From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy.

Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for patients with early stage cervical cancer. The majority of radical hysterectomies are performed with the open technique. However, laparoscopic, combined laparoscopic and vaginal, and robotic-assisted approaches may also be used. Compared with the abdominal radical hysterectomy (ARH), laparoscopic techniques are associated with less blood loss, shorter hospital stay, better cosmesis, and faster recovery. A further breakthrough in laparoscopic technique can only be made if safety and oncological clearance are comparable with ARH. We describe the technique and results of laparoscopic assisted radical vaginal hysterectomy and the transition to vaginal assisted laparoscopic radical hysterectomy.

[Symptomatic choledocholithiasis during pregnancy - the role of ultrasound, ERCP and EUS]. / Symptomatische Choledocholithiasis in der Schwangerschaft - Einsatz der Sonografie, ERCP und EUS.

We present an overview of the management of acute bilary pancreatitis in pregnancy with particular reference to endoscopy. Ultrasound is the gold standard for diagnosis. If clinical symptoms, laboratory parameters and transabdominal ultrasound do not allow appropriate decision making, endoscopic ultrasound (EUS) is the method of choice. EUS is preferably performed prior to ERCP during the same clinical session, this is of particular relevance for pregnant women with regards to the safety of mother and fetus. However, because the procedure is performed under fluoroscopic guidance, there are potential risks related to the radiation exposure. ERCP, especially in pregnant patients demands high expertise from the endoscopist, and with due diligence and attention to detail, the procedure can be safely performed.

Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature.

Approximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans- or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two- and three-dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed.

Creatinine deiminase (EC 3.5.4.21) from bacterium BN11: purification, properties and applicability in a serum/urine creatinine assay.

Creatinine deiminase (EC 3.5.4.21) from the anaerobic microorganism BN11 has been purified to homogeneity by ammonium sulfate fractionation, gel filtration on Sephacryl-S-300 superfine and chromatography on DEAE-Sepharose C1 6B. The final enzyme preparation had a specific activity of 78 units per mg protein. Analysis of creatinine deiminase by polyacrylamide gradient gel electrophoresis and fast-flow-liquid-chromatography gave a relative molecular mass of 285 kDa and 288 kDa, respectively. By treatment with sodium dodecylsulfate and 2-mercaptoethanol creatinine deiminase was dissociated yielding one polypeptide with a relative molecular mass of 47.5 kDa. The enzyme was entirely specific for creatinine and showed a Km value of 0.15 mM. Creatinine deiminase was used to determine the concentration of creatinine in serum and urine using a manual method and an automated system.

Orcein and litmus.

Orcein was separated into 14 dyes by partition chromatography. Their constitutions were determined mainly by spectroscopy and led to formulae that are derived from 7-amino-2-phenoxazone, 7-hydroxy-2-phenoxazone, and 7-amino-2-phenoxazime, and that were confirmed by syntheses. The major constituent of litmus is assembled polymerically from 7-hydroxy-2-phenoxazone chromophores. The mechanism of formation is elucidated.

Diagnosis of bovine virus diarrhoea by two enzyme-linked immunosorbent assays.

Two enzyme-linked immunosorbent assays (ELISAs) for the diagnosis of bovine virus diarrhoea (BVD) are described: CHEKIT-BVD-VIRUS and CHEKIT-BVD-SERO. The first test detects virus antigen in leucocytes, resulting in identification of persistently-infected animals, while the second detects antibodies to BVD virus (BVDV). It is well known that even persistently-infected animals may have antibodies to heterologous BVDV strains. These animals are still negative to the CHEKIT-BVD-SERO test because of immunotolerance to conserved virus antigens. Data on these two tests are summarised and a scheme is presented for the diagnosis of BVD using a combination of these two tests.

Search for exotic baryons in 800 GeV pp-->pXi+/-piX reactions.

We report the results of a high-statistics, sensitive search for narrow baryon resonances decaying to Xi-pi-, Xi-pi+, Xi+pi-, and Xi+pi+. The only resonances observed are the well known Xi0(1530) and Xi0(1530). No evidence is found for the states near 1862 MeV, previously reported by NA49 [Phys. Rev. Lett. 92, 042003 (2003)]. At the 95% confidence level, we find the upper limit for the production of a Gaussian enhancement with sigma=7.6 MeV in the Xi-pi- effective mass spectrum to be 0.3% of the number of observed Xi0(1530)-->Xi-pi+. We find similarly restrictive upper limits for an enhancement at 1862 MeV in the Xi-pi+, Xi+pi-, and Xi+pi+ mass spectra.

Measurement of the D(s)+ lifetime.

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.

[Surgical indication in myelomeningoceles (author's transl)]. / Zur Operationsindikation bei Myelomeningozelen.

Myelomeningoceles underlie critical indication for surgical closure. Clearcut contra indications such as total congenital hydrocephalus, intracranial haemorrhage and cerebral bith-traumatic lesions, severe forms of gibbus and the combination with other severe malformations eliminate the right of active surgery. The conservative treatment neither corresponds to therapeutic nihilism nor is it the inevitability of a lethal outcome. The author does not agree with conceptions such as selection of criteria of selection according to Lorber.

[Urgent pulmonary interventions in early childhood]. / Dringliche pulmonale Eingriffe im frühen Kindesalter.

The article deals with life threatening anomalies oft he lung in newborns which can only be cured by urgent surgical intervention. The clinical symptomatology is characterized in nearly all cases by intrathoracic displacement of healthy lung tissue. Own observations in connection with literature are dealt with.

[Therapeutic problems in bile duct atresia]. / Therapieprobleme bei der Gallengangsatresie.

Existence and patency of the intrahepatic bile ducts during the first weeks of age call for early surgery, before any further chance of active treatment will be lost due to obstruction. Every case of icterus persistent four to five weeks from birth should be an indication for laparotomy. Surgical treatment today is primarily characterised by hepatoportojejunostomy (Kasai II) and lymphodigestive shunt (Schweizer). 2 of 8 children survived five and seven years. All lethal courses had been due to progressive liver, cirrhosis and cirrhosis in conjunction with cholestasis. Hepatoportojejunostomy is considered to be the adequate surgical method. Lymphodigestive shunt is rejected as an exclusive approach and is accepted only when used in combination with hepatoportojejunostomy. Liver transplantation is likely to bear therapeutic promise in cases of insufficient shunt.

[Obstructive uropathies in early childhood--surgical intervention as renal protection]. / Obstruktive Uropathien im frühen Kindesalter--Der operative Eingriff als renale Protektion.

Anomalies in the urinary tract can be noticed early by prenatal sonography. In the case of obstruction, a decompressive procedure can follow immediately after birth. Long-term results of renal function in cases of pyeloureteral obstructions after 6-10 years make it clear that results are better the earlier pyelon resection is performed. In cases of obstructive megaureter, operative procedures are indicated for severe disturbances of ureteral transport. Progressive renal and ureteral wall destruction is promoted by performing operations too late.

[Hamartoma of the liver in childhood]. / Hamartome der Leber im Kindesalter.

Liver hamartoma is one of the very rare findings in childhood. It is a dysontogenetic malformation that grows clinically manifest with tumour-like appearance in the first or second year of age. Cystic and solid formations are described in this report. Findings are usually clearly delimited from clinically intact liver parenchyma. In surgical extirpation, that delimitation should be stringently observed to avoid unnecessary blood loss. The prognosis generally is good and should not be jeopardised by delay of surgical therapy. Reported are two cases of liver hamartoma, with both patients being laparotomised at the age of one and a half years.

[Possibility of renal vascularization by means of a jejunal flap]. / Zur Möglichkeit renaler Vaskularisation mittels Dünndarmpatch.

An animal experimental model for the additional vascularisation of the kidney is represented by means of an excluded demucosed small intestine segment. The immediate clinical signification is to be seen in lowering the hypertension in case of pyelonephritic renal shrinkage. Histologic investigations do not show any vascular communication between intestine and kidney and not any ingrowing of intestinal vessels in the kidney. If the improvement of reno-intestinal shunts could be particularly stimulated in case of a primary restricted blood offer must remain unsolved.

[Thoracic teratomas in childhood]. / Thorakale Teratome bei Kindern.

Thoracic teratomas are rare in children. They present a heterogeneous and problematic group of tumours. Extramediastinal lesions are unusual. Tomography is of particular value in cases of mediastinal teratomata, as this allows differentiation between the tumour and the heart. Of 31 cases of intrapulmonary teratoma that have been described, only 3 were in children. The authors report a unique case of combined mediastinal and intrapulmonary teratoma.

Influence of the activation state on the sedimentation properties of ribulose bisphosphate carboxylase from Alcaligenes eutrophus.

Ribulose-1,5-bisphosphate carboxylase from the chemolithotrophic hydrogen bacterium Alcaligenes eutrophus was maximally active in the presence of 50 mM HCO3- plus 10 mM Mg2+. Deactivation occurred upon removal of these ions. Reactivation was achieved by incubation of the enzymes with HCO3- plus Mg2+. The concentration of HCO3- (CO2) required for half-maximal activation was 1.84 nM (0.064 mM). Sedimentation velocity studies revealed that activation/deactivation is associated with drastic changes in the sedimentation properties of the enzyme. While the inactive form had a sedimentation coefficient, s20,w, of 17.5 S, the s20,w gradually decreased as the enzyme was reactivated and the fully reactivated form exhibited an s20,w of 14.3 S. A structural analogue of ribulose 1,5-bisphosphate, xylulose 1,5-bisphosphate, caused a deactivation of the enzyme concomitant with an increase in the sedimentation velocity. It is suggested that the alterations in the hydrodynamic properties accompanying the activation/deactivation process are due to considerable conformational changes that affect the molecular volume and/or the shape of the enzyme. Dissociation/association events were not involved in the changes. The s20,w of about 18 S, generally reported for the large hexadecameric ribulose bisphosphate carboxylases, appears to be characteristic of the inactive form.

[Gonadal and extragonadal yolk sac tumor]. / Beitrag zum gonadalen und extragonadalen Yolk-sac-Tumor.

Yolk-sac tumours are germ-cell tumours with gonadal and extragonadal location. Histologically they consist of primitive cellular forms configurated as a loose network. These tumours are of extreme malignancy and should be treated as radical as possible. Surgery should be combined with anticancer chemotherapy. However, with adequate treatment only children suffering from testicular tumours and not older than 2 years of life have a fair chance to survive. 3 cases are dealt with in detail.