Auswirkungen auf das Peritoneum durch Wasserstrahlanwendung - Experimentelle Untersuchungen mit Argonplasma

In dieser Studie wurde der Gewebeeffekt der Hybrid-Argonplasma-Koagulation (HybridAPC) am Rattenperitoneum untersucht. Bei diesem Instrument wird die monopolare Hochfrequenz-Koagulationstechnik der Argonplasma-Koagulation (APC) mit einer Wasserstrahl-Unterspritzung (mit physiologischer Kochsalzlösung) kombiniert. Vor Koagulation kann mit demselben Instrument ein Wasserkissen ins Gewebe eingebracht werden. Durch diese Maßnahme kann das Ausmaß des thermischen Schadens besser kontrolliert und tiefere Gewebeschichten geschont werden. Da bis Dato noch keine Studie den Effekt einer Gewebeunterspritzung vor Koagulation am Peritoneum untersucht, sollte dies in der vorliegenden Studie unter Anwendung der HybridAPC erfolgen. Methoden: Die Untersuchung der unterschiedlichen Gewebeeffekte erfolgte an 24 weiblichen Wistar-Ratten unter Allgemeinanästhesie. Auf der einen Seite der Bauchwand erfolgte nur eine Unterspritzung des Peritoneums um die alleinigen Auswirkungen der Unterspritzung auf das Gewebe zu prüfen. Auf der anderen Seite wurde nach Unterspritzung mit APC punktuell koaguliert. Pro Tier wurden mit jeder Behandlungsart zwei Läsionen gesetzt. Am 10. postoperativen Tag erfolgte die Euthanasierung der Tiere mit Evaluation der Adhäsionen und anschließender histopathologischer Auswertung des behandelten Gewebes (Second Look). Hierbei wurden folgende Parameter untersucht: Eindringtiefe der Wasserstrahl-Unterspritzung, Ausmaß des thermischen Schadens bei Koagulation, Grad der akuten und chronischen Entzündungsreaktion, Auftreten von Fremdkörperreaktionen und Karbonisation. Ergebnisse: Bei alleiniger Gewebeunterspritzung mit Kochsalzlösung konnte keine Adhäsion im Bereich der während der Operation traumatisierten Areale festgestellt werden. Bei 15% der Herde zeigte sich jedoch eine geringe chronische Entzündung. Die Schicht in welcher sich das Wasserkissen intraoperativ befand, konnte beim Second Look histologisch nicht mehr festgestellt werden. Die Anwendung der HybridAPC führte histologisch zu einer thermischen Schädigung der oberflächlichen Gewebeschichten mit einer Eindringtiefe von 329 ± 123 μm bei einem Energieeintrag von 106 ± 10,7 J. Im Bereich der 44 HybridAPC Läsionen konnte postoperativ nur eine Adhäsion (Grad 2) beobachtet werden. Schlussfolgerung: Die Ergebnisse der Studie legen nahe, dass die alleinige Unterspritzung des Peritoneums der Ratte mit physiologischer Kochsalzlösung einen geringen traumatischen und adhäsiogenen Reiz für das Gewebe darstellt. Durch die Unterspritzung des Gewebes vor Koagulation konnte die Tiefe des thermischen Schadens signifikant reduziert werden und auch die Varianz der Tiefe der thermischen Schädigung (im Vergleich zu vorausgegangen Studie der Arbeitsgruppe mit der konventionellen APC) am Rattenperitoneum vermindert werden. Nach Anwendung der HybridAPC bildeten sich signifikant weniger Adhäsionen im Bereich der Koagulationsareale als im Vergleich zur konventionellen APC aus

Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management

Mauricio Simoes Abrao1,, Felice Petraglia2, Tommaso Falcone3, Joerg Keckstein4, Yutaka Osuga5, and Charles Chapron6,7,8 Endometriosis Division, Obstetrics and Gynecological Department – Sao Paulo University, Sao Paulo, Brazil Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy Obstetrics, Gynecology andWomen's Health Institute, Cleveland Clinic, Cleveland, OH, USA Department of Obstetrics and Gynecology, Center for Endometriosis, Villach Hospital, Villach, Austria Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Hongo, Bunkyo, Tokyo, Japan Universite Paris Descartes, Sorbonne Paris Cite, Faculte de Medecine, Assistance Publique – Hopitaux de Paris (APHP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, 75679 Paris, France Institut Cochin, Universite Paris Descartes, Sorbonne Paris Cite CNRS (UMR 8104), Paris, France Inserm, Universite Paris Descartes, Sorbonne Paris Cite, Unite de recherche U1016, Paris, Franc

Recommendations for the surgical treatment of endometriosis—part 1: ovarian endometrioma

Study question: What does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide? / Summary answer: This document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age. / What is already known: Endometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis. / Study design, size and duration: A working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery. / Participants/materials, setting and methods: This document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis. / Main results and the role of chance: The document presents general recommendations for surgery of endometrioma and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them. / Limitations and reasons for caution: Owing to the limited evidence available, recommendations are mostly based on clinical expertise. / Wider implications of the findings: These recommendations complement previous guidelines on the management of endometriosis. / Study funding/competing interests: The meetings of the working group were funded by ESGE, ESHRE and WES. CB declares to be a member of the independent data monitoring committee for a clinical study by ObsEva and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences and Volition. ES received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest

Keyframe Extraction in Endoscopic Video

In medical endoscopy more and more surgeons archive the recorded video streams in a long-term storage. One reason for this development, which is enforced by law in some countries, is to have evidence in case of lawsuits from patients. Another more practical reason is to allow later inspection of previous procedures and also to use parts of such videos for research and for training. However, due to the dramatic amount of video data recorded in a hospital on a daily basis, it is very important to have good preview images for these videos in order to allow for quick filtering of undesired content and for easier browsing through such a video archive. Unfortunately, common shot detection and keyframe extraction methods cannot be used for that video data, because these videos contain unedited and highly similar content, especially in terms of color and texture, and no shot boundaries at all. We propose a new keyframe extraction approach for this special video domain and show that our method is signi�cantly better than a previously proposed approach

Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis

Study question: How should surgery for endometriosis be performed? / Summary answer: This document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age. / What is known already: Endometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe. / Study, design, size, duration: A working group of the European Society for Gynaecological Endoscopy (ESGE), European Society of Human Reproduction and Embryology (ESHRE) and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis. / Participants, materials, setting, methods: This document focused on surgery for deep endometriosis, and is complementary to a previous document in this series focusing on endometrioma surgery. / Main results and the role of chance: The document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis. / Limitations, reasons for caution: Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added. / Wider implications of the findings: These recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma. / Study funding - Competing interest(s): The meetings of the working group were funded by ESGE, ESHRE and WES

Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study.

INTRODUCTION Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman  = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings

Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial

Background Third-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. Methods In a double-blind, multicentre, randomised placebo-controlled trial, we recruited women who had been diagnosed with locally excised, hormone-receptor-positive DCIS. Eligible women were randomly assigned in a 1:1 ratio by central computer allocation to receive 1 mg oral anastrozole or 20 mg oral tamoxifen every day for 5 years. Randomisation was stratified by major centre or hub and was done in blocks (six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation and only the trial statistician had access to treatment allocation. The primary endpoint was all recurrence, including recurrent DCIS and new contralateral tumours. All analyses were done on a modified intention-to-treat basis (in all women who were randomised and did not revoke consent for their data to be included) and proportional hazard models were used to compute hazard ratios and corresponding confidence intervals. This trial is registered at the ISRCTN registry, number ISRCTN37546358. Results Between March 3, 2003, and Feb 8, 2012, we enrolled 2980 postmenopausal women from 236 centres in 14 countries and randomly assigned them to receive anastrozole (1449 analysed) or tamoxifen (1489 analysed). Median follow-up was 7·2 years (IQR 5·6–8·9), and 144 breast cancer recurrences were recorded. We noted no statistically significant difference in overall recurrence (67 recurrences for anastrozole vs 77 for tamoxifen; HR 0·89 [95% CI 0·64–1·23]). The non-inferiority of anastrozole was established (upper 95% CI <1·25), but its superiority to tamoxifen was not (p=0·49). A total of 69 deaths were recorded (33 for anastrozole vs 36 for tamoxifen; HR 0·93 [95% CI 0·58–1·50], p=0·78), and no specific cause was more common in one group than the other. The number of women reporting any adverse event was similar between anastrozole (1323 women, 91%) and tamoxifen (1379 women, 93%); the side-effect profiles of the two drugs differed, with more fractures, musculoskeletal events, hypercholesterolaemia, and strokes with anastrozole and more muscle spasm, gynaecological cancers and symptoms, vasomotor symptoms, and deep vein thromboses with tamoxifen. Conclusions No clear efficacy differences were seen between the two treatments. Anastrozole offers another treatment option for postmenopausal women with hormone-receptor-positive DCIS, which may be be more appropriate for some women with contraindications for tamoxifen. Longer follow-up will be necessary to fully evaluate treatment differences

Design of programmable universal manipulator

Tato bakalářská práce pojednává o průmyslových manipulač-ních zařízeních, jejich historii, základním rozdělení a možnosti použití u výrobních strojů. V další části je řešen konkrétní konstrukční návrh univerzálního programovatelného manipulátoru, který byl vybrán z návrhů variant.Katedra konstruování strojůObhájenoThis bachelor thesis deals with the industrial manipulators, their history, the basic classification and applications by pro-duction machines. The next part deals with the specific de-sign of programmable universal manipulator, which was se-lected from proposed variations

Feed mechanism and guide way of the universal center lathe's axis X and Z

V této diplomové práci bylo prozkoumáno současné řešení posuvových mechanismů a vedení univerzálních hrotových soustruhů. Na základě rešerše byly navrženy tři varianty, z kterých bylo vybráno konstrukční řešení, které bylo dále detailně zkonstruováno v CAD systému, a byla vytvořena výkresová dokumentace. Jednotlivé konstrukční části byly navrženy a zkontrolovány pomocí analytických a numerických výpočtů.Katedra konstruování strojůObhájenoIn this diploma sheet current construction of the feed mechanism and guide way of the universal center lathe's was examined. Based on the study three versions were designed. One of them was chosen and was design in detail in CAD system. Some parts of the construction were designed and checked by the analytic and numeric calculations