Posterior spinal cord block: a dosimetric study

To determine the optimal width of a midline posterior spinal block (MPSB) (to avoid delivering too great a dose to the cord and too small a dose to adjacent tissue), the authors determined with magnetic resonance (MR) imaging normal ranges of cord depth and width and correlated them with film dosimetric data. In 59 randomly selected patients there was a wide range for both depth and width. The average depths of the anterior and posterior surfaces of the cord were 6.7 cm +/- 1.4 and 5.4 cm +/- 1.3, respectively. The average cord width was 1.6 cm +/- 0.4. Optimal cord block width as a function of cord width was determined for a 6-MV photon beam. The optimal cord block width at the surface (half-value layer [HVL] thickness = 6) varied from 1.5 to 3.0 cm for cord widths of 0.8-2.4 cm, which correspond to two standard deviations from the average. There was no significant dependence on depth of the cord. For optimal treatment outcome, the MPSB width may have to be determined for each patient individually.     

Psychosoziale Aspekte bei Infertilität

The last few years have brought huge advances in the consideration of psychosocial aspects of infertility. This review begins with a presentation of the important demographic and medical preconditions involved. This is followed by an overview of psychosocial features typical of infertile couples and a discussion of the connections between distress and infertility. The psychological effects of reproductive medical treatment are described, and the long-term impact of involuntary childlessness is outlined. The basic principles, aims, and effects of counselling and psychotherapy with infertile couples are set out in detail, together with urgent requirements for the future.     

Wundinfektionen in der Gynäkologie und Geburtshilfe

Surgical site infections (SSI) are the second most frequent type of nosocomial infections. Increasing age and multimorbidity of gynecologic patients reduce the otherwise noticeable benefits of modern surgical procedures and antibiotic therapies. The most important prophylaxis of SSIs consists of the application of a single shot antibiotic 30-60 min before surgical incision. The diagnosis of SSI is made by clinical aspects and is based on classical symptoms. Therapeutically, local measures should first be applied and in cases of generalized symptoms empiric antibiotic therapy must be given. Abscesses should be opened widely and rinsed. The inlay of antiseptic substances or materials reduces the number of bacteria and improves granulation. For large-scale wounds good experience has been made with closed vacuum systems (VAC). Infections with methicillin-resistant S. aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) play an important role in intensive care and neonatology units and require close cooperation with microbiologists and hygiene specialists.     

Strahlentherapie des Uterussarkoms

For patients with a leiomyosarcoma or an endometrial stroma sarcoma the use of adjuvant radiation is questionable. Radiation therapy potentially increases the rate and severity of surgical complications in patients with recurrent disease. In patients with a carcinosarcoma postoperative radiation should be considered as adjuvant radiotherapy decreased the rate of local recurrences but not overall survival in retrospective studies and the randomized EORTC study. Therapy-related toxicity is mild and tolerable. A dose of at least 45 Gy conventionally fractionated should be used. A whole abdominal irradiation is not indicated. Due to early distant metastases effective and well tolerable systemic therapies need to be developed. It is absolutely necessary that the extent of surgery should be internationally standardized, a systematic lymphonodectomy should be carried out for carcinosarcomas and molecular prognostic markers should be established in order to estimate risks and prognosis of the patient.     

Adjuvante und definitive Radio-Chemo-Therapie des Vulvakarzinoms

Vulvar cancer is a relatively rare disease with an incidence of 4% of all gynaecologic cancers. Early vulvar cancers are treated by radical local excision of the tumour and inguinal lymph node dissection. The most important prognostic factors are the presence of lymph node metastasis and the magnitude of surgical margins. In high-risk cases, adjuvant radiotherapy can reduce the local recurrence rate and may improve survival. In advanced stages, combined chemoradiation reduces tumour size and improves the chance of partial or complete remission.     

Effect of adding albumin to solutions of somatostatin on inhibiting pentagastrin-stimulated acid secretion in dogs

In five conscious dogs with chronic gastric fistulas we studied the effect of somatostatin solutions on pentagastrin-stimulated acid secretion. Somatostatin was dissolved in 0.154 M NaCl alone or in the same amount of saline to which dog albumin had been added to give a 0.5% solution. Somatostatin produced a dose-dependent inhibition of pentagastrin-stimulated gastric secretion. However, the inhibition was significantly less when somatostatin was dissolved in saline as compared to saline plus albumin. This study suggests that albumin should be added to somatostatin solutions to preserve biological activity, and it confirms previous reports indicating that, without albumin, basic peptides have a tendency to stick to infusion systems.