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1.
Minerva Ginecol ; 72(1): 43-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32153163

RESUMO

INTRODUCTION: Endometriosis is a chronic hormone-dependent disease affecting approximately 25-30% of women in the third and fourth decade. Despite its frequency, it is often detected late. The aim of this overview article was to present a standardized treatment algorithm for an interdisciplinary endometriosis consultation considering conservative and surgical approaches. EVIDENCE ACQUISITION: Despite the frequency of endometriosis and a high number of publications dealing with the disease there is a lack of evidence in literature for standardized treatment algorithms allowing a rational diagnostic and therapeutic approach. In May 2019 we did a literature search in Medline. While finding 26702 publications under the term "endometriosis" there was only one publication for the search term "endometriosis consultation treatment algorithm." After screening the abstracts 144 publications in English, French or German language had been assessed as relevant for the diagnosis and therapy of endometriosis (143 overview articles and one guideline). EVIDENCE SYNTHESIS: Based on clinical evidence, we have developed a treatment algorithm for women with suspected endometriosis. The diagnosis includes a structured medical history with the identification of endometriosis-typical symptoms and a gynecological examination, if necessary additional examinations. The treatment algorithm is essentially divided into the phase of diagnosis and the phase of therapy as well as the prevention of recurrence or long-term treatment. A multi-professional team of visceral surgery, urology, nutritional medicine, physiotherapy and psychology can be consulted for support. CONCLUSIONS: The treatment of endometriosis should be multiprofessional, standardized and reproducible during specialized consultations at certified centers. So far, there are few publications on a standardized and clinically proven treatment algorithm for women with suspected endometriosis. The presented treatment algorithm could be helpful in the diagnosis and treatment of endometriosis patients, even at other centers.

2.
Ultraschall Med ; 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32198732

RESUMO

PURPOSE: The prediction of successful induction of labor (IOL) has been the subject of a series of studies. The predictive role of cervical sonographic and elastographic parameters has been controversially discussed. Lower uterine segment (LUS) thickness and strain values have not been discussed yet in this regard. MATERIALS AND METHODS: A prospective cohort study was performed to examine the predictive power of Bishop score parameters, sonographic cervical length (CL), cervical funneling, cervical strain values, LUS thickness and its strain values regarding successful IOL within 24 hours and intervals to onset of labor, ROM and delivery of the fetus. A p-value of < 0.05 was considered statistically significant. RESULTS: 135 patients were examined. A cervical length of 25 mm, the presence of cervical funneling and digital shorter cervix was significant for the prediction of successful induction of labor (IOL) within 24 hours. There was weak correlation between the functional CL and the onset of labor (r2 = 0.10) and ROM (r2 = 0.13). There was also a weak correlation between the cervical funnel width and the time interval to the onset of labor (r2 = 0.25), ROM (r2 = 0.23) and delivery of the fetus (r2 = 0.22). Cervical elastography, LUS thickness and strain values were not significant for the prediction of a successful IOL. CONCLUSION: We were able to show that cervical structural changes at the level of the internal os, i. e., shortening through funneling, may be the determining factor for successful IOL.

3.
Arch Gynecol Obstet ; 301(2): 611-618, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31853713

RESUMO

PURPOSE: To evaluate a simulation-based standardized training program for type 1 loop electrosurgical excision procedure (LEEP) under direct colposcopic vision in postgraduate teaching. METHODS: Seventeen participants (five experienced and 12 novice surgeons) performed 170 simulated cervical excisional procedures. Each participant performed 10 type 1 (cone length between 8 and 10 mm) excisional procedures under direct colposcopic vision on a low-fidelity simulator. Length of specimen was measured after each excision allowing the surgeons a subsequent resection to ensure a cone length of more than 8 mm. Main outcome measures were cone length, specimen fragmentation, and a self-developed score (LEEP score), which allowed the simultaneous evaluation of both measured parameters. RESULTS: The precision of the excision showed statistically significant improvement in the novice group during the training procedures after five procedures [LEEP score 1.61 (SD 1.34) vs. 0.46 (SD 0.58); p = 0.023], while experts showed consistently high performance. Inexperienced surgeons performed more frequently cuts that were too deep than experienced surgeons (33/120, 27.5% vs. 4/50, 8%; p = 0.003). CONCLUSIONS: Low-fidelity simulation training seems to be an effective method for learning the accurate cone length for a type 1 excision for novice surgeons. As excessive excisions are related with high risk for premature delivery in subsequent pregnancies, in our opinion, LEEP should be practiced in simulation training, especially before performing in woman of reproductive age.

4.
J Hum Kinet ; 69: 225-230, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31666904

RESUMO

There are resistance training methods that result in strength, others that enhance hypertrophy and others that stimulate power. The training modality of contrast provides all of these benefits in one session. The concept of French Contrast training is based on a combination of complex and contrast methods. The idea is to use four exercises to induce physiological responses of the athlete and train along the force-speed curve. The primary purpose of the study was to investigate the impact of the French Contrast Method on explosive strength and kinematic parameters of the triple jump among female college athletes. Ten female college athletes from the Helwan University's track and field team participated in this study. Participants were assessed before and after an 8-week training program for upper and lower body explosive strength. No significant differences were observed in anthropometric characteristics. Explosive strength variables (Sargent jump test, countermovement jump, and seated medicine ball throw) increased significantly and kinematic parameters of the triple jump improved. The results indicated that eight weeks of the French Contrast training can improve both explosive strength and kinematic parameters of the triple jump.

5.
Geburtshilfe Frauenheilkd ; 79(11): 1171-1175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31736505

RESUMO

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31612696

RESUMO

Objective: The conisation is one of the most common surgical procedures in gynaecology. Nevertheless, corresponding expertise of the surgeon is required. With small cone the oncological risk and with large cone the obstetric risk increase. Our prospective study aimed at finding out whether the self-developed conisation simulator is an appropriate instrument for medical students to learn the practical performance of conisation. Material and Methods: After a previous demonstration a loop conisation was done by the students at the sausage model as part of the gynaecological and obstetric practical clerkship. Then the study doctor was asked about the suitability and the realistic approach of the simulation course and the depth of the cones created by the students (target range 8-10 mm) as well as the LEEP score was measured. The students were asked to answer 12 questions with five answer categories of a questionnaire about the benefits of the course. Results: A total of 89 students participated in the course. The median cone depth was 8 mm (standard deviation 3.3 mm, minimum 3 mm, maximum 25 mm). The observed LEEP score amounted to 1.5. 88 answered the questionnaire (86 in full). The evaluation of the questionnaires showed a great satisfaction with the course of both the physician being in charge of the study and the students. Students considered the course as realistic one and the physician could have imagined all participants to assist in a conisation. Students rated the course consistently positive, especially towards the increase in practical skills. The greatest approval was observed for the statement "I enjoyed the course." and the slightest approval for "I have gained enough self-confidence for the application of high-frequency surgery." Conclusion: Practical surgery exercises on the surgical simulator are considered successful. They should be extended to other gynaecological operations as well as other medical subjects.

7.
Geburtshilfe Frauenheilkd ; 79(9): 949-958, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31523095

RESUMO

Introduction In the treatment of prolapse and incontinence, the choice of surgical procedure often depends not only on the clinical findings but also on the age of the patient. Uncertainty exists at present regarding the effect of patient age on treatment outcomes for both vaginal and laparoscopic procedures. The aim of this study is therefore to compare both the anatomical outcome after prolapse surgery and the functional outcome after incontinence surgery in the context of the treatment of stress urinary incontinence in older and younger patients. Patients/Methods This is a retrospective single-centre study conducted at a university site. Over the study period, a total of 407 women underwent surgery, 278 of whom were < 70 and 129 ≥ 70 years of age. They were assigned to one of three treatment groups (prolapse surgery, incontinence surgery or a combination of both types of surgery) and were then subjected to statistical analysis after assessment of the anatomical and functional outcome after 3 - 6 months. Results The most common form of prolapse among the 407 evaluated patients was in the anterior and middle compartment, with a higher degree of severity being diagnosed in the older patients. Grade 4 prolapse according to the Baden-Walker system was thus present in the anterior compartment in 15.6 vs. 28.8% (p = 0.033) and in the middle compartment in 5.7 vs. 23.7% (p < 0.001) of cases. Younger women underwent vaginal mesh implantation less frequently and laparoscopic sacropexy more frequently for this overall. The proportion of cases of combined prolapse and incontinence surgery was the same in both groups. Overall, high success rates were observed in both younger and older patients following prolapse and incontinence surgery. These rates were 93.5 vs. 84.8% (p = 0.204) after prolapse surgery and 92.8 vs. 84.2% (p = 0.261) after incontinence surgery. A significant disadvantage for the older patients was the persistence of stress urinary incontinence after prolapse surgery alone (19.6 vs. 50%, p = 0.030) and the rate of occult (de novo) stress urinary incontinence (7.4 vs. 20%, p = 0.030). Conclusion Our data show that both pelvic organ prolapse and stress urinary incontinence can be treated with surgery with good results in women aged ≥ 70 years. It was thus possible to show for the first time in a large patient population that older women should not be denied appropriate surgery but can be offered the same range of surgical options as younger patients.

8.
Minerva Ginecol ; 71(4): 298-305, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993959

RESUMO

INTRODUCTION: Protecting fertility in the presence of cancer has become highly significant, as the desire to give birth to a child is increasingly postponed to later in life, and long-term survival with cancer has increased. A variety of fertility-preserving methods have been developed. EVIDENCE ACQUISITION: To find them, we performed a literature search in Medline using the key words "female fertility preservation in cancer" in December 2017. A total of 2381 different publications were found. EVIDENCE SYNTHESIS: After screening the abstracts 78 publications in English, French, or German language had been assessed as relevant (17 dealing with medical approaches, six with surgical approaches, 15 with oocyte cryopreservation, 11 with ovarian tissue cryopreservation and 29 were review articles). In general, there are medical (non-surgical) and surgical approaches. Medical approaches comprise administration of GnRH-analogues during gonad toxic oncologic treatment, and cryopreservation of oocytes after ovarian stimulation. Surgical approaches comprise traditional methods of organ-saving surgery and ovarian transposition outside of the radiation portal as well as ovary cryopreservation as standard. CONCLUSIONS: It is important to inquire about a prospective desire to have children with premenopausal women with cancer and comprehensively explain the fertility conserving methods available. Every premenopausal woman with cancer should be counseled about the methods of fertility protection currently available at a multiprofessional center.


Assuntos
Criopreservação/métodos , Preservação da Fertilidade/métodos , Neoplasias/terapia , Feminino , Humanos , Oócitos/metabolismo , Ovário/metabolismo
9.
Arch Gynecol Obstet ; 299(6): 1557-1566, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30953183

RESUMO

BACKGROUND: Prenatal measurement of placental biomarkers was able to improve screening and diagnosis of preeclampsia. Little is known about the clinical role of placental biomarkers in the postpartum period. METHODS: This study is a prospective monocentric trial that included a total of 30 women with preeclamptic pregnancies. Serum placental biomarkers including soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured before and 2 h after delivery by Enzyme-Linked Immunosorbent Assay (ELISA) using commercially available kits according to manufacturer's instructions and correlated with the postpartum outcome. RESULTS: Postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure. Yet, the placental biomarkers were not able to predict general worsening of postpartum preeclampsia or other individual clinical or laboratory parameters. CONCLUSION: Serum concentrations of sFlt-1 and PlGF or their ratio in our study cohort did not completely predict the occurrence of postpartum preeclampsia. Yet, postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure.

10.
J Matern Fetal Neonatal Med ; : 1-5, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30897985

RESUMO

In accordance with women's preferences guidelines, referring to population-based and randomized trials, which recommends counseling women with vertex-first twins to attempt a vaginal delivery. Yet, the rising rates of twin caesareans are associated with the decline in skills of senior and junior obstetricians. Although noncephalic second twins have been in the focus of interest, prompt delivery of cephalic second twins can be trickier when the head does not engage. We illustrate how to avoid complications during instrumental delivery or internal podalic version and breech extraction of the second twin encouraging to start when membranes are still intact.

11.
Arch Gynecol Obstet ; 299(3): 817-824, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30607581

RESUMO

PURPOSE: We address the impact of applying loop electrosurgical excision procedure (LEEP) under direct colposcopic vision teaching to our undergraduates using a self-developed simulation model and a standardized assessment to evaluate the progress of learning. METHODS: The undergraduate teaching module was composed of a theoretical course on cervical dysplasia, colposcopy, electrosurgery and excisional procedures of the uterine cervix. This was followed by hands-on practical rounds. During the hands-on practice the students performed five "type 1" LEEP under direct colposcopic vision on the self-developed simulator. Based on specimen fragmentation and excision accuracy a score system was established. The students were asked to answer a course evaluation questionnaire. RESULTS: The accuracy of the excisions showed a statistically significant improvement during the five training procedures (excision depth 7.34 ± 1.60-8.54 ± 1.67 mm, p = 0.0041; deviation from target cone thickness 0.88 ± 1.16-0.13 ± 0.94 mm, p = 0.0116). The fragmentation of the conus decreased (2.57 ± 1.26-1.29 ± 0.60 pieces, p < 0.0001). All this led to a general improvement of the LEEP score (2.59 ± 1.93-0.84 ± 1.03, p = 0.001). The student's questionnaire revealed a subjective satisfaction and improvement of their knowledge in pathomechanism, diagnosis and therapy of cervical pathologies. CONCLUSION: Undergraduate surgical training, in cervical excisional procedure, is a successful method in improving the students' perception and management of cervical pathologies.

12.
Ann Anat ; 221: 101-107, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30300688

RESUMO

Anatomy is a cornerstone of medical undergraduate curricula. Due to increasing changes in various medical fields, a lot of new subjects were introduced in undergraduate curricula, while the teaching areas of basic sciences, i.e. anatomy, were reduced. The introduction of advanced diagnostic and therapeutic devices, i.e. ultrasound and laparoscopy, with outstanding imaging quality will be increasingly introduced in basic sciences. In our project, we examined the effect integrating ultrasound and laparoscopy in an anatomy undergraduate course to illustrate the female pelvis. Anatomy students that completed their practicum and cadaver dissection course were enrolled in our project. They received a theoretical introduction followed by a practical course of ultrasound or laparoscopy in the department of obstetrics and gynaecology. Following the course the students had to answer two questionnaires that evaluated their satisfaction, subjective knowledge-gain, problems and content of the course. At the end, a closing briefing was done to discuss the clinical skills and the course. The answers of the questionnaire were summed up in a Likert scale. 25 students were enrolled in the project. 52% attended laparoscopy operations, while 48% attended ultrasound examinations. After analysing the questionnaires using Likert scales (1=strongly agree, 5=strongly disagree) a general satisfaction of 1.5, a subjective knowledge gain of 2.4 and a thrive to extend these clinical skill programs in gynaecology and other specialities in basic science of 1.5 and 1.2, respectively, was reported. There were no statistically significant differences in the Likert scores between both groups (p>0.05). The introduction of ultrasound and laparoscopy in undergraduate basic science teaching programs is a promising method and should be further evaluated, standardized and expanded.


Assuntos
Anatomia/educação , Competência Clínica , Pelve/anatomia & histologia , Estudantes de Medicina , Voluntários , Anatomia/economia , Currículo , Educação de Graduação em Medicina , Feminino , Ginecologia/educação , Humanos , Laparoscopia/educação , Masculino , Obstetrícia/educação , Pelve/diagnóstico por imagem , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Ultrassonografia
13.
Swiss Med Wkly ; 148: w14658, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30378639
14.
Arch Gynecol Obstet ; 298(4): 773-779, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30116930

RESUMO

PURPOSE: To evaluate instrumental usage in laparoscopic gynecological surgeries and to develop key timesets of a laparoscopic operation, which allows categorization of the operation time into different sections. METHODS: In this prospective clinical observational study, frequency of instrument usage, time for instrument switches, and instrument utilization time were recorded in a standardized manner for laparoscopic surgeries in 103 endoscopic surgeries. RESULTS: A standard equipment (including atraumatic grasping forceps, irrigation and suction device, bipolar clamp, and laparoscopic scissors) was used for nearly all interventions. Bipolar clamps and scissors were changed most frequently. The tool used for the longest amount of time was the atraumatic grasping forceps. Laparoscopic instruments were switched 51 times per surgery (range 2-250 times). One instrument switch lasted for a median of 0.13 min (0.08-1.2 min). Median time for instrument switch for a single surgery added up to 6.83 min. Instrument switches required 10.5% of the overall operation time. CONCLUSION: We analyzed the current instrument usage in laparoscopic gynecological surgeries. The results of our standardized investigation suggest ways to reduce the time required for surgery and provide starting points for the standardization of the work routine.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/instrumentação , Laparoscopia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Adulto Jovem
15.
Ultraschall Med ; 38(1): 71-77, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25734411

RESUMO

Purpose To assess cervical elasticity in different regions by sonoelastography, to compare the results to the Bishop score, cervical length, week of pregnancy and other maternal factors (age, weight, parity) and to evaluate the reproducibility of the method. Materials and Methods 131 patients between 17 - 41 gestational weeks were examined by transvaginal cervical strain elastography. In the sagittal view strain values were calculated in 7 regions of interest (ROI; external and internal os anterior/posterior, middle part anterior/posterior, cervical canal). In the cross sectional views strain values in 3 ROIs were evaluated at the level of the internal and external cervical os (anterior/posterior, cervical canal). The intra- and interobserver variance was tested. Results Strain values differed highly significantly in different parts of the cervix (p < 0.001). The anterior parts and the cervical canal were significantly softer with increasing gestational age and Bishop score, and the posterior parts were significantly harder with increasing maternal age, weight, parity. Cervical length showed an inverse relationship to cervical softness. The intra- and interobserver variance was low. Conclusion Elastography is a reproducible method for the evaluation of cervical elasticity in pregnancy. It showed a significant association with the Bishop score and other maternal factors and could provide additional information about changes in cervical stiffness in pregnancy.


Assuntos
Colo do Útero/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Endossonografia/métodos , Complicações na Gravidez/diagnóstico por imagem , Adulto , Medida do Comprimento Cervical/métodos , Colo do Útero/fisiopatologia , Elasticidade , Feminino , Idade Gestacional , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/fisiopatologia , Estudos Prospectivos , Adulto Jovem
16.
PLoS One ; 11(11): e0166659, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27898669

RESUMO

INTRODUCTION: Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. MATERIAL AND METHODS: All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). RESULTS: Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7-35.2)) and EQ-5D scores (1 (0.61-1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2-33.5); 0.9 (0.2-1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. CONCLUSION: Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.


Assuntos
Laparoscopia , Leiomioma/cirurgia , Pré-Menopausa/fisiologia , Qualidade de Vida , Comportamento Sexual/fisiologia , Miomectomia Uterina/efeitos adversos , Adulto , Estudos de Coortes , Feminino , Humanos , Leiomioma/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos
17.
Int J Gynaecol Obstet ; 134(2): 225-30, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27233815

RESUMO

OBJECTIVE: To evaluate the learning process for total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSH) for benign uterine pathologies among surgeons inexperienced in laparoscopy. METHODS: A retrospective comparative study was conducted of all hysterectomies performed by four attending surgeons and three resident surgeons at a tertiary university center in Homburg/Saar, Germany. Laparoscopic procedures were assessed between October 1, 2009, and October 31, 2010 (period A); November 1, 2010, and March 31, 2012 (period B); and April 1, 2012, and June 30, 2013 (period C). Data were obtained by medical chart review. RESULTS: Overall, 269 patients underwent TLH and 165 underwent LSH. Duration of surgery for all surgeons decreased from 136 ± 60 minutes in period A to 118 ± 44 minutes in period B (P=0.013), but increased to 122 ± 56 minutes in period C (A vs C: P=0.067). Among attending surgeons, the duration of surgery seemed to decrease after 20 TLH procedures and after 10 LSH procedures. Among resident surgeons, duration decreased after 10 LSH procedures; no fall was apparent for TLH. CONCLUSION: Both TLH and LSH were readily adopted among a group of surgeons inexperienced in laparoscopy, although LSH might be easier to learn. Experienced surgeons have a steeper learning curve than do their inexperienced counterparts.


Assuntos
Histerectomia/educação , Laparoscopia/educação , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Complicações Pós-Operatórias/epidemiologia , Útero/cirurgia , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Tempo de Internação , Modelos Lineares , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Doenças Uterinas/cirurgia
18.
Prenat Diagn ; 36(4): 332-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26847019

RESUMO

OBJECTIVE: The objective of this study is to examine the association of lateral fetal neck cysts with increased nuchal translucency, chromosomal abnormalities and fetal malformations. METHOD: In a consecutive collective of 4216 prenatal ultrasound examinations between 11 and 17 weeks of gestation 32 fetuses with lateral neck cysts were found. The size of the cysts was examined. The association of the findings with increased nuchal translucency, chromosomal aberrations and fetal malformations was examined. RESULTS: All but two out of 32 cases had bilateral cysts. Seventeen fetuses had aneuploidy and an increased nuchal translucency, 15 of those with major structural malformations. Of the 15 fetuses with normal karyotype nine (60%) had an increased nuchal translucency, seven had a fetal malformation or hydrops. A favorable outcome was found in 6/15 fetuses with normal karyotype and normal nuchal translucency. Lateral neck cyst diameter was associated to nuchal translucency, chromosomal abnormality and/or fetal malformations. Cysts smaller than 3 mm had a favorable outcome even in the presence of an increased nuchal translucency. CONCLUSION: Fetuses with lateral neck cysts often not only present with increased nuchal translucency and chromosomal aberrations but also with fetal malformations. Fetuses with lateral neck cysts and increased nuchal translucency were aneuploid or had a fetal malformation in 85%. Cysts smaller than 3 mm had a favorable outcome. © 2016 John Wiley & Sons, Ltd.


Assuntos
Transtornos Cromossômicos/diagnóstico por imagem , Cistos/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Aberrações Cromossômicas , Transtornos Cromossômicos/genética , Cistos/congênito , Cistos/genética , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição da Translucência Nucal , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos
19.
Biomed Res Int ; 2015: 860784, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25961042

RESUMO

INTRODUCTION: Sacropexy is a generally applied treatment of prolapse, yet there are known possible complications of it. An essential need exists for better alloplastic materials. METHODS: Between April 2013 and June 2014, we performed a modified laparoscopic bilateral sacropexy (MLBS) in 10 patients using a MRI-visible PVDF mesh implant. Selected patients had prolapse POP-Q stages II-III and concomitant OAB. We studied surgery-related morbidity, anatomical and functional outcome, and mesh-visibility in MRI. Mean follow-up was 7.4 months. RESULTS: Concomitant colporrhaphy was conducted in 1/10 patients. Anatomical success was defined as POP-Q stage 0-I. Apical success rate was 100% and remained stable. A recurrent cystocele was seen in 1/10 patients during follow-up without need for intervention. Out of 6 (6/10) patients with preoperative SUI, 5/6 were healed and 1/6 persisted. De-novo SUI was seen in 1/10 patients. Complications requiring a relaparoscopy were seen in 2/10 patients. 8/10 patients with OAB were relieved postoperatively. The first in-human magnetic resonance visualization of a prolapse mesh implant was performed and showed good quality of visualization. CONCLUSION: MLBS is a feasible and safe procedure with favorable anatomical and functional outcome and good concomitant healing rates of SUI and OAB. Prospective data and larger samples are required.


Assuntos
Laparoscopia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Idoso , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Prospectivos , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento
20.
J Hum Kinet ; 40: 77-82, 2014 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-25031675

RESUMO

Taekwondo and judo competitions are divided into weight categories. Many athletes reduce their body mass a few days before competition in order to obtain a competitive advantage over lighter opponents. To achieve fast body mass reduction, athletes use a number of nutritional strategies, including choline supplementation. The goal of this study was to identify the effects of choline supplementation on body mass reduction and leptin levels among female taekwondo and judo athletes. Twenty-two female athletes (15 taekwondo and 7 judo athletes) were selected from different weight categories and divided into two groups, according to weight. The players in the experimental group took choline tablets for one week before a competition. The results revealed significant differences between pre- and post-competition measurements of leptin, free plasma choline, urine choline and urine malondialdehyde levels; body mass was also reduced in the post-competition measurements. In conclusion, choline supplementation could rapidly reduce body mass without any side effects on biochemical levels or static strength.

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