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Köln, Germany

Ahmadi S.A.,Universitatsklinikum Dusseldorf | Slotty P.J.,Universitatsklinikum Dusseldorf | Schroter C.,Uniklinik Cologne | Kropil P.,Universitatsklinikum Dusseldorf | And 3 more authors.
Clinical Neurology and Neurosurgery

Objective To present an innovative approach that does not rely on intraoperative X-ray imaging for identifying thoracic target levels and critically appraise its value in reducing the risk of wrong-level surgery and radiation exposure. Methods 96 patients admitted for surgery of the thoracic spine were prospectively enrolled, undergoing a total of 99 marking wire placements. Preoperatively a flexible marking wire derived from breast cancer surgery was inserted with computed tomography (CT) guidance at the site of interest - the wire was then used as an intraoperative guidance tool. Results Wire placement was considered successful in 96 cases (97%). Most common pathologies were tumors (62.5%) and degenerative disorders (16.7%). Effective doses from CT imaging were significantly higher for wire placements in the upper third of the thoracic spine compared to the lower two thirds (p = 0.015). Radiation exposure to operating room personnel could be reduced by more than 90% in all non-instrumented cases. No adverse reactions were observed, one patient (1.04%) underwent surgical revision due to an epifascial empyema. No wires had to be removed due to lack of patient compliance or infection. Conclusions This is a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a marking wire. Its application merits consideration in any spinal case where X-ray localization could prove unsafe, particularly in cases lacking bony pathologies such as intradural tumors. © 2014 Elsevier B.V. Source

Foth D.,Uniklinik Cologne | Goretzlehner G.,Parkstrasse 11
Geburtshilfe und Frauenheilkunde

During perimenopause, the time immediately prior to and the first year after the last menstrual period, female reproductive capacity is low, but pregnancy is still possible. Ovulation may occur without warning and effective contraception is still necessary if pregnancy is not desired. There is no contraceptive method that is contraindicated due to age. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives with low dosages of ethinylestradiol, vaginal ring, progestin pills, injectables, implants, intrauterine system with levonorgestrel, natural estrogen (estradiol) in combination with a progestin, intrauterine devices, barrier methods and tubal ligations. However, women need to receive accurate individual advice about the risks and benefits of each contraceptive method. Oral hormonal contraceptives are a safe option for healthy, normotonic non-smokers without any contraindications up until one or two years beyond menopause. In addition to the effective contraception, non-contraceptive benefits such as the treatment of bleeding disorders or dysmenorrhea play an important role. For women with contraindications against estrogens progestin-only methods (pills, injectables, implants) offer possible choices. The intrauterine system (IUS) with levonorgestrel remains the most effective contraceptive method, even in women with bleeding disorders. For smokers all estrogen-progestin combinations are contraindicated because of the known increased risk for cardiovascular disease. © Georg Thieme Verlag KG Stuttgart. Source

Beckmann M.W.,Universitatsklinikum Erlangen Nurnberg | Juhasz-Boss I.,Universitatsklinikum des Saarlandes | Denschlag D.,Hochtaunus Kliniken Bad Homburg | Gass P.,Hochtaunus Kliniken Bad Homburg | And 10 more authors.
Geburtshilfe und Frauenheilkunde

The appropriate surgical technique to treat patients with uterine fibroids is still a matter of debate as is the potential risk of incorrect treatment if histological examination detects a uterine sarcoma instead of uterine fibroids. The published epidemiology for uterine sarcoma is set against the incidence of accidental findings during surgery for uterine fibroids. International comments on this topic are discussed and are incorporated into the assessment by the German Society for Gynecology and Obstetrics (DGGG). The ICD-O-3 version of 2003 was used for the anatomical and topographical coding of uterine sarcomas, and the Operations- und Prozedurenschlüssel (OPS) 2014, the German standard for process codes and interventions, was used to determine surgical extirpation methods. Categorical qualifiers were defined to analyze the data provided by the Robert Koch Institute (RKI), the German Federal Bureau of Statistics (DESTATIS; Hospital and Causes of Death Statistics), the population-based Cancer Register of Bavaria. A systematic search was done of the MEDLINE database and the Cochrane collaboration, covering the period from 1966 until November 2014. The incidence of uterine sarcoma and uterine fibroids in uterine surgery was compared to the literature and with the different registries. The incidence of uterine sarcoma in 2010, standardized for age, was 1.53 for Bavaria, or 1.30 for every 100 000 women, respectively, averaged for the years 2002-2011, and 1.30 for every 100 000 women in Germany. The mean incidence collated from various surveys was 2.02 for every 100 000 women (0.35-7.02; standard deviation 2.01). The numbers of inpatient surgical procedures such as myoma enucleation, morcellation, hysterectomy or cervical stump removal to treat the indication uterine myoma have steadily declined in Germany across all age groups (an absolute decrease of 17% in 2012 compared to 2007). There has been a shift in the preferred method of surgical access from an abdominal/vaginal approach to endoscopic or endoscopically assisted procedures to treat uterine fibroids, with the use of morcellation increasing by almost 11 000 coded procedures in 2012. Based on international statements (AAGL, ACOG, ESGE, FDA, SGO) on the risk of uterine sarcoma as an coincidental finding during uterine fibroid surgery and the associated risk of a deterioration of prognosis (in the case of morcellation procedures), this overview presents the opinion of the DGGG in the form of four Statements, five Recommendation and four Demands. © 2015, Georg Thieme Verlag KG. Source

Ambe P.,RWTH Aachen | Esfahani B.J.,RWTH Aachen | Tasci I.,RWTH Aachen | Christ H.,Uniklinik Cologne | Kohler L.,RWTH Aachen
Surgical Endoscopy and Other Interventional Techniques

Background: Laparoscopic cholecystectomy (LC) seems to be more challenging in males than in females. The surgery seems to be longer in male patients. There also seems to be an increased rate of conversion to open surgery in male patients. We sought to objectively verify this widespread belief. Methods: We performed a retrospective analysis of laparoscopic cholecystectomies performed between January 2004 and November 2009 in our hospital. Within this period 1844 cholecystectomies were performed in our community-based hospital. After a strict inclusion procedure, 1571 cases of LC for symptomatic gallbladder disease were analyzed (501 males, 1071 females). The time for surgery, defined as the interval from placement of the Veress needle to wound closure in minutes, and the rate of conversion to open surgery were the main parameters considered. Results: The time for surgery in male patients was significantly longer compared to that for females (p < 0.0001). The male cohort was significantly older than the female cohort at the time of surgery (p < 0.001). The rate of conversion to open surgery was significantly higher in male patients (5.6%) compared to 2.9% for females (p < 0.0001). Conclusion: Based on our analysis, LC had a significantly longer duration of surgery in the male cohort. The rate of conversion to open surgery was also significantly higher in male cohort. Thus, LC could be more challenging in male patients. © 2011 Springer Science+Business Media, LLC. Source

Ruping M.J.G.T.,Uniklinik Cologne | Keulertz C.,Uniklinik Cologne | Vehreschild J.J.,Uniklinik Cologne | Lovenich H.,St. Jans Gasthuis | And 3 more authors.
Supportive Care in Cancer

Background: Stomatitis, including oral mucositis and ulcerations induced by HSV-reactivation are major sources of morbidity after high-dose (HD) chemotherapy and subsequent autologous hematopoietic stem cell transplantation (SCT). While increased synthesis of pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α)-as well as reactivation of viral infections have frequently been observed in this setting, data on their association with the severity of mucositis is limited. Materials and methods: Fifteen patients with Hodgkin's or non-Hodgkin's lymphoma receiving HD conditioning chemotherapy and autologous SCT were assessed with respect to oral pain and severity of stomatitis on day -6, 0, +5 to +7, +13 to +15, and +100. On the same dates, IL-1 and TNF-α were quantified in saliva and screening for a wide range of viral pathogens was carried out by cell culture and PCR and complemented by serological analyses. t Tests were used to assess potential associations between these variables. Results: All but one patient had a positive HSV IgG titer at baseline. Reactivation as confirmed by HSV PCR was observed in seven patients (50%). There was a significant association between the presence of HSV in saliva samples and severity of stomatitis (t test, p=0.015). The highest concentration of TNF-α and IL-1 coincided with the maximum intensity of stomatitis, but the association was not significant. Conclusion: We found a significant association between the presence of HSV in saliva samples and severity of stomatitis in patients receiving HD chemotherapy and subsequent autologous SCT. While acyclovir prophylaxis has become standard for patients undergoing allogeneic SCT, this issue has not been sufficiently explored for other chemotherapy regimens. Based on our findings, conduction of a well-powered controlled randomized trial may be warranted. © 2010 Springer-Verlag. Source

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