Prolapse and sexual function 8 years after neovagina according to Shears: a study of 43 cases with Mayer-von Rokitansky-Küster-Hauser syndrome

Introduction and hypothesis: To investigate sexual and anatomical outcome after Shears neovagina in patients with Mayer-von Rokitansky-Kuster-Hauser syndrome (MRKH). Methods: Forty-three consecutive patients with MRKH syndrome underwent surgery creating a neovagina according to Shears. Follow-up was 8years. Sexual function was assessed using the Female Sexual Function Index (FSFI) as patient reported outcome; anatomical results were assessed measuring anterior, posterior and apical prolapse using the ICS Pelvic Organ Prolapse Score (ICS-POP Score). Pelvic floor contraction was measured applying the Oxford grading system. Results: Thirty-seven of the patients were regularly sexually active and filled in the FSFI; mean total FSFI was 27.2 (range 24-28). No significant prolapse of the neovagina was noted, 11 patients had a grade I cystocele, rectocele or apical descent that was asymptomatic. Oxford grading of the pelvic floor contraction was 4 in median (range 2-5). Conclusion: The neovagina according to Shears is a valuable surgical option with good sexual and anatomical outcome 8 years after therap

Agrogentechnik und Biotechpflanzenproduktion : Entwicklung, Stand und Zukunftspotential

Pflanzen sind die Nahrungsgrundlage für Mensch und Tier und werden es bleiben. Was unverfälschte Natur zu bieten hat, konnte nie befriedigen, doch war ein langer, weit in die vorchristliche Zeit zurückreichender Weg zurückzulegen, um von essbaren Wildpflanzen und einfachen Landrassen zu den heutigen Hochleistungssorten bei Getreide, Soja, Raps und anderen zu gelangen. Auch heute ist das Potential der klassischen Pflanzenzüchtung noch keineswegs erschöpft. Genomsequenzierung, auf molekulare Marker gestützte Identifizierung züchterisch wertvoller Merkmale und andere früher unbekannte Methoden können Züchtungsprogramme vereinfachen und die Sortenentwicklung beschleunigen. Es bleibt aber eine prinzipielle Schranke, welche die konventionelle Pflanzenzüchtung von wenigen Ausnahmen abgesehen nicht überwinden kann: Sie kann die Artgrenzen nicht überspringen und bleibt auf die Nutzung des arteigenen Genvorrats angewiesen. Das änderte sich um 1985, als es erstmals gelang, bakterielle Gene in dafür gut geeignete Modellpflanzen wie den Tabak einzuführen und zwar so, dass sie exprimiert wurden, d. h. ein funktionelles Proteinprodukt lieferten und sich stabil an die sexuellen Nachkommen dieser ersten transgenen Pflanzen vererbten. Zehn Jahre später begann der kommerzielle Anbau von herbizidresistentem und wenig später insektenresistentem Mais in den USA und Kanada. Es war die Geburtsstunde der Agrogentechnik. Heute werden transgene Kulturpflanzen dort, wo ihre prinzipiellen Gegner weniger Einfluss haben als hierzulande, auf mehr als 180 Millionen ha Ackerland angebaut. Mehr als eine Milliarde Menschen und ein Mehrfaches an Nutztieren haben sich bis heute von Genpflanzen und daraus hergestellten Nahrungs- und Futtermitteln ernährt. Der Grund für den Erfolg der neuen Technik liegt darin, dass sie messbare wirtschaftliche und ökologische Vorzüge hat, die sich in niedrigeren Umweltbelastungen, höheren Erträgen und deutlichen Einkommensverbesserungen der landwirtschaftlichen Betriebe niederschlagen. Während man die Vorteile der Agrogentechnik heute leicht erkennen kann, sind die ihr zugeschriebenen Risiken spekulativ geblieben. Es gibt weder zwingende theoretische Argumente noch praktische Erfahrungen, die dazu berechtigen, der gentechnischen Pflanzenzüchtung ein gegenüber traditionellen Verfahren größeres Gefahrenpotential zuzuschreiben. Ihre realisierbaren Anwendungen gehen über den gegenwärtig noch dominierenden Anbau herbizid- und insektenresistenter Ackerpflanzen weit hinaus. Sie umfassen Nahrungspflanzen mit erhöhter Krankheitsresistenz, verbesserter Trockentoleranz, besserer Verträglichkeit aus ihnen hergestellter Lebensmittel, ausgeglichenem Gehalt an Aminosäuren, Vitaminen und Spurenelementen ebenso wie Industriepflanzen zur Produktion von Grund- und Wirkstoffen für die Chemie- und Pharmaindustrie. An diesen Entwicklungen arbeiten öffentliche und private Forschungseinrichtungen überall in der Welt. Der Mangel an nutzbarem Ackerland, Trinkwasser und sich abzeichnende Folgen des Klimawandels für die Landwirtschaft erzeugen einen wachsenden Druck zur möglichst wirkungsvollen Nutzung aller verfügbaren Ressourcen. Zwar kann die Agrogentechnik das Welternährungsproblem ebensowenig dauerhaft lösen wie irgendeine andere Technik, solange das exponentielle Wachstum der Erdbevölkerung nicht zum Stillstand kommt. Sie vermag aber die Folgen der Übervölkerung abzumildern; denn sie leistet einen wesentlichen Beitrag zur Verbesserung der Grundversorgung und zu einer effizienteren, die Naturvorräte schonenden Landwirtschaft. Die Verdrängung der konventionellen Sorten durch transgene wird deshalb weitergehen. Transgene Ackerpflanzen der ersten Generation, die überwiegend nur ein transgenes Merkmal tragen, werden gegenwärtig rasch durch modernere Stapelsorten ersetzt, die zwei oder mehrere Transgene exprimieren. Sie sind oft herbizidtolerant und gleichzeitig gegen alle wichtigen Schädlinge resistent, die in den jeweiligen Anbaugebieten vorkommen. Gleichzeitig kommen immer mehr Sorten auf den Markt, die nicht nur für die Produzenten Vorteile haben sondern auch ernährungsphysiologisch wertvoller sind als ihre konventionellen Vorläufer. Am Ende dieser Entwicklung werden die konventionellen Sorten auf dem Agrarweltmarkt kaum noch eine Rolle spielen. Dieses Buch behandelt Geschichte, Methoden, Entwicklungsstand und Zukunftspotential der Agrogentechnik, beschreibt typische Vertreter dieses Kulturpflanzentyps und gibt anhand ausgewählter noch im Versuchsstadium stehender Prototypen einen Ausblick auf die kommende Entwicklung und ihre absehbaren Auswirkungen auf die Tier- und Pflanzenproduktion

“A very orderly retreat”: Democratic transition in East Germany, 1989-90

East Germany's 1989-90 democratisation is among the best known of East European transitions, but does not lend itself to comparative analysis, due to the singular way in which political reform and democratic consolidation were subsumed by Germany's unification process. Yet aspects of East Germany's democratisation have proved amenable to comparative approaches. This article reviews the comparative literature that refers to East Germany, and finds a schism between those who designate East Germany's transition “regime collapse” and others who contend that it exemplifies “transition through extrication”. It inquires into the merits of each position and finds in favour of the latter. Drawing on primary and secondary literature, as well as archival and interview sources, it portrays a communist elite that was, to a large extent, prepared to adapt to changing circumstances and capable of learning from “reference states” such as Poland. Although East Germany was the Soviet state in which the positions of existing elites were most threatened by democratic transition, here too a surprising number succeeded in maintaining their position while filing across the bridge to market society. A concluding section outlines the alchemy through which their bureaucratic power was transmuted into property and influence in the “new Germany”

Prolapse and sexual function 8 years after neovagina according to Shears: a study of 43 cases with Mayer-von Rokitansky-Küster-Hauser syndrome

To investigate sexual and anatomical outcome after Shears neovagina in patients with Mayer-von Rokitansky-Kuster-Hauser syndrome (MRKH)

Frequency of disease-associated and other nuclear autoantibodies in patients of the German network for systemic scleroderma: correlation with characteristic clinical features

Introduction In the present study, we analysed in detail nuclear autoantibodies and their associations in systemic sclerosis (SSc) patients included in the German Network for Systemic Scleroderma Registry. Methods Sera of 863 patients were analysed according to a standardised protocol including immunofluorescence, immunoprecipitation, line immunoassay and immunodiffusion. Results Antinuclear antibodies (ANA) were detected in 94.2% of patients. In 81.6%, at least one of the autoantibodies highly associated with SSc or with overlap syndromes with scleroderma features was detected, that is, anti-centromere (35.9%) or anti-topoisomerase I (30.1%), followed in markedly lower frequency by antibodies to PM-Scl (4.9%), U1-ribonucleoprotein (U1-RNP) (4.8%), RNA polymerases (RNAPs) (3.8%), fibrillarin (1.4%), Ku (1.2%), aminoacyl-transfer RNA synthetases (0.5%), To (0.2%) and U11-RNP (0.1%). We found that the simultaneous presence of SSc-associated autoantibodies was rare (1.6%). Furthermore, additional autoantibodies were detected in 55.4% of the patients with SSc, of which anti-Ro/anti-La, anti-mitochondrial and anti-p25/p23 antibodies were most frequent. The coexistence of SSc-associated and other autoantibodies was common (43% of patients). SSc-associated autoantibodies disclosed characteristic associations with clinical features of patients, some of which were previously not acknowledged. Conclusions This study shows that five autoantigens (that is, centromere, topoisomerase I, PM-Scl, U1-RNP and RNAP) detected more than 95% of the known SSc-associated antibody responses in ANA-positive SSc patients and characterise around 79% of all SSc patients in a central European cohort. These data confirm and extend previous data underlining the central role of the determination of ANAs in defining the diagnosis, subset allocation and prognosis of SSc patients

The correlation of urethral resistance pressure with maximum urethral closure pressure and stress incontinence

OBJECTIVE: Aim of the study was to correlate urethral retro resistance pressure with the maximum urethral closure pressure (MUCP) and functional urethral length (FUL) in patients with urinary incontinence and healthy individuals. STUDY DESIGN: Two hundred and twenty patients with the complaint of urinary incontinence had a urodynamic examination including urethral pressure profiles and URP. Additionally, 15 healthy individuals without the complaint of any incontinence had their URP and urethral pressure profiles measured. The correlation of MUCP, FUL and URP were calculated using Graph Pad Instat 4.0 for windows. RESULTS: URP correlates well with the diagnosis of urodynamic stress incontinence. Correlation coefficient between URP and MUCP is 0.9262. Healthy individuals have significantly higher values for URP and MUCP. CONCLUSION: URP is a valuable less invasive test than conventional urethral function tests for the diagnosis of urodynamic incontinence with an excellent correlation of MUCP and URP

Gynaecological operations: do they improve sexual life?

Aim of the study was to determine if gynaecological operations have an effect on sexual function using the current medlined literature. We performed a Medline search using the terms "sexual life/function after operative gynaecological treatment", "sexual life/function after operations for gynaecological problems", "sexual life/function after hysterectomy", "sexual life/function, incontinence" and "sexual life/function, pelvic organ prolapse". Reviews were excluded. We divided the operations into four groups of (1) combined prolapse and incontinence operations, (2) prolapse operations only, (3) incontinence operations only and (4) hysterectomy and compared pre-to postoperative sexual outcome. Thirty-six articles including 4534 patients were identified. Only 13 studies used a validated questionnaire. The other authors used self-designed and non-validated questionnaires or orally posed questions by the examiner to determine sexual function. Prolapse operations particularly posterior repair using levator plication seem to deteriorate sexual function, incontinence procedure have some worsening effect on sexual function and hysterectomy seems to improve sexual function with no differences between subtotal or total hysterectomy. Gynaecological operations do influence sexual function. However, little validated data are available to come to this conclusion

Sexual function after vaginal and abdominal fistula repair

OBJECTIVE The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). STUDY DESIGN Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analogue scale to measure general disturbance by the fistula. RESULTS After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding any domain of sexual function or visual analog scale. CONCLUSION Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable