Interdisciplinary Laparoscopic Implantation of Neuromodulation Leads to the Sacral Plexus for Therapy of Chronic Pelvic Pain and Neurogenic Bladder Dysfunctions.

OBJECTIVE: The aim of this study was to report on the use of laparoscopic implantation of leads on the branches of the sacral plexus for neuromodulation in the treatment of chronic pelvic pain (CPP) in a multidisciplinary setting with the help of electrophysiological neuromonitoring. MATERIALS AND METHODS: Between 2012 and 2019, six female patients complaining of chronic pain and bladder and bowel dysfunctions underwent laparoscopic exposure and nerve identification with the help of electrophysiological neuromonitoring. A lead was placed laparoscopically in direct contact with the affected nerve. Pain intensity (numerous ranking scale [NRS]), generic health status (EQ-5D-5L), Becks Depressions Inventory (BDI-V), Pain Catastrophizing Scale (PCS), and Client Satisfaction Questionnaire (CSQ-8) were assessed pre-/postoperatively as well as three and six months after surgery. Statistical analysis was performed using Mann-Whitney U and Wilcoxon rank-sum test. RESULTS: The median age was 36.5 years. NRS improved from a median of 9.5 preoperatively to 3.0 (p < 0.001) at six-month follow-up. Median EQ-5D-5L index value before treatment was 0.18, indicating a notably lowered quality of life and increased up to 0.83 after six months (p < 0.001). Preoperative median BDI-V scores indicated a major depressive mood and improved from a median of 46.0 to 12.0 after six months (p = 0.007). Preoperative PCS was elevated with a median score of 41.0 and decreased to 4.0 after six months (p < 0.001). CSQ showed that patients were satisfied with the treatment. CONCLUSIONS: This unique method is an alternative and effective treatment option for CPP even years after primary endometriosis surgery.

Erucin and benzyl isothiocyanate suppress growth of late stage primary human ovarian carcinoma cells and telomerase activity in vitro.

In the present study we analysed the effects of isothiocyanates (ITCs)--plant-derived sulphur-containing constituents known for their potential chemotherapeutic activity--on growth inhibition and programmed death in primary ovarian carcinoma cells from ascites of human patients. Twenty-four hour exposure of carcinoma cells to 5-50 µM erucin or benzyl ITC led to a concentration-dependent viability loss, as determined by erytrosin B cell staining. This concurred with an increase in internucleosomal DNA fragmentation, mitochondrial membrane depolarization and downregulation of Akt as indicator for apoptosis induction. Cell accumulation at the G2/M phase was evident after 48 h of erucin treatment. Telomerase, a selective target of cancer cells, was suppressed by erucin. Although pre-treatment of cells with the thiol antioxidant N-acetylcysteine could completely prevent initialization of the apoptotic process, it failed to abolish ITC-mediated telomerase suppression. Taken together, in our study, ITC exerted comparable cytotoxic efficacy against primary ovarian cancer cells as reported for corresponding cell lines. The clinical significance of this observation should be addressed in future studies and the role of telomerase further investigated.

Use of complementary and alternative medicine in departments of obstetrics in Germany.

BACKGROUND: This nationwide study aimed to assess the use of complementary and alternative medicine (CAM) methods in German departments of obstetrics. METHODS: All German departments of obstetrics were identified and were sent a questionnaire designed to assess which CAM methods, if any, they used during childbirth, how frequently, and why. SPSS software was used for statistical analyses (Spearman's bivariate correlation, cross-tabulation, and Pearson's chi-square test). RESULTS: The questionnaires were returned by 40.3% (381/946) of the identified departments. The most commonly used CAM therapy was acupuncture (available in 97.3% (366/376) of departments) followed by homeopathy (offered in 93.4%) and aromatherapy (available in 76.6%). Most decisions regarding CAM use were made by midwives; only decisions on acupuncture were taken by obstetricians and midwives. Reasons given for using CAM were patient demand and perceived efficacy of CAM, particularly by midwives. Obstetricians were only partly convinced of the efficacy of CAM methods and their conviction varied with the type of unit they worked in. CONCLUSIONS: CAM methods are widely used in German departments of obstetrics despite lacking evidence of effectiveness. Efficacy, side effects and consequences of CAM use should be assessed using the mandatory German quality assurance measures and birth surveys. CAM use elsewhere also merits further study.

Can iridology detect susceptibility to cancer? A prospective case-controlled study.

OBJECTIVE: This prospective case-control study aimed to investigate the value of iridology as a diagnostic tool in detecting some common cancers. SUBJECTS: One hundred ten (110) subjects were enrolled in the study: 68 subjects had histologically proven cancers of the breast, ovary, uterus, prostate, or colorectum, and 42 were control subjects. METHODS: All subjects were examined by an experienced practitioner of iridology, who was unaware of their gender or medical details. He was allowed to suggest up to five diagnoses for each subject and his results were then compared with each subject's medical diagnosis to determine the accuracy of iridology in detecting malignancy. RESULTS: Iridology identified the correct diagnosis in only 3 cases (sensitivity, 0.04). CONCLUSION: Iridology was of no value in diagnosing the cancers investigated in this study.

[Does dark field microscopy according to Enderlein allow for cancer diagnosis? A prospective study]. / Erlaubt die Dunkelfeldmikroskopie nach Enderlein die Diagnose von Krebs? Eine prospektive Studie.

BACKGROUND: Dark field microscopy according to Enderlin claims to be able to detect forthcoming or beginning cancer at an early stage through minute abnormalities in the blood. In Germany and the USA, this method is used by an increasing number of physicians and health practitioners (non-medically qualified complementary practitioners), because this easy test seems to give important information about patients' health status. OBJECTIVE: Can dark field microscopy reliably detect cancer? MATERIALS AND METHODS: In the course of a prospective study on iridology, blood samples were drawn for dark field microscopy in 110 patients. A health practitioner with several years of training in the field carried out the examination without prior information about the patients. RESULTS: Out of 12 patients with present tumor metastasis as confirmed by radiological methods (CT, MRI or ultra-sound) 3 were correctly identified. Analysis of sensitivity (0.25), specificity (0.64), positive (0.09) and negative (0.85) predictive values revealed unsatisfactory results. CONCLUSION: Dark field micoroscopy does not seem to reliably detect the presence of cancer. Clinical use of the method can therefore not be recommended until future studies are conducted.