Die bakterielle Spondylodiszitis

Die Spondylodiszits ist eine seltene Erkrankung, die mit einer hohen Morbidität und Mortalität einhergeht. Ziel dieser retrospektiven Studie war es neueste Erkenntnisse über das Krankheitsbild der Spondylodiszitis anhand der Auswertung der in dieser Arbeit vorliegenden großen Datenlage auszumachen, um die diagnostischen und therapeutischen Algorithmen zu optimieren. Detailliert werden in dieser Arbeit die entscheidenden Charakteristika der Spondylodiszitis beschrieben. Es wird bei dieser seltenen, jedoch gefährlichen Krankheit deutlich, dass die Betreuung der Patienten in die Hand ausgewiesener Experten gehört. Daher sollte bei noch so geringem Verdacht auf eine Spondylodiszits die direkte Einweisung in eine Spezialklinik zur weiteren Behandlung erfolgen

Cyclosporin-A induced Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome (PRES) is a recently proposed clinico-neuroradiological entity observed in a variety of clinical settings such as cyclosporin A (CsA) neurotoxicity. We report a 3.5-year-old Syrian boy in whom steroid-resistant focal segmental glomerulosclerosis (FSGS) was recently diagnosed. The patient remitted his nephrotic syndrome after 10 days of CsA administration. However, he shortly developed altered mental status, visual impairment, focal neurological deficits and seizures. We discontinued CsA that resulted in complete reversal of the patient′s encephalopathical condition over a period of 4 months. We conclude that PRES should be suspected in immunosuppresed patients with kidney disease if they have a sudden episode of neurological symptoms

Intraperitoneal cisplatin and doxorubicin as maintenance chemotherapy for unresectable ovarian cancer

$\textbf {Background:}$ Primary advanced, unresectable ovarian cancer (OC) is treated with palliative systemic chemotherapy. Intraperitoneal chemotherapy may be an alternative local maintenance therapy. $\textbf {Case presentation:}$ A 75 year old woman with laparoscopically and histologically confirmed unresectable OC was treated with 13 cycles of intraperitoneal cisplatin $7.5 mg/m^{2}$ and doxorubicin $1.5 mg/m^{2}$ over 2 years using laparoscopic pressurized intraperitoneal aerosol chemotherapy (PIPAC). Objective tumor response (tumor regression on histology, stable disease on repeated video-laparoscopy and peritoneal carcinomatosis index) was noted. No Common Terminology Criteria for Adverse Events (CTCAE) > grade 3 were observed. EORTC QLQ-C30 quality of life measurements were stable throughout the therapy. $\textbf {Conclusions:}$ Repeated intraperitoneal chemotherapy with cisplatin and doxorubicin applied as PIPAC may be an effective maintenance treatment in women with primary advanced, unresectable OC

Performance of a DNA methylation marker panel using liquid-based cervical scrapes to detect cervical cancer and its precancerous stages

Abstract Background A change of cervical cancer screening algorithms to an HPV-based screening setting is discussed in many countries, due to higher sensitivity of HPV testing compared to cytology. Reliable triage methods are, however, an essential prerequisite in such a setting to avoid overtreatment and higher screening costs. Results In this study, a series of cervical scrapes collected in PreservCyt liquid-based cytology (LBC) medium from women with cervical cancer (n = 5), cervical intraepithelial neoplasia grade 1–3 (n = 74), and normal cytology (n = 201; further n = 352 collected in SureThin®) were assessed for methylation of the marker regions ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671 using the GynTect assay and compared to cobas® HPV and CINtec Plus® biomarker results. All samples from women with cervical cancer, 61.2% of CIN3, 44.4% of CIN2 and 20.0% of CIN1 cases were scored positive for the GynTect methylation assay. In contrast, all CIN, irrespective of severity grade, and carcinomas were positive by both, CINtec Plus and cobas HPV. The specificity of GynTect for CIN3+ was 94.6% compared to 69.9% for CINtec Plus and 82.6% for cobas HPV (all HPV types) and 90.6% for cobas HPV 16/18. DNA methylation analysis of this methylation marker panel (GynTect assay) in cervical scrapes consistently detects cervical cancer and the majority of CIN3 as well as a subset of CIN1/2 lesions. The detection rate among cytologically normal samples is extraordinarily low (1.5%). Conclusion GynTect shows excellent performance when using cervical scrape material collected in liquid-based cytology media, a prerequisite for employing such a test as a triage in screening programs. Compared to the other test systems used in this work, GynTect showed higher specificity while still detecting all cancer cases

Neuroendocrine carcinoma of the cervix: a systematic review of the literature

Abstract Background Neuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer. The prognosis of women with NECC is poor and there is no standardized therapy for this type of malignancy based on controlled trials. Methods We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials describing the management and outcome of women with NECC. Results Three thousand five hundred thirty-eight cases of NECC in 112 studies were identified. The pooled proportion of NECC among women with cervical cancer was 2303/163470 (1.41%). Small cell NECC, large cell NECC, and other histological subtypes were identified in 80.4, 12.0, and 7.6% of cases, respectively. Early and late stage disease presentation were evenly distributed with 1463 (50.6%) and 1428 (49.4%) cases, respectively. Tumors expressed synaptophysin (424/538 cases; 79%), neuron-specific enolase (196/285 cases; 69%), chromogranin (323/486 cases; 66%), and CD56 (162/267; 61%). The most common primary treatment was radical surgery combined with chemotherapy either as neoadjuvant or adjuvant chemotherapy, described in 42/48 studies. Radiotherapy-based primary treatment schemes in the form of radiotherapy, radiochemotherapy, or radiotherapy with concomitant or followed by chemotherapy were also commonly used (15/48 studies). There is no standard chemotherapy regimen for NECC, but cisplatin/carboplatin and etoposide (EP) was the most commonly used treatment scheme (24/40 studies). Overall, the prognosis of women with NECC was poor with a mean recurrence-free survival of 16 months and a mean overall survival of 40 months. Immune checkpoint inhibitors and targeted agents were reported as being active in three case reports. Conclusion NECC is a rare variant of cervical cancer with a poor prognosis. Multimodality treatment with radical surgery and neoadjuvant/adjuvant chemotherapy with cisplatin and etoposide with or without radiotherapy is the mainstay of treatment for early stage disease while chemotherapy with cisplatin and etoposide or topotecan, paclitaxel, and bevacizumab is appropriate for women with locally advanced or recurrent NECC. Immune checkpoint inhibitors may be beneficial, but controlled evidence for their efficacy is lacking

Accuracy of intrapartum fetal blood gas analysis by scalp sampling

Fetal blood gas analysis (FBGA) using scalp blood is commonly used to identify serious fetal distress. However, there is a lack of data regarding its accuracy and reliability. The aim of this studywas to determine the positive predictive value (PPV) and negative predictive value (NPV) of FBGA for predicting postpartum acidosis in case of nonreassuring fetal heart rate tracings (NRFHRT). To this end, we conducted a retrospective cohort study of singleton term deliveries with NRFHRT according to Fédération Internationale de Gynécologie et d’Obstétrique and Fisher cardiotocography scores undergoing FBGA in a university hospital. The PPV and NPV of FBGA regarding neonatal acidosis (defined as a pH value $\leq$ 7.15 in arterial or venous umbilical cord blood) and Apgar scores indicating neonatal depression (defined as a 5-min Apgar score $\leq$5) were evaluated. Multivariate analysis was used to determine the influence of cardiotocography variations and the time delay between FBGA and delivery on the accuracy of FBGA.We analyzed 343 deliveries with NRFHRT. In 32 (9%) of these cases, fetal acidosis was confirmed by a postpartum umbilical cord blood pHvalue $\leq$ 7.15. In 308/343 (90%) cases, FBGA identified NRFHRT as false positive (as confirmed by nonacidotic postpartum pH values) and thus avoided unnecessary interventions such as operative delivery. The overall test accuracy of FBGA was 91%. FBGA accurately predicted postpartum cord bloodpHvalueswith amargin of $\pm$0.2 in 319/343 (93%) cases. On the other hand, the false negative rate of FBGA was 8% (29/343). The PPV and NPV of FBGA for predicting postpartum acidosis were 50% and 91%, respectively. The sensitivity was 9% and the specificity was 99%. In a multivariate logistic regression analysis, maternal body mass index (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.01–1.17; $\it P$=.029) and cardiotocography variations (OR0.80; 95%CI 0.66–0.98; $\it P$=.029) independently affected the predictive value of FBGA. ThePPV of FBGA regarding neonatal depression according to Apgar scores was low with only 17%.We conclude that FBGA may be used in clinical practice to rule out, but not to rule in, neonatal acidosis in parturients with NRFHRT. It can avoid unnecessary interventions such as cesarean section or operative vaginal delivery in up to 90% of cases, but cannot reliably detect fetal acidosis. $\textbf {Abbreviations:}$ BMI = body mass index, CI = confidence interval, CTG = cardiotocography, FBGA = fetal blood gas analysis, FIGO = Fédération Internationale de Gynécologie et d’Obstétrique, NPV = negative predictive value, NRFHRT = nonreassuring fetal heart rate tracing, OR = odds ratio, PPV = positive predictive value

Factors associated with post-relapse survival in patients with recurrent cervical cancer : the value of the inflammation-based Glasgow Prognostic Score

Purpose The aim of the present study was to assess the value of the Glasgow Prognostic Score (GPS) as a prognostic tool for predicting post-relapse survival (PRS) in patients with recurrent cervical cancer. Methods We retrospectively evaluated the data of 116 patients with recurrent cervical cancer in whom serologic biomarkers had been assessed at the time of relapse. The GPS was calculated as follows: patients with elevated serum C-reactive protein levels and hypoalbuminemia were allocated a score of 2, and those with 1 or no abnormal value were allocated a score of 1 and 0, respectively. To assess the association between factors including the GPS and PRS, we performed uni- and multivariate survival analyzes. Results After a median follow-up of 20.9 months from recurrence, a 5-year PRS rate of 25% (SE 4.7%) was observed. Only in 29.8% of the patients, recurrence was limited to the pelvis. In uni- and multivariate survival analyzes, the GPS [HR 1.6 (95% CI 0.92.4), p=0.01], a history of radiation therapy as part of initial treatment [HR 2.7 (95% CI 1.16.9), p=0.03], and the presence of peritoneal carcinomatosis or multiple sites of relapse [HR 4.2 (95% CI 1.99.3), p<0.001] were associated with shorter PRS. The GPS correlated with higher squamous cell carcinoma antigen levels (p=0.001), shorter median PRS (p=0.009), and less intensive treatment for relapse (p=0.02). Conclusions A higher GPS at the time of relapse, a history of radiation therapy, and the presence of peritoneal carcinomatosis or multiple sites of relapse are independently associated with shorter PRS in patients with recurrent cervical cancer.(VLID)365858

Surgical performance of large loop excision of the transformation zone in a training model

Large loop excision of the transformation zone (LLETZ) is one of the most common procedures in operative gynecology and it is a routine part of the surgical training program of residents. There is, however, no established and standardized method of teaching residents how to perform LLETZ. Here, we present a surgical training model and assessed the improvement of surgical skills during repeated hands-on trainings of LLETZ in this model. Surgical novices and experts were recruited and were shown a LLETZ training video and then performed 3 LLETZ training sessions on consecutive days. Surgical skills were assessed by Objective Structured Assessment of Technical Skills (OSATS). Global rating scale (GRS), confidence (CON), fragmentation rate (FR), performance time (PT), and OSATS scores were calculated. Intra- and interobserver variabilities were determined. The construct validity of OSATS was assessed comparing metric scores of novices with those of experts. Sixty-eight probands (58 novices, 10 experts) were recruited. GRS, 2.3$\pm$1.3 (median$\pm$SD) versus 1.4$\pm$0.6, P<.001; CON, 2.7$\pm$0.9 versus 1.6$\pm$0.6, P<.001; FR, 81% versus 100%, P<.001; PT, 152$\pm$33 versus 120$\pm$27seconds, P=.006; and OSATS scores, 18.8$\pm$1.3 versus 19.1$\pm$1.1, P=.16 of novices improved from session 1 to session 3. OSATS showed construct validity with metric scores (GRS, 1.1$\pm$0.3 vs 2.3$\pm$0.8, P<.001; CON, 1.0$\pm$0.0 vs 2.7$\pm$0.9, P<.001; PT 125$\pm$30 vs 152$\pm$33seconds, P=.02; OSATS scores, 19.6$\pm$0.7 vs. 18.8$\pm$1.3, P=.02) reliably discriminating between experts and novices. Intra- and interobserver variabilities across probands were 0.99$\pm$0.03 and 0.64$\pm$0.10, respectively. OSATS scores were independent of handedness, sex, and regular sports activity in univariate and multivariate analyses. Repeated hands-on trainings improve surgical performance of LLETZ in a surgical training model with construct validity. $\textbf {Abbreviations:}$ CON = confidence, FR = fragmentation rate, GRS = global rating scale, LLETZ = large loop excision of the transformation zone, OSATS = Objective Structured Assessment of Technical Skills, PT = performance time

A randomized comparison of video demonstration versus hands-on training of medical students for vacuum delivery using Objective Structured Assessment of Technical Skills (OSATS)

$\textbf {Background:}$ To compare medical students’ skills for vaginal operative delivery by vacuum extraction (VE) after hands-on training versus video demonstration. $\textbf {Methods:}$ We randomized medical students to an expert demonstration (group 1) or a hands-on (group 2) training using a standardized VE algorithm on a pelvic training model. Students were tested with a 40-item Objective Structured Assessment of Technical Skills (OSATS) scoring system after training and 4 days later. OSATS scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were secondary outcomes. We assessed the constructive validity of OSATS in this VE model comparing metric scores of experts and students. $\textbf {Results:}$ In all, 137 students were randomized. OSATS scores were higher in group 2 (n=63) compared with group 1 (n=74) (32.89$\pm$6.39 vs 27.51$\pm$10.27, respectively; P<0.0001). Global rating scale (1.49$\pm$0.76 vs 2.33$\pm$0.94, respectively; P<0.0001), confidence (2.22$\pm$0.75 vs 3.26$\pm$0.94, respectively; P=0.04), self-assessment (2.03$\pm$0.62 vs 2.51$\pm$0.77, respectively; P<0.0001), and performance time (38.81$\pm$11.58seconds vs 47.23$\pm$17.35 seconds, respectively; P=0.001) also favored group 2. After 4 days, this effect persisted with OSATS scores still being significantly higher in group 2 (30.00$\pm$6.50 vs 25.59$\pm$6.09, respectively; P=0.001). The assessed OSATS scores showed constructive validity. In a multiple linear regression analysis, group assignment independently influenced OSATS scores, whereas sex, handedness, sports activities, and type of curriculum were not independently associated with OSATS scores. $\textbf {Conclusions:}$ Hands-on training is superior to video demonstration for teaching VE on a pelvic model. $\textbf {Abbreviations:}$ CON = confidence, GRS = global rating scale, OSATS = Objective Structured Assessment of Technical Skills, PT = performance time, SA = self-assessment, VE = vacuum extraction