Survey of current practices and opinions of German Society of Gynecologic Endoscopy members regarding the treatment of ovarian neoplasia by robotic surgery.

PURPOSE: As data on this topic are sparse and contradictory, we aimed to ascertain the opinions of the members of the German Society of Gynecologic Endoscopy (AGE) regarding the use of robotic surgery in the treatment of ovarian malignancies. METHODS: In 2015, an anonymous questionnaire was sent to AGE members to assess their views on the treatment of ovarian malignancies by robotic surgery according to T stage and the current treatment practices in their facilities. RESULTS: Of the 228 respondents, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [n = 218 (96%)] respondents reported treating < 10% of their patients using robotic surgery. Respondents felt that T1 and borderline ovarian tumors, but not T2 (51%) or T3/4 (76%) tumors, should and could be treated by robot surgery. 162 (71%) respondents considered the currently available data on this subject to be insufficient, and 42% indicated their willingness to participate in clinical studies on the applicability of robotic surgery to the treatment of T1/2 ovarian tumors. CONCLUSION: The majority of AGE members surveyed considered robotic surgery to be an option for the treatment of T1 ovarian malignancies and borderline ovarian tumors. However, prospective randomized studies are needed to determine the relevance of robotic surgery in this context.

Impact of different intraoperative CO2 pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO2 : a prospective randomised controlled clinical trial.

OBJECTIVE: To compare the effects of two different intraoperative CO2 pressures (8 and 15 mmHg) during laparoscopic hysterectomy for benign uterine pathologies in terms of postoperative abdominal and shoulder pain, laparoscopy-mediated vegetative alterations, pain medication requirement, arterial CO2 pressure (pCO2 ), surgical parameters, and safety. DESIGN: Prospective randomised controlled study. SETTING: German university hospital. POPULATION: Female patients undergoing laparoscopic hysterectomy for benign uterine pathologies. METHODS: Patients were randomised to a standard pressure (SP; 15 mmHg, control) or low-pressure (LP; 8 mmHg, experimental) group. MAIN OUTCOME MEASURES: Primary outcomes were postoperative abdominal and shoulder pain intensities, measured via numeric rating scale (NRS) and vegetative parameters (fatigue, nausea, vomiting, bloating) at 3, 24, and 48 hours postoperatively. Secondary outcomes were pain medication requirement (mg) and arterial pCO2 (mmHg). Surgical parameters and intra- and postoperative complications were also recorded. RESULTS: In total, 178 patients were included. Patients in the LP group (n = 91) showed significantly lower postoperative abdominal and shoulder pain scores, fewer vegetative alterations, lower pain medication requirements, a shorter postoperative hospitalization, and lower intra- and postoperative arterial pCO2 values compared with the SP group (n = 87; P ≤ 0.01). No differences in intra- and postoperative complications were observed between groups. CONCLUSIONS: Low-pressure laparoscopy seems to be an effective and safe technique for the reduction of postoperative pain and laparoscopy-induced metabolic and vegetative alterations following laparoscopic hysterectomy for benign indications. TWEETABLE ABSTRACT: Low-pressure laparoscopy seems to be an effective and safe technique for reduction of pain following laparoscopic hysterectomy.

Transverse pion structure beyond leading twist in constituent models.

The understanding of the pion structure as described in terms of transverse-momentum-dependent parton distribution functions (TMDs) is of importance for the interpretation of currently ongoing Drell-Yan experiments with pion beams. In this work we discuss the description of pion TMDs beyond leading twist in a pion model formulated in the light-front constituent framework. For comparison, we also review and derive new results for pion TMDs in the bag and spectator model.

Linking MRI to daily life experience: the example of poststroke depression.

OBJECTIVE: The state-of-the-art tools of neurology, in particular modern neuroimaging techniques, have yet to benefit from the revolution in mobile technologies that provide new insights into the mechanisms underlying clinical syndromes. This study demonstrates the manner in which mobile technologies may provide information that is complementary to MRI data, using the illustration of poststroke depression. METHODS: MRI examinations were provided to 15 stroke patients, followed by computerized ambulatory monitoring of daily life experiences over 1 week. RESULTS: The occurrence of daily life events was significantly associated with the intensity of positive affect during the ambulatory monitoring period. This emotional reactivity was also significantly associated with functional connectivity in brain regions linked with the risk of depression 3 months following stroke. CONCLUSIONS: Novel mobile technologies provide information that is inaccessible to hospital-based tests, and allow for more complete investigations of disorder expression and etiology.

Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers in atrial fibrillation.

Atrial fibrillation is the most prevalent clinically relevant arrhythmia; a major cause of morbidity and hospitalization. Additionally, atrial fibrillation carries a significant risk of thrombo-embolic events, specifically cerebrovascular accident. Among the most prevalent risk factors for atrial fibrillation, hypertension not only has the strongest correlation but is also the most prevalent. The renin-angiotensin-aldosterone system represents a prime target for the treatment of hypertension through the use of angiotensin-converting enzymes inhibitors and angiotensin II receptor blockers. In addition to blood pressure control, these medications have been shown to reduce the occurrence of atrial fibrillation. They have been shown to have effects at the cellular level in preventing atrial fibrosis. Additionally, these medications may prevent the development ofatrial fibrillation, reduce the duration of atrial fibrillation, and facilitate electrical cardioversion in patients with the arrhythmia. Therefore, patients with, or at risk for atrial fibrillation may benefit from treatment with renin-angiotensin-aldosterone system antagonists; deriving benefits from these medications beyond simple blood pressure control.

Cardiac arrhythmias in obstructive sleep apnea.

Obstructive sleep apnea syndrome (OSA) is associated with different types of cardiac arrhythmias. The original studies, concentrated mostly on nocturnal brady- and tachyarrhythmias. More recent studies documented high prevalence of atrial fibrillation (AF) and its association with obesity and other risk factors for AF. In addition, continuous positive airway pressure (CPAP) prevents recurrence of AF after cardioversion. In, OSA the highest risk for sudden death is at night in comparison to general population most of who die suddenly between six and noon. This observation suggests that hypoxia or other nocturnal abnormality, trigger sudden death. An important recent finding is the beneficial effect of CPAP on sudden death. The role of pacing in OSA remains controversial. In general, pacemaker therapy is not indicated in patients with nocturnal bradyarrhythmias. However, some authors recommend pacing in those with severe nocturnal bradyarrhythmias not tolerating or not responding to CPAP. According to a recent study, 59% of patients with permanent pacemaker have OSA.

[Professor MUDr. Frantisek Pór's School of Internal Medicine]. / Internistická skola profesora MUDr. Frantiska Póra.

The article pays tribute to prof. MUDr. Frantisek Pór and his significant role in the development of internal medicine in Kosice and in Eastern Slovakia, where he actively pursued his profession from 1945 to 1971. He was the founder of the school of internal medicine in the proper sense of the word having laid down its organisation, therapy and prevention, training and research bases. His pupils, and the pupils of his pupils, have carried on his legacy till this day. This fact was remembered on the occasion of the 15th commemoration held by the Kosice Doctors' Association in his honour and memory and on the occasion of the upcoming 60th anniversary of the foundation of the Faculty of Medicine at Pavol Jozef Safárik University in Kosice.

Persistence of improvement in insulin sensitivity following a dietary weight loss programme.

AIM: Short-term dietary weight loss can improve insulin resistance but long-term studies are lacking. We sought to quantify the degree to which maintenance of weight loss after a short-term dietary intervention was associated with persistent metabolic benefits. METHODS: Fifty-seven insulin-resistant obese subjects had insulin-mediated glucose disposal quantified through the steady-state plasma glucose (SSPG) test, and associated metabolic risk markers quantified at baseline, after a 16-week dietary weight loss intervention, and in 25 subjects, at follow-up of 28.8 +/- 13 months. Changes in metabolic variables over time were analysed and correlation with weight loss ascertained. Those with greatest vs. least long-term SSPG response (responders vs. non-responders) were compared. Multivariate analysis was performed for predictors of persistent SSPG response. RESULTS: At follow-up, the 25 subjects who returned for metabolic testing had, on average, maintained their weight loss. Insulin-mediated glucose disposal remained significantly improved vs. baseline, as did plasma triglyceride and HDL cholesterol (HDL-C) concentrations, and improvement correlated with total amount of weight lost. Comparison of SSPG responders to non-responders showed no difference in amount of weight lost and SSPG change during the 16-week dietary intervention; however, SSPG non-responders regained 2.6% of weight lost, whereas responders lost an additional 1.5% at follow-up (p < 0.05 vs. non-responders). Non-responders had baseline characteristics consistent with more severe insulin resistance, including higher fasting plasma glucose (p = 0.03). Long-term SSPG change was independently predicted by both total weight loss (p = 0.005) and baseline fasting plasma glucose (p = 0.007). CONCLUSIONS: Improvement in insulin sensitivity is maintained for 2-3 years following dietary weight loss if weight is not regained. Triglyceride and HDL-C concentrations also remain improved over time, consistent with improvement in insulin sensitivity. Fasting glucose and weight regain predict less long-term response in insulin sensitivity. These results highlight the potential long-term benefits of weight loss and importance of preventing weight regain among high-risk individuals.

Single nucleotide polymorphisms refine QTL intervals for hip joint laxity in dogs.

Hip laxity is one characteristic of canine hip dysplasia (CHD), an inheritable disease that leads to hip osteoarthritis. Using a genome-wide screen with 250 microsatellites in a crossbreed pedigree of 159 dysplastic Labrador retrievers and unaffected greyhounds, we previously identified putative (P < 0.01) QTL on canine chromosomes 11 and 29 (CFA11 and CFA29). To refine these QTL locations, we have genotyped 257 dogs including 105 Labrador retrievers, seven greyhounds, four generations of their crossbreed offspring and three German shepherds for 111 and 171 SNPs on CFA11 and CFA29 respectively. The distraction index (DI, a measure of maximum hip laxity) was used as an intermediate phenotype that predicts whether a hip joint will or will not develop osteoarthritis. Using a multipoint linkage analysis, significant evidence (95% posterior probability) was found for QTL contributing to hip laxity in the 16.2-21 cM region on CFA11 that explained 15-18% of the total variance in DI. Evidence for an independent QTL on CFA29 was weaker than that on CFA11. Identification of the causative mutation(s) will lead to better understanding of biochemical pathways in both dogs and humans with hip laxity and dysplasia.

Non-arrhythmic therapy of ventricular tachyarrhythmias and sudden cardiac death after acute myocardial infarction.

The management of ventricular tachyarrhythmias and prevention of sudden cardiac death after acute myocardial infarction (AMI) underwent important evolution. In the CAST study, encanaide and other antiarrhythmic drugs were not only ineffective but also increased mortality after myocardial infarction. Amiodarone had some beneficial effect on arrhythmic events without improving survival, and ICDs failed to improve outcome early after AMI. In comparison, short and long term survival benefits of beta blockers, angiotensine converting enzyme inhibitors and aldosterone antagonists after AMI is well established. This review discusses the role of non-arrhythmic therapy in the prevention of ventricular tachyarrhythmia's and sudden cardiac death after AMI.

The use of common elder Sambucus nigra to promote Aphidophagous syrphids in apple orchards.

Elder shrubs (Sambucus nigra L.) were planted in an experimental apple orchard as bordering hedgerow with the objective of rearing syrphids (Diptera: Syrphidae) and consequently enhancing the biological control of the rosy apple aphid Dysaphis plantaginea (Passerini). The inoculative introduction of the specific elder aphid Aphis sambuci L. (Homoptera: Aphididae) in late March 2002 and again in 2003 led to the complete hedgerow turning into an early and productive alternative prey reservoir for indigenous syrphids. The species Scaeva pyrastri (L.), S. selenetica (Meigen), Syrphus ribesii (L.), S. vitripennis Meigen, Epistrophe eligans (Harris), E. nitidicollis (Meigen), Platycheirus scutatus (Meigen), Eupeodes corollae (F.), Meligramma triangulifera (Zetterstedt) and Episyrphus balteatus (De Geer) developed on the elder hedgerow during the spring 2002 taking advantage of the aphid infestation. The season 2003 was characterised by a quite different species abundance pattern as, contrary to the previous year when both monovoltine and polyvoltine species were equally represented, the monovoltine syrphids (Epistrophe spp.) represented the dominant group exploiting the elder aphids. A parallel analysis showed that the faeces of the first adult syrphids observed ovipositing on the elder hedgerow in spring contained digested pollen of mainly apple. Our observations indicate the possibility of establishing a local population of monovoltine syrphids in apple orchards by managing an aphid-infested elder hedgerow, without any additional pollen or nectar producing plants.

Serum and liver micronutrient antioxidants and serum oxidative stress in patients with chronic hepatitis C.

OBJECTIVES: The exact pathogenesis of liver injury and fibrosis in chronic hepatitis C (CHC) is unclear. Free radicals play a role in CHC liver damage. Antioxidants (AO) (enzymatic and nonenzymatic) scavenge free radicals and prevent tissue injury. The aims of our study were to estimate serum levels of malondialdehyde (MDA), serum and liver levels of nonenzymatic fat-soluble AO, and to correlate the liver AO levels with the degree of inflammation and fibrosis on biopsy. METHODS: AO levels were estimated by high-pressure liquid chromatography in the pretreatment serum and liver biopsy specimen of 20 treatment-naïve patients with CHC who were not on vitamin supplements. Serum levels of MDA were measured as a marker of increased oxidative stress. Twenty-two healthy individuals with no history of vitamin supplementation served as controls. AO analyzed were: retinol, alpha- and gamma-tocopherol, lutein, beta-cryptoxanthin, lycopene, and alpha- and beta-carotene. RESULTS: Twenty CHC patients (11 men, nine women, mean age 48.5 +/- 7.9 yr) were studied. Patients and controls were comparable in age and sex. Serum MDA levels were significantly higher in CHC patients compared with controls (1.62 +/- 0.57 vs 0.23 +/- 0.15 micromol/L, p = < 0.0000). Serum levels of all AO except lutein were significantly decreased in CHC patients, and their levels were two to ten times lower than serum levels in controls. Liver levels of alpha-carotene (p = 0.0004), beta-carotene (p = 0.006), and lutein (p = 0.002) correlated with the serum levels, whereas the levels of retinol, alpha-tocopherol, lycopene, and beta-cryptoxanthin showed no correlation. Serum MDA levels were significantly higher in patients with moderate-to-severe inflammation or fibrosis compared with those with mild inflammation or fibrosis. The levels of all liver AO except alpha-carotene were significantly lower in patients with moderate-to-severe fibrosis. The severity of inflammation (portal or lobular) did not affect liver AO levels. CONCLUSIONS: Our findings suggest that increased oxidative stress is present in patients with CHC. Micronutrient AO are severely depleted in serum and liver tissue of patients with CHC, and liver levels of some AO appear to reflect serum levels. Increasing fibrosis is associated with decreased liver AO levels indicating that severe disease may be a consequence of AO depletion or decreased liver storage resulting from fibrosis.

Willem Einthoven--inventor of electrocardiography.

Willem Einthoven, the inventor of the string galvanometer electrocardiograph, was born in the Dutch East Indies, studied medicine in Utrecht Holland, and became chairman of the Department of Physiology at the University of Leiden. In 1924 he was awarded the Nobel Price for physiology and medicine. Einthoven became interested in electrophysiology after Waller's demonstration of the human electrogram using Lippmann's capillary electrometer. Because of important limitations of this device, Einthoven decided to construct the string galvanometer to be used for physiological research and in clinical medicine. Einthoven's main achievements in electrophysiology were the description of the normal ECG, some physiological effects on the ECG, the three ECG leads and the triangle rule. In 1906 in cooperation with the university hospital, Einthoven demonstrated the clinical usefulness of the electrocardiograph.

A history of atrial fibrillation.

Vulpian in France and Hoff and Ludwing in Germany first studied atrial fibrillation in experimental animals. In clinical medicine, de Senac and others, first observed irregular and fast pulse. Hering in 1903 described "pulsus irregularis perpetuus" as a distinct arrhythmia. Hering believed, that this was an extrasystolic rhythm disturbance, while Cushny and Edmunds suggested atrial fibrillation as its cause. Mackenzie was another British author who played an important role in the clarification of atrial fibrillation, particularly after Cushny convinced him, that the so-called nodal rhythm was atrial fibrillation. Einthoven reported the first ECG of atrial fibrillation without recognizing its true nature. Finally in 1909 and 1910 Lewis in London and, Rothberger and Winterberg in Vienna established atrial fibrillation as a clinical entity.

The role of the initial 12-lead ECG in risk stratification of patients with acute coronary syndrome.

This article reviews the prognostic significance of the initial 12 lead ECG in acute coronary syndrome (ACS). In patients with non ST segment elevation ACS, the initial ECG may vary from a normal one to an ECG which demonstrates T wave inversion and ST segment deviation. Patients, who present with either a normal ECG or T wave inversion in less than 5 leads, are considered to be at low risk. Those patients who have ST segment depression or a combination of ST segment depression and elevation have the highest incidence of cardiac death, re-infarction and recurrent chest pain. In patients with ST segment elevation ACS, the mortality and morbidity is mostly influenced by infarct size. The ECG findings which correlate with infarct size are 1) the degree and extent of ST segment elevation, 2) the infarct related coronary artery and 3) distortion of the terminal portion of the QRS complex. Patients with acute anterior wall myocardial infarction due to a proximal occlusion of the left anterior descending (LAD) coronary artery have the worst short and long-term prognosis. The ECG manifestation of a proximal left anterior descending artery occlusion is ST segment elevation in lead aVL and the precordial leads, combined with ST segment depression in the inferior leads. With regard to patients who have an acute inferior wall myocardial infarction, the patients at highest risk are those with a proximal right coronary artery (RCA) occlusion artery and posterolateral extension. The ECG findings in proximal right coronary artery occlusion are ST segment in the inferior leads and in V4R. Less frequently ST segment elevations may be present in lead V1 and V2. Patients with posterolateral wall extension can be identified by the presence of ST segment depression in the right precordial leads. Finally, distortion of the terminal portion of the QRS complex is an important indicator of poor outcome. (Fig. 3, Ref. 42.)

Adenosine induced monomorphic ventricular tachycardia.

Polymorphic ventricular tachycardia has been reported following the administration of adenosine for the treatment of SVT. We present a case of monomorphic ventricular tachycardia in a 75-year-old man following the intravenous administration of adenosine for stress testing.