Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin ...Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n = 128 745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8% , in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal- operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal- lacerations were less frequent in primipara if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is < 36 cm, and if no further traumas of the birth canal occur. Results were similar for multiparae: severe perineal lacerations were less frequent if the active period of labour is < 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well- justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.展开更多
The aim of this study was to evaluate the effect of acupuncture analgosedation (AAS) in minor gynecologic operative-diagnostic procedures. Material and Methods: The prospective study included 43 women with minor gynec...The aim of this study was to evaluate the effect of acupuncture analgosedation (AAS) in minor gynecologic operative-diagnostic procedures. Material and Methods: The prospective study included 43 women with minor gynecologic operative procedures. All women were treated using manual acupuncture (AP) points with analgetic and sedative effects. Out of a total of 43 women, 9 had cervical polyps, requiring polyp ablation, cervical channel excochleation (ECC), and dilatation, and curettage (D & C), and 2 patients required a paracervical anaesthesia (PCA) during dilatation of the cervical channel. ECC and D & C were done in 6 women with ultrasonographically suspicious endometrial neoplasias, in 10 women with perimenopausal metrorrhagia, and in 5 women with postmenopausal metrorrhagia. PCA was necessary in 1 woman with endometrial neoplasia, in 2 with perimenopausal metrorrhagia, and in 1 with postmenopausal metrorrhagia. In 2 cases the diagnosis was missed abortion and in 6 cases incomplete spontaneous miscarriage, requiring dilatation, evacuation, and curettage (D & E & C). In the group with missed abortion PCA was necessary in 2 and intravenous analgosedation (ivAS) in 1 woman. In a young nulliparous woman with incomplete spontaneous abortion, in addition to AAS, PCA and ivAS were required due to severe pain and psycho-emotional instability. Loop excision of the transformation zone is a very painful procedure, so 1 woman needed PCA and 1 woman ivAS. Sonohysterosalpingography was done twice for primary sterility and once for secondary sterility, for which MS was sufficient during the operation. In a total of 43 patients treated with MS 10 PCA and 3 ivAS were additionally required. Results: A good analgosedative effect of AP during the operative-diagnostics procedures was achieved in 76.8% of cases. Conclusion: MS requires the full commitment of the obstetrician or anaesthesiologist during the AP procedure, as well as a good pre-analgosedation interview, since the patient s motivation and psycho-emotional state during the choice of AP points should be taken into consideration.展开更多
A rupture of a splenic artery aneurysm in the postpartal period is a rare but dramatic event with a high rate of maternal mortality. We report on a 29- year- old woman who, after a normal ambulant delivery in our depa...A rupture of a splenic artery aneurysm in the postpartal period is a rare but dramatic event with a high rate of maternal mortality. We report on a 29- year- old woman who, after a normal ambulant delivery in our department, experienced an attack of pain in the left epigastrium 7 hours later at home and fell into a state of hemodynamic shock. Owing to a targeted diagnostic work-up and immediate surgical intervention, the patient survived this incident with no damage. According to the international published literature, the mortality rate for this condition is 50% . In developed countries a rupture of a splenic artery aneurysm during pregnancy or the postpartal period is a very significant cause of maternal morbidity and mortality. Based on a review of the published literature, the causes, diagnosis, clinical work-up and treatment of these ruptures are addressed in the Discussion section. For the purpose of differential diagnosis, every obstetrician and emergency medicine specialist should be familiar with this relatively rare condition. Immediate diagnosis and prompt establishment of the indication for laparotomy are essential in order to ensure that the mother and the child survive the incident.展开更多
We report on a 25- year- old prima gravida in the 26th week of pregnancy with a malaria tropica infection from Kenya. A prior therapy for Lues latens seropositiva had been successful. Hospital admission was because of...We report on a 25- year- old prima gravida in the 26th week of pregnancy with a malaria tropica infection from Kenya. A prior therapy for Lues latens seropositiva had been successful. Hospital admission was because of uncommon fever, chronic anemia and increasing thrombocytopenia. After typical attacks of fever malaria tropica was diagnosed in blood slides; because of this an intravenous therapy with chinin and clindamycin over 8 days was started. As a side effect of the chinin therapy premature labour resulted, which necessitated tocolytic treatment. The patient returned to give birth in the 40th week of pregnancy; a girl with a birth weight of 3560 g was born (APGAR score 9/10/10, pHNA 7.27). Signs of connatal lues did not show up in the first 14 days of the infant’ s life. In Europe malaria infections during pregnancy are rarely described in the literature. However, for a differential diagnosis of uncommon attacks of fever in pregnancy blood slides are recommended. In principle in pregnancy travel to malaria-endemic areas should be avoided. After the 16th week of pregnancy mefloquine is the current drug of choice for chemoprophylaxis.展开更多
Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary h...Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary hemostasis. In this paper we present a new dissection tool, the “Jet Grasper” (KARL STORZ?), which represents a further step towards simple, safe and effective laparoscopic peritoneal resection. Methods: The “Jet Grasper”, was developed to enable selective dissection of the peritoneum and, if necessary, other organs in the case of adhesions. For the tissue resection different techniques can be applied (e.g. ultrasound, mechanical or electrosurgical energy). Results: The tool features a dissection forceps with a narrow slit at the end of the jaw. Further selective dissection is achieved by applying water pressure retroperitoneally via a controlled water pressure pump. Furthermore a diameter difference between the jaw and the sheath potentiates dissection. The thin jaws are introduced precisely to separate and/or dissect layers in a physiological manner to enable further dissection of the peritoneum at a safe distance. Larger vessels can subsequently be targeted for bipolar coagulation in the opened retroperitoneal area. As we are exclusively presenting a completely new device, no patient data are included here. However, a prospective randomized study already started in April 2012, and will be reported after completion in two years. Conlusion: The new dissection tool combines selective dissection and resection under controlled water pressure, known from aquadissection. It provides enhanced and atraumatic possibilities in performing pelvic peritoneal resection via selective dissection and reduction of blood loss.展开更多
We report a case of an uncommon course of a metastatic carcinoma of the rectum with genital manifestation and the palliative plastic surgery treatment.
Cumulative pregnancy rates are useful when counselling couples about th eir cha nce of conceiving during infertility treatment. Especially in older patients who have a lower chance of conceiving cumulative pregnancy r...Cumulative pregnancy rates are useful when counselling couples about th eir cha nce of conceiving during infertility treatment. Especially in older patients who have a lower chance of conceiving cumulative pregnancy rates are important. Pat ients also have to be counselled about the physical and psychological stress of infertility treatment. In addition to the pregnancy rates, drop-out rates are a direct -and maybe themost important -marker of the physicians quality in an IVF program. Data of 394 in vitro fertilization (IVF) cycles in 151 patients ag ed ≥40 years were analysed retrospectively. Data were analysed using descriptiv e statistics as well as the Kaplan Meier procedure. A real cumulative pregnancy rate (RCPR) of 17.2%was achieved after 4 cycles with an expected cumulative pre gnancy rate (ECPR) of 35.4%. In patients aged 40-42 years a RCPR of 20.6%with an ECPR of 38.7%was reached, while the chances to conceive decreased rapidly a fter the age of 43 years (RCPR 12.1%). Adrop-out rate of non-pregnant patient s of 42.6-51.4%was observed after each cycle. Especially patients ≥40 years h ave to be counselled individually about their specific chances to conceive. The drop-out rate should be used as an important marker of quality control.展开更多
Intrauterine insemination (IUI) offers a less invasive, less timeconsuming and less expensive method of infertility treatment compared to invitro fertilisation. 1005 IUI cycles in 349 women were analysed retrospecti...Intrauterine insemination (IUI) offers a less invasive, less timeconsuming and less expensive method of infertility treatment compared to invitro fertilisation. 1005 IUI cycles in 349 women were analysed retrospectively. In 29.2%of these women at least one pregnancy was achieved by IUI. The pregnancy rate per cycle was 9.4-11.7%in the first 4 cycles and decreased thereafter. The female age influenced the chance of conceiving (13.0, 10.6 and 6.8%with a female age of ≤30, 31-35 and 36-40 years, respectively) as well as the cause of infertility. The duration of infertility correlated with the pregnancy rate, but without reaching statistical significance. The pregnancy rate also decreased with a spermatozoa concentration <20 million/ml, with <5%of normal morphology and with <50%motile spermatozoa. The percentage of nonpregnant patients who discontinued therapy early was only 4.8-16.0%per cycle. However the percentage of patients who switched to an ICSI therapy increased from 9.9%after the first cycle to 37.1 %after the sixth cycle.展开更多
Proteoglycans and collagen molecules are interacting with each other thereby forming various connective tissues. The sulfation pattern of proteoglycans differs depending on the kind of tissue and/or the degree of matu...Proteoglycans and collagen molecules are interacting with each other thereby forming various connective tissues. The sulfation pattern of proteoglycans differs depending on the kind of tissue and/or the degree of maturation. Tissues from Cnidaria are suitable examples for exploration of the effects in relation to the presence and the absence of sulfate groups, when studying characteristic fragments of the long proteoglycan carbohydrate chains in silico. It has been described that a non-sulfated chondroitin appears as a scaffold in early morphogenesis of all nematocyst types in Hydra. On the other hand, sulfated glucosaminoglycans play an important role in various developmental processes of Cnidaria. In order to understand this biological phenomenon on a sub-molecular level we have analysed the structures of sulfated and non-sulfated proteoglycan carbohydrate chains as well as the structure of diverse collagen molecules with computational methods including quantum chemical calculations. The strong interactions between the sulfate groups of the carbohydrates moieties in proteoglycans and positively charged regions of collagen are essential in stabilizing various Cnidaria tissues but could hinder the nematocyst formation and its proper function. The results of our quantum chemical calculations show that the sulfation pattern has a significant effect on the conformation of chondroitin structures under study.展开更多
《2015年St.Gallen早期乳腺癌国际专家共识》在外科手术领域做出了若干更新,指出最小可接受保乳切缘为"无浸润性肿瘤或导管原位癌(ductual carcinoma in situ,DCIS)印染";只要切缘达到"无浸润性肿瘤或DCIS印染"标...《2015年St.Gallen早期乳腺癌国际专家共识》在外科手术领域做出了若干更新,指出最小可接受保乳切缘为"无浸润性肿瘤或导管原位癌(ductual carcinoma in situ,DCIS)印染";只要切缘达到"无浸润性肿瘤或DCIS印染"标准以及有计划行术后放疗,小叶组织来源、广泛导管内成分、年轻病人、多灶或多中心和不良生物学亚型的早期乳腺癌同样可行保乳手术;ACOSOG Z0011的结果在临床实践中推广是可行的。展开更多
文摘Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n = 128 745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8% , in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal- operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal- lacerations were less frequent in primipara if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is < 36 cm, and if no further traumas of the birth canal occur. Results were similar for multiparae: severe perineal lacerations were less frequent if the active period of labour is < 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well- justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.
文摘The aim of this study was to evaluate the effect of acupuncture analgosedation (AAS) in minor gynecologic operative-diagnostic procedures. Material and Methods: The prospective study included 43 women with minor gynecologic operative procedures. All women were treated using manual acupuncture (AP) points with analgetic and sedative effects. Out of a total of 43 women, 9 had cervical polyps, requiring polyp ablation, cervical channel excochleation (ECC), and dilatation, and curettage (D & C), and 2 patients required a paracervical anaesthesia (PCA) during dilatation of the cervical channel. ECC and D & C were done in 6 women with ultrasonographically suspicious endometrial neoplasias, in 10 women with perimenopausal metrorrhagia, and in 5 women with postmenopausal metrorrhagia. PCA was necessary in 1 woman with endometrial neoplasia, in 2 with perimenopausal metrorrhagia, and in 1 with postmenopausal metrorrhagia. In 2 cases the diagnosis was missed abortion and in 6 cases incomplete spontaneous miscarriage, requiring dilatation, evacuation, and curettage (D & E & C). In the group with missed abortion PCA was necessary in 2 and intravenous analgosedation (ivAS) in 1 woman. In a young nulliparous woman with incomplete spontaneous abortion, in addition to AAS, PCA and ivAS were required due to severe pain and psycho-emotional instability. Loop excision of the transformation zone is a very painful procedure, so 1 woman needed PCA and 1 woman ivAS. Sonohysterosalpingography was done twice for primary sterility and once for secondary sterility, for which MS was sufficient during the operation. In a total of 43 patients treated with MS 10 PCA and 3 ivAS were additionally required. Results: A good analgosedative effect of AP during the operative-diagnostics procedures was achieved in 76.8% of cases. Conclusion: MS requires the full commitment of the obstetrician or anaesthesiologist during the AP procedure, as well as a good pre-analgosedation interview, since the patient s motivation and psycho-emotional state during the choice of AP points should be taken into consideration.
文摘A rupture of a splenic artery aneurysm in the postpartal period is a rare but dramatic event with a high rate of maternal mortality. We report on a 29- year- old woman who, after a normal ambulant delivery in our department, experienced an attack of pain in the left epigastrium 7 hours later at home and fell into a state of hemodynamic shock. Owing to a targeted diagnostic work-up and immediate surgical intervention, the patient survived this incident with no damage. According to the international published literature, the mortality rate for this condition is 50% . In developed countries a rupture of a splenic artery aneurysm during pregnancy or the postpartal period is a very significant cause of maternal morbidity and mortality. Based on a review of the published literature, the causes, diagnosis, clinical work-up and treatment of these ruptures are addressed in the Discussion section. For the purpose of differential diagnosis, every obstetrician and emergency medicine specialist should be familiar with this relatively rare condition. Immediate diagnosis and prompt establishment of the indication for laparotomy are essential in order to ensure that the mother and the child survive the incident.
文摘We report on a 25- year- old prima gravida in the 26th week of pregnancy with a malaria tropica infection from Kenya. A prior therapy for Lues latens seropositiva had been successful. Hospital admission was because of uncommon fever, chronic anemia and increasing thrombocytopenia. After typical attacks of fever malaria tropica was diagnosed in blood slides; because of this an intravenous therapy with chinin and clindamycin over 8 days was started. As a side effect of the chinin therapy premature labour resulted, which necessitated tocolytic treatment. The patient returned to give birth in the 40th week of pregnancy; a girl with a birth weight of 3560 g was born (APGAR score 9/10/10, pHNA 7.27). Signs of connatal lues did not show up in the first 14 days of the infant’ s life. In Europe malaria infections during pregnancy are rarely described in the literature. However, for a differential diagnosis of uncommon attacks of fever in pregnancy blood slides are recommended. In principle in pregnancy travel to malaria-endemic areas should be avoided. After the 16th week of pregnancy mefloquine is the current drug of choice for chemoprophylaxis.
文摘Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary hemostasis. In this paper we present a new dissection tool, the “Jet Grasper” (KARL STORZ?), which represents a further step towards simple, safe and effective laparoscopic peritoneal resection. Methods: The “Jet Grasper”, was developed to enable selective dissection of the peritoneum and, if necessary, other organs in the case of adhesions. For the tissue resection different techniques can be applied (e.g. ultrasound, mechanical or electrosurgical energy). Results: The tool features a dissection forceps with a narrow slit at the end of the jaw. Further selective dissection is achieved by applying water pressure retroperitoneally via a controlled water pressure pump. Furthermore a diameter difference between the jaw and the sheath potentiates dissection. The thin jaws are introduced precisely to separate and/or dissect layers in a physiological manner to enable further dissection of the peritoneum at a safe distance. Larger vessels can subsequently be targeted for bipolar coagulation in the opened retroperitoneal area. As we are exclusively presenting a completely new device, no patient data are included here. However, a prospective randomized study already started in April 2012, and will be reported after completion in two years. Conlusion: The new dissection tool combines selective dissection and resection under controlled water pressure, known from aquadissection. It provides enhanced and atraumatic possibilities in performing pelvic peritoneal resection via selective dissection and reduction of blood loss.
文摘We report a case of an uncommon course of a metastatic carcinoma of the rectum with genital manifestation and the palliative plastic surgery treatment.
文摘Cumulative pregnancy rates are useful when counselling couples about th eir cha nce of conceiving during infertility treatment. Especially in older patients who have a lower chance of conceiving cumulative pregnancy rates are important. Pat ients also have to be counselled about the physical and psychological stress of infertility treatment. In addition to the pregnancy rates, drop-out rates are a direct -and maybe themost important -marker of the physicians quality in an IVF program. Data of 394 in vitro fertilization (IVF) cycles in 151 patients ag ed ≥40 years were analysed retrospectively. Data were analysed using descriptiv e statistics as well as the Kaplan Meier procedure. A real cumulative pregnancy rate (RCPR) of 17.2%was achieved after 4 cycles with an expected cumulative pre gnancy rate (ECPR) of 35.4%. In patients aged 40-42 years a RCPR of 20.6%with an ECPR of 38.7%was reached, while the chances to conceive decreased rapidly a fter the age of 43 years (RCPR 12.1%). Adrop-out rate of non-pregnant patient s of 42.6-51.4%was observed after each cycle. Especially patients ≥40 years h ave to be counselled individually about their specific chances to conceive. The drop-out rate should be used as an important marker of quality control.
文摘Intrauterine insemination (IUI) offers a less invasive, less timeconsuming and less expensive method of infertility treatment compared to invitro fertilisation. 1005 IUI cycles in 349 women were analysed retrospectively. In 29.2%of these women at least one pregnancy was achieved by IUI. The pregnancy rate per cycle was 9.4-11.7%in the first 4 cycles and decreased thereafter. The female age influenced the chance of conceiving (13.0, 10.6 and 6.8%with a female age of ≤30, 31-35 and 36-40 years, respectively) as well as the cause of infertility. The duration of infertility correlated with the pregnancy rate, but without reaching statistical significance. The pregnancy rate also decreased with a spermatozoa concentration <20 million/ml, with <5%of normal morphology and with <50%motile spermatozoa. The percentage of nonpregnant patients who discontinued therapy early was only 4.8-16.0%per cycle. However the percentage of patients who switched to an ICSI therapy increased from 9.9%after the first cycle to 37.1 %after the sixth cycle.
基金Elements of the project are financed by the European Commission’s Framework Program 7(BIO-NMR-00007)-Bio-NMR grant:Jellyfish protein NMR(BIO-NMR-00007)-IEP.
文摘Proteoglycans and collagen molecules are interacting with each other thereby forming various connective tissues. The sulfation pattern of proteoglycans differs depending on the kind of tissue and/or the degree of maturation. Tissues from Cnidaria are suitable examples for exploration of the effects in relation to the presence and the absence of sulfate groups, when studying characteristic fragments of the long proteoglycan carbohydrate chains in silico. It has been described that a non-sulfated chondroitin appears as a scaffold in early morphogenesis of all nematocyst types in Hydra. On the other hand, sulfated glucosaminoglycans play an important role in various developmental processes of Cnidaria. In order to understand this biological phenomenon on a sub-molecular level we have analysed the structures of sulfated and non-sulfated proteoglycan carbohydrate chains as well as the structure of diverse collagen molecules with computational methods including quantum chemical calculations. The strong interactions between the sulfate groups of the carbohydrates moieties in proteoglycans and positively charged regions of collagen are essential in stabilizing various Cnidaria tissues but could hinder the nematocyst formation and its proper function. The results of our quantum chemical calculations show that the sulfation pattern has a significant effect on the conformation of chondroitin structures under study.
文摘《2015年St.Gallen早期乳腺癌国际专家共识》在外科手术领域做出了若干更新,指出最小可接受保乳切缘为"无浸润性肿瘤或导管原位癌(ductual carcinoma in situ,DCIS)印染";只要切缘达到"无浸润性肿瘤或DCIS印染"标准以及有计划行术后放疗,小叶组织来源、广泛导管内成分、年轻病人、多灶或多中心和不良生物学亚型的早期乳腺癌同样可行保乳手术;ACOSOG Z0011的结果在临床实践中推广是可行的。
