ABSTRACT
Future developments of MIS will strongly depend on economic conditions in the managed care system. There are clear indications for benign diseases but in malignant tumors well defined oncologic standards are mandatory to maintain.
Subject(s)
Genital Diseases, Female/surgery , Genital Neoplasms, Female/surgery , Laparoscopy/trends , Microsurgery/trends , Minimally Invasive Surgical Procedures/trends , Equipment Design , Female , Forecasting , Humans , Laparoscopes , Managed Care Programs/trends , Microsurgery/instrumentation , Minimally Invasive Surgical Procedures/instrumentationABSTRACT
43 cases with severe preeclampsia with HELLP syndrome were observed out of 14890 deliveries from 1980 to 1993 in the Department of Obstetrics and Gynecology, University of Mainz. In 17 cases there were grave complications (14 renal failure: 3 patients requiring dialysis; 6 bleedings: abdominal wall hematoma in 5 patients after caesarean section, 1 rupture of the liver; 3 pulmonary complications; 9 cerebral complications: 7 eclamptic convulsions, 1 amaurosis caused by partial infarction of the posterior cerebral artery, 1 sinus venous thrombosis). The plasmatic blood-clotting factors were in the normal range, except for 2 cases. In 27 patients TAT and D-dimers were determined. In 17 of these 27 patients TAT and D-dimers increased up to extreme levels (TAT > 20 micrograms/l and D-dimers > 1000 micrograms/l). In 12 of these 17 patients, complications occurred during in the course of the disease (70%). On the other hand, only 3 out of 12 patients (30%) with a low activation of blood coagulation (TAT > 10 and < 20 micrograms/l; D-dimers > 800 and < 1000 microgram(s)/l) had shown complications. It is suggested that the early determination of TAT and D-dimers may help to avoid complications.
Subject(s)
HELLP Syndrome/blood , Hemorrhage/blood , Pre-Eclampsia/blood , Adolescent , Adult , Blood Coagulation Tests , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome , Risk FactorsABSTRACT
The pelvic exenteration procedure must be considered a multimodal therapeutic concept from a humanistic-medical point of view. Careful patient selection, radical resection of all tumor-infiltrated organs, complete interdisciplinary organ reconstruction, and optimal perioperative management including full psychosomatic rehabilitation are mandatory. This concept should only be realized in medical centers with highly sophisticated infrastructures.
