妊娠期凝血障碍最常见的原因:①大量出血后的稀释性凝血障碍病及不适宜的输液过量,如在产后子宫收缩乏力时;②消耗性凝血障碍病弥漫性血管内凝血(DIC),如胎盘早剥、妊娠高血压病、宫内死胎、败血症(如羊膜感染综合征)或羊水栓塞;③血小...妊娠期凝血障碍最常见的原因:①大量出血后的稀释性凝血障碍病及不适宜的输液过量,如在产后子宫收缩乏力时;②消耗性凝血障碍病弥漫性血管内凝血(DIC),如胎盘早剥、妊娠高血压病、宫内死胎、败血症(如羊膜感染综合征)或羊水栓塞;③血小板减少病和内科疾病的出血素质.Blutgerinnungsstrungen in der展开更多
We describe a 14-year-old girl with intermittent pelvic pain. Abdominal sonography and MRI examination revealed cysticsolid tumors in the pelvis reaching up to the umbilical level. After primary diagnostic laparoscopi...We describe a 14-year-old girl with intermittent pelvic pain. Abdominal sonography and MRI examination revealed cysticsolid tumors in the pelvis reaching up to the umbilical level. After primary diagnostic laparoscopic evaluation the expansion of the mass and the unknown dignity required laparotomy. We found a double, complete adnexal torsion on the left side and a cystic tumor of the right ovary. Both partial salpingectomy and partial ovariectomy on the left side were necessary. The cyst of the right ovary (5 cm) was also extirpated. The histological examination demonstrated a huge haematosalpinx on the left side with hemorrhagic infarction and a corpus luteum cyst of the right ovary.展开更多
Introduction: Urogenital prolapse is a very common condition in women with a prevalence of 30%. If conservative therapy fails or is not desired by the patient, prolapse repair is usually performed under general or reg...Introduction: Urogenital prolapse is a very common condition in women with a prevalence of 30%. If conservative therapy fails or is not desired by the patient, prolapse repair is usually performed under general or regional anaesthetic. The aim of the study was to evaluate feasibility, efficacy and functional outcome after fascial prolapse repairs under local anaesthetic (LA). Patients and methods: Between November 1999 and December 2000, 130 consecutive patients presenting with anterior or posterior prolapse or both were invited to have their procedure performed under LA.All patients with a symptomatic minimum stage II prolapse were included. Prior to surgery all women completed a standardized questionnaire examining the specific and non-specific symptoms of prolapse and their situation was classified using the ICS Pelvic Organ Prolapse (POP-Q) system. Follow up was 30 months. Objective success was defined as a stage 1 or less and no symptoms of bulge, subjective success was defined as lack of specific or non-specific symptoms of prolapse. Results: There were 128 patients who agreed to have their operations performed under LA: 68 in the anterior group, 52 in the posterior group and 8 with a combined anterior and posterior repair. Objective cure rate was 88%for posterior repair, 87%for anterior repair and 63%for combined repair. Success rates were no different in primary from recurrent cases. There were no intraoperative complications and operating time was 21 min (anterior repair) or 23 min (posterior repair). There was no de novo postoperative urinary or stool incontinence and all patients but two would have the operation performed again under the same circumstances. The two remaining refused due to embarrassment but for no other reason. Conclusion: Local anaesthetic prolapse repair is feasible and effective in middle term results. It is well accepted by the patients who benefit from less side effects and short hospital stay.展开更多
The retrospective comparison with the suture technique showed that the bipolar vessel sealing system (BVSS) used in abdominal hysterectomy procedures for benign bleeding disorders does not reduce postoperative pain wi...The retrospective comparison with the suture technique showed that the bipolar vessel sealing system (BVSS) used in abdominal hysterectomy procedures for benign bleeding disorders does not reduce postoperative pain within the first 36 hours. The visual analogue scale (VAS) was used to measure pain intensity in both groups, each having 20 patients. Despite the effect of vessel sealing without contracting the peritoneum and not leaving of foreign material in situ in the patient, only a reduced pain intensity was apparent 6 hours postoperatively. The vessel sealing system is a reliable method for hemostasis.展开更多
Purpose:Aim of the survey was to analyze the prevalence of unintended pregnancies,induced abortions and their association with determinants e.g.contraception,emer-gency contraception(EC),and socio -demographic data in...Purpose:Aim of the survey was to analyze the prevalence of unintended pregnancies,induced abortions and their association with determinants e.g.contraception,emer-gency contraception(EC),and socio -demographic data in Germanwomen.Material and Method s:A German ver-sion of a modified questionnaire on c ontraception designed by the European Group of Contracepti on was applied.Anonymized data sheets encompassin g 1217women aged15-45years recruited from gynaecological services in D¨usseldorf and Regensburg were analy zed usingχ2-test and age -adjusted logistic regression a nalysis.Results:51%of first pregnancies were unplanned and 37%of all preg-nancies were unwanted.Induced abortion of this subgroup was observed in 35%and 55%,resp.Overall,7.9%of all participants reported at least o ne abortion resulting in193abortions per 1000births.There was a clear age -dependent correlation with 1.4%abortions among women aged 15-19and 21.1%among those aged40-45years.This corresponds to 0.5and 1.0abortion per 100fertile years,resp.EC was applied at least o nce by 19%of all participants.EC was significantly more frequently used by women with unintended pregnancies(26%)or abortions(28%)as compared to the other participant s(14%and19%,resp.;p <0.01).The amount of contraceptive means ever used could be identified a s an important indi-cator for a history of induced aborti on and EC,resp.(oddsratio95%confidence interval:3.51.8-6.9and10.46.5-16.,resp.).Occupation,marital status,level of urbanisation and religious affiliation were identified as further determinants.Conclusio n:Women with in-creased risk for abortions and EC can be more selectively identified by their lifetime pattern of contraception and so-ciodemographic data.Medical atten dance and devices for women of increased risk should in particular focus on the necessity to use an effective contra ceptive and the im-provement of patients’compliance.展开更多
The term Charcot Wilbrand syndrome (CWS) denotes dream loss following focal b rain damage. We report the first case of CWS, in whom neuropsychological functio ns, extension of the underlying lesion, and sleep architec...The term Charcot Wilbrand syndrome (CWS) denotes dream loss following focal b rain damage. We report the first case of CWS, in whom neuropsychological functio ns, extension of the underlying lesion, and sleep architecture changes were asse ssed. A 73 year old woman reported a total dream loss after acute, bilateral o ccipital artery infarction (including the right inferior lingual gyrus), which l asted for over 3 months. In the absence of sleep wake complaints and (other) ne uropsychological deficits, polysomnography demonstrated an essentially normal sl eep architecture with preservation of REM sleep. Dreaming was denied also after repeated awakenings from REM sleep. This observation suggests that CWS (1) can r epresent a distinct and isolated neuropsychological manifestation of deep occipi tal lobe damage, and (2) may occur in the absence of detectable REM sleep abnorm alities.展开更多
Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the ...Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the sonography as well as how to treat residual material in the uterus and when to begin with contraception. Particularly when switching to at home administration of Misoprostol, however, definite and evidencebased management is crucial. The present study’ s objective is to evaluate the medical abortions carried out at our clinic during one year with a special focus on the ultrasound findings two weeks after the administration of Mifepriston and Misoprostol, the therapeutical interventions in case of residuals and the subsequent contraception. Materials and Methods: The data of all 232 patients who underwent medical abortion in the period from March 1, 2002 to February 28, 2003 were retrospectively reviewed. The cases were evaluated with regard to success rate, frequency of expulsion within the first four hours, ultrasound findings, possible therapeutic intervention and subsequent contraception, if known. The data were evaluated using descriptive statistics; statistical significance was calculated by means of the chi- square test, where appropriate. Results: Ninety- five percent of the women had a successful medical abortion. With the applied dosage 60% of the expulsions took place within the first four hours. Only one third of the patients had no more vaginal bleeding at time of the postabortion control. In almost 40% of the cases residuals were suspected, in about two thirds the endometrium was thicker than 10mm. In those cases, where data on this matter were available, the endometrium returned to normal with and without administration of Misoprostol. For less than half of the patients, subsequent contraception had already been initiated or had already been planned. Conclusions: The presented data seem to justify a watchful wait without further therapeutic intervention in the case of suspected residuals and/or an endometrium thickness of maximally 16 mm. Based on our findings we assume that this management is applicable in the case of Misoprostol administered at home, as well. Further analysis of our results will have to be performed to assess their validity.展开更多
We report a case of a 31-year-old patient with primary antiphospholip id synd rome (APS) and a past medical history of deep vein thrombosis and intrauterine f etal death followed by pulmonary embolism in her first pre...We report a case of a 31-year-old patient with primary antiphospholip id synd rome (APS) and a past medical history of deep vein thrombosis and intrauterine f etal death followed by pulmonary embolism in her first pregnancy. In this pregna ncy treatment with low molecular weight heparin (LMWH) and aspirin was institute d and pregnancy outcome was uneventful. In the immediate post partum period a va scular inflammation of the finger and toe pulps made a steroid therapy necessary . Although there is general consensus on how to manage APS during pregnancy, no guidelines exist for the immediate peripartum period. Management plans should be individualized and aim for continuous anticoagulation in pregnancy. Time around delivery without anticoagulation should be kept to a minimum. The decision resp ecting the route of delivery should be guided by obstetric indications only. Aft er delivery intensive monitoring of affected patients should be instituted to di agnose complications without undue delay.展开更多
文摘妊娠期凝血障碍最常见的原因:①大量出血后的稀释性凝血障碍病及不适宜的输液过量,如在产后子宫收缩乏力时;②消耗性凝血障碍病弥漫性血管内凝血(DIC),如胎盘早剥、妊娠高血压病、宫内死胎、败血症(如羊膜感染综合征)或羊水栓塞;③血小板减少病和内科疾病的出血素质.Blutgerinnungsstrungen in der
文摘We describe a 14-year-old girl with intermittent pelvic pain. Abdominal sonography and MRI examination revealed cysticsolid tumors in the pelvis reaching up to the umbilical level. After primary diagnostic laparoscopic evaluation the expansion of the mass and the unknown dignity required laparotomy. We found a double, complete adnexal torsion on the left side and a cystic tumor of the right ovary. Both partial salpingectomy and partial ovariectomy on the left side were necessary. The cyst of the right ovary (5 cm) was also extirpated. The histological examination demonstrated a huge haematosalpinx on the left side with hemorrhagic infarction and a corpus luteum cyst of the right ovary.
文摘Introduction: Urogenital prolapse is a very common condition in women with a prevalence of 30%. If conservative therapy fails or is not desired by the patient, prolapse repair is usually performed under general or regional anaesthetic. The aim of the study was to evaluate feasibility, efficacy and functional outcome after fascial prolapse repairs under local anaesthetic (LA). Patients and methods: Between November 1999 and December 2000, 130 consecutive patients presenting with anterior or posterior prolapse or both were invited to have their procedure performed under LA.All patients with a symptomatic minimum stage II prolapse were included. Prior to surgery all women completed a standardized questionnaire examining the specific and non-specific symptoms of prolapse and their situation was classified using the ICS Pelvic Organ Prolapse (POP-Q) system. Follow up was 30 months. Objective success was defined as a stage 1 or less and no symptoms of bulge, subjective success was defined as lack of specific or non-specific symptoms of prolapse. Results: There were 128 patients who agreed to have their operations performed under LA: 68 in the anterior group, 52 in the posterior group and 8 with a combined anterior and posterior repair. Objective cure rate was 88%for posterior repair, 87%for anterior repair and 63%for combined repair. Success rates were no different in primary from recurrent cases. There were no intraoperative complications and operating time was 21 min (anterior repair) or 23 min (posterior repair). There was no de novo postoperative urinary or stool incontinence and all patients but two would have the operation performed again under the same circumstances. The two remaining refused due to embarrassment but for no other reason. Conclusion: Local anaesthetic prolapse repair is feasible and effective in middle term results. It is well accepted by the patients who benefit from less side effects and short hospital stay.
文摘The retrospective comparison with the suture technique showed that the bipolar vessel sealing system (BVSS) used in abdominal hysterectomy procedures for benign bleeding disorders does not reduce postoperative pain within the first 36 hours. The visual analogue scale (VAS) was used to measure pain intensity in both groups, each having 20 patients. Despite the effect of vessel sealing without contracting the peritoneum and not leaving of foreign material in situ in the patient, only a reduced pain intensity was apparent 6 hours postoperatively. The vessel sealing system is a reliable method for hemostasis.
文摘Purpose:Aim of the survey was to analyze the prevalence of unintended pregnancies,induced abortions and their association with determinants e.g.contraception,emer-gency contraception(EC),and socio -demographic data in Germanwomen.Material and Method s:A German ver-sion of a modified questionnaire on c ontraception designed by the European Group of Contracepti on was applied.Anonymized data sheets encompassin g 1217women aged15-45years recruited from gynaecological services in D¨usseldorf and Regensburg were analy zed usingχ2-test and age -adjusted logistic regression a nalysis.Results:51%of first pregnancies were unplanned and 37%of all preg-nancies were unwanted.Induced abortion of this subgroup was observed in 35%and 55%,resp.Overall,7.9%of all participants reported at least o ne abortion resulting in193abortions per 1000births.There was a clear age -dependent correlation with 1.4%abortions among women aged 15-19and 21.1%among those aged40-45years.This corresponds to 0.5and 1.0abortion per 100fertile years,resp.EC was applied at least o nce by 19%of all participants.EC was significantly more frequently used by women with unintended pregnancies(26%)or abortions(28%)as compared to the other participant s(14%and19%,resp.;p <0.01).The amount of contraceptive means ever used could be identified a s an important indi-cator for a history of induced aborti on and EC,resp.(oddsratio95%confidence interval:3.51.8-6.9and10.46.5-16.,resp.).Occupation,marital status,level of urbanisation and religious affiliation were identified as further determinants.Conclusio n:Women with in-creased risk for abortions and EC can be more selectively identified by their lifetime pattern of contraception and so-ciodemographic data.Medical atten dance and devices for women of increased risk should in particular focus on the necessity to use an effective contra ceptive and the im-provement of patients’compliance.
文摘The term Charcot Wilbrand syndrome (CWS) denotes dream loss following focal b rain damage. We report the first case of CWS, in whom neuropsychological functio ns, extension of the underlying lesion, and sleep architecture changes were asse ssed. A 73 year old woman reported a total dream loss after acute, bilateral o ccipital artery infarction (including the right inferior lingual gyrus), which l asted for over 3 months. In the absence of sleep wake complaints and (other) ne uropsychological deficits, polysomnography demonstrated an essentially normal sl eep architecture with preservation of REM sleep. Dreaming was denied also after repeated awakenings from REM sleep. This observation suggests that CWS (1) can r epresent a distinct and isolated neuropsychological manifestation of deep occipi tal lobe damage, and (2) may occur in the absence of detectable REM sleep abnorm alities.
文摘Objectives: The medical method of artificial abortion is established and well accepted in Switzerland. During the postabortion control period, however, issues arise concerning the interpretation of the results of the sonography as well as how to treat residual material in the uterus and when to begin with contraception. Particularly when switching to at home administration of Misoprostol, however, definite and evidencebased management is crucial. The present study’ s objective is to evaluate the medical abortions carried out at our clinic during one year with a special focus on the ultrasound findings two weeks after the administration of Mifepriston and Misoprostol, the therapeutical interventions in case of residuals and the subsequent contraception. Materials and Methods: The data of all 232 patients who underwent medical abortion in the period from March 1, 2002 to February 28, 2003 were retrospectively reviewed. The cases were evaluated with regard to success rate, frequency of expulsion within the first four hours, ultrasound findings, possible therapeutic intervention and subsequent contraception, if known. The data were evaluated using descriptive statistics; statistical significance was calculated by means of the chi- square test, where appropriate. Results: Ninety- five percent of the women had a successful medical abortion. With the applied dosage 60% of the expulsions took place within the first four hours. Only one third of the patients had no more vaginal bleeding at time of the postabortion control. In almost 40% of the cases residuals were suspected, in about two thirds the endometrium was thicker than 10mm. In those cases, where data on this matter were available, the endometrium returned to normal with and without administration of Misoprostol. For less than half of the patients, subsequent contraception had already been initiated or had already been planned. Conclusions: The presented data seem to justify a watchful wait without further therapeutic intervention in the case of suspected residuals and/or an endometrium thickness of maximally 16 mm. Based on our findings we assume that this management is applicable in the case of Misoprostol administered at home, as well. Further analysis of our results will have to be performed to assess their validity.
文摘We report a case of a 31-year-old patient with primary antiphospholip id synd rome (APS) and a past medical history of deep vein thrombosis and intrauterine f etal death followed by pulmonary embolism in her first pregnancy. In this pregna ncy treatment with low molecular weight heparin (LMWH) and aspirin was institute d and pregnancy outcome was uneventful. In the immediate post partum period a va scular inflammation of the finger and toe pulps made a steroid therapy necessary . Although there is general consensus on how to manage APS during pregnancy, no guidelines exist for the immediate peripartum period. Management plans should be individualized and aim for continuous anticoagulation in pregnancy. Time around delivery without anticoagulation should be kept to a minimum. The decision resp ecting the route of delivery should be guided by obstetric indications only. Aft er delivery intensive monitoring of affected patients should be instituted to di agnose complications without undue delay.
