High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit

Background High intensity focused ultrasound (HIFU) is a novel method which offers the non-invasive ablation of tissues without harming overlying organs or skin. It has been introduced successfully in urology for the ablation of prostatic hyperplasia and seems to be promising in the treatment of uterine fibroids. In this study we aimed to examine the feasibility and possible side effects of HIFU treatment of uterine tissues using an experimental mobile HIFU unit with ultrasound guidance. Methods For these experiments, a 1.07 MHz ultrasound source was used which allows treatment depths between 0 and 10 cm. In 12 patients scheduled to have abdominal hysterectomy, 5–60 impulses of HIFU were applied through the intact skin upon uterine tissues directly prior to the surgical procedure. Tissue intensities lay between 3,200 and 6,300 W/cm2 and a fixed pulse length of 4 s was used. Results No side effects were encountered other than one first-degree skin burn and the treatment was well tolerated. Histology showed clearly demarcated coagulative necrosis in the targeted tissues. Treatment was concluded in less than 45 min for each patient. Conclusion Focused ultrasound is an effective method to selectively destroy tissue within the uterus and the transabdominal access route is very feasible. This study shows that a mobile ultrasound source can be used safely and effectively to destroy uterine tissues, such as fibroids, without major side effects.     

Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact

Objectives

The goal of our work is the development of a numerical model of pregnant woman in driving position. We present an application to the study of injury mechanisms during a frontal car crash for a seat belt restrained pregnant woman in driving position.

Materials and methods

We integrated a digital representation of a pregnant uterus, foetus and placenta in a previous existing numerical model of non pregnant Human body in driving position, the Humos model^®. The realization of a numerical simulation of a frontal car crash enabled us to analyze the part played by the safety belt in the organic traumatisms.

Results

Three phases were highlighted. The first phase consists of a translation forwards of the pregnant uterus during the impact. The second phase is a rotation forwards in the sagittal plan of the pregnant uterus with for axis of rotation the posterior wall of the pubis. The third phase is a vertical adjustment coupled to a translation of the uterus towards the back. This translation leads the uterus to impact the spine.

Conclusion

The development of a pregnant numerical model in the field of accidentology allows the analysis of organic traumatisms. That makes it possible to study the role played by the existing safety systems. This model might make it possible to develop safety systems specific to the pregnant woman.     

Hülsenarteriengeschwulst der Milz

Ohne ZusammenfassungMit 3 Textabbildungen.     

Rohbaumwolle als Ursache von Asthma Bronchiale

Zusammenfassung Es wird ein Fall von Asthma bronchiale nach Kontakt mit peruanischer Baumwolle beschrieben (erworbene Allergie auf Grundlage erblicher Belastung). Die prinzipiellen Voraussetzungen zur Diagnose des allergischen Asthma bronchiale werden an Hand dieses Falles erörtert. Ähnliche Fälle von Erkrankung der Atmungsorgane bei Baumwollarbeitern in der Literatur stellen sich bei näherer Betrachtung nicht als allergische Krankheit im engeren Sinne heraus. Es handelt sich um Massenerkrankungen, wahrscheinlich parasitärer Ursache. Bei dem ausgeführten Falle ist der parasitäre Ursprung nicht wahrscheinlich. Es handelt sich um eine streng spezifische Idiosynkrasie, deren Entstehung nicht sicher geklärt werden kann.     

Rekonvaleszentenserumbehandlung der Encephalitis und Frage Ihrer ätiologie

Zusammenfassung Auch die sporadischen Fälle von Economo-Encephalitis sollen — zur Unterscheidung von anderen sporadischen Encephalitiden — als Encephaliticaepidemica bezeichnet werden, weil dieser Begriff als Krankheitsbezeichnung allgemein eingeführt ist.Zwei frische Fälle (1930) typischer schwerer kindlicher Economo-Encephalitis wurden durch i.m. Injektion von R.S. der Göttinger Encephalitisstation prompt beeinflußt und vorläufig geheilt.Jeder frische Fall von epidemischer Encephalitis soll auch im Kindesalter alsbald mit R.S. behandelt werden.Die Ergebnisse der Hornhautimpfungen vonKnauer undJaensch bilden keinen hinreichenden Grund, etwa aus ätiologischen Gründen die nosologische Krankheitseinheit Encephalitica epidemica in ihrer bisherigen Form aufzugeben.Klinischer Verlauf und Obduktionsbefund zweier Fälle, die das Bild der abakteriellen eitrigen Meningitis darboten, werden mitgeteilt. Keine Beeinflussung durch das Göttinger R.S., Hornhautimpfung mit den Liquores (Prof.Grüter) negativ.Nach einem Vortrage, gehalten auf der Tagung Südwestdeutscher und Rheinischwestfälischer Kinderärzte in Gießen am 12. April 1931.     

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

Background Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life.Methods We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care.Results Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005).Conclusions Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.Subject terms: Cancer, Cancer     

Advances in urinary proteome analysis and biomarker discovery

Noninvasive diagnosis of kidney diseases and assessment of the prognosis are still challenges in clinical nephrology. Definition of biomarkers on the basis of proteome analysis, especially of the urine, has advanced recently and may provide new tools to solve those challenges. This article highlights the most promising technological approaches toward deciphering the human proteome and applications of the knowledge in clinical nephrology, with emphasis on the urinary proteome. The data in the current literature indicate that although a thorough investigation of the entire urinary proteome is still a distant goal, clinical applications are already available. Progress in the analysis of human proteome in health and disease will depend more on the standardization of data and availability of suitable bioinformatics and software solutions than on new technological advances. It is predicted that proteomics will play an important role in clinical nephrology in the very near future and that this progress will require interactive dialogue and collaboration between clinicians and analytical specialists.