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Tremmel E, Starrach T, Buschmann C, Trillsch F, Kolben T, Mahner S, Burges A, Kost B, Ehmann L, Burgmann DM. Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series. Arch Gynecol Obstet 2024; 309:1227-1236. [PMID: 38078931 PMCID: PMC10894165 DOI: 10.1007/s00404-023-07290-4] [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: 07/08/2023] [Accepted: 11/06/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. METHODS In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG-analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. RESULTS Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. CONCLUSION Treatment strategies were based on the patient's individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.
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Affiliation(s)
- E Tremmel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - C Buschmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - F Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - B Kost
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - L Ehmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - D M Burgmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Simon P, Petroff D, Dorn C, Ehmann L, Kloft C, Prettin C, Dietrich A, Zeitlinger M, Kees F, Wrigge H. Measurement of soft tissue drug concentrations in morbidly obese and non-obese patients - A prospective, parallel group, open-labeled, controlled, phase IV, single center clinical trial. Contemp Clin Trials Commun 2019; 15:100375. [PMID: 31193565 PMCID: PMC6535681 DOI: 10.1016/j.conctc.2019.100375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Pharmacokinetic (PK) and pharmacodynamic (PD) data on perioperative antibiotic prophylaxis or antibiotic therapy are rare in patients suffering from morbid obesity. Furthermore, dosing regimens should be based on PK/PD models that ensure effective antibiotic exposure not in plasma, but primarily at the site of infection, mostly in the interstitial fluid (ISF). The aim of this trial is to investigate whether current dosing regimens of various antibiotics lead to effective concentrations in the ISF of morbidly obese patients. Methods We designed a prospective, parallel group, open-labeled, controlled single center trial to investigate the plasma and tissue pharmacokinetics of the antibiotics linezolid, meropenem, tigecycline, piperacillin/tazobactam, fosfomcyine, cefazolin, metronidazole and as secondary aim the analgesics metamizole and acetaminophen. Inclusion criteria comprise body mass index ≥35 kg/m2 for obese or between 18.5 and 30 kg/m2 for non-obese patients scheduled for elective abdominal surgery. For PK analysis, blood and microdialysate samples of subcutaneous tissue were collected 0–8 h after study drug administration. The primary endpoint is to investigate a possible dependency of the area-under-the-curve (AUC0-8) in the interstitial fluid on body weight and obesity with population based pharmacokinetic analysis. Discussion Inadequate dosing regimes of antibiotics may be a relevant factor for morbidity and mortality of patients, as well as for the development of bacterial antibiotic resistance. The measurement of plasma and tissue concentrations will provide information necessary for PK/PD-modelling. These data about antibiotic PK/PDcharacteristics in soft tissue and their dependence on weight should help to develop weight-dependent models for calculation of patient's individual doses of different antibiotics. Trial registration EU clinical trials register (EudraCT-No. 2012-004383-22) and German Clinical trials Register (DRKS00004776);
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Affiliation(s)
- P Simon
- University of Leipzig, Department of Anaesthesiology and Intensive Care Medicine, Leipzig, Germany.,University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany
| | - D Petroff
- University of Leipzig, Clinical Trial Centre Leipzig, Germany
| | - C Dorn
- University of Regensburg, Institute of Pharmacy, Regensburg, Germany
| | - L Ehmann
- Freie Universitaet Berlin, Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Berlin, Germany
| | - C Kloft
- Freie Universitaet Berlin, Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Berlin, Germany
| | - C Prettin
- University of Leipzig, Clinical Trial Centre Leipzig, Germany
| | - A Dietrich
- University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany.,University of Leipzig, Department of Visceral, Transplantation, Vascular and Thoracic Surgery, Leipzig, Germany
| | - M Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - F Kees
- University of Regensburg, Department of Pharmacology, Regensburg, Germany
| | - H Wrigge
- University of Leipzig, Department of Anaesthesiology and Intensive Care Medicine, Leipzig, Germany.,University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany.,Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Germany
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Tillack C, Ehmann L, Koglin S, Schauber J, Wollenberg A, Brand S. Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterized by interferon-gamma-expressing Th1 and IL-17/IL-22-expressing Th17 cell infiltrates and respond to anti-IL-12/IL-23 antibody treatment. Z Gastroenterol 2012. [DOI: 10.1055/s-0032-1324133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ruzicka L, Hösli H, Ehmann L. Polyterpene und Polyterpenoide LXXXVIII. Zur Dehydrierung von Hederagenin, Oleanolsäure und Sumaresinolsäure mit Selen oder Palladium. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19340170151] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Meystre C, Ehmann L, Neher R, Miescher K. Über Steroide. (42. Mitteilung). Ein einfacher Abbau der Gallensäuren-Seitenkette zur Methylketonstufe II. Helv Chim Acta 2004. [DOI: 10.1002/hlca.6602801178] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ruzieka L, Brüngger H, Egli R, Ehmann L, Goldberg MW. Polyterpene und Polyterpenoide LXXVII. Weitere Beiträge zur Dehydrierung des Betulins, des Gypsogenins und der Siaresinolsäure. über das Oxy-sapotalin. Helv Chim Acta 2004. [DOI: 10.1002/hlca.193201501177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ruzicka L, Brüngger H, Egli R, Ehmann L, Furter M, Hösli H. Polyterpene und Polyterpenoide LXV. Über die Dehydrierung einiger Triterpene, Sapogenine und damit verwandter Körper. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19320150139] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ruzicka L, Ehmann L, Mörgeli E. Polyterpene und Polyterpenoide LXXXI. Synthese des 1,2,5,6-Tetramethyl-naphtalins und einiger analoger Kohlenwasserstoffe. Ein Beitrag zur Kenntnis des Kohlenstoffgerüstes der Triterpene. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19330160145] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ruzicka L, Ehmann L, Goldberg MW, Hösli H. Polyterpene und Polyterpenoide LXXXIV. Synthese des 1,2-Cyclopentano-phenanthrens, des α- und des β-Methylderivats desselben und des Chrysens. Helv Chim Acta 2004. [DOI: 10.1002/hlca.193301601107] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ehmann L, Miescher K. Über Steroide. 57. Mitteilung. Cyclo-bisdehydro-doisynolsäuren. Über oestrogene Carbonsäuren XIV. Helv Chim Acta 2004; 30:413-8. [DOI: 10.1002/hlca.19470300151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ehmann L, Tyberghein JM. Diclofenac suppositories in osteoarthrosis. A double-blind comparison with indomethacin. Practitioner 1981; 225:757-8. [PMID: 7027231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ehmann L, Heusler K, Meystre C, Wieland P, Anner G, Wettstein A. �ber 9,11-unges�ttigte 16?-Methylallopregnene. �ber Steroide 160. Mitt. Helv Chim Acta 1959. [DOI: 10.1002/hlca.19590420726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ruzicka L, Pieth P, Reichstein T, Ehmann L. Polyterpene und Polyterpenoide LXXX. Zur Kenntnis der Alantolactone. Synthese des 1,4-Dimethyl-6-isopropyl- und des 1,5-Dimethyl-7-isopropyl-naphtalins. Helv Chim Acta 1933. [DOI: 10.1002/hlca.19330160137] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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