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[Operative therapy of female stress incontinence]. 【女性压力性尿失禁的手术治疗】。
Pub Date : 2006-06-01 DOI: 10.1055/s-2006-933371
J Lahodny, B Lahodny, M Birner, A Kaider

Description of the fateful change of the differing operation methods for the treatment of female stress incontinence between 1979-2005. For the reason of scientific cognitions and many years of applying experience there are two logical and anatomical well-founded possibilities for the treatment of stress incontinence: 1. Elevation of the bladder neck to it's original position by a shortarm sling plasty. In doing that vaginally the ligg. urethrotendinea and the ligg. pubourethralia posteriora are connected suburethrally by a shortarm sling plasty or a double sling plasty and in this way the bladderneck is elevated to the height of the arcus tendineus fasciae pelvis. So a horizontal bladder base plate able to contract results with a retrovesical angle of about 90 %. The anatomic proof for continence. 2. Producing of the urethrovesical reflex by UST (Urethra Surrounding Tape). A polypropylene mesh with a circumference of 1,5 x 2,6 cm is fixed to the inner surface of the right and left os pubis and paraurethrally right and left too. This stable hammock causes a physiological impression of the dorsal urethra of about 2 mm. Because of that the urethrovesical reflex is set off leading to the contraction of the bladder neck and the relaxation of the detrusor vesicae muscle. This minimal invasive stress incontinence operation method brings about a subjective incontinence healing rate of 83.7 % and a clinical healing rate of 97.7 %. That means the same results like after TVT (Tension Free Vaginal Tape) or TOT (Transobturatorial Tape). In contrast to TVT or TOT there are no complications with UST.

描述了1979-2005年间治疗女性压力性尿失禁的不同手术方法的决定性变化。由于科学认识和多年的应用经验,治疗压力性尿失禁有两种逻辑和解剖学上有充分根据的可能性:用短吊带成形术将膀胱颈部抬高到原来的位置。在做这个的过程中。尿道腱素和光。后尿道通过短吊带成形术或双吊带成形术连接在尿道下,这样膀胱颈被提升到骨盆筋膜腱弓的高度。所以一个水平的膀胱基底板能够收缩膀胱后角约90%的结果。自制的解剖学证据。2. 尿道环绕带对尿道反射的影响。一个周长为1.5 x 2.6 cm的聚丙烯网固定在左右耻骨和左右尿道旁的内表面。这种稳定的吊床使尿道背部产生约2毫米的生理印痕。因此膀胱反射会引起膀胱颈的收缩膀胱逼尿肌的松弛。该微创应激性尿失禁手术方法主观失禁治愈率为83.7%,临床治愈率为97.7%。这意味着与TVT(无张力阴道带)或TOT(经阴道带)后的结果相同。与TVT或TOT相比,UST没有并发症。
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引用次数: 0
[Integrin expression in eutopic and ectopic endometrium]. 整合素在异位和异位子宫内膜中的表达。
Pub Date : 2006-06-01 DOI: 10.1055/s-2006-921550
R Gaetje, A Rody, S Kissler, M Kaufmann, A Ahr

The significance of retrograde menstruation as a risk factor for endometriosis has been confirmed by numerous clinical observations. Integrins mediate both cell-cell and cell-matrix adhesion, and it is therefore suspected that integrins are involved in the development of endometriosis. Using immunohistochemistry, integrin expression in eutopic and ectopic endometrium is examined in endometriosis patients and control individuals. In nearly all cases, the glandular epithelial cells in the endometrium showed expression of alpha (2-), alpha (3)-, alpha (6)- and alpha (v)- integrin and a low percentage of expression of alpha (1)-, alpha (4)-, and alpha (5)-integrin. In comparison with eutopic endometrium, ectopic endometrium shows reduced expression of alpha (2)- and alpha (v)-integrin. Since no differences in alpha (2)- and alpha (v)-integrin expression were observed in eutopic endometrium between endometriosis patients and control individuals, it may be suspected that the reduced expression of these in ectopic endometrium is explained by influences in the altered environment -- e. g., in the peritoneal fluid -- on the ectopic endometrium.

月经逆行作为子宫内膜异位症的危险因素的重要性已被大量临床观察证实。整合素介导细胞-细胞和细胞-基质的粘附,因此怀疑整合素参与了子宫内膜异位症的发生。应用免疫组织化学方法,对子宫内膜异位症患者和对照个体的异位和异位子宫内膜中整合素的表达进行了检测。在几乎所有病例中,子宫内膜腺上皮细胞均表达α(2-)、α(3)-、α(6)-和α (v)-整合素,α(1)-、α(4)-和α(5)-整合素的表达比例较低。与异位子宫内膜相比,异位子宫内膜显示α(2)-和α (v)-整合素的表达减少。由于在异位子宫内膜异位症患者和对照组之间未观察到α(2)-和α (v)-整合素表达的差异,因此可能怀疑异位子宫内膜中α(2)-整合素和α (v)-整合素表达的减少可以通过改变的环境(例如腹膜液)对异位子宫内膜的影响来解释。
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引用次数: 4
[Plastic reconstructive procedures of vulvar carcinoma: results and complications]. 外阴癌整形再造术:效果及并发症。
Pub Date : 2006-06-01 DOI: 10.1055/s-2006-933424
W Weikel, M Schmidt, E Steiner, P G Knapstein, H Kölbl

Purpose: This study describes the results of the plastic reconstructive measures in 207 patients with a primary or a recurrent vulvar cancer. These procedures were analysed in sight of surgical excision, previous therapy, and detailed postoperative results.

Methods: All procedures and clinical parameters were recorded standardized in a data bank and analysed using statistical methods.

Results: In 123 local (cutaneous or fasciocutaneous) and 84 regional (myocutaneous) flaps we found a primary healing in about 2/3 of the cases. Local flaps exhibited secondary healing in 31 %, regional flaps in 20 %. This often involved the donor sites and generally did not present any permanent problems. Pronounced healing disturbances (necrosis of more than 10 %) was not achieved in local flaps, in regional flaps it aroused in 5.9 %. Gluteal femoral flaps were used most frequently and showing the best results of all myocutaneous flaps. They were comparable with the local reconstructions by a high degree of reliability and healing. In 15 cases a tissue-loss was observed. In these patients, elevated risk factors, certain oncological characteristics and technical problems could be demonstrated.

Conclusion: Plastic surgery enlarges the spectrum of operative therapy of vulvar cancer, especially in extensive or recurrent tumors, leading to a favourable oncological outcome and good cosmetic results. Severe healing disturbances are rare and can be controlled.

目的:本研究描述了207例原发性或复发性外阴癌的整形重建措施的结果。从手术切除、既往治疗和详细术后结果的角度分析这些手术。方法:将所有手术过程及临床参数标准化录入数据库,采用统计学方法进行分析。结果:123个局部(皮肤或筋膜)皮瓣和84个局部(肌皮)皮瓣中,约2/3的病例获得了原发性愈合。局部皮瓣继发愈合率为31%,局部皮瓣继发愈合率为20%。这通常涉及捐赠地,一般不会造成任何永久性问题。局部皮瓣未出现明显的愈合障碍(坏死超过10%),局部皮瓣出现明显愈合障碍的比例为5.9%。在所有肌皮瓣中,臀股肌皮瓣使用频率最高,效果最好。在高度的可靠性和愈合方面,它们与局部重建相当。在15例中观察到组织丢失。在这些患者中,可以证明危险因素升高,某些肿瘤特征和技术问题。结论:整形外科扩大了外阴癌的手术治疗范围,特别是对肿瘤的广泛性和复发性,可获得良好的肿瘤预后和美容效果。严重的愈合障碍是罕见的,是可以控制的。
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引用次数: 1
[Antibiotic prophylaxis in cesarean section -- piperacillin versus piperacillin/tazobactam in 300 cesarean sections]. 剖宫产术中的抗生素预防——300例剖宫产术中哌拉西林与哌拉西林/他唑巴坦的比较
Pub Date : 2006-06-01 DOI: 10.1055/s-2005-872566
K J Wagner, U Bier, R Callies, P A Regidor, A E Schindler

Introduction: Antibiotic prophylaxis is a standard procedure in obstetric surgery and has been discussed in various investigations. Use of treatment is judged by high efficacy and good tolerance.

Method: In 300 patients undergoing cesarean sections we compared results of application of Piperacillin 4 g and Piperacillin/Tazobactam 4.5 g after cut of umbilical cord. Tazobactam/Piperacillin is a combination of a broad-spectrum penicillin and a beta-lactamase inhibitor with increased toxicity against staph. aureus, enterobacter, and other germs responsible for local and systemic infections in obstetric surgery.

Results: We did not observe any severe adverse effects. Rate of severe wound infections was 1.3 % (Tazobactam/Piperacillin) and 2 % (Piperacillin alone). The difference showed no statistic significance (p > 0.01). During postoperative course we found a higher increase of CRP (p < 0.01) in the Piperacillin group. CRP proved to be a useful objective parameter to distinguish between patients with or without postoperative infections. No differences were found in the number of leucocytes, time in hospital and other parameters.

前言:抗生素预防是产科手术的标准程序,并在各种调查中进行了讨论。以疗效高、耐受性好为判断标准。方法:对300例剖宫产患者剖宫产后剪脐带后应用哌拉西林4 g与哌拉西林/他唑巴坦4.5 g的效果进行比较。他唑巴坦/哌拉西林是广谱青霉素和β -内酰胺酶抑制剂的组合,对葡萄球菌的毒性增加。产科手术中引起局部和全身感染的金黄色葡萄球菌、肠杆菌和其他细菌。结果:未见严重不良反应。严重伤口感染率为1.3%(他唑巴坦/哌拉西林)和2%(哌拉西林单用)。差异无统计学意义(p > 0.01)。术后,我们发现哌拉西林组CRP升高较高(p < 0.01)。CRP被证明是一个有用的客观参数,以区分患者是否术后感染。白细胞数、住院时间等指标均无差异。
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引用次数: 6
[Adjuvant therapy with trastuzumab in primary breast neoplasms--findings and validity of--opinion on the competence of the Central Oncology section of the North German Society]. 【曲妥珠单抗在原发性乳腺肿瘤中的辅助治疗——结果和对北德学会中央肿瘤学分会能力的有效性意见】。
Pub Date : 2006-06-01
Jens Huober
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引用次数: 0
[Women "healthcare" and obstetrics - "thoughts of farewell"]. [妇女“保健”和产科-“告别的想法”]。
Pub Date : 2006-06-01 DOI: 10.1055/s-2006-933510
H Hepp

Medicine, and so within also gynecology and obstetrics is shaped in the process of the last decade by changes of interaction between female-patient and physician in "Arbeitszeitgesetz" (law upon daily working time), the introduction of payment-system an case by case based lump-sums and intrusion (interference) of the political administration into autonomy of medical faculties. The contribution concerns with these prevailing economical required changes, interacting and beyond inter-disciplinarity. The progress in medicine by research is causing potential capacity and secondary costs explosion. Including financing of health service and decisive determinants: the demographic development of society, the change in working sphere and particularly law-dominated prenatal-medicine. This, future of medicine determining political, ethical and legal challenge must be accepted by medical professions. Solutions are pointed out.

在过去十年的过程中,妇女病人和医生在“每日工作时间法”(Arbeitszeitgesetz)中相互作用的变化、以个案为基础的一次性付款支付制度的引入以及政治管理对医学院系自主权的侵犯(干预)影响了医学,妇产科学也是如此。贡献涉及这些普遍的经济所需的变化,相互作用和超越跨学科。医学研究的进步正在引起潜在能力和二次成本的爆炸式增长。包括为保健服务和决定性因素提供资金:社会人口发展、工作领域的变化,特别是法律主导的产前医学。这一决定医学未来的政治、伦理和法律挑战必须为医疗专业人员所接受。并提出了解决方案。
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引用次数: 0
[Treatment of pregnancy associated gynaecological malignancies]. [妊娠相关妇科恶性肿瘤治疗]。
Pub Date : 2006-06-01 DOI: 10.1055/s-2006-933376
W Janni, B Gerber, F Bergauer, B Rack, H Sommer, K Friese

Pregnancy, leading to new life, on one hand, and life threatening malignancies an the other hand, are per se diametric subjects. Symptoms of malignancies are ignored more frequently during pregnancy by patients and physicians, often resulting in delayed diagnosis. Diagnosis and treatment of gynaecological malignancies, however, are increasingly important for four reasons: the peak incidence of several malignancies occurs during the reproductive age; late pregnancies present more often in an age group with increased risk for cancer, intensified care for pregnant women leads to more thorough diagnosis, and, curative treatment of malignancies gives women the potential chance for becoming pregnant. For these reasons, special features of the diagnosis and treatment of gynaecological malignancies will regularly part of routine patient care. This review article covers certain practice related features of gynaecological malignancies.

一方面是孕育新生命的怀孕,另一方面是危及生命的恶性肿瘤,这两者本身就是截然不同的主题。在怀孕期间,恶性肿瘤的症状往往被患者和医生忽视,往往导致诊断延误。然而,妇科恶性肿瘤的诊断和治疗越来越重要,原因有四个:几种恶性肿瘤的发病率高峰发生在育龄期;在患癌症风险较高的年龄组中,晚孕更为常见,加强对孕妇的护理可导致更彻底的诊断,对恶性肿瘤的治愈性治疗使妇女有可能怀孕。由于这些原因,妇科恶性肿瘤的诊断和治疗的特点将成为常规病人护理的一部分。本文综述了妇科恶性肿瘤的一些临床特点。
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引用次数: 5
Die Autofluoreszenz-Laparoskopie: ein neues endoskopisches Verfahren zur Verbesserung der Endometriosediagnostik 这种装置能有效改善内窥镜诊断技术
Pub Date : 2006-05-15 DOI: 10.1055/s-2006-944459
S. Schäfer, A. Staebler, L. Kiesel, O. Buchweitz
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引用次数: 0
Einfluss der maternalen Diabeteskonstellation auf die Gefäßdichte in den Plazentazotten 用糖尿病引起的动脉导管影响胎盘血管密度
Pub Date : 2006-05-15 DOI: 10.1055/S-2006-944448
C. Bartz, M. Kadyrow, P. Bertolami, W. Rath, B. Huppertz
Im Verlauf einer normalen Schwangerschaft kommt es zu einer Gefasdilatation feto-plazentarer Gefase, die damit den steigenden Anspruchen des Trophoblasten entgegenkommen. Der raumliche Abstand zwischen Gefaslumen und Trophoblast wird verringert. In Schwangerschaften von Typ-I-Diabetikerinnen konnte eine verstarkte Angiogenese in diesem Stromgebiet gezeigt werden. Wir untersuchten hier, inwieweit die diabetische Stoffwechsellage der Mutter in Gruppen unterschiedlicher Diabetessituationen den relativen Anteil der Gefas an Schnitten von Plazentazotten verandert und Einfluss auf die Gefasproliferation nimmt. Methode: Paraffinschnitte von Zottengewebe folgender Patientinnengruppen wurden untersucht: Kontrollen; diatetisch eingestellter Gestationsdiabetes (GDM), insulinbehandelter GDM, Typ-I-Diabetes mellitus (DM) und Typ-I-DM mit weiteren klinischen Komplikationen. Die Schnitte wurden immunhistochemisch mit Anti-CD34 (QBend 10) gefarbt. Die Gefasanschnitte wurden gezahlt, und die Flachenanteile der Gefasanschnitte wurden an zufallig ausgewahlten Schnittbildern in Beziehung zur Gesamtzottenflache gesetzt. Ergebnisse: In den Plazentazotten der Kontrollen war der Gefasflachenanteil signifikant hoher im Vergleich zu allen diabetischen Stoffwechselsituationen. Insulinbehandelte GDM zeigten den geringsten Gefasflachenanteil. Auf der anderen Seite wiesen die GDM die gleiche Anzahl an Gefasanschnitten wie die Kontrollen auf, wahrend Typ-I-DM tendenziell hohere Gefaszahlen pro Zotte hatten. Schlussfolgerung: Obwohl es zu einer verstarkten Gefasproliferation der plazentaren Strombahnen kommt, die zu einer hoheren Gefasdichte pro Zotte fuhrt, ist der Gefasflachenanteil dieser Gefase dramatisch verringert. Es scheint so, als ware die Elongation dieser Gefase verbunden mit einer verminderten Gefasdilatation. Moglicherweise erklaren diese vaskularen Veranderungen die unterschiedlichen klinischen fetalen Auswirkungen verschiedener diabetischer Stoffwechsellagen.
我经历过正常的怀孕但雷电击中了镀银的镀线一行生物的生存空间会缩短。在i型糖尿病孕妇中,在这一带发现了一个失明的血管生成过程。我们研究了一下,母亲的糖尿病情况下,以及不同糖尿病情况下的糖尿病会怎样影响到到胎盘切片研究的相对比例和对健康的影响。(纽约)调查了以下病人(场所)的蜡烛糖尿病预防糖尿病(GDM)、胰岛素治疗型GDM、i型糖尿病(DM)和有其他临床并发症的i型糖尿病。人体免疫缺陷被染色上了抗cd34路加会把路加的平方图小心地按取到的切口图像与整体平方图作对照。结果:与所有糖尿病对应的代谢状况相比,在药物的前腔激素明显更高。胰岛素喂格曼的活物种清单在另一方面,德国火车司机协会提出的假冒车辆数目,与控制机构的数字是一样的。结论是,虽然我们的市会成为胎盘市的一个黑标点,导致每条住宅住宅的空间越来越大,但是上车的空间越来越小。你好,这真是个大事有些人相信,血管急促的变化可以解释多种糖尿病给人类造成的医疗影响。
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引用次数: 0
Die Entwicklung der gynäkologischen Endoskopie in Deutschland unter besonderer Berücksichtigung der Komplikationen 从德国发展的妇科内科特别注意这方面的并发症
Pub Date : 2006-05-15 DOI: 10.1055/S-2006-944504
M. Hebold, Hh Riedel
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引用次数: 0
期刊
Zentralblatt fur Gynakologie
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