Zentralblatt für Gynäkologie
-
Randomized Controlled Trial Comparative Study Clinical Trial
[Does para-cervical block offer additional advantages in abortion induction with gemeprost in the 2nd trimester?].
Uterus-specific synthetic Prostaglandin analogues (gemeprost, sulproston etc.) have been widely employed for termination of pregnancy in the second trimester. Since paracervical anaesthesia may be useful during this procedure, we investigated in this prospective randomised study its impact on the clinical course of abortion and pain especially in the late first and second stage of labour. ⋯ Paracervical anaesthesia is a method for analgesia during second trimester abortion with a low rate of side effects. It can shorten the duration of last period of second trimester abortion in some cases but has no impact on the perception of pain nor requirement of analgesics and so with only limited benefit in second trimester abortion with vaginal gemeprost.
-
With the identification and recombinant production of the hematopoietic growth factors, these cytokines have been evaluated in the treatment of primary bone marrow failure states and following myelosuppressive chemotherapy or radiotherapy. An increasing number of clinical trials with hematopoietic factors have been performed in patients with haematological and oncological diseases. Granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), erythropoietin and, in phase I/II trials, thrombopoietin (TPO) are available for the clinical use. ⋯ This results in a marked reduction of infectious risks and a shortening of drug- and radiation-induced myelosuppression. CSFs are most important in mobilizing peripheral blood progenitor cells (PBPC) and have allowed high-dose therapy combined with stem cell support in gynecological malignancies, e.g. ovarian carcinoma and breast cancer. However, evidence based, clinical practical guidelines for the use of hematopoietic growth factors in gynecological malignancies are not for all circumstances available.
-
From 1973 through 1993, the University of Leipzig Women's Hospital treated 285 patients with primary vulvar malignancies. Of these, 269 cases (94.3%) were squamous cell carcinomas. The patients age averaged 69 years (25-95 years). 232 women (81.4%) were older than 60 years. ⋯ These findings, therefore, justify the individualized operative treatment of patients with vulvar carcinoma according to each patient's initial prognostic situation. The relatively seldom vulvar carcinoma should only be treated by experienced surgeons in an appropriate hospital environment. Moreover, assessment of histological sections must be standardized, reproducible and above all, include the very accurate evaluation of all resection edges.
-
Reduction mammaplasties can be performed--if contraindications are respected--as oncoplastic operations. They have the advantage that the lump has clear margins and is surrounded by a thick layer of healthy tissue. ⋯ The axillary cavity must be cleared and the oncoplastic (reconstructed) breast be irradiated with 50 Gy. The mastopexia (breastlifting) is less apt to be used as an oncoplastic operation, as the removed tissue is rather skin and subcutaneous fatty tissue than the breast gland itself.
-
Caesarean and vaginal deliveries of macrosomic infants weighing > or = 4500 g were studied, and pregnant women analysed by indication for caesarean section, presentation, parity and age. Both maternal and neonatal injuries occurred. Puerperal morbidity was noted in women delivered either by caesarean section or vaginally. ⋯ In conclusion, decision making on management options when delivering a macrosomic infant depends on fetal presentation and maternal age and parity. Vertex presenting macrosomic infants weighing > or = 4500 g should be delivered vaginally, but liberal judgement is suggested in resorting to caesarean section delivery. Abnormal presentation, as well as malpresentations in primiparous women, are an absolute indication for caesarean section, whereas malpresentations in multiparous women are a relative (underlying) indication for caesarean section.