Uterine Radial Artery Resistance Index Predicts Reproductive Outcome in Women with Recurrent Pregnancy Losses and Thrombophilia.

Uterine radial artery resistance index (URa-RI) by Doppler ultrasound may reflect the changes in the uteroplacental circulation and be associated with adverse events in early pregnancy. Recurrent pregnancy losses (RPL) are associated with thrombophilia, and anticoagulation treatment with low molecular weight heparin improves pregnancy outcome in women with RPL and thrombophilia. A retrospective cohort study was conducted in 139 pregnant women with 3 or more RPL and thrombophilia. The relationship between pregnancy outcome and dynamic changes of URa-RI was analyzed in 116 women who delivered a liveborn infant and 23 who miscarried the index pregnancy. Patients were on preconception low molecular weight heparin, low-dose aspirin (81mg per day), and prednisone treatment. URa-RI was measured during periovulation time, at the time of positive pregnancy test, and then repeated every two weeks until 32-week gestation or the time of miscarriage. The URa-RI at 8-week gestation was significantly higher in women who miscarried the index pregnancy than those who delivered alive born infant (0.51±0.08 vs. 0.42±0.03, P<0.001). Receiver operating characteristic curve analysis demonstrated that URa-RI of 8 wk gestation effectively distinguished women who miscarried from those who had a live birth with an area under the curve of 82.6% (95% CI 69.01-97.17). After adjusting for covariates including age, BMI, and number of miscarriages, multiple logistic regression models showed that each 0.1 unit increase of URa-RI of 8 wk gestation was associated with 18.70-point increase in the risk of miscarriage (OR19.70, 95%CI 4.26-91.1, P<0.001), and women with an URa-RI≥0.45 had an OR of 49.48 (95% CI 8.01-307.95; P<0.001) for miscarriage compared to those who had URa-RI<0.45. In women with RPL and inherited thrombophilia, increased URa-RI at 8-week gestation was associated with spontaneous abortion independent of other risk factors while they were on anticoagulation treatment.

Shutting down operating theater ventilation when the theater is not in use: infection control and environmental aspects.

OBJECTIVE: In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed. DESIGN: Experimental study. SETTING: Neurosurgical OR of a German university hospital. METHODS: The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated. RESULTS: In 13 investigations, a median of 1.3 x 10(4) particles 0.5 microm/m3 or greater (range, 5.8 x 10(3) to 1.1 x 10(5)) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 x 10(4) particles 0.5 microm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels. CONCLUSIONS: Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.

[A Calcutript-Lithoclast comparison: electrohydraulic lithotripsy versus acoustic pressure wave lithotripsy. An in vitro study on chalk cubes]. / Comparaison Calcutript-Lithoclast: lithotritie électro-hydraulique versus lithotritie par ondes de pression acoustiques. Etude in vitro sur des cubes de craie.

Intracorporeal lithotripters are available in nearly all urological institutions. The authors compared the CALCUTRIPT made by K. Storz Co. and the Swiss LITHOCLAST in in vitro studies. No major difference in the efficacy of disintegration was observed after subjecting chalk cubes to the two modalities. Human tissue of the renal pelvis, ureter and bladder was exposed to both energy-sources. In the case of the electrohydraulic shock wave the authors found complete rupture of all three layers of the ureteric wall after exposure even with low energy, while tissue perforation was observed in only one of 72 tissue samples exposed to the LITHOCLAST. The authors recommend the LITHOCLAST because of its minimal invasiveness for the treatment of calculi especially in the ureter.

[Urethroplasty using a free dermo-epidermal of preputial mesh graft: Meshgraft urethroplasty]. / Urétroplastie par greffe libre en grillage dermo-épidermique ou préputial: urétroplastie Meshgraft.

Long urethral strictures raise serious problems in terms of appropriate treatment. Reconstruction techniques using scrotal skin have a high recurrence rate. In order to avoid complications, a dermoepidermal or preputial Meshgraft was used to reconstruct a new urethra in two stages. In the first stage, the graft was raised and transplanted onto the open urethra. 8 to 12 weeks later, in the second stage, the new urethra is closed. Since 1977, Meshgraft urethroplasty has been performed in 128 patients, using the skin of the foreskin (n = 75) or medial surface of the thigh (n = 53). A good anatomical and functional result was obtained in all but three cases, regardless of the graft donor site. This operative technique constitutes a very effective method for the lasting treatment of long or complicated urethral strictures, for example in patients with spinal cord injuries.

[Wall-stent for treatment of bulbar urethral stricture and DSD in spastic bladder]. / Der Wallstent zur Behandlung der bulbären Harnröhrenstriktur und der DSD bei spastischer Blase.

Since may 1989 a urethral Wallstent has been used for the treatment of short urethral strictures and for DSD in paraplegic patients with reflex bladder activity. Forty-nine patients have now been followed-up, which exceeds the 6-month margin. Out of these, 25 suffered from a short stricture of the bulbous urethra and 24 had spastic bladders with severe DSD. Eighteen of the 25 patients with strictures had previous unsuccessful direct vision urethrotomies; 17 in the DSD group had undergone failed sphincterotomies. In all but 2 cases the infravesical obstruction could be treated effectively solely by stent implantation. The results obtained equal those of a well-performed end-to-end anastomosis of the bulbous urethra or a 12, o'clock sphincterotomy.

[Is down-staging of advanced bladder cancer by neoadjuvant chemotherapy possible?--MVEC protocol]. / Gibt es ein Downstaging des fortgeschrittenen Blasenkarzinoms durch neoadjuvante Chemotherapie?--MVEC-Schema.

In 22 patients with advanced transitional cell carcinoma of the bladder, neoadjuvant chemotherapy according to the MVEC regimen was given. Subsequent radical cystectomy showed down-staging in 7 patients (32%). The preoperative clinical staging revealed regression of the bladder cancer in 77% of all cases. Down-grading was seen in only 2 patients. Because of the discrepancy between preoperative clinical staging and the histopathological staging after radical cystectomy, invasive tumour surgery is necessary even when clinical staging has not revealed a tumour after chemotherapy.

[Tympanoplasty after previous mastoidectomy (author's transl)]. / Die sanierende Antrotomie als Vorbereitung zur Tympanoplastik

Suppuration in ears suffering from a central perforation of the ear drum can frequently be stopped by mastoidectomy. This previous operation prepares ears for later tympanoplasty. 64 ears (55 patients) were treated by this way. Suppuration ceased in 47 ears. Spontaneous closure of the perforation could be seen in 7 cases. 23 ears underwent tympanoplastic procedures, always during a second intervention, 17 patients did not want further operations after the suppuration of their ears had stopped. Another 17 ears continued to reveal suppurative secretion in spite of mastoidectomy, mostly because of severe infection (resistant bacteria) or of insufficient mastoidectomy.