[Minimal invasive surgery in gynaecology]. / Minimal-invasive Chirurgie in der Gynäkologie.

In Gynaecology there have been many innovative developments towards minimal invasive surgery. Today patients can profit of these new techniques in all fields of gynaecological surgery, some of which are described: The treatment of benign adnexal pathology including ectopic pregnancy is a domain of laparoscopy. Also symptomatic myomas can be enucleated by laparoscopy with favourable pregnancy outcome. The role of endoscopy in malignant disease has still to be defined though pelvic and paraaortal lymphonodectomy and even radical hysterectomy have been shown to be feasible. Pathology of the uterine cavity (myomas, polyps, septae) is routinely treated by hysteroscopy. The concept of operative treatment of stress urinary incontinence has changed since the minimal invasive TVT procedure has shown to be as successful as the classic colposuspension. For patients with breast cancer there has been a change from (ultra-) radical surgery to breast conserving treatment. Furthermore with the concept of the sentinel lymphnode a reduction of the morbidity of the classical lymphonodectomy is achieved without loss of information about the axillary lymphnode status.

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial.

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.

The localization of thromboxane synthase in normal and pathological human kidney tissue using a monoclonal antibody Tü 300.

Thromboxane, excreted in the urine in increased amounts in glomerular, vascular and tubulo-interstitial diseases, is considered to originate from the kidney. The localization of thromboxane synthase, a key enzyme of arachidonic acid metabolism, was studied in the human kidney by immunohistology using the monoclonal antibody Tü 300. In the interstitial tissue dendritic reticulum cells surrounding the tubules expressed high concentrations of the enzyme. In glomeruli the enzyme was weakly expressed in podocytes. This was confirmed by co-localization with an antiserum directed to podocalyxin, a marker of the visceral epithelial cells. In the study of various kidney diseases, massive accumulation of thromboxane synthase containing cells was observed in interstitial diseases, whereas in glomerular diseases there were no differences from normal kidney; in a case of thrombotic microangiopathy podocytes exhibited an increase in thromboxane-synthase. The thromboxane-synthase positive infiltrating interstitial cells were shown by conventional light microscopy to be mononuclear phagocytic cells. The physiological sources of renal thromboxane are dendritic reticular cells and podocytes. In interstitial renal disease infiltrating cells of the monocyte/macrophage system constitute the major site of thromboxane synthesis. In glomerular disease, a characteristic alteration of thromboxane-synthase was not found.

[Metabolic activity of goat adipose tissue at the end of gestation and at the beginning of lactation: level of deoxyribouncleic acid content and lipoprotein lipase activity]. / Activité métabolique du tissu adipeux de la chèvre en fin de gestation et en début de lactation: teneur en acide désoxyribonucléique et activité lipoprotéinelipasique

In the goat the passage from late pregnancy to early lactation is accompanied by a decrease of the epiploon lipoprotein lipase activity and an increase in the epiploon DNA content. The between-goat variations allow us to emphasize a linear relation between the lipoprotein lipase activity decrease and the reduction of the epiploon volume, expressed on a DNA basis. These parameters, used as indicators of the adipose tissue metabolic status, could contribue to the determination of a feeding strategy adapted to high yield milking Ruminants.