Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors.

PURPOSE: The aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications. METHODS: All patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications. RESULTS: Data from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01-1.04], surgery duration (OR, 1.02; 95% CI 1.02-1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99-1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01-1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99-1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21-1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications. CONCLUSION: In this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.

An adaptable, reusable, and light implant for chronic Neuropixels probes.

Electrophysiology has proven invaluable to record neural activity, and the development of Neuropixels probes dramatically increased the number of recorded neurons. These probes are often implanted acutely, but acute recordings cannot be performed in freely moving animals and the recorded neurons cannot be tracked across days. To study key behaviors such as navigation, learning, and memory formation, the probes must be implanted chronically. An ideal chronic implant should (1) allow stable recordings of neurons for weeks; (2) be light enough for use in mice; (3) allow reuse of the probes after explantation. Here, we present the "Apollo Implant", an open-source and editable device that meets these criteria and accommodates up to two Neuropixels 1.0 or 2.0 probes. The implant comprises a "payload" module that is attached to the probe and is recoverable, and a "docking" module that is cemented to the skull. The design is adjustable, making it easy to change the distance between probes, the angle of insertion, and the depth of insertion. We tested the implant across seven labs in head-fixed mice, freely moving mice, and freely moving rats. The number of neurons recorded across days was stable, even after repeated implantations of the same probe. The Apollo implant provides an inexpensive, lightweight, and flexible solution for reusable chronic Neuropixels recordings.

Vaginal operative delivery in Germany: a national survey about experience and self-reported competency.

BACKGROUND: To determine German obstetricians' self-perceived experience with vacuum and forceps deliveries. PATIENTS AND METHODS: Using a web-based survey, German obstetricians were invited to participate in a survey. This survey was approved by the German society of obstetrics and gynecology. RESULTS: Surveys of 635 obstetricians were received. All obstetricians reported performing significantly less forceps than vacuum deliveries. Almost all obstetricians want to perform more delivery, which indicates the willingness to learn both. More obstetricians felt confident to perform vacuum than forceps. In a similar obstetrical indication, most of the obstetricians would prefer to perform a vacuum assisted delivery. The majority of the obstetricians wished to receive more training in vaginal operative deliveries. CONCLUSION: Most of the German obstetricians prefer to use vacuum-assisted vaginal deliveries and feel less confident to perform forceps deliveries. Standardized training to improve the quality of care is recommended.

Correlation between first polar body morphology and further embryo development.

First polar body (PB) morphology of human oocytes can indicate further embryo development and viability. However, controversial data have been published in this topic. Our retrospective study analyses the fertilization and further development of oocytes in relation to different morphological features of the first PB. The morphology of 3387 MII oocytes from 522 in vitro fertilization (IVF) treatments were assessed before intracytoplasmic sperm injection (ICSI). Oocytes were classified according to their first PB morphology. Assessment of fertilization and embryonic development (cell number, embryo grade, amount of anuclear fragmentation and presence of multinucleated blastomeres) was performed 16-20 and 42-48 hours after ICSI. Our results show that fertilization rate and embryo quality is influenced by PB morphology, while speed of development is not affected by the morphology of the first PB. Contrary to previous findings, our results suggest that oocytes with a fragmented PB had a higher developmental ability than those with an intact PB. However, we observed a lower viability of oocytes with a large PB. Since there are contradictions in this and previous observations, an extensive study is needed with standard hormonal stimulation protocol and oocyte evaluation criteria.

Decreased insulin requirement in acute renal failure in diabetic nephropathy.

Twelve of 13 diabetics with azotemic nephropathy experienced exacerbation of renal failure and decreased insulin requirement after coronary angiography utilizing radiographic contrast material. The single patient who did not develop acute renal failure had no evidence of decreased insulin requirement. Eleven of 12 patients had decreased insulin requirement: mean decrement in insulin dose, 40%; mean decrement in fasting blood glucose level, 33%; mean decrement in peak blood glucose level, 42%. The 12th patient underwent peritoneal dialysis against hypertonic glucose without need of an increased insulin dose. Eight of 11 patients experienced a total of 19 insulin reactions; one patient was hypoglycemic continuously, despite infusion of glucose and discontinuation of insulin. The decrement of insulin requirement was not proportional to the rise in either serum creatinine or potassium concentrations. We suggest that when acute renal failure occurs in diabetics, decreased insulin requirement should be anticipated and the insulin dose lowered.

Fluid and electrolyte problems in patients with advanced carcinoma.

Brief outlines of these problems serve to suggest some etiologic factors in their production. The patient seldom presents with a single or simple cause or solution. The body reacts with compensations or side effects, and suffers complications and mixed disorders -- all of which probabilities must be investigated and appreciated before rational therapy can be initiated.

The effect of repeated oral doses of lornoxicam on antipyrine elimination in normal human volunteers.

Treatment with lornoxicam 4 mg twice daily for 14 d did not produce any change in salivary antipyrine elimination in 11 of 12 healthy volunteers. Anomalous results in one subject are presented and discussed.

[Pharmacokinetic and chemical investigations in children after oral administration of lidaprim (author's transl)]. / Pharmakokinetische und klinisch-chemische Untersuchungen an Kindern nach oraler Gabe von Lidaprim

Lidaprim, a new bactericidal combination of trimethoprim and sulfametrol, was administered to 20 patients of a paediatric surgical ward over a period of 7 or more days. Analytic determination of plasma and urine concentrations of the chemotherapeutic agent showed homogeneous drug levels at the chosen dosage. No cumulation was observed. Drug tolerance was excellent. Only one patient developed urticaria when the substance was given together with penicillin, but it was not necessary to stop medication in this case.

[Comparative pharmacokinetics of the beta-1 receptor blookader celiprolol after a single oral administration in subjects with health kidneys and in patients with impaired renal function]. / Vergleichende Pharmakokinetik des Beta 1-Rezeptoren-Blockers Celiprolol nach oraler Einzelgabe an Nierengesunde und an Patienten mit eingeschränkter Nierenfunktion.

Pharmacokinetic parameters were determined after the oral administration of a single tablet containing 200 mg celiprolol HCl to 8 healthy volunteers with normal kidney function and 6 patients with stable impaired renal function of different degrees of severity. The plasma levels and the urinary excretion of celiprolol were followed up for 48 hours after administration with the help of specific chemo-analytical methods. The substance was equally well absorbed both by healthy volunteers and patients with renal disease. While the cumulative renal excretion (0 to 48 hours after administration) was reduced from 18.2% in healthy volunteers to 2.3% of the applied dose in kidney patients, the global elimination constant k fell from 0.104 h-1 in healthy volunteers to 0.072 h-1 in the patients with renal disease. It can be assumed that in patients with impaired renal function at least a part of the lacking renal elimination of celiprolol can be taken over by "extrarenal elimination". According to the method of Dettli a reduction in dosage of the beta 1-blocker, celiprolol is not necessary in patients with more or less impaired kidney function.

[Tissue concentrations of sulfametrol-trimethoprim in the human prostate (author's transl)]. / Zur Bestimmung der Gewebskonzentration von Sulfametrol-Trimethoprim in der menschlichen Prostata.

Ten patients with normal liver and kidney functions were admitted to a urology department for prostatectomy because of benign prostatic hypertrophy. They received a twice daily administration of 2 tablets of sulfametrole/trimethoprim (Lidaprim) for 4 days; the last dose of 2 tablets was given 4 hours before surgery. Having been enucleated by the suprapubic route, the prostatic glands were examined both histologically and chemico-analytically. The concentrations of the chemotherapeutically active substances were determined in the plasma and in the prostatic tissues. The prostatic tissue concentration of sulfametrole was 24,0 +/- 8,6 mg/kg and that of trimethoprim 7,1 +/- 2,2 mg/kg.

Problems of long-term cannulation of cisterna magna and subarachnoid space in the conscious dog.--Technical note--.

Studies on the influence of substances on the central nervous system and on the function of the blood-CSF-barrier made long-term cannulation of the CSF compartment interesting. This study was to test, whether a permanent CSF-drainage from any point of the subarachnoid space was possible with modified "tissue cages" (Guyton 1963). For that purpose a steel wire cage and a teflon cage were implanted subarachnoidally into beagle dogs. The two cages stopped draining on the second and on the third day respectively. Histological examination showed, that, because of the strong reaction of animal tissue to implanted material, direct cannulation of the CSF compartment does not seem feasible. In the second part the "Manuilov-system" was modified. An indwelling guiding tube was implanted and fixed with a horseshoe shaped plate to the occipital bone. Puncture can be made on the awake dog without local anaesthetic and produces samples of 1.5 to 2.0 ml CSF for up to 30 days without complications.

[Relative clinical biological availability of a combination of trimethoprim-sulfamethoxazole in fasting children and after a meal]. / Relative klinische Bioverfügbarkeit der Kombination Trimethoprim-Sulfametrol, nüchtern und nach einer Mahlzeit, bei Kindern.

Lidaprim, a bactericidal chemotherapeutical agent, was administered to 10 patients in a children's hospital, in the form of an oval suspension for children. The initial dosage was given on an empty stomach, the second after a standard meal. The concentrations of the chemotherapeutical agents in the plasma and the urine were chemically analysed. The bio-availability of the preparation was very good. A standard meal, taken just before dosage, led to a delay in absorption both for Trimethoprim and Sulfametrol. In the period under surveillance, 0-12 hours after administration, an absorption loss could be calculated from the plasma and urine levels in the case of both Trimethoprim and Sulfametrol. In spite of this effect, adequate plasma and urine levels with a bactericidal action, were achieved with the usual dosage. The clinical success and compatibility of the preparation were good in every single case.

[Levels of sulfametrole-trimethoprim in blood and lung-tissue during treatment of respiratory tract infection (author's transl)]. / Blutspiegel und Spiegel im Lungengewebe von Sulfametrol-Trimethoprim während der Behandlung bronchopulmonaler Erkrankungen.

A report is given on the examination of the levels of sulfametrole and trimethoprim in blood and lung tissue of 29 patients with pulmonary tumours of various origin, who were subjected to a pre-operative treatment with 2 tablets 2 times daily of the sulfametrole-trimethoprim combination Lidaprim for an average period of one week because of concurrent bronchopulmonary infections. About 14 hours after the last tablet dose samples of tumour-free lung tissue and blood were removed during the operation and subjected to a chemical analysis of sulfametrole and trimethoprim. The mean blood level of sulfametrole was 30.3 micrograms/ml and of trimethoprim 2.0 micrograms/ml; the mean levels in the lung tissue was 19.2 micrograms/g of sulfametrole and 9.2 micrograms/g of trimethoprim. Trimethoprim via the blood is stored in the lung tissue. The relationship of these results to the good clinical activity of the combination sulfametrole/trimethoprim in the treatment of infections of bacterial origin in the upper and lower airways is discussed.