Intra-Abdominal Sarcoma Spread Risk due to Morcellation in Minimal-Invasive Myoma Surgery

In April 2014 the food and drug administration (FDA) discouraged the use of laparoscopic morcellation in minimal-invasive hysterectomy or myoma surgery (MIS) [2]. The American Association of Gynecological Laparoscopists [3] and the European Society of Gynecological Endoscopy [4] stated the importance of further evaluation and the necessity of scientific data-based studies before final conclusions could be taken. As the results of prospective, register-based studies can take several years to be generated, we performed a retrospective singlecenter evaluation of 10,731 uterine morcellations, being the biggest series ever, which data will be published soon. Out of the 10,731 intra-abdominal uterine morcellations in laparoscopic hysterectomy, 81.3 % showed myomata; in those 8,720 six patients histologically showed to have a leiomyosarcoma (≥ 10 mitoses per high power field). After secondary oncological surgery and a follow-up of ≥ 2 years, five women were cured; one patient died due to diffuse intra-abdominal sarcoma spread

Laparoscopic Sacropexy: A Retrospective Analysis of the Subjective Outcome in 310 Cases

Background and Objective. The aim of this study was to assess the subjective outcome following laparoscopic sacropexy. Methods. We performed a retrospective cohort study among women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. 310 patients received questionnaires during followup assessing major pre- and postoperative symptoms and overall satisfaction. Results. 214 (69%) patients responded to the questionnaire. Mean followup was 24.5 months. The number of patients with back or lower abdominal pain, foreign body sensation in the vagina and prolapse-related symptoms, urinary symptoms, vaginal and bladder infections, and the need for pessary usage decreased significantly postsurgically. Bowel symptoms increased slightly but not significantly. Two years after surgery, nearly 2 thirds of the women were satisfied or very satisfied with the outcome. Conclusion. Laparoscopic sacropexy is an effective treatment of descensus, with favorable or satisfactory subjective outcomes

The Energy Spectrum of TeV Gamma-Rays from the Crab Nebula as measured by the HEGRA system of imaging air Cherenkov telescopes

The Crab Nebula has been observed by the HEGRA (High-Energy Gamma-Ray Astronomy) stereoscopic system of imaging air Cherenkov telescopes (IACTs) for a total of about 200 hrs during two observational campaigns: from September 1997 to March 1998 and from August 1998 to April 1999. The recent detailed studies of system performance give an energy threshold and an energy resolution for gamma-rays of 500 GeV and ~ 18%, respectively. The Crab energy spectrum was measured with the HEGRA IACT system in a very broad energy range up to 20 TeV, using observations at zenith angles up to 65 degrees. The Crab data can be fitted in the energy range from 1 to 20 TeV by a simple power-law, which yields dJg/dE = (2.79+/-0.02 +/- 0.5) 10^{-7} E^{-2.59 +/- 0.03 +/- 0.05}, ph m^{-2} s^{-1} TeV^{-1} The Crab Nebula energy spectrum, as measured with the HEGRA IACT system, agrees within 15% in the absolute scale and within 0.1 units in the power law index with the latest measurements by the Whipple, CANGAROO and CAT groups, consistent within the statistical and systematic errors quoted by the experiments. The pure power-law spectrum of TeV gamma-rays from the Crab Nebula constrains the physics parameters of the nebula environment as well as the models of photon emission.Comment: to appear in ApJ, 29 pages, 6 figure

Correlated intense X-ray and TeV activity of Mrk~501 in 1998 June

We present exactly simultaneous X-ray and TeV monitoring with {\it RXTE} and HEGRA of the TeV blazar Mrk 501 during 15 days in 1998 June. After an initial period of very low flux at both wavelengths, the source underwent a remarkable flare in the TeV and X-ray energy bands, lasting for about six days and with a larger amplitude at TeV energies than in the X-ray band. At the peak of the TeV flare, rapid TeV flux variability on sub-hour timescales is found. Large spectral variations are observed at X-rays, with the 3--20 keV photon index of a pure power law continuum flattening from $\Gamma=2.3$ to $\Gamma=1.8$ on a timescale of 2--3 days. This implies that during the maximum of the TeV activity, the synchrotron peak shifted to energies $\gtrsim 50$ keV, a behavior similar to that observed during the longer-lasting, more intense flare in 1997 April. The TeV spectrum during the flare is described by a power law with photon index $\Gamma=1.9$ and an exponential cutoff at $\sim$ 4 TeV; an indication for spectral softening during the flare decay is observed in the TeV hardness ratios. Our results generally support a scenario where the TeV photons are emitted via inverse Compton scattering of ambient seed photons by the same electron population responsible for the synchrotron X-rays. The simultaneous spectral energy distributions (SEDs) can be fit with a one-zone synchrotron-self Compton model assuming a substantial increase of the magnetic field and the electron energy by a factor of 3 and 10, respectively.Comment: Accepted for publication in ApJ, Part

Twenty-first century laparoscopic hysterectomy: should we not leave the vaginal step out?

The objective of this study was to compare surgical outcomes for laparoscopically assisted vaginal hysterectomy (LAVH) with total laparoscopic hysterectomy (TLH) in three teaching hospitals in the Netherlands. This study is a multicenter cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-2). One hundred and four women underwent a laparoscopic hysterectomy between March 1995 and March 2005 at one of three teaching hospitals. This included 37 women who underwent LAVH and 67 who underwent TLH. Blood loss, operating time, and intraoperative complications such as bladder or ureteric injury as well as conversion to an open procedure were recorded. In the TLH group, average age was statistically significant lower, as well as the mean parity, whereas estimated uterus size was statistically significant larger, compared to the LAVH group. Main indication in both groups was dysfunctional uterine bleeding. In the TLH group, mean blood loss (173 mL) was significant lower compared to the LAVH group (457 mL), whereas length of surgery, uterus weight, and complication rates were comparable between the two groups. The method of choice at the start of the study period was LAVH, and by the end of the study period, it had been superceded by TLH. LAVH should not be regarded as the novice’s laparoscopic hysterectomy. Moreover, with regard blood loss, TLH shows advantages above LAVH. This might be due to the influence of the altered anatomy in the vaginal stage of the LAVH procedure. Therefore, when a vaginal hysterectomy is contraindicated, TLH is the procedure of choice. LAVH remains indicated in case of vaginal hysterectomy with accompanying adnexal surgery

TeV Gamma-ray Observations of the Crab and Mkn 501 during Moonshine and Twilight

TeV Gamma-ray signals from the Crab Nebula and Mkn 501 were detected with the HEGRA CT1 imaging Cerenkov telescope during periods when the moon was shining and during twilight. This was accomplished by lowering the high voltage supply of the photomutipliers in fixed steps up to 13%. No other adjustments were made and no filters were used. Laser runs could not establish any non-linearity in the gain of the individual pixels, and the trigger rate was uniform over the whole camera. The energy threshol was increased by up to a factor of two, depending on the amount of HV reduction. In a series of observations lasting 11.7 hours, a signal with a 3.4 sigma significance was detected from the Crab. During the 1997 multiple flare episode of Mkn 501 a 26 sigma combined excess has been recorded during 134 hours of observations under various moonshine/twilight conditions. The results show that this technique can easily be adapted to increase the exposure of a source, which is important for sources showing rapid time variability such as AGNs or GRBs. Observations can be made up to ~20 deg. angular separation from the moon and until the moon is 85% illuminated (ten to eleven days before and after new moon), as well as during 20 to 40 minutes during twilight, before the commencement of astronomical darkness.Comment: 16 pages, 5 figures, submitted to Astroparticle Physic

Uterine fibroids – what’s new?

Uterine fibroids are the commonest benign tumours of women and affect all races with a cumulative lifetime risk of around 70%. Despite their high prevalence and the heavy economic burden of treatment, fibroids have received remarkably little attention compared to common female malignant tumours. This article reviews recent progress in understanding the biological nature of fibroids, their life cycle and their molecular genetic origins. Recent progress in surgical and interventional management is briefly reviewed, and medical management options, including treatment with selective progesterone receptor modulators, are also discussed

The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study

Purpose Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. Methods 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. Results 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. Conclusion Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting

The influence of conventional and extended supracervical hysterectomy on sexuality and quality of life parameters: a prospective bi-center study with a special focus on postoperative spotting

Purpose Supracervical as well as total hysterectomy are considered to improve postoperative sexuality as well as quality of life, but the benefit of supracervical hysterectomy (LSH) is impaired in up to 20 percent by postoperative spotting. The aim of this study was to analyze the influence of a conical excision of the cervical stump during supracervical hysterectomy on the postoperative spotting rate and its influence on sexuality and in turn quality of life. Methods 321 Patients who underwent a laparoscopic supracervical hysterectomy with conical excision (extended laparoscopic supracervical hysterectomy, eLSH, n = 166, Dormagen hospital) or with straight cervical resection (laparoscopic supracervical hysterectomy, LSH, n = 133, MIC Clinics Berlin) were included. Sexual matters, quality of life parameters and additional questions were recorded before operation, at three months of follow up, and at one year of follow up in both groups using a validated questionnaire (German version of International Consultation on Incontinence Questionnaire Vaginal Symptoms Module, ICIQ_VS). Statistical analysis included the impact and impairment of bleeding on sexuality, quality of life in both groups and co-factors such as vaginal symptoms. Results 11.3% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves quality of life and sexuality and a conical excision of the remaining stump is associated with a lower but insignificantly reduced spotting rates. Postoperative spotting has no negative influence on sexual matter score of ICIQ_VS, but reduces the postoperative quality of life focusing on vaginal symptoms in a significant way. Conclusion The improvement of ICIQ_VS scores after supracervical hysterectomy is independent of postoperative spotting, but the quality-of-life score is positively influenced by a reduction in the postoperative spotting rate

Intra-Abdominal Sarcoma Spread Risk due to Morcellation in Minimal-Invasive Myoma Surgery

After a warning of the Society of Gynecologic Oncology (SGO) in December 2013, concerning the possible increase of disseminating tumor cells during intercorporal morcellation, the LANCET ONCOLOGY published an editorial in February 2014 stating that the patient safety must be a priority in all aspects of care. In April 2014 the food and drug administration (FDA) discouraged the use of laparoscopic morcellation in minimal-invasive hysterectomy or myoma surgery (MIS