Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery.

PURPOSE: The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery. METHODS: A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury. RESULTS: In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations. CONCLUSION: Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations.

Catheter-mounted smart hydrogel ultrasound resonators for intravenous analyte monitoring.

Continuous monitoring of drug concentrations in blood plasma can be beneficial to guide individualized drug administration. High interpatient variability in required dosage and a small therapeutic window of certain drugs, such as anesthetic medications, can cause risks and challenges in accurate dosing during administration. In this work, we present a sensing platform concept using a smart hydrogel micro resonator sheet with medical ultrasound readout that is integrated on the top of a catheter. This concept is validated in-vitro using glucose as an easy to access and handle target analyte. In the case of continuous glucose measurement, our novel catheter-mounted sensing platform allows the detection of glucose concentrations in the range of 0 mM to 12 mM. While these experiments use a well-known glucose-sensitive smart hydrogel for proof-of-principle experiments, this new sensing platform is intended to provide the basis for continuous monitoring of various intravenously applied medications. Selectivity to different drugs, e.g., fentanyl, can be accomplished by developing a corresponding smart hydrogel composition.Clinical Relevance- Many intravenous medications, especially anesthetics, show considerable pharmacokinetic inter-subject variability. Continuous monitoring of intravenous analyte concentrations would enable individualizing the administration of these drugs to the specific patient.

Impaired Clearance From the Brain Increases the Brain Exposure to Metoclopramide in Elderly Subjects.

The antiemetic and gastroprokinetic drug metoclopramide is a weak substrate of the blood-brain barrier (BBB) efflux transporter P-gp and displays central nervous system (CNS) side effects (i.e., extrapyramidal symptoms and tardive dyskinesia) caused by dopamine D2 receptor blockade in the basal ganglia. These side effects occur with a higher incidence in elderly people. We used positron emission tomography to assess the brain distribution of [11 C]metoclopramide in young (n = 11, 26 ± 3 years) and elderly (n = 7, 68 ± 9 years) healthy men both after administration of a microdose (9 ± 7 µg) and a microdose co-injected with a therapeutic dose of unlabeled metoclopramide (10 mg). For both doses, elderly subjects had a significantly higher total volume of distribution (VT ) of [11 C]metoclopramide in the basal ganglia than young subjects (microdose: +26%, therapeutic dose: +41%). Increases in VT (= K1 /k2 ) were caused by significant decreases in the transfer rate constant of [11 C]metoclopramide from brain into plasma (k2 , microdose: -18%, therapeutic dose: -30%), whereas the distributional clearance from plasma into brain (K1 ) remained unaltered. This reduction in the clearance of [11 C]metoclopramide (k2 ) from the brains of elderly subjects may be caused by an age-related decrease in the activity of P-gp at the BBB and may contribute to the higher incidence of CNS side effects of metoclopramide in the aged population. Our data suggest that an age-associated decrease in the clearance properties of the BBB may modulate the CNS effects or side effects of clinically used P-gp substrates.

Risk-taking in vaccination, surgery, and gambling environments: Evidence from a framed laboratory experiment.

Vaccination involves a tradeoff between two risky alternatives, namely, susceptibility and immunization. By designing a controlled laboratory experiment, we investigate the association between risk preferences and immunization decisions. To contrast the role of risk preferences in vaccination decisions with other domains, we implemented four frames: vaccination, surgery, complex neutral, and simple neutral. We found direct framing effects for females but not for males. For the former, the demand for the safer alternative is significantly larger in the surgery frame than in all other frames. For male subjects, we found a significant association between stated risk preferences and choice behavior in the simple neutral frame but not in the other three frames. For female subjects, we observed the exact opposite. Although the complexity of the decision problem matters, there is no indication of differential roles of risk preferences for a given complexity. We found that the share of consistent choices is significantly larger in the surgery frame as compared to the two neutral frames, that is, context improves decision making. This does not apply to the vaccination frame, so there is something about vaccinations that prevents individuals from better understanding the decision problem at hand.

Extravascular use of drug-eluting beads: a promising approach in compartment-based tumor therapy.

Intraperitoneal carcinomatosis (PC) may occur with several tumor entities. The prognosis of patients suffering from PC is usually poor. Present treatment depends on the cancer entity and includes systemic chemotherapy, radiation therapy, hormonal therapy and surgical resection. Only few patients may also benefit from hyperthermic intraperitoneal chemotherapy with a complete tumor remission. These therapies are often accompanied by severe systemic side-effects. One approach to reduce side effects is to target chemotherapeutic agents to the tumor with carrier devices. Promising experimental results have been achieved using drug-eluting beads (DEBs). A series of in vitro and in vitro experiments has been conducted to determine the suitability of their extravascular use. These encapsulation devices were able to harbor CYP2B1 producing cells and to shield them from the hosts immune system when injected intratumorally. In this way ifosfamide--which is transformed into its active metabolites by CYP2B1--could be successfully targeted into pancreatic tumor growths. Furthermore DEBs can be used to target chemotherapeutics into the abdominal cavity for treatment of PC. If CYP2B1 producing cells are proven to be save for usage in man and if local toxic effects of chemotherapeutics can be controlled, DEBs will become promising tools in compartment-based anticancer treatment.

Intraperitoneal use of doxorubicin drug-eluting beads in sheep: a pilot safety study.

BACKGROUND: Intraperitoneal carcinmatosis and intra-abdominal tumour cell dissemination may occur with several tumour entities. At this final stage of the tumour disease, systemic chemotherapy remains only palliative and may be accompanied by severe side-effects. Alternatively, compartment-based therapy by intraperitoneal (i.p.) instillation of doxorubicin drug-eluting beads (dox-DEB) has been proposed. Here we investigated the safety, pharmacokinetics and side-effects of i.p. dox-DEB in a large animal trial. MATERIALS AND METHODS: Ten black-headed meat-sheep received i.p. polyvinyl-alcohol-encapsulated doxorubicin. The plasma concentration of doxorubicin, blood count and laboratory findings were recorded and histological examination of the organs was performed. RESULTS: After i.p. instillation, elevated serum levels of doxorubicin were obtained. After this initial phase, serum levels remained constant. Upon autopsy, no signs of systemic toxicity were detected. Beads remained within the peritoneal cavity and were not systemically distributed. However, we found significant local toxicity in five sheep, three of which died due to severe peritonitis. CONCLUSION: Doxorubicin can be successfully targeted to the peritoneal cavity by bead encapsulation. Local toxic effects must be controlled in order to facilitate clinical utility.