1
|
Berger L, Grimm A, Sütterlin M, Spaich S, Sperk E, Tuschy B, Berlit S. Major complications after intraoperative radiotherapy with low-energy x-rays in early breast cancer. Strahlenther Onkol 2024; 200:276-286. [PMID: 37591980 DOI: 10.1007/s00066-023-02128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To describe and analyze major local complications after intraoperative radiotherapy (IORT) with low-energy x‑rays during breast-conserving surgery (BCS) in early breast cancer. METHODS Ten women out of 408 who were treated with IORT between 2002 and 2017 and subsequently developed a severe local complication requiring surgical intervention were retrospectively identified and analyzed. Demographic, clinical, and surgical parameters as well as complication characteristics and treatment methods were evaluated. RESULTS At initial presentation, eight patients (80%) showed redness, six (60%) seroma, six (60%) wound infection, six (60%) suture dehiscence, and four (40%) induration of the former surgical area. Hematoma and necrosis were observed in one case (10%) each. Time interval until appearance of the first symptoms ranged from directly postoperative until 15 years postoperatively (median 3.1 months). Initial treatment modalities comprised antibiotic therapy (n = 8/80%) and transcutaneous aspiration of seroma (n = 3/30%). In the majority of patients, smaller surgical interventions (excision of a necrotic area/fistula [n = 6/60%] or secondary suture [n = 5/50%]) were sufficient to overcome the complication, yet larger interventions such as complex flap surgery and mastectomy were necessary in one patient each. CONCLUSION IORT is an efficient and safe treatment method as < 2.5% of all IORT patients experienced major local complications. However, it seems to pose the risk of causing severe local complications that may require lengthy and burdensome treatment. Thorough preoperative counseling, implementation of recommended intraoperative precautions, and high vigilance for first symptoms of complications during follow-up appointments are necessary measures.
Collapse
Affiliation(s)
- Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Anja Grimm
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
2
|
Grimm A, Wollmann E, Sperk E, Weiß C, Sütterlin M, Berlit S, Tuschy B. Intraoperative radiotherapy (IORT) of early breast cancer with low-energy x-rays in breast-conserving surgery : Prospective identification of pre- and intraoperative factors influencing the feasibility of IORT. Strahlenther Onkol 2024; 200:296-305. [PMID: 37792017 DOI: 10.1007/s00066-023-02149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The aim of this study is to identify pre- and intraoperative factors indicating the feasibility of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS). MATERIALS AND METHODS From January 2018 to December 2019, a total of 128 women undergoing BCS due to early breast cancer were included in this prospective observational study, independent of whether IORT was planned or not. Patient and tumor characteristics as well as surgical parameters that could potentially influence the feasibility of IORT were recorded for the entire collective. In addition, a preoperative senological assessment was performed and analyzed to assess the feasibility of IORT. Logistic regression was then used to identify relevant preoperative parameters and to generate a formula predicting the feasibility of IORT. RESULTS Of the 128 included women undergoing BCS, 46 were preoperatively rated to be feasible, 20 to be questionably feasible for IORT. Ultimately, IORT was realized in 30 patients. The most frequent reasons for omission of IORT were insufficient tumor-to-skin distance and/or an excessively large tumor cavity. Small clinical tumor size and large tumor-to-skin distance according to preoperative ultrasound were significantly related to accomplishment of IORT. CONCLUSION We observed that preoperative ultrasound-based tumor-skin distance is a significant factor in addition to already known parameters to predict feasibility of IORT. Based on our findings we developed a formula to optimize IORT planning which might serve as an additional tool to improve patient selection for IORT in early breast cancer.
Collapse
Affiliation(s)
- Anja Grimm
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Theodor-Kutzer Ufer 1-3, Mannheim, Germany.
| | - Eva Wollmann
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
3
|
Goerdt L, Poemsl J, Spaich S, Welzel G, Abo-Madyan Y, Ehmann M, Berlit S, Tuschy B, Sütterlin M, Wenz F, Sperk E. Longitudinal cosmetic outcome after planned IORT boost with low kV X-rays-monocentric results from the TARGIT BQR registry. Transl Cancer Res 2023; 12:1715-1726. [PMID: 37588731 PMCID: PMC10425636 DOI: 10.21037/tcr-23-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/20/2023] [Accepted: 06/07/2023] [Indexed: 08/18/2023]
Abstract
Background Intraoperative radiotherapy can serve as an anticipated boost (IORT boost) in combination with a subsequent external whole breast irradiation in high-risk breast cancer patients and is part of many guidelines. Nevertheless, there are only few prospective data available regarding cosmetic outcome after IORT boost using kV X-rays. The aim of this study was to evaluate the cosmetic outcome of patients treated within the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) in one center. Methods In the context of the TARGIT BQR study standardized photos in three positions (arms down, arms up, from the side) were available for different time points. For this analysis a layperson, a radiation oncologist and a gynecologist evaluated available photos at different time points during follow-up with up to 4 years using the Harvard scale (comparison of treated and the untreated breast; rating: excellent, good, fair, poor). Longitudinal results were compared to preoperative results (baseline). Results Seventy-three patients were available for the analysis. Baseline cosmetic assessment was excellent/good in 98.8% (mean value for all three positions). Postoperative cosmetic outcome (median) was good for all positions and remained constant for 4 years. Around 30% of the patients showed a constant or even improved cosmetic outcome compared to baseline. Only few patients showed a poor result at 4 years. The majority of patients showed an excellent or good cosmetic outcome at all time points. Conclusions Patients from the prospective TARGIT BQR study treated with IORT boost and additional whole breast irradiation showed good or excellent cosmetic outcomes in most cases during 4 years of follow-up. These results add important information for shared decision making in breast cancer patients.
Collapse
Affiliation(s)
- Lukas Goerdt
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Janina Poemsl
- Department of Paediatric and Adolescent Medicine, University Hospital Augsburg, Medical Faculty Augsburg, Augsburg, Germany
| | - Saskia Spaich
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Chief Executive Officer, University Hospital Freiburg, Freiburg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
4
|
Stefanovic S, Werner E, Gerigk M, Hornung R, Karic U, WEIß C, Tuschy B, Berlit S, Sütterlin M. Therapy Guidance by Vaginal Smears of Pregnant Women With Preterm Complications in Correlation With Maternal and Neonatal Outcome: A Retrospective Analysis. In Vivo 2023; 37:1211-1218. [PMID: 37103084 DOI: 10.21873/invivo.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM This retrospective cohort study enrolled hospitalized women with 24+0 to 33+6 gestational weeks with conditions associated with preterm birth. We evaluated the ability of vaginal swab isolates to guide antibiotic management decisions in the setting of threatened preterm towards a clinical advantage, i.e., longer delay between diagnosis and birth, better neonatal outcomes. PATIENTS AND METHODS Vaginal swabs were obtained from all patients and antibiotic resistance profiles determined in case of growth. The cohort was divided into two groups: the antibiogram-noncongruently managed Group 1 and the antibiogram-congruently managed Group 2. These groups were compared in regard to multiple maternal and neonatal endpoints. RESULTS In total, 698 cases were analyzed - 224 in Group 1 and 474 in Group 2. Antibiotics were ordered/continued by the treating physician in 138 cases (138/698; 19.8%) upon review of vaginal swab cultures results. Forty-five among them (32.6%) received antibiotics inactive against the isolated bacteria. 335 (25.4%) patients had only normal vaginal flora, and 95.6% of them had not received antibiotics. Facultatively pathogenic microorganisms were isolated in 52% patients. Only 5% of the neonates had bacterial isolates identical to those of their mothers. There were no significant differences in outcomes between Group 1 and Group 2. CONCLUSION No association was found between a swab-result-guided antibiotic management protocol and maternal or fetal outcome in the setting of preterm birth risk between 24 and 34 gestational weeks. These findings underline the importance of critical rethinking the frequency of vaginal smears and fine-tuning the indications for antibiotic treatment.
Collapse
Affiliation(s)
- Stefan Stefanovic
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Eva Werner
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- Department of Gynecology and Obstetrics, Worms County Hospital, Worms, Germany
| | - Marlis Gerigk
- Institute of Medical Microbiology and Hygiene, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralph Hornung
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Uros Karic
- University Hospital for Infectious and Tropical Diseases, Belgrade University School of Medicine, Belgrade, Serbia
- IMDI Science Center, Belgrade, Serbia
| | - Christel WEIß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
5
|
Stefanovic S, Sütterlin M, Gaiser T, Scharff C, Neumann M, Berger L, Froemmel N, Tuschy B, Berlit S. Microscopic, Macroscopic and Thermal Impact of Argon Plasma, Diode Laser, and Electrocoagulation on Ovarian Tissue. In Vivo 2023; 37:531-538. [PMID: 36881055 PMCID: PMC10026650 DOI: 10.21873/invivo.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM To compare the microscopic, macroscopic and thermal damage inflicted to ovarian tissue by conventional monopolar and bipolar energy, argon plasma coagulation (APC) and diode laser. MATERIALS AND METHODS Bovine ovaries were used as a substitute for human tissue and subjected to the four aforementioned techniques and the inflicted damage was measured. Sixty fresh and morphologically similar cadaveric bovine ovaries were divided into five equal groups, each group was subjected to one of the following energy applications for both 1 and 5 s: Monopolar, bipolar electrocoagulation, diode laser, preciseAPC® and forcedAPC® Ovarian temperatures were measured at 4 and 8 s after treatment. Formalin-fixed ovarian specimens were examined by pathologists regarding macroscopic, microscopic and thermal tissue damage. RESULTS None of the ovaries reached the temperature producing severe damage (40°C) after 1 s of energy transfer. Heating of adjacent ovarian tissue was least pronounced when preciseAPC® and monopolar electrocoagulation were applied (27.2±3.3°C and 28.2±2.9°C after 5 s of application, respectively). Conversely, 41.7% of the ovaries subjected to bipolar electrocoagulation for 5 s overheated. ForcedAPC® resulted in the most pronounced lateral tissue defects (2.8±0.3 mm after 1 s and 4.7±0.6 mm after 5 s). When the modalities were applied for 5 s, the electrosurgical instruments (mono- and bipolar) and preciseAPC® induced similar lateral tissue damage (1.3±0.6 mm, 1.1±1.6 mm and 1.2±1.3 mm, respectively). preciseAPC® created the shallowest defect of all the techniques (0.05±0.1 mm after 5 s of application). CONCLUSION Our study hints at superior safety profiles of preciseAPC® and monopolar electrocoagulation compared to bipolar electrocoagulation, diode laser and forcedAPC® for ovarian laparoscopic surgery.
Collapse
Affiliation(s)
- Stefan Stefanovic
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Scharff
- Institute of Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcel Neumann
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Berger
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Benjamin Tuschy
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
6
|
Berger L, Tuschy B, Stefanovic S, Yen K, Weiss C, Sütterlin M, Spaich S, Berlit S. Forensic Medical Examination After Sexual Violence: Implications Based on Victims' Perceptions. In Vivo 2023; 37:848-857. [PMID: 36881047 PMCID: PMC10026665 DOI: 10.21873/invivo.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM The objective of this study was to assess the perception of the forensic medical examination (FME) by victims of sexual violence. Based on patient-related outcomes gained in terms of personnel, chronological and spatial parameters, an additional aim was to derive improved examination procedures. PATIENTS AND METHODS A total of 49 sexually assaulted women were enrolled in this study. After standardized FME by a forensic doctor followed by a gynecologist, women were asked to complete a questionnaire addressing general perception, preferences regarding attending staff's sex, sequence and time frame of the examinations performed. The attending gynecologist also completed a questionnaire addressing demographic and medical parameters of the patient as well as assault-related information. RESULTS The examination setting in general was evaluated positively. Nevertheless, 52% of examined victims perceived the FME as an additional psychological burden. Overall, 85% of the affected women preferred a female forensic physician and 76% a female gynecologist to perform the examination. When women said they experienced a violation of their privacy during the gynecological examination, a male was more often present (60% vs. 35%, p=0.0866). Regarding the sequence of the examination components, 65% of the victims preferred to start with their medical history followed by the forensic and then the gynecological examination. CONCLUSION Forensic medical and gynecological examination after sexual assault is an essential procedure, yet it is a potentially further traumatizing experience for the victim. The identified patient preferences should be taken into account in order to diminish further trauma.
Collapse
Affiliation(s)
- Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Stefanovic
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Kathrin Yen
- Institute for Forensic and Traffic Medicine, Heidelberg University, Heidelberg, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
7
|
Berger L, Wolf-Breitinger M, Weiß C, Tuschy B, Berlit S, Sütterlin M, Spaich S. Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany. Cancer Causes Control 2023; 34:469-477. [PMID: 36854989 PMCID: PMC10105660 DOI: 10.1007/s10552-023-01677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE According to the recently implemented organized cervical cancer screening program in Germany, women older than 35 years with negative cytology but persistent high-risk human papilloma virus (hrHPV) infection > 12 months should be referred to colposcopy for further evaluation. This study aimed to present and dissect colposcopic and histopathological findings with particular focus on associated hrHPV genotypes. METHODS This study is a retrospective analysis of clinical data from 89 hrHPV positive patients with normal cytology who underwent colposcopic examination at a certified dysplasia outpatient clinic in Germany in 2021. RESULTS While 38 (43%) women had a normal colposcopic finding, 45 (51%) had minor and 6 (7%) major changes. Thirty-one (35%) of the women were HPV 16 and/or HPV 18 positive and 58 (65%) women were positive for other hrHPV only. Among patients who underwent colposcopy with biopsies (in case of an abnormal finding or type 3 transformation zone, n = 68), eight (12%) had cervical intraepithelial neoplasia (CIN) 3 and six (9%) had CIN 2. The proportion of women diagnosed with CIN 3 varied among different hrHPV genotypes (HPV 16: 11%, HPV 18: 33%, HPV 31: 27%, HPV 33: 33%, HPV 52: 33%). CONCLUSION Persistently hrHPV positive women with negative cytology are at increased risk of being diagnosed with CIN 3. As CIN 3 prevalence seems to differ with regard to hrHPV strain, immediate HPV genotyping for risk stratification and subsequent early referral for colposcopy might constitute a feasible strategy.
Collapse
Affiliation(s)
- Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany.
| | - Maja Wolf-Breitinger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany
| | - Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68165, Mannheim, Germany
| |
Collapse
|
8
|
Spaich S, Berlit S, Berger L, Weiss C, Tuschy B, Sütterlin M, Stefanovic S. First experiences with a diode laser in major gynecological laparoscopic procedures show lack of benefit and impaired feasibility. Lasers Med Sci 2023; 38:34. [PMID: 36600026 DOI: 10.1007/s10103-022-03696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study is to evaluate feasibility and potential benefit of a diode laser in major laparoscopic procedures in gynecology. METHODS Between 2018 and 2020, a total of 42 cases were enrolled in this study comparing standard electrosurgery with diode laser-supported therapy in laparoscopic supracervical hysterectomy (LASH), total laparoscopic hysterectomy (TLH), or laparoscopic myoma enucleation (LME). Dual wavelength 45 W diode laser light was used to cut and coagulate during laparoscopy in the prospective interventional arm consisting of 11 cases, while 31 matching patients who received conventional treatment with monopolar/bipolar current for the same interventions were retrospectively identified in our laparoscopy database. Recruitment in the prospective interventional laser diode arm was terminated after only 11 patients (instead of planned 50) due to intense hemorrhage and massive smoke development. RESULTS A total of 42 cases were analyzed (11 LME, 19 LASH, and 12 TLH). Strong smoke development was evident in all 11 cases in the diode laser arm. It was necessary to convert to bipolar or monopolar current in all hysterectomies (n = 9) with initial diode laser implementation due to increased bleeding and smoke development. Conventional current sources had to be used in LMEs (n = 2) due to excessive bleeding and poor visibility during enucleation of the fibroid. A significant difference (p < 0.0001) was observed regarding smoke development when comparing the laser arm with the control arm. CONCLUSION We found a 45-W diode laser to be inferior to electrosurgical techniques for major laparoscopic gynecologic surgeries regarding bleeding control and smoke development.
Collapse
Affiliation(s)
- Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Berger
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Stefanovic
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
9
|
Wuhrer A, Uhlig S, Tuschy B, Berlit S, Sperk E, Bieback K, Sütterlin M. Wound Fluid from Breast Cancer Patients Undergoing Intraoperative Radiotherapy Exhibits an Altered Cytokine Profile and Impairs Mesenchymal Stromal Cell Function. Cancers (Basel) 2021; 13:2140. [PMID: 33946741 PMCID: PMC8124792 DOI: 10.3390/cancers13092140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/05/2021] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Intraoperative radiotherapy (IORT) displays an increasingly used treatment option for early breast cancer. It exhibits non-inferiority concerning the risk of recurrence compared to conventional external irradiation (EBRT) in suitable patients with early breast cancer. Since most relapses occur in direct proximity of the former tumor site, the reduction of the risk of local recurrence effected by radiotherapy might partially be due to an alteration of the irradiated tumor bed's micromilieu. Our aim was to investigate if IORT affects the local micromilieu, especially immune cells with concomitant cytokine profile, and if it has an impact on growth conditions for breast cancer cells as well as mammary mesenchymal stromal cells (MSC), the latter considered as a model of the tumor bed stroma.42 breast cancer patients with breast-conserving surgery were included, of whom 21 received IORT (IORT group) and 21 underwent surgery without IORT (control group). Drainage wound fluid (WF) was collected from both groups 24 h after surgery for flow cytometric analysis of immune cell subset counts and potential apoptosis and for multiplex cytokine analyses (cytokine array and ELISA). It served further as a supplement in cultures of MDA-MB 231 breast cancer cells and mammary MSC for functional analyses, including proliferation, wound healing and migration. Furthermore, the cytokine profile within conditioned media from WF-treated MSC cultures was assessed. Flow cytometric analysis showed no group-related changes of cell count, activation state and apoptosis rates of myeloid, lymphoid leucocytes and regulatory T cells in the WF. Multiplex cytokine analysis of the WF revealed group-related differences in the expression levels of several cytokines, e.g., oncostatin-M, leptin and IL-1β. The application of WF in MDA-MB 231 cultures did not show a group-related difference in proliferation, wound healing and chemotactic migration. However, WF from IORT-treated patients significantly inhibited mammary MSC proliferation, wound healing and migration compared to WF from the control group. The conditioned media collected from WF-treated MSC-cultures also exhibited altered concentrations of VEGF, RANTES and GROα. IORT causes significant changes in the cytokine profile and MSC growth behavior. These changes in the tumor bed could potentially contribute to the beneficial oncological outcome entailed by this technique. The consideration whether this alteration also affects MSC interaction with other stroma components presents a promising gateway for future investigations.
Collapse
Affiliation(s)
- Anne Wuhrer
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (B.T.); (S.B.); (M.S.)
| | - Stefanie Uhlig
- FlowCore Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (S.U.); (K.B.)
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (B.T.); (S.B.); (M.S.)
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (B.T.); (S.B.); (M.S.)
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Karen Bieback
- FlowCore Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (S.U.); (K.B.)
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, German Red Cross Blood Donor Services, Heidelberg University, 68167 Mannheim, Germany
- Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (B.T.); (S.B.); (M.S.)
| |
Collapse
|
10
|
Spaich S, Link G, Ortiz Alvarez S, Weiss C, Sütterlin M, Tuschy B, Berlit S. Einfluss von peripartaler Erwartungshaltung, Geburtsmodus und Dammverletzungen auf die postpartale Sexualität von Frauen. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717175] [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: 10/23/2022] Open
Affiliation(s)
- S Spaich
- Universitätsfrauenklinik Mannheim
| | - G Link
- Universitätsfrauenklinik Mannheim
| | | | - C Weiss
- Universitätsmedizin Mannheim, Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung
| | | | - B Tuschy
- Universitätsfrauenklinik Mannheim
| | - S Berlit
- Universitätsfrauenklinik Mannheim
| |
Collapse
|
11
|
Spaich S, Link G, Alvarez SO, Weiss C, Sütterlin M, Tuschy B, Berlit S. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women's Postpartum Sexuality. J Sex Med 2020; 17:1312-1325. [PMID: 32532706 DOI: 10.1016/j.jsxm.2020.04.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/29/2019] [Revised: 03/31/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sexual health has been identified as an important factor for postpartum quality of life. Although pregnancy-related changes in anatomy and metabolism return to their prepregnancy state, female sexual function may not be at the level it was before birth because of physical and psychological changes. AIM The goal of our study was to explore the influence of the mode of delivery, perineal injury, and peripartum expectations on postpartum sexual function. METHODS Between 2013 and 2018, 522 women were enrolled in this prospective investigation. At time of recruitment during the peripartum hospitalization, patients completed a standardized questionnaire addressing expectations concerning postpartum sexuality with focus on expected influence of the mode of delivery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and Sexual Activity Questionnaire (SAQ) at time of recruitment to evaluate baseline sexual function (4 weeks before pregnancy). Follow-up assessments were conducted at 3, 6, and 12 months postpartum. OUTCOMES Peripartum expectations, influence of the mode of delivery, and perineal injury were analyzed for their impact on women's sexual function within 12 months postpartum by repetitive FSFI and SAQ assessments. RESULTS A total of 522 women with 263 spontaneous vaginal deliveries, 41 operative vaginal deliveries, and 218 cesarean sections were analyzed. Although the data demonstrate a significant postpartum decline in sexual function at 3 and 6 months postpartum, sexual functioning converges to baseline prepregnancy values 12 months postpartum. This observation was independent of the mode of delivery and perineal injuries with no significant between-group differences at any of the analyzed time points. Apart from breastfeeding, for which negative anticipations resulted in impaired sexuality, women's expectations (pertaining to quantity and quality of female orgasm, partner's sexuality, fear of altered sexuality, frequency of intercourse, the mode of delivery) do not influence female sexual function at 12 months postpartum. CLINICAL IMPLICATIONS Deciphering the potential influence of patient expectations as well as pregnancy- and childbirth-related aspects on female postpartum sexuality will help in the effort to improve women's postpartum sexual health. STRENGTHS & LIMITATIONS As a strength of this study, postpartum sexuality was independently assessed with 2 different scoring systems (FSFI and SAQ). Limitations include that our follow-up is incomplete and amounts to about 2-thirds of patients who were initially recruited. CONCLUSION The mode of delivery and perineal trauma do not influence women's postpartum sexual function. With the exception of breastfeeding, peripartum expectations do not result in altered sexual functioning at 12 months postpartum. Spaich S, Link G, Alvarez SO, et al. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women's Postpartum Sexuality. J Sex Med 2020;17:1312-1325.
Collapse
Affiliation(s)
- Saskia Spaich
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
| | - Georgina Link
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Ortiz Alvarez
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
12
|
Uhlig S, Wuhrer A, Berlit S, Tuschy B, Sütterlin M, Bieback K. Intraoperative radiotherapy for breast cancer treatment efficiently targets the tumor bed preventing breast adipose stromal cell outgrowth. Strahlenther Onkol 2020; 196:398-404. [PMID: 32030446 PMCID: PMC7089893 DOI: 10.1007/s00066-020-01586-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/16/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Mesenchymal stromal cells (MSC) in bone marrow have been shown to be radioresistant, which is related to pronounced DNA repair mechanisms. Intraoperative radiotherapy (IORT) during breast-conserving surgery for early breast cancer is an innovative technique applying low energy x‑ray to the tumor bed immediately after removal of the tumor. IORT is considered to reduce the risk of local tumor recurrence by directly targeting cells of the tumor bed and altering the local microenvironment. Aim of this study was to investigate whether IORT affects the outgrowth potential of breast adipose tissue-derived MSC (bASC) as part of the tumor bed. MATERIALS AND METHODS After surgical tumor resection, biopsies of the tumor bed were taken before (pre IORT) and after IORT (post IORT) and processed applying well-established protocols for ASC isolation and characterization. RESULTS In all, 95% of pre IORT tumor bed samples yielded persistently outgrowing bASC with typical ASC characteristics: fibroblastoid morphology, proliferation, adipogenic and osteogenic differentiation and ASC surface marker expression. However, none of the post IORT samples yielded persistent outgrowth of bASC. CONCLUSIONS After breast-conserving surgery, approximately 90% of local recurrences emerge in close proximity to the initial tumor bed, potentially reflecting a significant contribution of the tumor bed to relapse. Our data show that IORT, besides the proven effect on breast cancer cells, efficiently modifies the tumor environment by having an impact on tumor bed bASC. This effect on tumor bed stromal cells might contribute to reduce the risk of tumor relapse and metastases.
Collapse
Affiliation(s)
- Stefanie Uhlig
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, German Red Cross Blood Donor Services, Heidelberg University, Friedrich-Ebert Str. 107, 68167, Mannheim, Germany
- FlowCore Mannheim, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl Str. 13-17, 68167, Mannheim, Germany
| | - Anne Wuhrer
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Karen Bieback
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, German Red Cross Blood Donor Services, Heidelberg University, Friedrich-Ebert Str. 107, 68167, Mannheim, Germany.
- FlowCore Mannheim, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl Str. 13-17, 68167, Mannheim, Germany.
| |
Collapse
|
13
|
Pez M, Keller A, Welzel G, Abo-Madyan Y, Ehmann M, Tuschy B, Berlit S, Sütterlin M, Wenz F, Giordano FA, Sperk E. Long-term outcome after intraoperative radiotherapy as a boost in breast cancer. Strahlenther Onkol 2019; 196:349-355. [PMID: 31641788 DOI: 10.1007/s00066-019-01525-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/13/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate long-term oncological outcome and incidence of chronic side effects in patients with breast cancer and intraoperative radiotherapy given as an upfront boost (IORT boost). METHODS Retrospective analysis of 400 patients with an IORT boost with low-energy X‑rays (20 Gy), subsequent whole-breast irradiation (46-50 Gy), and annual oncological follow-up. Side effects were prospectively evaluated (LENT-SOMA scales) over a period of up to 15 years. Side effects scored ≥grade 2 at least three times during follow-up were judged to be chronic. RESULTS The median age was 63 years (30-85) and the median follow-up was 78 months (2-180) after IORT boost. In 15 patients a local recurrence occurred, resulting in a local recurrence rate at 5, 10, and 15 years of 2.0%, 6.6%, and 10.1%, respectively. The overall survival rates at 5, 10, and 15 years were 92.1%, 81.8%, and 80.7%, respectively. The most common high-grade side effects were fibrosis (21%) and pain (8.6%). The majority of side effects occurred within the first 3 years. The actuarial rates of chronic fibrosis were 19.1% and 21.1% at 5 and ≥8 years, of chronic pain 8.6% at ≥4 years, of chronic edema of the breast 2.4% at ≥2 years, of chronic lymphedema 0.0% at 5 and 10 years, and of chronic hyperpigmentation 0.5% at ≥2 years. Side effects were similar or less than expected from an external beam boost. CONCLUSION IORT boost appears to be a highly efficient and safe method for upfront delivery of the tumor bed boost in high-risk breast cancer patients.
Collapse
Affiliation(s)
- Matthias Pez
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anke Keller
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Grit Welzel
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Yasser Abo-Madyan
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Ehmann
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Gynecology and Obstetrics, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Gynecology and Obstetrics, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Gynecology and Obstetrics, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, Freiburg, Germany
| | - Frank A Giordano
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Elena Sperk
- University Medical Center Mannheim, Medical Faculty Mannheim, Department of Radiation Oncology, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
14
|
Kehl S, Weiss C, Dammer U, Berlit S, Große-Steffen T, Faschingbauer F, Sütterlin M, Beckmann M, Schneider M. Induction of Labour in Growth Restricted and Small for Gestational Age Foetuses – A Historical Cohort Study. Geburtshilfe Frauenheilkd 2019; 79:402-408. [PMID: 31000886 PMCID: PMC6461466 DOI: 10.1055/a-0834-8199] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/26/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose
Induction of labour for small-for-gestational-age (SGA) foetus or intrauterine growth restriction (IUGR) is common, but data are limited. The aim of this study was therefore to compare labour induction for SGA/IUGR with cases of normal foetal growth above the 10th percentile.
Material and Methods
This historical multicentre cohort study included singleton pregnancies at term. Labour induction for SGA/IUGR (IUGR group) was compared with cases of foetal growth above the 10th percentile (control group). Primary outcome measure was caesarean section rate.
Results
The caesarean section rate was not different between the 2 groups (27.0 vs. 26.2%, p = 0.9154). In the IUGR group, abnormal CTG was more common (30.8 vs. 21.9%, p = 0.0214), and foetal blood analysis was done more often (2.5 vs. 0.5%, p = 0.0261). There were more postpartum transfers to the NICU in the IUGR group (40.0 vs. 12.8%, p < 0.0001), too.
Conclusion
Induction of labour for foetal growth restriction was not associated with an increased rate of caesarean section.
Collapse
Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christel Weiss
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Ulf Dammer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | - Marc Sütterlin
- Frauenklinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | | | | |
Collapse
|
15
|
Kehl S, Weiss C, Dammer U, Berlit S, Große-Steffen T, Faschingbauer F, Sütterlin M, Beckmann MW, Schneider MO. [Induction of Labour In Growth Restricted and Small for Gestational Age Fetuses - A Historical Cohort Study]. Z Geburtshilfe Neonatol 2019; 223:40-47. [PMID: 30650455 DOI: 10.1055/a-0809-6110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Induction of labour for small-for-gestational-age (SGA) foetus or intrauterine growth restriction (IUGR) is common, but data are limited. The aim of this trial was therefore to compare labour induction for SGA/IUGR with cases with normal fetal growth beyond the 10th percentile. MATERIAL AND METHODS This historical multicentre cohort study included singleton pregnancies at term. Labour induction for SGA/IUGR (IUGR group) was compared with cases of fetal growth beyond the 10th percentile (control group). Primary outcome measure was caesarean section rate. RESULTS The caesarean section rate was not different between the 2 groups (27.0 vs. 26.2%, p=0.9154). In the IUGR group, abnormal CTG was more common (30.8 vs. 21.9%, p=0.0214), and fetal blood analyses were conducted more often (2.5 vs. 0.5%, p=0.0261). There were more postpartum transfers to the NICU in the IUGR group (40.0 vs. 12.8%, p<0.0001), too. CONCLUSION Induction of labour for fetal growth restriction was not associated with an increased rate of caesarean section.
Collapse
Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - Christel Weiss
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Mannheim
| | - Ulf Dammer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | | | | | | | | | | | | |
Collapse
|
16
|
Nickol J, Berlit S, Lis S, Hornemann A, Sütterlin M, Tuschy B. Haemodynamische Auswirkungen einer intramyometranen Epinephrininjektionen zur Blutungsreduktion bei laparoskopischer Myomenukleation. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671399] [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: 10/28/2022] Open
Affiliation(s)
- J Nickol
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - S Lis
- Zentralinstitut für Seelische Gesundheit, Institut für Psychiatrische und Psychosomatische Psychotherapie, Mannheim, Deutschland
| | - A Hornemann
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - B Tuschy
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| |
Collapse
|
17
|
Werner E, Hornung R, Berlit S, Petzold A, Miethke T, Weiß C, Sütterlin M. Lassen sich pathologische Keime im maternalen Vaginalabstrich postpartal beim Kind nachweisen? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671491] [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: 10/28/2022] Open
Affiliation(s)
- E Werner
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - R Hornung
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - A Petzold
- Universitätsmedizin, Institut für medizinische Mikrobiologie und Hygiene, Mannheim, Deutschland
| | - T Miethke
- Universitätsmedizin, Institut für medizinische Mikrobiologie und Hygiene, Mannheim, Deutschland
| | - C Weiß
- Medizinische Fakultät Mannheim, Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| |
Collapse
|
18
|
Berlit S, Tuschy B, Wuhrer A, Jürgens S, Buchweitz O, Lis S, Sütterlin M, Hornemann A. Einfluss der totalen versus subtotalen laparoskopischen Hysterektomie auf die weibliche Sexualität. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671084] [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: 10/28/2022] Open
Affiliation(s)
- S Berlit
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenheilkunde, Mannheim, Deutschland
| | - B Tuschy
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenheilkunde, Mannheim, Deutschland
| | - A Wuhrer
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenheilkunde, Mannheim, Deutschland
| | - S Jürgens
- Tagesklinik Altonaer Strasse, Hamburg, Deutschland
| | - O Buchweitz
- Tagesklinik Altonaer Strasse, Hamburg, Deutschland
| | - S Lis
- Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenheilkunde, Mannheim, Deutschland
| | - A Hornemann
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenheilkunde, Mannheim, Deutschland
| |
Collapse
|
19
|
Kehl S, Weiss C, Dammer U, Faschingbauer F, Große-Steffen T, Berlit S, Sütterlin M, Beckmann MW, Schneider M. Ist die Geburtseinleitung bei intrauteriner Wachstumsrestriktion und small-for-gestational-age-Feten problematisch? Eine historische Kohortenstudie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671186] [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: 10/28/2022] Open
Affiliation(s)
- S Kehl
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - C Weiss
- Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Deutschland
| | - U Dammer
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - F Faschingbauer
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - T Große-Steffen
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin Mannheim, Universität Heidelberg, Frauenklinik, Mannheim, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - M Schneider
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| |
Collapse
|
20
|
Wuhrer A, Tuschy B, Berlit S, Bieback K, Uhlig S, Sütterlin M. Einfluss einer intraoperativen Strahlentherapie des Mammakarzinoms auf das Mikromilieu im Tumorbett. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671525] [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: 10/28/2022] Open
Affiliation(s)
- A Wuhrer
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - B Tuschy
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - K Bieback
- Institut für Immunologie und Transfusionsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Flow Core, Mannheim, Deutschland
| | - S Uhlig
- Institut für Immunologie und Transfusionsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Flow Core, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| |
Collapse
|
21
|
Tuschy B, Gabbert M, Weiss C, Hornemann A, Wuhrer A, Sütterlin M, Berlit S. Einfluss einer Ulipristalacetatmedikation auf die weibliche Sexualität bei Frauen mit symptomatischem Uterus myomatosus. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671657] [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: 10/28/2022] Open
Affiliation(s)
- B Tuschy
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - M Gabbert
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - C Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Deutschland
| | - A Hornemann
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - A Wuhrer
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim, Deutschland
| |
Collapse
|
22
|
Hornung R, Werner E, Berlit S, Petzold A, Miethke T, Weiß C, Sütterlin M. Nutzen und Probleme des Vaginalabstrichs in der Schwangerschaft. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671490] [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: 10/28/2022] Open
Affiliation(s)
- R Hornung
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - E Werner
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - S Berlit
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| | - A Petzold
- Universitätsmedizin, Institut für medizinische Mikrobiologie und Hygiene, Mannheim, Deutschland
| | - T Miethke
- Universitätsmedizin, Institut für medizinische Mikrobiologie und Hygiene, Mannheim, Deutschland
| | - C Weiß
- Medizinische Fakultät Mannheim, Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsmedizin, Frauenklinik, Mannheim, Deutschland
| |
Collapse
|
23
|
Nickol J, Berlit S, Lis S, Hornemann A, Tsagogiorgas C, Sütterlin M, Tuschy B. Hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy. Arch Gynecol Obstet 2018; 298:933-938. [PMID: 30229298 DOI: 10.1007/s00404-018-4891-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate changes in hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy. METHODS A total of 185 women with symptomatic uterine fibroids who underwent laparoscopic myomectomy were enrolled in this study. Eighty-six women (study collective) received an intramyometrial injection of epinephrine and were compared to ninety-nine women (control collective) who underwent laparoscopic myomectomy without an intramyometrial epinephrine injection. Demographic parameters, change of hemodynamic parameters during surgery as well as hemoglobin drop after surgery were analyzed. RESULTS In the study collective maximum systolic blood pressure (p < 0.001), maximum increase of the systolic blood pressure within 5 min (p = 0.003), duration of hypertension (p = 0.012), maximal (p < 0.001) and mean heart rate (p = 0.005), maximal increase of heart rate within 5 min (p = 0.003) and difference of mean to maximal heart rate (p < 0.001) were higher compared to the control collective. There was no difference in pre- and postoperative hemoglobin levels in both collectives and no intraoperative clinically relevant complication occurred due to intramyometrial epinephrine injection. CONCLUSION The intramyometrial application of epinephrine seems to be safe but leads to significant alterations of hemodynamic parameters without a significant change in postoperative hemoglobin levels.
Collapse
Affiliation(s)
- Jana Nickol
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Charalambos Tsagogiorgas
- Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
24
|
Tuschy B, Gabbert M, Weiss C, Hornemann A, Wuhrer A, Sütterlin M, Berlit S. Changes in sexuality during ulipristal acetate treatment in women with symptomatic uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2018; 228:106-110. [PMID: 29920429 DOI: 10.1016/j.ejogrb.2018.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/11/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate changes in sexuality in women treated with Ulipristal acetate (UPA) due to symptomatic uterine fibroids. STUDY DESIGN A total of 102 women with symptomatic uterine fibroids undergoing conservative therapy with UPA were enrolled in this observational study. Sexuality was evaluated before and after a three month UPA treatment using the Female Sexual Functioning Index (FSFI) as well as the Sexual Activity Questionnaire (SAQ). Before treatment was initiated, participants additionally filled in a standardised questionnaire addressing the expected changes in sexuality due to UPA. Demographic parameters, expectations concerning changes in sexuality, and FSFI- and SAQ-scores were analysed. RESULTS The average age of the study collective was 42.3 years. For the majority of the included women (n = 70; 71.4%) sexuality was rated as an important issue and 86 women (87.8%) did not think that UPA would have an impact on the frequency of sexual intercourse, the quality (n = 91; 92.9%) or frequency of orgasms (n = 87; 88.8%) neither sexual receptivity (n = 88; 89.8%). Full data sets were available for 73 patients (71.6%). The FSFI showed significantly higher sub scores regarding desire (3.6 ± 1.2 vs. 3.9 ± 1.2; p = 0.0012) and arousal (4.2 ± 1.7 vs. 4.4 ± 1.9; p = 0.0151) as well as a higher total score (26.6 ± 9.0 vs. 27.4 ± 9.5; p = 0.0008) after UPA treatment. Regarding the SAQ a statistically significant difference regarding the subscore "habit" was found (p < 0.0001) comparing pre with post interventional scores. CONCLUSION Sexuality in general seems to be important for women with symptomatic uterine fibroids. As the treatment with UPA appears to improve sexuality, this circumstance can be mentioned in a pre-therapeutic counselling.
Collapse
Affiliation(s)
- Benjamin Tuschy
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany.
| | - Mirja Gabbert
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Ludolf-Krehl-Strasse 13-17 Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Anne Wuhrer
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| |
Collapse
|
25
|
Berlit S, Tuschy B, Wuhrer A, Jürgens S, Buchweitz O, Kircher AT, Sütterlin M, Lis S, Hornemann A. Sexual functioning after total versus subtotal laparoscopic hysterectomy. Arch Gynecol Obstet 2018; 298:337-344. [PMID: 29948170 DOI: 10.1007/s00404-018-4812-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/06/2018] [Indexed: 12/24/2022]
Abstract
AIM To evaluate postoperative sexual functioning and the influence of patients' expectations on the change in sexuality following laparoscopic total (TLH) versus subtotal hysterectomy (LASH). METHODS A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this bicentric prospective study. Sexual functioning (SF) was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes in SF after surgery. At 3, 6 and 12 months following surgery, women were asked again to assess their level of SF (FSFI). Data of women who participated in at least one FSFI follow-up assessment were analysed (n = 92). We compared the change in SF after surgery between patients with TLH (n = 46) and LASH (n = 46). Additionally, we calculated regression analyses with the patients' expectations as a predictor for change in FSFI scores. RESULTS Comparing the change of FSFI scores after surgery in both collectives revealed differences only 3 months after surgery, as improvement was stronger for the LASH collective compared to the THL group (p = 0.006). There were no changes comparing collectives after 6 (p = 0.663) and 12 (p = 0.326) months. Concerning patients' expectations, for the LASH group baseline SF (p < 0.001), but not expectations (p = 0.567) predicted the strength of change at each of the follow ups: a lower level of baseline SF was linked to a stronger improvement after surgery. For the THL collective, both baseline SF (p < 0.001) as well as patients' expectations (3 months: p = 0.077, 6 months: p = 0.37, 12 months: p = 0.024) predicted the strength of change: both, a lower level of baseline SF and higher expectations towards an improvement predicted a stronger improvement. CONCLUSION The preservation of the cervix does not show an advantage in improving SF after surgery. Both methods induce a comparable improvement in long-time SF, especially in patients with an impaired sexuality pre-surgery. Furthermore, patients' expectations concerning this matter seem to have an impact on the postoperative outcome; therefore, this circumstance should be considered in future projects.
Collapse
Affiliation(s)
- Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anne Wuhrer
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sven Jürgens
- Ambulatory Day Clinic Altonaer Strasse, Hamburg, Germany
| | - Olaf Buchweitz
- Ambulatory Day Clinic Altonaer Strasse, Hamburg, Germany
| | - Anna-Theresa Kircher
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Central Institute of Mental Health, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
26
|
Grosse-Steffen T, Krämer M, Tuschy B, Weiss C, Sütterlin M, Berlit S. Topic anaesthesia with a eutectic mixture of lidocaine/prilocaine cream after elective caesarean section: a randomised, placebo-controlled trial. Arch Gynecol Obstet 2017; 296:771-776. [PMID: 28803262 DOI: 10.1007/s00404-017-4486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/03/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Aim of the study was to investigate the topical application of a eutectic mixture of lidocaine/prilocaine (EMLA®) cream after caesarean section (CS) and its effect on postoperative pain, time to mobilisation, and time to discharge. MATERIALS AND METHODS A total of 189 pregnant women were enrolled; full data sets were available for 139 of them, who were prospectively randomised to receive either placebo (control group) or EMLA® cream (study group) on the CS lesion directly as well as 24 h after surgery. Postoperative pain was assessed 24 and 48 h after surgery using the short form of the McGill Pain Questionnaire (SF-MPQ). Additional analgesic pain medication on demand was assessed in both groups. RESULTS A total of 62 women were allocated randomly to the study and 77 patients to the control group before primary CS. There were no statistically significant differences regarding demographic and surgical parameters comparing both collectives. In addition, the postoperative total pain scores after 24 h [McGill total: 38.5 (0-102) vs. 50 (0-120) p = 0.0889] as well as after 48 h [24 (0-79) vs. 30.5 (0-92); p = 0.1455] showed no significant differences. Furthermore, time to mobilisation (hours) [9.68 (2.18-51.38) vs. 9.47 (4.18-41.77); p = 0.5919] and time to discharge (hours) [98.6 (54.08-170.15) vs. 98.2 (43.45-195.87); p = 0.5331] were comparable. CONCLUSION The postoperative application of EMLA® cream after CS did not reduce postoperative pain or time to mobilisation or discharge, so that its use in this context has to be seen critically.
Collapse
Affiliation(s)
- Thomas Grosse-Steffen
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Malin Krämer
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
27
|
Berlit S, Tuschy B, Stützer P, Schmahl C, Lis S, Sütterlin M. Psychologische und biologische Einflussfaktoren auf den Wunsch einer primären Schnittentbindung ohne absolute medizinische Indikation – Eine prospektive Studie. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606174] [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: 10/18/2022] Open
Affiliation(s)
- S Berlit
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim
| | - B Tuschy
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim
| | - P Stützer
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim
| | - C Schmahl
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - S Lis
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - M Sütterlin
- Universitätsmedizin Mannheim, Frauenklinik, Mannheim
| |
Collapse
|
28
|
Berlit S, Lis S, Jürgens S, Buchweitz O, Hornemann A, Sütterlin M, Tuschy B. Postoperative sexual functioning in total versus subtotal laparoscopic hysterectomy: what do women expect? Arch Gynecol Obstet 2017; 296:513-518. [PMID: 28685227 DOI: 10.1007/s00404-017-4452-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/26/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate sexual functioning and expected changes in sexual functioning in women with planned total versus subtotal laparoscopic hysterectomy. METHODS A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this study with a cross-sectional design. Full data sets were available for 112 patients, so that 56 patients with planned total laparoscopic hysterectomy (TLH) and 56 women with planned laparoscopic supracervical hysterectomy (LASH) were preoperatively assessed. Sexual functioning was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes on sexual function after the procedure. Demographic parameters, expectations concerning postoperative sexuality and FSFI scores were analysed and compared in women undergoing TLH and LASH. RESULTS There were no significant differences concerning demographic parameters and FSFI scores comparing collectives. Sexuality in general was considered more important in women undergoing LASH (2.88 ± 0.83 vs. 2.48 ± 0.89; p = 0.011). Also, in 29 patients (52%) opting for LASH and 8 (14%) patients undergoing TLH a potential change in postoperative sexuality had an impact on their choice for a subtotal/total hysterectomy, respectively (p < 0.001). CONCLUSION Patients' expectations concerning preservation of the cervix and postoperative sexuality appear to have the potential to bias investigations comparing total with subtotal hysterectomy. Hence, future research focusing on this issue should be accomplished incorporating patients' expectations stratified by mode of intervention.
Collapse
Affiliation(s)
- Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | | | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
29
|
Ellethy T, Welzel G, Sperk E, Neumaier C, Tuschy B, Berlit S, Ehmann M, Sütterlin M, Wenz FK, Abo-Madyan Y. Hypofractionated, normofractionated and intraoperative breast irradiation: Long term cosmetic outcome based on photographic evaluation. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.568] [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] [Indexed: 11/20/2022] Open
Abstract
568 Background: Photographic documentation of breast changes after breast radiotherapy (RT) is a helpful tool to both subjectively and objectively evaluate cosmesis. The aim of this study was to evaluate cosmesis in breast cancer patients after receiving hypofractionated whole breast RT (HF-WBRT), normofractionated (NF-WBRT), intraoperative RT (IORT) or combined WBRT/IORT. Methods: After excluding cases with missing or inadequate photos from three prospective clinical trials, KOSIMA, TARGIT-A & TARGIT-E, 155 and 205 cases were included in a subjective analysis while 132 and 185 cases were included in an objective analysis postoperatively and after 2 years respectively. Subjective evaluation was done by 9 observers using the Harvard scale. Objective evaluation was done by assessing percentage breast retraction (pBRA). Based on the treatment received, patients were divided into 5 groups: 1. HF-WBRT 40/2,67 Gy ± Boost, 2. NF-WBRT 50/2 Gy ± Boost, 3. NF-WBRT 56/2 Gy, 4. IORT 20 Gy, 5. IORT 20 Gy+WBRT 46/2 Gy. Results: Subjectively, the rate of excellent-good cosmesis was 92% postoperatively and 84% after 2 years while objectively it was around 56% at both time points. At 2 years, no significant difference was observed between the 5 treatment groups with the subjective excellent-good cosmesis being 82%, 80%, 92%, 83%, 85% (p = 0.546) and objective being 56%, 61%, 52%, 53%, 50% (p = 0.883) in groups 1-5 respectively. Factors possibly affecting cosmesis at 2 years were examined. No significant difference was observed with age, smoking, BMI, chemotherapy, hormone therapy or type of axillary surgery. Significantly better cosmesis was observed with upper outer tumor location compared to other quadrants (p < 0.0001) also with a ratio of excised/total breast volume under 20% (p < 0.0294). Conclusions: Cosmetic outcome after hypofractionated and IORT was similar to normofractionated breast RT. After 2 years of treatment, cosmetic deterioration remained acceptable, overall < 10%. Tumor location and excised breast volume were the only factors significantly affecting cosmetic outcome.
Collapse
Affiliation(s)
- Tarek Ellethy
- Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Neumaier
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik K. Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
30
|
Stützer PP, Berlit S, Lis S, Schmahl C, Sütterlin M, Tuschy B. Elective Caesarean section on maternal request in Germany: factors affecting decision making concerning mode of delivery. Arch Gynecol Obstet 2017; 295:1151-1156. [PMID: 28324224 DOI: 10.1007/s00404-017-4349-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate sociopsychological factors of women undergoing a caesarean section on maternal request (CSMR). METHODS Twenty-eight women who underwent CSMR and 29 women with vaginal delivery (VD) filled in standardized questionnaires concerning psychological burden (SCL-R 90), fear of childbirth (W-DEQ, STAI), personality structure (HEXACO-Pi-R) and social support (F-SozU) as well as one questionnaire assessing potential factors influencing their mode of delivery. RESULTS Women with CSMR were older (36.5 ± 5.4 vs. 30.6 ± 5.2 years; p < 0.001) and suffered more from fear of childbirth (W-DEQ 4.3 ± 0.8 vs. 3.7 ± 1.2; p = 0.041), concerns for their child (W-DEQ 2.0 ± 1.5 vs. 1.3 ± 0.7; p = 0.026) and appraised the birth less negative (W-DEQ 2.0 ± 0.7 vs. 2.7 ± 1.1; p = 0.008). The majority of parturients had chosen their preferred mode of delivery before pregnancy (CS 61% vs. VD 82%, p = 0.328). In the decision-making process for the mode of delivery, the advice of the partner (85 and 90%) played an important role. 82% of the women who delivered via CSMR did not regret the decision for this mode of delivery. CONCLUSION Women who underwent CS had higher fear of childbirth and appraised the birth less negative. The majority did not regret the decision for the CS and would even choose this mode of delivery for their next pregnancy. Although the partner and the physician seem to be important in the decision process for of the mode of delivery, reasons for the choice for CSMR appear to be multifactorial.
Collapse
Affiliation(s)
- Paul Philipp Stützer
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
31
|
Tuschy B, Stützer P, Berlit S, Schmahl C, Lis S, Sütterlin M. Psychologische und biologische Einflussfaktoren auf den Wunsch einer primären Schnittentbindung ohne absolute medizinische Indikation – Eine prospektive Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592871] [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] Open
|
32
|
Stützer P, Tuschy B, Berlit S, Lis S, Schmahl C, Sütterlin M. Retrospektive Untersuchung der Persönlichkeitsstruktur von Frauen mit einer Schnittentbindung ohne absolute medizinische Indikation. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592934] [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] Open
|
33
|
Berlit S, Tuschy B, Sütterlin M, Lis S, Jürgens S, Buchweitz O, Hornemann A. Einfluss der totalen versus subtotalen laparoskopischen Hysterektomie auf die weibliche Sexualität – Was erwarten Patientinnen? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593301] [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] Open
|
34
|
Kirscht J, Weiss C, Nickol J, Berlit S, Tuschy B, Hoch B, Trebin AV, Große-Steffen T, Sütterlin M, Kehl S. Dilatation or no dilatation of the cervix during cesarean section (Dondi Trial): a randomized controlled trial. Arch Gynecol Obstet 2016; 295:39-43. [DOI: 10.1007/s00404-016-4189-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
|
35
|
Kehl S, Schelkle A, Thomas A, Puhl A, Meqdad K, Tuschy B, Berlit S, Weiss C, Bayer C, Heimrich J, Dammer U, Raabe E, Winkler M, Faschingbauer F, Beckmann MW, Sütterlin M. Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial. Ultrasound Obstet Gynecol 2016; 47:674-679. [PMID: 26094600 DOI: 10.1002/uog.14924] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine whether the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique for estimating amniotic fluid volume is superior for predicting adverse pregnancy outcome. METHODS This was a multicenter randomized controlled trial including 1052 pregnant women with a term singleton pregnancy across four hospitals in Germany. Women were assigned randomly, according to a computer-generated allocation sequence, to AFI or SDP measurement for estimation of amniotic fluid volume. Oligohydramnios was defined as AFI ≤ 5 cm or the absence of a pocket measuring at least 2 × 1 cm. The diagnosis of oligohydramnios was followed by labor induction. The primary outcome measure was postpartum admission to a neonatal intensive care unit. Further outcome parameters were the rates of diagnosis of oligohydramnios and induction of labor (for oligohydramnios or without specific indication), and mode of delivery. RESULTS Postpartum admission to a neonatal intensive care unit was similar between groups (4.2% (n = 21) vs 5.0% (n = 25); relative risk (RR), 0.85 (95% CI, 0.48-1.50); P = 0.57). In the AFI group, there were more cases of oligohydramnios (9.8% (n = 49) vs 2.2% (n = 11); RR, 4.51 (95% CI, 2.2-8.57); P < 0.01) and more cases of labor induction for oligohydramnios (12.7% (n = 33) vs 3.6% (n = 10); RR, 3.50 (95% CI, 1.76-6.96); P < 0.01) than in the SDP group. Moreover, an abnormal cardiotocography was seen more often in the AFI group than in the SDP group (32.3% (n = 161) vs 26.2% (n = 132); RR, 1.23 (95% CI, 1.02-1.50); P = 0.03). The other outcome measures were not significantly different between the two groups. CONCLUSIONS Use of the AFI method increased the rate of diagnosis of oligohydramnios and labor induction for oligohydramnios without improving perinatal outcome. The SDP method is therefore the favorable method to estimate amniotic fluid volume, especially in a population with many low-risk pregnancies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- S Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - A Schelkle
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - A Thomas
- Department of Obstetrics, Charité Virchow-Klinikum, Berlin, Germany
| | - A Puhl
- Department of Obstetrics and Gynaecology, University Medical Centre Mainz, Mainz, Germany
| | - K Meqdad
- Department of Obstetrics, Charité Virchow-Klinikum, Berlin, Germany
| | - B Tuschy
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - S Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - C Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| | - C Bayer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - J Heimrich
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - U Dammer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - E Raabe
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M Winkler
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - F Faschingbauer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
36
|
Berlit S, Sütterlin M. Die bioelektrische Impedanzanalyse in der Gynäkologie und Geburtshilfe. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0035-1570039] [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] Open
|
37
|
Berlit S, Temerinac D, Chen X, Sütterlin M, Kehl S. Einfluss des kindlichen Gewichts auf die Kaiserschnittrate und das fetale Outcome nach Geburtseinleitung. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566528] [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]
|
38
|
Tuschy B, Sperk E, Berlit S, Wenz F, Sütterlin M. Onkologie. Intraoperative Strahlentherapie beim Mammakarzinom. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0034-1382926] [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: 10/24/2022] Open
Affiliation(s)
| | - Elena Sperk
- Klinik für Strahlentherapie und Radioonkologie der Universitätsmedizin Mannheim
| | | | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie der Universitätsmedizin Mannheim
| | | |
Collapse
|
39
|
Kehl S, Ziegler J, Schleussner E, Tuschy B, Berlit S, Kirscht J, Hägele F, Weiss C, Siemer J, Sütterlin M. Sequential use of double-balloon catheter and oral misoprostol versus oral misoprostol alone for induction of labour at term (CRBplus trial): a multicentre, open-label randomised controlled trial. BJOG 2014; 122:129-36. [DOI: 10.1111/1471-0528.13116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- S Kehl
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
- Department of Obstetrics and Gynaecology; Erlangen University Hospital; Erlangen Germany
| | - J Ziegler
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
| | - E Schleussner
- Department of Obstetrics; Jena University Hospital; Jena Germany
| | - B Tuschy
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
- Department of Obstetrics and Gynaecology; Frankenthal Hospital; Frankenthal Germany
| | - S Berlit
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
- Department of Obstetrics and Gynaecology; Frankenthal Hospital; Frankenthal Germany
| | - J Kirscht
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
| | - F Hägele
- Department of Obstetrics and Gynaecology; Diakonie Hospital; Mannheim Germany
| | - C Weiss
- Department of Medical Statistics and Biomathematics; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
| | - J Siemer
- Department of Obstetrics and Gynaecology; Ludmillenstift Hospital; Meppen Germany
| | - M Sütterlin
- Department of Obstetrics and Gynaecology; University Medical Centre Mannheim; Heidelberg University; Heidelberg Germany
- Department of Obstetrics and Gynaecology; Frankenthal Hospital; Frankenthal Germany
| |
Collapse
|
40
|
Berlit S, Tuschy B, Weiss C, Leweling H, Sütterlin M, Kehl S. Die bioelektrische Impedanzanalyse als Diagnostikum der Präeklampsie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388044] [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: 10/24/2022] Open
|
41
|
Kirscht J, Berlit S, Tuschy B, Hoch B, Trebin A, Sütterlin M, Kehl S. Zervixdilatation im Rahmen eines Kaiserschnitts – eine randomisiert kontrollierte Studie (Dondi-Trial). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388213] [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: 10/24/2022] Open
|
42
|
Pankert K, Berlit S, Tuschy B, Hornemann A, Sütterlin M. Die weibliche Sexualität nach der Geburt. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388225] [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: 10/24/2022] Open
|
43
|
Tuschy B, Berlit S, Brade J, Hüttner F, Hornemann A, Sütterlin M. Effektivität einer topischen transdermalen Schmerzmittelapplikation nach gynäkologischen minimal invasiven Eingriffen – Ergebnisse einer prospektiv randomisierten verblindeten Studie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388271] [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: 10/24/2022] Open
|
44
|
Berlit S, Stojakowits M, Tuschy B, Weiss C, Leweling H, Sütterlin M, Kehl S. Bioelectrical impedance analysis in the assessment of pre-eclampsia. Arch Gynecol Obstet 2014; 291:31-8. [PMID: 25047271 DOI: 10.1007/s00404-014-3369-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Aim of this prospective investigation was to assess pre-eclampsia by bioelectrical impedance analysis (BIA). METHODS A total of 22 pre-eclamptic as well as matched (patients' age, gestational age, parity, gravidity) healthy pregnant women underwent whole body BIA on admission and then, pre-eclamptic patients, every 2 days until childbirth. For all measured BIA single values and their corresponding reference value mean, standard deviation, minimum and maximum were calculated to compare pre-eclamptic women with corresponding reference values. Furthermore a paired t test and an ANOVA of repeated measurements were performed to detect differences of intraindividual measurements. Subsequently an analysis of variance was accomplished to analyse general changes in the course of time of investigated patients, who were measured more than once. RESULTS Except for the phase angle, BIA parameters of pre-eclamptic women compared to corresponding reference values were significantly different, suggesting an increase of total body water in pre-eclampsia. Repeated measurements did not reveal statistically significant intra- or interindividual differences in the course of time. CONCLUSION Bioelectrical impedance analysis allows differentiating healthy from pre-eclamptic women. Further investigations are needed to analyse if BIA is capable to serve as a prognostic diagnostic tool in the detection of deterioration of pre-eclampsia.
Collapse
Affiliation(s)
- Sebastian Berlit
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
| | | | | | | | | | | | | |
Collapse
|
45
|
Berlit S, Tuschy B, Brade J, Sütterlin M, Hornemann A. Feasibility and perioperative morbidity of minilaparoscopic hysterectomy. In Vivo 2014; 28:263-266. [PMID: 24632984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To analyze the feasibility and perioperative morbidity of minilaparoscopy compared to conventional laparoscopy (CL) in patients undergoing laparoscopic hysterectomy. PATIENTS AND METHODS Between 04/2012 and 04/2013, 31 patients were prospectively enrolled to undergo hysterectomy via minilaparoscopy with 3.5-mm instruments. A cohort of 108 matched patients who underwent hysterectomy via CL performed by the same surgeon between 08/2011 and 12/2012 served as the control group. RESULTS There were no statistically significant differences concerning duration of surgery, overall hospital stay and perioperative haemoglobin drop between groups. However, in the study group, the registered blood loss via suction tube was higher (p-value=0.0216) and in two women, intraoperative complications occurred in the form of thermal damage of the ureter via bipolar coagulation. CONCLUSION Hysterectomy via minilaparoscopy is a feasible laparoscopic approach. Nevertheless, the use of minilaparoscopy should be considered carefully as the reduced diameter of the instruments might impede certain surgical procedures, such as vessel sealing.
Collapse
Affiliation(s)
- Sebastian Berlit
- University Medical Center Mannheim; Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | | | | | | | | |
Collapse
|
46
|
Tuschy B, Berlit S, Lis S, Sütterlin M, Hornemann A. Influence of a robotic camera holder on postoperative pain in women undergoing gynaecological laparoscopy. In Vivo 2014; 28:229-234. [PMID: 24632978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To investigate the influence of a robotic camera holder on postoperative pain in women undergoing gynaecological laparoscopy. PATIENTS AND METHODS Sixty-one women were prospectively enrolled in the study and underwent either conventional laparoscopy or laparoscopy using an active camera holder. Twenty-four and 48 h after surgery abdominal pain was assessed using the short form of the McGill Pain Questionnaire. Demographic data, and clinical and surgical parameters were evaluated. RESULTS Twenty-seven women underwent laparoscopy with an active camera holder (study group) and 34 women underwent laparoscopy with human camera assistance (control group). Women in the study group were older (43.5±8.6 vs. 37.4±10.4 years; p=0.018) while the duration of surgery was shorter in women who underwent conventional laparoscopy (97±37 vs. 71±33 min; p=0.005). Total pain scores 24 h (28.3±24.2 vs. 44.0±35.0; p=0.049643) as well as 48 h (18.0±20.0 vs. 33.8±31.0; p=0.016) after surgery were significantly less in the study group. CONCLUSION The usage of a robotic camera holder results in less postoperative pain in women undergoing gynaecological laparoscopy.
Collapse
Affiliation(s)
- Benjamin Tuschy
- University Medical Centre Mannheim, Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
| | | | | | | | | |
Collapse
|
47
|
Tuschy B, Berlit S, Brade J, Sütterlin M, Hornemann A. Solo surgery – Early results of robot-assisted three-dimensional laparoscopic hysterectomy. MINIM INVASIV THER 2014; 23:230-4. [DOI: 10.3109/13645706.2014.893890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
48
|
Tuschy B, Berlit S, Brade J, Sütterlin M, Hornemann A. Full High-definition three-dimensional gynaecological laparoscopy--clinical assessment of a new robot-assisted device. In Vivo 2014; 28:111-115. [PMID: 24425844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To investigate the clinical assessment of a full high-definition (HD) three-dimensional robot-assisted laparoscopic device in gynaecological surgery. PATIENTS AND METHODS This study included 70 women who underwent gynaecological laparoscopic procedures. Demographic parameters, type and duration of surgery and perioperative complications were analyzed. Fifteen surgeons were postoperatively interviewed regarding their assessment of this new system with a standardized questionnaire. RESULTS The clinical assessment revealed that three-dimensional full-HD visualisation is comfortable and improves spatial orientation and hand-to-eye coordination. The majority of the surgeons stated they would prefer a three-dimensional system to a conventional two-dimensional device and stated that the robotic camera arm led to more relaxed working conditions. CONCLUSION Three-dimensional laparoscopy is feasible, comfortable and well-accepted in daily routine. The three-dimensional visualisation improves surgeons' hand-to-eye coordination, intracorporeal suturing and fine dissection. The combination of full-HD three-dimensional visualisation with the robotic camera arm results in very high image quality and stability.
Collapse
Affiliation(s)
- Benjamin Tuschy
- University Medical Center Mannheim, Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
| | | | | | | | | |
Collapse
|
49
|
Berlit S, Tuschy B, Weiss C, Hornemann A, Leweling H, Stojakowits M, Sütterlin M, Kehl S. Bioelektrische Impedanzanalyse: Normwerte in der Schwangerschaft. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361341] [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: 10/26/2022]
|
50
|
Kehl S, Thomas A, Puhl AG, Schelke A, Meqdad K, Berlit S, Tuschy B, Bayer C, Hautmann S, Dammer U, Raabe E, Winkler M, Faschingbauer F, Beckmann MW, Sütterlin M. Single Deepest vertical Pocket oder Amnion Fluid Index zur Fruchtwasser-Evaluation (SAFE-Studie): eine randomisiert kontrollierte Multicenter-Studie. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361367] [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: 10/26/2022]
|