinical routine. Pulmonary veins can be visualized in almost a quarter of the cases. First trimester congenital heart diseases are strongly associated with chromosomal abnormalities during the first trimester. © Georg Thieme Verlag KG Stuttgart - New York. Source


Bullmann C.,Zentrum fur Endokrinologie | Minnemann T.,Zentrum fur Endokrinologie
Gynakologische Endokrinologie | Year: 2011

Congenital adrenal hyperplasia (CAH) encompasses a group of hereditary diseases. The severity of the causative mutation determines the clinical picture. The most common form is 21-hydroxylase deficiency which can be detected within the first days of life due to the established newborn screening in Germany and can be treated early. Untreated CAH accounts for virilization of girls, a precocious puberty in girls and boys with accelerated bone age followed by a short stature. Additional life-threatening salt-wasting crises occur in cases of classical salt-wasting CAH. The treatment of the classical CAH includes a lifelong drug therapy, which involves treatment with corticosteroids and also mineral corticoids in the presence of salt-wasting. Treatment is controlled by clinical and laboratory parameters whereby treatment as well as over-treatment must be avoided by individualized therapy. Both women and men with classical CAH show impaired fertility. In addition to a hormonal therapy which must be optimized, undesirable effects of excess androgen are causative for impaired fertility in women and men. © 2011 Springer-Verlag. Source


Bullmann C.,Zentrum fur Endokrinologie
Gynakologische Endokrinologie | Year: 2011

Thyroid dysfunction and structural changes of the thyroid are common diseases which affect women more often than men. A distinction is made between latent and overt thyroid dysfunction. In cases of overt dysfunction the concentrations of free thyroid hormones are altered. Both hypothyroidism and hyperthyroidism can be caused by a variety of mechanisms. A manifest failure is always an indication for therapy. In cases of fertility desire or pregnancy a latent hypothyroidism also needs therapy by thyroid hormone substitution. In Germany one third of the population have structural changes such as an enlarged thyroid or adenomatous goitre. Medicinal treatment, radioiodine therapy and thyroid surgery are available for treatment. © 2011 Springer-Verlag. Source

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