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Schneider H, Masilela T, Mndebele J, Vallabhjee K, Petersen I, Gilson L, Engelbrecht B. Special series on the District Health System. S Afr Med J 2023; 113:14. [PMID: 38525616 DOI: 10.7196/samj.2023.v113i11.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
| | - T Masilela
- Outcomes Facilitator, Department of Planning, Monitoring and Evaluation, South Africa.
| | - J Mndebele
- Chief Director, District Health Services, KwaZulu-Natal Department of Health, South Africa.
| | - K Vallabhjee
- Advisor, Clinton Health Access Initiative, South Africa.
| | - I Petersen
- Director and Research Professor, Centre for Rural Health, School of Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Gilson
- Professor, Division of Health Policy and Systems, School of Public Health, University of Cape Town, South Africa.
| | - B Engelbrecht
- Adjunct Associate Professor, School of Public Health, University of Cape Town, and Extraordinary Associate Professor, Faculty of Health Sciences, North West University, Potchefstroom, South Africa.
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Schiffer M, Carls E, Wagner K, Engelbrecht B, Duerr D, Welz A, de la JM, Pfeifer A, Fleischmann K, Roell W. Transplantation of Cx43 Expressing Fibroblasts: An Option for Postinfarct Arrhythmia Prevention? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Schiffer
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - E. Carls
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - K. Wagner
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - B. Engelbrecht
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - D. Duerr
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - A. Welz
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - J. M. de la
- University of Zaragoza, Institute of Material Science of Aragón, Zaragoza, Spain
| | - A. Pfeifer
- Department of Pharmacology and Toxicology, University Bonn, Bonn, Germany
| | - K. Fleischmann
- Department of Physiology I, University Bonn, Bonn, Germany
| | - W. Roell
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
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Ottersbach A, Mykhaylyk O, Heidsieck A, Eberbeck D, Rieck S, Zimmermann K, Breitbach M, Engelbrecht B, Brügmann T, Hesse M, Welz A, Sasse P, Wenzel D, Plank C, Gleich B, Hölzel M, Bloch W, Pfeifer A, Fleischmann BK, Roell W. Improved heart repair upon myocardial infarction: Combination of magnetic nanoparticles and tailored magnets strongly increases engraftment of myocytes. Biomaterials 2017; 155:176-190. [PMID: 29179133 DOI: 10.1016/j.biomaterials.2017.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/05/2017] [Accepted: 11/11/2017] [Indexed: 01/02/2023]
Abstract
Cell replacement in the heart is considered a promising strategy for the treatment of post-infarct heart failure. Direct intramyocardial injection of cells proved to be the most effective application route, however, engraftment rates are very low (<5%) strongly hampering its efficacy. Herein we combine magnetic nanoparticle (MNP) loading of EGFP labeled embryonic cardiomyocytes (eCM) and embryonic stem cell-derived cardiomyocytes (ES-CM) with application of custom designed magnets to enhance their short and long-term engraftment. To optimize cellular MNP uptake and magnetic force within the infarct area, first numerical simulations and experiments were performed in vitro. All tested cell types could be loaded efficiently with SOMag5-MNP (200 pg/cell) without toxic side effects. Application of a 1.3 T magnet at 5 mm distance from the heart for 10 min enhanced engraftment of both eCM and ES-CM by approximately 7 fold at 2 weeks and 3.4 fold (eCM) at 8 weeks after treatment respectively and also strongly improved left ventricular function at all time points. As underlying mechanisms we found that application of the magnetic field prevented the initial dramatic loss of cells via the injection channel. In addition, grafted eCM displayed higher proliferation and lower apoptosis rates. Electron microscopy revealed better differentiation of engrafted eCM, formation of cell to cell contacts and more physiological matrix formation in magnet-treated grafts. These results were corroborated by gene expression data. Thus, combination of MNP-loaded cells and magnet-application strongly increases long-term engraftment of cells addressing a major shortcoming of cardiomyoplasty.
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Affiliation(s)
- Annika Ottersbach
- Department of Cardiac Surgery, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany; Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Olga Mykhaylyk
- Institute of Molecular Immunology/ Experimental Oncology, Klinikum München rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 München, Germany
| | - Alexandra Heidsieck
- Institute of Medical Engineering (IME.TUM), Boltzmannstr. 11, 85748 Garching b. München, Germany
| | - Dietmar Eberbeck
- Physikalisch-Technische Bundesanstalt (PTB), Abbestraße 2-12, 10587 Berlin, Germany
| | - Sarah Rieck
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Katrin Zimmermann
- Institute of Pharmacology and Toxicology, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Martin Breitbach
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Britta Engelbrecht
- Department of Cardiac Surgery, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Tobias Brügmann
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Michael Hesse
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Armin Welz
- Department of Cardiac Surgery, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Philipp Sasse
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Daniela Wenzel
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Christian Plank
- Institute of Molecular Immunology/ Experimental Oncology, Klinikum München rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 München, Germany
| | - Bernhard Gleich
- Institute of Medical Engineering (IME.TUM), Boltzmannstr. 11, 85748 Garching b. München, Germany
| | - Michael Hölzel
- Unit for RNA Biology, Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Wilhelm Bloch
- Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany
| | - Bernd K Fleischmann
- Institute of Physiology I, Life&Brain Center, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany.
| | - Wilhelm Roell
- Department of Cardiac Surgery, Medical Faculty, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany.
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Engelbrecht B, Klein A, Breitbach M, Parikh A, Lee J, Zimmermann K, Ottersbach A, Dürr D, Welz A, Pfeifer A, Salama G, Kotlikoff M, Fleischmann B, Röll W. Long-term Reduction of Post-infarct Ventricular Tachycardia by Direct Lentiviral Connexin 43 Gene Transfer. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bacon S, Engelbrecht B, Schmid J, Pfeiffer S, Gallagher R, McCarthy A, Burke M, Concannon C, Prehn JHM, Byrne MM. MicroRNA-224 is Readily Detectable in Urine of Individuals with Diabetes Mellitus and is a Potential Indicator of Beta-Cell Demise. Genes (Basel) 2015; 6:399-416. [PMID: 26110317 PMCID: PMC4488671 DOI: 10.3390/genes6020399] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/11/2015] [Accepted: 06/18/2015] [Indexed: 12/16/2022] Open
Abstract
MicroRNA (miRNA) are a class of non-coding, 19–25 nucleotide RNA critical for network-level regulation of gene expression. miRNA serve as paracrine signaling molecules. Using an unbiased array approach, we previously identified elevated levels of miR-224 and miR-103 to be associated with a monogenic form of diabetes; HNF1A-MODY. miR-224 is a novel miRNA in the field of diabetes. We sought to explore the role of miR-224 as a potential biomarker in diabetes, and whether such diabetes-associated-miRNA can also be detected in the urine of patients. Absolute levels of miR-224 and miR-103 were determined in the urine of n = 144 individuals including carriers of a HNF1A mutation, participants with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) and normal controls. Expression levels were correlated with clinical and biochemical parameters. miR-224 was significantly elevated in the urine of carriers of a HNF1A mutation and participants with T1DM. miR-103 was highly expressed in urine across all diabetes cohorts when compared to controls. For both miR-224 and-103, we found a significant correlation between serum and urine levels (p < 0.01). We demonstrate that miRNA can be readily detected in the urine independent of clinical indices of renal dysfunction. We surmise that the differential expression levels of miR-224 in both HNF1A-MODY mutation carriers and T1DM may be an attempt to compensate for beta-cell demise.
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Affiliation(s)
- Siobhán Bacon
- Department of Endocrinology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Britta Engelbrecht
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Jasmin Schmid
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Shona Pfeiffer
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Ross Gallagher
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Ailbhe McCarthy
- Department of Endocrinology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Marie Burke
- Department of Endocrinology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Caoimhín Concannon
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Jochen H M Prehn
- Departments of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Maria M Byrne
- Department of Endocrinology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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Engelbrecht B, Mattern Y, Scheibler S, Tschoepe D, Gawlowski T, Stratmann B. Methylglyoxal impairs GLUT4 trafficking and leads to increased glucose uptake in L6 myoblasts. Horm Metab Res 2014; 46:77-84. [PMID: 24108388 DOI: 10.1055/s-0033-1357121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Methylglyoxal (MG) is a highly reactive dicarbonyl compound derived mainly from glucose degradation pathways, but also from protein and fatty acid metabolism. MG modifies structure and function of different biomolecules and thus plays an important role in the pathogenesis of diabetic complications. Hyperglycemia-associated accumulation of MG might be associated with generation of oxidative stress and subsequently insulin resistance. Therefore, the effects of MG on insulin signaling and on translocation of glucose transporter 4 (GLUT4) were investigated in the rat skeletal muscle cell line L6-GLUT4myc stably expressing myc-tagged GLUT4. Twenty four-hour MG treatment resulted in elevated GLUT4 presentation on the surface of L6 myoblasts and in an increased uptake of glucose even without insulin stimulation. Exogenously added MG neither effected IRS-1 expression nor IRS-1 phosphorylation. A decreased expression of Akt1 but not Akt2 and concomitantly increased apoptosis were detected following MG treatment. To exclude that oxidative stress caused by MG treatment leads to increased GLUT4 translocation, effects of pretreatment with 2 antioxidants were investigated. The antioxidant and MG scavenger NAC prevented the MG-induced GLUT4 translocation. In contrast, tiron, a well-known antioxidant that does not exert MG-scavenger function, had no impact on MG-induced GLUT4 translocation supporting the hypothesis of a direct effect of MG on GLUT4 trafficking. In conclusion, prolonged treatment with MG augments GLUT4 level on the surface of L6 myoblasts, at least in part through a higher translocation of GLUT4 from the intracellular compartment as well as a reduction of GLUT4 internalization, resulting in increased glucose uptake.
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Affiliation(s)
- B Engelbrecht
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
| | - Y Mattern
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
| | - S Scheibler
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
| | - D Tschoepe
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
| | - T Gawlowski
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
| | - B Stratmann
- Heart and Diabetes Center NRW, Ruhr-University Bochum, Diabetes Center, Bad Oeynhausen, Germany
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Engelbrecht B, Stratmann B, Hess C, Tschoepe D, Gawlowski T. Impact of GLO1 knock down on GLUT4 trafficking and glucose uptake in L6 myoblasts. PLoS One 2013; 8:e65195. [PMID: 23717693 PMCID: PMC3662699 DOI: 10.1371/journal.pone.0065195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/26/2013] [Indexed: 11/23/2022] Open
Abstract
Methylglyoxal (MG), a highly reactive α-dicarbonyl metabolite of glucose degradation pathways, protein and fatty acid metabolism, plays an important role in the pathogenesis of diabetic complications. Hyperglycemia triggers enhanced production of MG and increased generation of advanced glycation endproducts (AGEs). In non-enzymatic reactions, MG reacts with arginine residues of proteins to form the AGEs argpyrimidine and hydroimidazolone. Glyoxalase 1 (GLO1), in combination with glyoxalase 2 and the co-factor glutathione constitute the glyoxalase system, which is responsible for the detoxification of MG. A GLO1 specific knock down results in accumulation of MG in targeted cells. The aim of this study was to investigate the effect of intracellularly accumulated MG on insulin signaling and on the translocation of the glucose transporter 4 (GLUT4). Therefore, L6 cells stably expressing a myc-tagged GLUT4 were examined. For the intracellular accumulation of MG, GLO1, the first enzyme of the glyoxalase pathway, was down regulated by siRNA knock down and cells were cultivated under hyperglycemic conditions (25 mM glucose) for 48 h. Here we show that GLO1 knock down augmented GLUT4 level on the cell surface of L6 myoblasts at least in part through reduction of GLUT4 internalization, resulting in increased glucose uptake. However, intracellular accumulation of MG had no effect on GLUT4 concentration or modification. The antioxidant and MG scavenger NAC prevented the MG-induced GLUT4 translocation. Tiron, which is also a well-known antioxidant, had no impact on MG-induced GLUT4 translocation.
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Affiliation(s)
- Britta Engelbrecht
- Ruhr-University Bochum, Diabetes Center, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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Engelbrecht B, Stratmann B, Tschöpe D, Gawlowski T. Einfluss von Methylglyoxal auf die insulin-induzierte Translokation von GLUT4 in L6-Myoblasten-Zellen*. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gawlowski T, Stratmann B, Stork I, Engelbrecht B, Brodehl A, Niehaus K, Körfer R, Tschoepe D, Milting H. Heat shock protein 27 modification is increased in the human diabetic failing heart. Horm Metab Res 2009; 41:594-9. [PMID: 19384818 DOI: 10.1055/s-0029-1216374] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic conditions like diabetes mellitus (DM) leading to altered metabolism might cause cardiac dysfunction. Hyperglycemia plays an important role in the pathogenesis of diabetic complications including accumulation of methylglyoxal (MG), a highly reactive alpha-dicarbonyl metabolite of glucose degradation pathways and increased generation of advanced glycation endproducts (AGEs). The aim of this investigation was to study the extent of the MG-modification argpyrimidine in human diabetic heart and in rat cardiomyoblasts grown under hyperglycemic conditions. Left ventricular myocardial samples from explanted hearts of patients with cardiomyopathy with (n=8) or without DM (n=8) as well as nonfailing donor organs (n=6), and rat cardiac myoblasts H9c2 treated with glucose were screened for the MG-modification argpyrimidine. The small heat shock protein 27 (Hsp27) revealed to be the major argpyrimidine containing protein in cardiac tissue. Additionally, the modification of arginine leading to argpyrimidine and the phosphorylation of Hsp27 are increased in the myocardium of patients with DM. In H9c2 cells hyperglycemia leads to a decrease of the Hsp27-expression and an increase in argpyrimidine content and phosphorylation of Hsp27, which was accompanied by the induction of oxidative stress and apoptosis. This study shows an association between diabetes and increased argpyrimidine-modification of myocardial Hsp27, a protein which is involved in apoptosis, oxidative stress, and cytoskeleton stabilization.
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Affiliation(s)
- T Gawlowski
- Heart and Diabetes Center NRW, Ruhr-University Bochum for the Meta-Card Research Group, Diabetes Center, 32545 Bad Oeynhausen, Germany
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Engelbrecht B, Gawlowski T, Mattern Y, Tschöpe D, Stratmann B. Auswirkungen des Glyoxalase 1-Knock-Downs auf die HSP27-Expression und das Aktin-Zytoskelett. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pattinson RC, Louw NS, Engelbrecht B, Nieuwoudt AJ. Complications in 8509 laparoscopic Falope ring sterilizations performed under local anaesthesia. S Afr Med J 1983; 64:975-6. [PMID: 6228023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
During the 3-year period 1 January 1980-31 December 1982, 8509 laparoscopic Falope ring sterilizations were performed under local anaesthesia in rural areas of the Cape Province by the Sterilization Service of Tygerberg Hospital. Despite the fact that 476 of the patients had undergone previous lower abdominal surgery, major complications (anaphylactic shock after injection of lignocaine and inadvertent perforation of the bladder by the trocar) occurred in only 2 cases. It was not possible to complete the sterilization under local anaesthesia in 98 cases, resulting in a technical failure rate of 1.15%. A prospective study of the minor complications encountered among the 193 patients sterilized during November 1982 showed that torn tubes occurred in 3.1% and uterine perforation in 2.1%. This can be partially explained by the fact that evidence of previous pelvic infection was seen during laparoscopy in 9.3% of cases. The pregnancy rate after sterilization was 0.28% for the group as a whole.
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Nieuwoudt AJ, Louw NS, Engelbrecht B. [Interval Falope ring sterilization in the Cape Province: experience with 9175 cases over 4 years]. S Afr Med J 1983; 64:972-4. [PMID: 6648736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
During a 4-year period 9175 women were sterilized under local anaesthesia by the laparoscopic Falope ring method. These procedures were performed in smaller towns in the Cape Province. The method used, its cost-effectiveness, and its acceptability to patients are described in detail. This venture proves convincingly that a highly sophisticated medical service can be made available to rural areas, ensuring greater support for a high-priority primary health care service.
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