Urogynäkologische Diagnostik – Update 2019

Zur erfolgreichen Therapie von komplexen Beckenbodenfunktionsstörungen wie Harninkontinenz und Genitalsenkung ist eine individuelle und abgestufte Diagnostik unverzichtbar. Eine Erfassung aller störenden Symptome mit Einschätzung des Leidensdrucks sowie eine urogynäkologische Untersuchung mit verschiedenen Funktionstests sind leicht durchführbar und erfordern keinen technischen Aufwand. Die Einschätzung des Ausmaßes der Beckenbodenschädigung und die Evaluation der Koordinations‑, Relaxations- und Kontraktionsfähigkeit der Levatormuskulatur geben Aufschluss über einen adäquaten Therapiestart. Die Durchführung einer Beckenbodensonographie sollte ebenfalls großzügig erfolgen. Die 2‑D-Sonographie liefert in der Inkontinenzdiagnostik vielfältige und ausreichende Informationen, wie Mobilität der Harnröhre und Lagekontrolle von eingelegten Bändern. Bei Prolapszuständen könnte der 3‑D-Ultraschall durch Detektion tieferer Muskelschichten wertvolle Zusatzbefunde aufzeigen, die eine noch bessere Planung des Operationsverfahrens und Aufklärung der Patientin ermöglichen. Die urodynamische Untersuchung und die Urethrozystoskopie sollten individuell bei Bedarf Einsatz finden.     

Safety and efficacy of botulinum toxin type A following long-term use

Botulinum toxin serotype A (BoNT-A) has long heritage of use leading to confidence in its safety and efficacy. The application of BoNT-A does not lead to persistent histological changes in the nerve terminal or the target muscle. Clinical trials defined the safety and tolerability profile of BoNT-A across common therapeutic indications and showed an incidence of adverse events of approximately 25% in the BoNT-A-treated group compared with 15% in the control group. Focal weakness was the only adverse event to occur more often following BoNT-A treatment. Long-term BoNT-A administration has been assessed in various treatment settings, with the level and duration of BoNT-A efficacy response being maintained over repeated rounds of injection with no major safety concerns. The treatment of children with cerebral palsy often require long-term, repeated, multimuscle BoNT-A injections that lead to the administration of comparably higher toxin doses. Despite the high total body doses used, their distribution over multiple muscles and injection sites means that systemic side effects are rare. Recent formulation changes have reduced the incidence of antibody development following treatment with BOTOX^®. These findings show long-term BoNT-A treatment to be both safe and efficacious for a wide variety of indications.     

Effect of ankle position on isometric quadriceps strengthening

A prospective study of 20 normal subjects was undertaken to determine the effect of three ankle positions (active dorsiflexion, active plantar flexion, natural or rest position) on comfort and facilitation of quadriceps contraction in isometric strengthening in a supine position with the hip and knee fully extended. Surface EMG activity was found to be greatest for the vastus lateralis followed by the vastus medialis and least for the rectus femoris. Equal facilitation was apparent with either active ankle dorsiflexion or plantar flexion. Both were superior to the natural (rest) position. In situations where isometric quadriceps exercises are required, the authors recommend either active ankle dorsiflexion or plantar flexion to facilitate quadriceps strengthening. The choice between the two positions should be based on patient comfort.     

Assessment of early alveolar particle clearance and macrophage function following an acute inhalation of sulfuric acid mist

Rabbits were exposed to submicrometer sulfuric acid mist at 1 mg/m3 for 1 hr to assess effects on alveolar region clearance of a polystyrene latex tracer aerosol. Bronchopulmonary lavage was performed at selected times after exposure for functional characterization of alveolar macrophages. In vivo, clearance was accelerated in acid exposed animals relative to sham controls. Acid exposure produced no change in the viability or numbers of macrophages recovered. Although an increase in the number of polymorphonuclear leukocytes, primary neutrophils, was observed by 1 hr in both acid and sham groups, compared to nonexposed controls, levels were normal by 12 hr in shams but continued elevated in the acid group through 24 hr. Reduced in vitro macrophage adherence was observed after acid exposure. In vivo uptake of the tracer particles by macrophages was enhanced during the first 3 hr after acid exposure and in vitro phagocytosis by polymorphonuclear leukocytes was increased through 48 hr post-exposure. The results indicate some functional alterations in free cells after in vivo exposure to H2SO4 and the production of a mild inflammatory response. This latter was associated with an acceleration of inert particle clearance from the alveolar region.     

Europäische Forschungsförderung in der Ophthalomologie

Ohne Zusammenfassung     

Toxic epidermal necrolysis; 15 years'' experience in a Dutch burns centre

BACKGROUND: Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss. OBJECTIVES: Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN. PATIENTS/METHODS: Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004. RESULTS: Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established. CONCLUSIONS: Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival.     

女性慢性下腹痛的干预性治疗

1背景 育龄妇女常见慢性下腹痛，可造成身体损害、情绪忧伤及导致巨大的健康服务费用。美国在这方面的花费超过8亿8千万美元（Mathias 1996）。英国全国数据库的一般性诊治资料显示，慢性下腹痛发病率及流行率与偏头痛、背部痛、哮喘发病率相似（Zondervan 1999）。     

Parapapillary diameter of retinal vessels. I. Estimating the size of the optic papilla (a papillometric study of over 264 normal eyes)

The diameter of the temporal superior and inferior retinal artery and vein were measured at the optic disk border and 2 mm from the disk center in 264 nonselected normal eyes on the basis of photographs, with correction of magnification. Additionally, the individual ocular magnification factor was determined by Littmann's method. The mean caliber of the artery was 0.113 +/- 0.019 mm at the disk border and 0.118 +/- 0.023 2 mm from the disk center. The corresponding values for the vein were 0.149 +/- 0.026 mm and 0.159 +/- 0.026 mm. The correlations between vessel caliber and disk size were not significant, but the relationship between disk size and the quotient of vessel diameter divided by disk size was highly significant (p less than 0.0001). Vessel diameter can therefore be taken as an independent unit for determining optic disk size in relative and approximately also in absolute units. Thus, mean horizontal disk diameter (1.77 +/- 0.33 mm) corresponded to 16.3 +/- 3.5 artery and 12.3 +/- 2.6 vein diameters (measured at the optic disk border). The mean individual ocular magnification factor was 0.302 +/- 0.017, with a Gauss standard distribution. If the optical characteristics of a photographed eye are not known and the ocular magnification factor is assumed to be 0.302, then 68.3% of all eyes will be covered with an inaccuracy of 5.6% and 95.5% of all eyes with an inaccuracy of 11.2%.