Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
1.
Int Urogynecol J ; 34(8): 1987-1989, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36897370

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications. METHODS: Video footage shows the laparoscopic management of mesh failure and mesh erosion after sacrocolpopexy with narrated video sequences of two patients. RESULTS: Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable. The video deals with two women referred to our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, after laparoscopic sacrocolpopexies that were carried out in remote hospitals. Both patients were asymptomatic more than 1 year after surgery. CONCLUSIONS: Complete mesh removal after sacrocolpopexy and repeat prolapse surgery can be challenging but is feasible and is aimed at improving patients' complaints and symptoms.


Assuntos
Laparoscopia , Prolapso de Órgão Pélvico , Prolapso Uterino , Feminino , Humanos , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Prolapso Uterino/cirurgia , Vagina/cirurgia
2.
Int Urogynecol J ; 33(6): 1601-1608, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35129645

RESUMO

INTRODUCTION AND HYPOTHESIS: Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. The paucity of data on long-term outcome after PUR contributes to these drawbacks. The aim of this study was to assess long-term persistence of elevated PVR (post-void residual urine) volume after PUR. Pathophysiology, risk factors and management of PUR are reviewed. METHODS: In our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, all patients who were referred for PUR were asked to participate in this study. PVR was measured sonographically every 2 days until day 15, then after 6, 12, 24 and 36 months and, if increased, the patients were instructed to perform clean intermittent self-catheterization. If retention persisted longer than the lactation period, multichannel urodynamics was performed. RESULTS: Sixty-two patients were included. The median PVR normalized at day 7. Long-term voiding disorders were found in 8.2%, 6.7%, and 4.9% after 1, 2, and 3 years respectively. Multichannel urodynamics confirmed in all patients with persisting retention an acontractile detrusor and de novo stress urinary incontinence in 4 cases. Quantile regression did not reveal any factor contributing to earlier recovery. Eighty-nine percent of the patients with PUR had operative vaginal deliveries, emphasizing the importance of this risk factor for PUR. CONCLUSIONS: In most cases PUR resolves early, but voiding difficulties persist more often than previously thought, and for these patients the consequences are devastating. Obstetric awareness, early active management, and developing management strategies in the postpartum period might preclude lower urinary tract morbidity.


Assuntos
Cateterismo Uretral Intermitente , Transtornos Puerperais , Retenção Urinária , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Cateterismo Uretral Intermitente/efeitos adversos , Período Pós-Parto , Gravidez , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Retenção Urinária/terapia
3.
AAPS PharmSciTech ; 23(7): 233, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-36002610

RESUMO

The manufacturing of biopharmaceutical drug solutions can involve close contact with various polymeric components, including common filter membranes. Potential leachable substances from filters may interact with the protein and thereby increase the structural damage and aggregation. The main aim of the study deals with the assessment of extractable and leachable (E/L) from different filters and the potential effect of E/Ls on protein (human granulocyte-colony stimulating factor (rh-GCSF) stability. The present study examines the E/L profile of five different polymeric filter membranes using various chromatographic techniques including LC-MS and GC-MS. In order to investigate their effect on protein stability, G-CSF (human granulocyte colony-stimulating factor) formulations were spiked with filter leachable stock solutions at two different pH levels. The spiked formulations were further analyzed with respect to their aggregation behavior. The results demonstrated a higher E/L content in the case of polyamide (PA), polycarbonate (PC), and polyethersulfone (PES) filters as compared to the polytetrafluoroethylene (PTFE) and regenerative cellulose (RC) filter materials. The E/L from RC and PES was found surface-active, whereas E/L from PA and RC significantly altered the particle size/structure resulting in the aggregation of proteins. Furthermore, bisphenol A was found to be one of the E/L substances from PC filters and can impose significant health problems when administered along with pharmaceutical products. The present study reports a qualitative rank ordering of the filter membranes in terms of their propensity to generate E/Ls and thus can be helpful in selecting a suitable membrane filter.


Assuntos
Celulose , Proteínas , Cromatografia Líquida , Contaminação de Medicamentos/prevenção & controle , Embalagem de Medicamentos , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Espectrometria de Massas , Preparações Farmacêuticas , Proteínas/química
4.
Int Urogynecol J ; 32(12): 3275-3286, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34170341

RESUMO

INTRODUCTION AND HYPOTHESIS: The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. METHODS: Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. RESULTS: Average internal consistency of the ACSS resulted in a Cronbach's alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. CONCLUSIONS: The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.


Assuntos
Cistite , Adulto , Cistite/diagnóstico , Cistite/epidemiologia , Feminino , Alemanha , Humanos , Linguística , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
5.
J Minim Invasive Gynecol ; 28(8): 1544-1551, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33476749

RESUMO

STUDY OBJECTIVE: To evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE). DESIGN: Single-center retrospective cohort study. SETTING: University hospital. PATIENTS: A total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan. INTERVENTIONS: Surgical resection of the DIE nodule from the dorsal compartment. MEASUREMENTS AND MAIN RESULTS: After surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3-18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001). CONCLUSION: Postoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.


Assuntos
Endometriose , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos
6.
Acta Obstet Gynecol Scand ; 99(5): 591-597, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31943126

RESUMO

INTRODUCTION: Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. MATERIAL AND METHODS: In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov NCT03850158. RESULTS: In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. CONCLUSIONS: The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal surgery and low rASRM stages have a significant positive effect on the ICG detection rate. NIR fluorescence imaging with ICG was helpful in the resection of deep infiltrating nodules in providing a better visualization of endometriosis.


Assuntos
Corantes/administração & dosagem , Endometriose/diagnóstico por imagem , Endometriose/patologia , Verde de Indocianina/administração & dosagem , Adulto , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Imagem Óptica/métodos , Projetos Piloto , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho
8.
Int Urogynecol J ; 28(11): 1657-1661, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28417154

RESUMO

INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (MUI), defined as mixed symptoms of stress urinary incontinence (SUI) and overactive bladder (OAB), is a difficult entity if conservative treatment has failed. Cure rates are low compared with SUI, particularly the OAB component, may deteriorate after sling insertion. Bulking agents pose an appealing alternative for the treatment of MUI. They have shown beneficial effect in small case studies, but larger series are lacking. The aim of this prospective study was an analysis of treatment efficacy and safety profile of the bulking agent, Bulkamid, in female patients with MUI. METHODS: One hundred fifty-four women with MUI symptoms (components of SUI/OAB within the limits of 60-40% either way) received bulking therapy with polyacrylamide hydrogel (Bulkamid). Patients were followed-up 3 months postoperatively. Primary outcome was the domain Incontinence impact on the King's Health Questionnaire (KHQ). Secondary outcomes were the other KHQ domains, visual analog scale (VAS), and International Continence Society (ICS) standardized pad weight test as objective measurement of incontinence. RESULTS: Statistically significant improvements were found for all KHQ domains, pad weight test, and the visual analog scale (VAS) before and after bulking. Overall complication rate was 13%. CONCLUSIONS: This study has shown improvement in MUI after bulking therapy according to both subjective and objective outcomes. We can advocate bulking therapy for treating MUI, as it is simple and safe and shows both objective and subjective improvement and relief. Long-term results (up to 1 year) are awaited.


Assuntos
Resinas Acrílicas/uso terapêutico , Hidrogéis/uso terapêutico , Incontinência Urinária/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
9.
J Minim Invasive Gynecol ; 24(7): 1079-1080, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28400220

RESUMO

STUDY OBJECTIVE: To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." DESIGN: Explanatory video demonstrating the technique and intraoperative findings. SETTING: University hospital. PATIENT: The 68-year-old patient was referred with a vaginal mesh erosion that resulted in abscess formation at the vaginal apex. The patient was symptomatic with an increasingly foul-smelling vaginal discharge for about 1 year. She had a laparoscopic sacrocolpopexy in a remote hospital 22 months before the current operation and had a total abdominal hysterectomy 15 years ago. The, patient's history was uneventful without dyspareunia, incontinence or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. The local institutional review board granted exemption for this publication. INTERVENTION: Frequently, pelvic organ prolapse can only be effectively treated if the surgical procedure comprises support of the central compartment. Laparoscopic sacrocolpopexy shows superior outcomes for this indication, with success rates of up to 96%. However, a rare side effect of laparoscopic sacrocolpopexy is mesh erosion, occurring in up to 2.4% [1]. These erosions are usually treated laparoscopically [2]. In this video we show an alternative route for excision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess irrigation and mesh excision with minimally invasive instruments. MEASUREMENTS AND MAIN RESULTS: For treatment of the abscess and removal of the exposed mesh, the SILS trocar was placed vaginally, and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Because no mesh material was exposed after excision, the vagina was not closed to avoid creating a cavity with the risk of promoting reabscess formation, and secondary wound healing was anticipated. Laparoscopy was used to confirm that no intra-abdominal lesion coexisted or occurred. There were no signs of further infection of the residual mesh beyond the area exposed in the vagina. The patient's only symptom was foul-smelling discharge, but no back pain or signs of systemic inflammation were found. Knowing that foreign body (mesh) infection usually needs to be treated by complete mesh removal, we did not have any clues of distant mesh infection and counseled the patient that if reinfection occurred a second surgery might be necessary. Nevertheless, we treated this patient with abscess drainage and removal of large parts of the mesh. Thus, the operation was not extended to a complete mesh excision to prevent major surgery and the risk of recurrent prolapse. Particularly, the area of the mesh excision was inspected with the rendezvous technique (light source vaginally, laparoscopic pelvic view with laparoscopic light source switched off) to identify the area of mesh excision from the intra-abdominal area. Sigmoid and rectum were distant to this area, suggesting that no bowel lesion occurred. No complications occurred in the postoperative course. In the follow-up visit 6 months postoperatively the patient was asymptomatic, and the vaginal examination was uneventful with no recurrent erosion. Although improved oversight and richness of detail achieved by the vaginal SILS method is helpful in patients like our case with a suspended vaginal vault, its costs need to be balanced against conventional vaginal approaches (e.g., use of a Lonestar retractor). CONCLUSION: The SILS trocar and laparoscope used (SILS Port; Covidien, New Haven, CT) vaginally provide a magnificent and detailed view to allow for exact preparation by means of microinvasive instruments in vaginal surgery, even more in patients with a suspended vaginal vault where access to the apex can be tricky. The "pneumovagina" created by CO2 insufflation further helps to expose the vaginal apex. The rendezvous technique can additionally be used to identify intra-abominal lesions.


Assuntos
Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Vagina/cirurgia , Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade
10.
Ann Surg Oncol ; 23(7): 2206-11, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26790667

RESUMO

BACKGROUND: In endometrial cancer (EMCA), indocyanine green (ICG) sentinel lymph node (SLN) mapping has been reported, mainly in conjunction with robotic surgery. OBJECTIVE: We aimed to evaluate detection rates, sensitivity, and false negative (FN) rate of laparoscopic ICG SLN mapping in EMCA, and to evaluate differences in surgical outcomes between patients subjected to SLN biopsy only versus lymphadenectomy. METHODS: A retrospective analysis of EMCA patients undergoing ICG SLN mapping ± pelvic (PLND) and/or para-aortic lymphadenectomy (PALND) was performed. Detection rates were calculated for the entire cohort. Sensitivity and FN rates were calculated for patients undergoing lymphadenectomy after SLN mapping, and surgical outcome was compared among patients undergoing SLN mapping only versus lymphadenectomy. RESULTS: Of 75 patients, 33 underwent SLN mapping and 42 underwent SLN mapping followed by PLND/PALND. Overall and bilateral detection rates were 96 % (72/75) and 88 % (66/75), respectively, and the median number of removed SLNs, pelvic non-SLNs (NSLN) and para-aortic NSLNs was 3, 27, and 19, respectively. With a FN rate of 8.3 %, only one patient had bilateral FN SLNs and a metastatic para-aortal NSLN. Estimated blood loss (EBL) and operative (OR) time were significantly lower in patients undergoing SLN mapping only. No differences in complication rates between patients undergoing SLN mapping only and patients undergoing lymphadenectomy were recorded. CONCLUSIONS: Laparoscopic ICG SLN mapping has excellent overall and bilateral detection rates and a low FN rate. Compared with lymphadenectomy, SLN biopsy is associated with significantly lower EBL and shorter OR time.


Assuntos
Adenocarcinoma de Células Claras/patologia , Carcinossarcoma/patologia , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/patologia , Verde de Indocianina , Laparoscopia/métodos , Linfonodo Sentinela/patologia , Adenocarcinoma de Células Claras/diagnóstico por imagem , Adenocarcinoma de Células Claras/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/cirurgia , Corantes , Cistadenocarcinoma Seroso/diagnóstico por imagem , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/cirurgia , Feminino , Seguimentos , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela
11.
J Minim Invasive Gynecol ; 23(2): 270-3, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26476388

RESUMO

We present cases of 2 pregnant patients with early-stage cervical cancer who have undergone indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by laparoscopic SLN biopsy, pelvic lymphadenectomy, and cervical conization. Eight milliliters of ICG were injected in the 4 quadrants of the cervix after having obtained an adequate pneumoperitoneum and having inspected the abdominal cavity. SLNs were identified in both hemipelvises in both patients. In the final pathologic analysis, both SLNs and non-SLNs were negative for metastatic disease. No adverse events from ICG injection were recorded. ICG SLN mapping seems to be feasible in pregnant cervical cancer patients.


Assuntos
Corantes , Verde de Indocianina , Linfonodos/patologia , Complicações Neoplásicas na Gravidez/patologia , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Adulto , Conização , Feminino , Humanos , Laparoscopia , Excisão de Linfonodo , Metástase Linfática , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Resultado da Gravidez , Espectroscopia de Luz Próxima ao Infravermelho , Neoplasias do Colo do Útero/cirurgia
12.
Drug Dev Ind Pharm ; 42(8): 1360-4, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26755129

RESUMO

CONTEXT: Manufacturing solid low-dose pharmaceutical products has always the homogeneity challenge. In continuous manufacturing, there is the additional challenge of feeding active pharmaceutical ingredient (API) dry powder at low rates. This paper presents a method for feeding API particles into a continuous extrusion process using a suspension. The challenges for feeding and the product homogeneity are both addressed. OBJECTIVE: The objective of this study is to demonstrate the feasibility of manufacturing low-dose extrudates by feeding the API particles in a diluted anti-solvent suspension. MATERIALS AND METHODS: Extrudates with an Ibuprofen content of 0.021% and 0.043% (w/w) were prepared by feeding a 0.9% w/w suspension of Ibuprofen particles into a Coperion extruder. RESULTS AND DISCUSSION: The homogeneity (RSD) of extrudates was tested during a time span of 30 min and had values between 2% and 7%. CONCLUSION: Feeding particles in an anti-solvent suspension offers a simple feeding option for API and minor components which yield products of desired homogeneity. The liquid feeding approach offers a simplified process with enhanced process control possibilities.


Assuntos
Preparações Farmacêuticas/química , Tecnologia Farmacêutica/métodos , Química Farmacêutica/métodos , Temperatura Alta , Ibuprofeno/química , Pós/química , Solventes/química , Suspensões/química
13.
Ann Surg Oncol ; 22(13): 4198-203, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26122376

RESUMO

BACKGROUND AND PURPOSE: (99)TC combined with blue-dye mapping is considered the best sentinel lymph node (SLN) mapping technique in cervical cancer. Indocyanine green (ICG) with near infrared fluorescence imaging has been introduced as a new methodology for SLN mapping. The aim of this study was to compare these two techniques in the laparoscopic treatment of cervical cancer. METHODS: Medical records of patients undergoing laparoscopic SLN mapping for cervical cancer with either (99)Tc and patent blue dye (Group 1) or ICG (Group 2) from April 2008 until August 2012 were reviewed. Sensitivity, specificity, and overall and bilateral detection rates were calculated and compared. RESULTS: Fifty-eight patients were included in the study-36 patients in Group 1 and 22 patients in Group 2. Median tumor diameter was 25 and 29 mm, and mean SLN count was 2.1 and 3.7, for Groups 1 and 2, respectively. Mean non-SLN (NSLN) count was 39 for both groups. SLNs were ninefold more likely to be affected by metastatic disease compared with NSLNs (p < 0.005). Sensitivity and specificity were both 100 %. Overall detection rates were 83 and 95.5 % (p = nonsignificant), and bilateral detection rates were 61 and 95.5 % (p < 0.005), for Groups 1 and 2, respectively. In 75 % of cases, SLNs were located along the external or internal iliac nodal basins. CONCLUSIONS: ICG SLN mapping in cervical cancer provides high overall and bilateral detection rates that compare favorably with the current standard of care.


Assuntos
Adenocarcinoma/secundário , Carcinoma de Células Escamosas/secundário , Verde de Indocianina/administração & dosagem , Laparoscopia , Linfonodos/patologia , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma de Células Escamosas/cirurgia , Corantes/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Imagem Óptica/métodos , Prognóstico , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/cirurgia
14.
Chirality ; 27(3): 211-5, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25418781

RESUMO

New recreational drugs such as amphetamine-, cathinone, and benzofury derivatives gained high popularity on the drug market in recent years. They can be purchased via the Internet from different providers and online portals. Most of these compounds are chiral, which makes the development of chiral separation methods necessary. Besides this, it is useful to find out if the compounds were sold as racemic mixtures. Also, it is important to check whether the new psychoactive compounds contain further ingredients or impurities. The aim of this research was the continuation of the application of a method for indirect chiral separation of 24 new psychoactive compounds recently purchased via the Internet. After derivatization with the chiral derivatization reagent trifluoroacetyl-L-prolyl chloride, chromatographic separation of diastereomers was achieved using a 30 m HP5-MS capillary column. As carrier gas, helium was used with a constant flow of 1.0 ml/min. Three different column temperature programs were tested. Under optimum conditions 13 out of 24 compounds were successfully resolved into their enantiomers obtaining Rs values up to 7.0. The use of a single quadrupole mass spectrometer as the detector allowed the identification of the compounds in multicomponent samples.


Assuntos
Cromatografia Gasosa-Espectrometria de Massas/métodos , Drogas Ilícitas/química , Fluoracetatos , Estereoisomerismo
16.
J Minim Invasive Gynecol ; 22(7): 1304-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26122899

RESUMO

We present a case of laparoscopic surgical management of an iatrogenic lymphorrhea using indocyanine green (ICG). A case of a patient who developed recurrent symptomatic lymphorrhea after laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy for an early stage cervical cancer is presented. Intraoperative bipedal interdigital subcutaneous injection of ICG exactly localized the disrupted lymphatic duct on fluorescence imaging performed with a near-infrared laparoscopic fluorescent optic device, thus allowing a successful surgical repair.


Assuntos
Fístula/diagnóstico , Histerectomia/efeitos adversos , Doença Iatrogênica , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Doenças Linfáticas/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Corantes , Diagnóstico por Imagem , Feminino , Fístula/cirurgia , Humanos , Verde de Indocianina , Doenças Linfáticas/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Clin Oral Investig ; 19(6): 1537-46, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25420538

RESUMO

OBJECTIVES: To evaluate possible differences in periodontal inflammatory, microbiological and clinical parameters between women with preterm premature rupture of membranes (PPROM) and controls with uncomplicated pregnancies. MATERIALS AND METHODS: Fifty-six women (32 test (PPROM) and 24 controls (uncomplicated pregnancies)) were examined at three time-points (T1: gestational weeks 20-35, T2: within 48 h after parturition, T3: 4-6 weeks after parturition). The examinations included assessment of the Periodontal Screening Index, collection of gingival crevicular fluid (GCF) and subgingival as well as vaginal bacterial sampling. RESULTS: Periodontal inflammation was found to be higher in the test compared with the control group (p < 0.05) and decreased over time in both groups (p < 0.05). Microbiological outcomes showed no intergroup differences (p > 0.05) in prevalence of bacteria, but a decrease in subgingival periodontopathogens from T1 to T2 in the test group (p < 0.05) was observed. Interleukin (IL)-1ß levels in GCF at T2 were not different between groups (p > 0.05). In women with PPROM, GCF levels of IL-8 (p < 0.05) and C-reactive protein (p < 0.05) were lower and IL-10 levels higher (p < 0.05) compared with controls. CONCLUSIONS: Periodontal inflammation is elevated during pregnancy and seems to be more pronounced in women with PPROM. CLINICAL RELEVANCE: The findings of the present study revealed an association between periodontal inflammation and PPROM, thus emphasizing the importance of optimizing self-performed oral hygiene in pregnant women.


Assuntos
Ruptura Prematura de Membranas Fetais , Periodontite/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Líquido do Sulco Gengival/química , Humanos , Periodontite/microbiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos
18.
Am J Obstet Gynecol ; 211(1): 74.e1-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24530974

RESUMO

OBJECTIVE: The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). STUDY DESIGN: Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair using either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively before surgery and at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analog scale to measure general disturbance by the fistula. RESULTS: After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding sexual function or visual analog scale. CONCLUSION: Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Fístula Vesicovaginal/cirurgia , Abdome , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Psicogênicas/diagnóstico , Resultado do Tratamento , Vagina , Fístula Vesicovaginal/complicações
19.
Chirality ; 26(8): 411-8, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24909415

RESUMO

In the last years the identification of new legal and illegal highs has become a huge challenge for the police and prosecution authorities. In an analytical context, only a few analytical methods are available to identify these new substances. Moreover, many of these recreational drugs are chiral and it is supposed that the enantiomers differ in their pharmacological potency. Since nonenantioselective synthesis is easier and cheaper, they are mainly sold as racemic mixtures. The goal of this research work was to develop an inexpensive method for the chiral separation of cathinones and amphetamines. This should help to discover if the substances are sold as racemic mixtures and give further information about their quality as well as their origin. Chiral separation of a set of 6 amphetamine and 25 cathinone derivatives, mainly purchased from various Internet shops, is presented. A LiChrospher 100 RP-18e, 250 x 4 mm, 5 µm served as the stationary phase. The chiral mobile phase consisted of methanol, water, and sulfated ß-cyclodextrin. Measurements were performed under isocratic conditions in reversed phase mode using UV detection. Four model compounds of the two substance classes were used to optimize the mobile phase. Under final conditions (methanol:water 2.5:97.5 + 2% sulfated ß-cyclodextrin) enantiomers of amphetamine and five derivatives were baseline separated within 23 min. In all, 17 cathinones were completely or partially chirally separated. However, as only 3 of 25 cathinones were baseline resolved, the application of this method is limited for cathinone analogs. Additionally, the results were compared with an RP-8e column.


Assuntos
Alcaloides/química , Alcaloides/isolamento & purificação , Anfetamina/química , Anfetamina/isolamento & purificação , Cromatografia Líquida de Alta Pressão/métodos , beta-Ciclodextrinas/química , Cromatografia Líquida de Alta Pressão/economia , Cromatografia de Fase Reversa , Espectrofotometria Ultravioleta , Estereoisomerismo
20.
Eur J Emerg Med ; 2024 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-39264430

RESUMO

BACKGROUND: In hypoxemic children with difficult airway, or for minor elective procedures, the use of a supraglottic airway device may be preferred to endotracheal intubation, whether with a laryngeal mask or laryngeal tube. Second-generation laryngeal masks may offer a better safety profile. Whether they should be preferred to laryngeal tubes is unknown. This study aimed to compare the efficacy and safety of second-generation laryngeal masks and laryngeal tubes in children. METHODS: This randomised-controlled trial was conducted in a single university hospital in children <18 years undergoing elective anaesthesia in urology, minor paediatric surgery and gynaecology. Patients were 1 : 1 randomised to the laryngeal mask or laryngeal tube group. Children were allocated a second-generation laryngeal tube or a second-generation laryngeal mask as the primary airway device. The primary endpoint was insertion time. Secondary endpoints included first-attempt success, overall success and complications, which included hypoxia (SpO2 < 90%), laryngospasm, bronchospasm, aspiration and bleeding. RESULTS: In total, 135 patients were randomised, with 61 allocated to the laryngeal tube and 74 to the laryngeal mask group, with a median age of 5.4 and 4.9 years, respectively. Median insertion time was significantly longer in the laryngeal tube group (37 vs. 31 s; difference of medians: 6.0 s; 95% confidence interval: 0.0-13.0). The laryngeal tube had a significantly lower first-attempt (41.0%) and overall success rate (45.9%) than the laryngeal mask (90.5% and 97.3%, respectively). Those allocated to the laryngeal tube group had a higher ratio of complications (27.8%) compared to the laryngeal mask group (2.7%). CONCLUSION: This randomised-controlled trial reported that in children undergoing elective anaesthesia, the use of a laryngeal tube was associated with a longer insertion time.

SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa