Observational multicentric study to evaluate efficacy, adverse effects and acceptance of bowel cleansing prior to colonoscopy with sodium picosulfate / magnesium citrate formulation CitraFleet®.

The various efficient methods available for bowel preparation prior to colonoscopy differ in patient acceptance. Combining the laxative sodium picosulfate with hyperosmotic magnesium citrate, used in this study in the formulation CitraFleet(®), allows the uptake of the purgative substances as a solution of low volume. This observational study with 737 patients evaluated efficacy of bowel preparation, potential side or adverse effects and patient acceptance of this medicinal product when used by resident physicians in Germany.Colon cleansing with CitraFleet(®) was considered very good to sufficient in 95.2 % of the patients and inadequate in only 4.8 %. In 75 % of the colonoscopies, bowel preparation was rated very good or good. Compared to the standard regimen of two portions taken the day before endoscopy, cleaning efficacy was better when patients received one of the doses on the morning of the day of colonoscopy. The quality of bowel preparation was rated lower by gastroenterologists without any prior experience with sodium picosulfate/magnesium citrate. The overall assessment of the colon cleansing procedure by the 76 participating physicians was very positive and patient acceptance was also very high which can be considered a clear advantage over alternative methods. Efficacy of colon cleansing with CitraFleet(®) was not substantially affected by typical deviations from the recommended standard procedure, emphasizing the robustness of the method. Only one of the patients reported a mild adverse effect potentially caused by the cleansing agents.

Severity and duration of mental deficiency symptoms after intravenous administration of propofol.

The severity and duration of cognitive performance capacity deficits after intravenous administration of propofol were determined using the validated psychological test procedure syndrome short test (SKT), a simple reaction test and original driving licence exam questions. The test battery was performed before, immediately after, as well as 1 and 2 h after propofol administration in 23 persons. Immediately after propofol anaesthesia, six individuals had a slight performance loss, and four subjects showed mild deficits, consistent with medium organic neuropsychologic disorder or dementia. The status of the subjects rapidly changed for the better, and 2 h after propofol anaesthesia, only one person (4%) showed slight deficits of memory and attention. Therefore, it is suggested that patients refrain from any participation in road traffic for at least 2 h after propofol anaesthesia. Driving a car should not be admitted until an interval of 6 h has elapsed.

Eradication of Helicobacter pylori with pantoprazole and two antibiotics: a comparison of two short-term regimens.

BACKGROUND: High rates of Helicobacter pylori eradication can be achieved by combining proton pump inhibitors with two antibiotics. However, in the search for an optimal therapy a direct comparison of different regimens is necessary. METHODS: For this open study, 331 patients with duodenal ulcer were screened and randomly allocated to either pantoprazole 40 mg b.d., clarithromycin 500 mg b.d., and metronidazole 500 mg b.d. (PCM) or pantoprazole 40 mg b.d., amoxycillin 1000 mg b.d., and clarithromycin 500 mg b.d. (PAC) for 7 days. Both combinations were followed by a 7-day therapy with pantoprazole 40 mg o.d. alone. Eradication of H. pylori was assessed by use of a 13C-urea breath test 4 weeks after the intake of the last medication. RESULTS: Eradication rates were 90% in intention-to-treat patients from the PCM (132 out of 147; 95% CI: 84-94%) and the PAC group (135 out of 150; 95% CI: 84-94%). H. pylori was eradicated in 112 out of 117 per protocol patients of the PCM group (96%; 95% CI: 90-99%) and in 119 out of 126 patients of the PAC group (94%; 95% CI: 89-98%). Rapid relief from ulcer pain and a decrease in the mean intensity of other gastrointestinal symptoms was observed. Sixty-nine patients reported adverse events, none of which were related to the intake of pantoprazole. Four serious adverse events, none related to the trial medication, were observed. CONCLUSIONS: Both pantoprazole-based short-term triple therapies are highly effective and well-tolerated treatment regimens in the eradication of H. pylori.

Concentrations of various arachidonic acid metabolites in menstrual fluid are associated with menstrual pain and are influenced by hormonal contraceptives.

In a pilot study we investigated the association between concentrations of various eicosanoids in menstrual blood with pain and oral contraceptive use. Menstrual fluid was collected on tampons by 12 women who did not use an oral contraceptive but suffered from slight primary dysmenorrhea and by three pain-free women who used an oral contraceptive. Eicosanoids (cyclooxygenase products: 6-ketoprostaglandin F1 alpha, thromboxane B2, prostaglandin E2, prostaglandin F2 alpha, 13,14-dihydro-15-ketoprostaglandin F2 alpha, 12-hydroxy-heptadecatrienoic acid; lipoxygenase products: 5-, 12-, 15-hydroxy-eicosatetraenoic acid (HETE), leukotriene B4, leukotriene C4, leukotriene D4, leukotriene E4) and female sex steroids (17 beta-estradiol and progesterone) were analyzed by the combined use of high-performance liquid chromatography and radioimmunoassay. 12-HETE was the main arachidonic acid metabolite. An increased metabolism of arachidonic acid was associated with pain, especially when synthesis of 12-HETE was elevated. Oral contraceptive use decreased the synthesis of prostaglandins as well as leukotrienes. The concordant changes of cyclooxygenase and lipoxygenase products in dysmenorrhea or in oral contraceptive use may be explained by an increased or decreased phospholipid metabolism, respectively.

Measurement of eicosanoids in menstrual fluid by the combined use of high pressure chromatography and radioimmunoassay.

Methods are described for the quantification of various eicosanoids (cyclooxygenase products: 6-KETO, TXB2, PGE2, PGF2 alpha, DHK; lipoxygenase products: 5-, 12-, 15-HETE, LTB4, LTC4, LTD4, LTE4) in menstrual blood collected by tampons. Samples were extracted with acidified ethanol. After purification by SEP-PACK C18 columns, the compounds were separated by reversed phase HPLC using a ternary gradient system. The eicosanoid concentrations of the fractionated eluents were measured by radioimmunoassay and corrected for recovery. 12-HETE was the most prominent metabolite of arachidonic acid in menstrual blood (mean: 1174 ng/g blood). With the exception of PGF2 alpha and TXB2 (mean: 343 and 212 ng/g blood, respectively) other eicosanoids were detected in remarkable lower concentrations.

[Surgical treatment of invasive malignancies of the vulva using CO2 laser]. / Die operative Behandlung von invasiven Malignomen der Vulva unter Einsatz des CO2-lasers.

In a retrospective study, we analysed 26 CO2-laser vulvectomies within the observation period between 1982 and 1990. Indications for vulvectomies were invasive malignancies of the vulva, FIGO stage I to III. 91.7% were squamous cell carcinomas. The mean age of patients was 69.3% (43 to 87) years. Five radical local excisions, one modified radical vulvectomy and in all other cases radical vulvectomy was performed. Laser surgery of the vulva was combined with bilateral lymphadenectomy or radiotherapy of inguinal lymph nodes. If necessary, a gluteal rotation flap was built to achieve closure of the wound without tension. No serious intra- or postoperative complications were observed, wound breakdown with per secundam healing as the most common complication occurred in 29.1%. Functional and cosmetic results were examined in a detailed follow-up at least 12 months postoperatively, showing promising results (56.3% good, 37.5% satisfactory, 6.3% unsatisfactory). The surgical procedure, perioperative management, recurrence rate (3 patients, 12.5%), as well as functional and cosmetic results, are presented and discussed in detail. The use of CO2-laser in surgical treatment of vulvar malignancies improves cosmetic and functional results. This is important, particularly with regard to the increasing number of young women with vulvar neoplasia.

[Mucoviscidosis screening with immunoreactive trypsin]. / Mukoviszidose-Screening mit immunreaktivem Trypsin.

Up to now 49,116 immunoreactive trypsin (IRT) measurements have been carried out in Austrian newborns in the first week of life. Related to provisionally chosen cut-off points, 301 newborns (0.61%) showed an elevated IRT value; 253 of them were successfully recalled. According to a direct strategy, sweat tests were done without a second IRT measurement in 101 infants; eleven of them were identified as cystic fibrosis (CF) patients. In accordance with a 2-step strategy, 152 infants were reinvestigated by a second IRT determination. Twenty-eight of them again showed an elevated IRT value, as based on provisional, age-dependent reference values; seven were subsequently identified as CF patients by sweat testing. So far two false-negative findings were obtained on IRT screening: one child was later identified as having CF on the basis of typical clinical symptoms and a positive sweat test, the other patient presenting with meconium ileus showed a normal IRT value after surgery, but was subjected to a sweat test in view of the underlying condition. These preliminary results suggest a CF incidence of 1 to 2460 newborns in Austria. Hence, IRT screening appears to be a reliable method for identifying CF patients in the newborn period, thereby facilitating early treatment and genetic counselling.

[Prognostic factors in stage Ia-IIb invasive cervix cancer after radical hysterectomy with special reference to stroma reaction]. / Prognosefaktoren beim invasiven Zervixkarzinom der Stadien Ia-IIb nach radikaler Hysterektomie unter besonderer Berücksichtigung der Stromareaktion.

158 cases of invasive carcinoma of the uterine cervix stages Ia to IIb were analysed with respect to the following prognostic criteria: histological stage, presence of nodal metastases, vascular space invasion and inflammatory stromal reaction at the periphery of the tumor. The assessment of these criteria was correlated to the prevalence of tumor recurrence. In cases with absent nodal metastases, a significant increase of tumor recurrence in stage IIb compared to other stages was noted. A constant increase of the recurrence rate was found, when nodal metastases were present, although the incidence of positive lymph nodes was approximately equal in stages Ic, IIa and IIb. The involvement of the parametrium therefore appears to be a significant parameter for the poor prognosis in stage IIb. Vascular space invasion proved to be a significant parameter with regard to lymph node involvement. When no vascular space invasion was obvious, 94% of the cases showed tumor-free lymph nodes. Overall, heavy inflammatory infiltration at the tumor periphery correlated with a good prognosis. In cases of heavy inflammatory stromal reaction, the risk of nodal metastases and tumor recurrence was significantly lower, independent of the histological stage. The incidence of heavy inflammatory infiltration was significantly higher in microinvasive carcinomas than in clinically invasive tumors. Therefore, the extent of inflammation appears to be an additional useful prognostic index to identify a group of patients at high risk for recurrence and reduced chance of survival.

[Morphologic and functional long-term results after Vecchietti operation for the formation of a neovagina]. / Morphologische und funktionelle Langzeitergebnisse nach Vecchietti-Operation zur Bildung einer Neovagina.

For creation of a neovagina in patients with congenital vaginal agenesis, a variety of operative procedures are recommended. Basically, two different procedures are described: (1) Application of pressure or traction to the perineum and (2) plastic-surgical operations. Since 1981, the 2nd Department of Obstetrics and Gynecology, Vienna, utilises the method described by Vecchietti. 9 Patients with congenital absence of the vagina and one with vaginal occlusion after radiotherapy underwent Vecchietti's procedure. Patients were seen after a follow-up period of at least 5 years. We evaluated morphological and functional long-term results using a detailed questionnaire as well as clinical investigations including cytological smears, screening for vaginal infections and determination of sexual hormone levels in peripheral blood. To evaluate distensibility and greatest cross-sectional diameter of the neovagina, a vaginal cast (vinyl-polysiloxan) was obtained. All patients treated for congenital malformations showed good to excellent functional results.

[Effect of hormonal contraceptives on eicosanoid content of menstrual blood]. / Einfluss hormoneller Kontrazeptiva auf den Eicosanoidgehalt des Menstrualblutes.

PIP: The derivatives of arachidonic acid are generally called by the term eicosanoid. Arachidonic acid is a starting material for a series of biologically highly active metabolites that are formed either through cyclooxygenase, e.g., the prostaglandins (PG), or through various lipoxygenase ways, e.g., hydroxyarachidonic acids (HETE), leukotriene (LT), and peptide-LT. Eicosanoids also take part in menstrual bleeding; in dysmenorrhea also cyclooxygenase inhibitors, e.g., indomethacin have been proven to fight pain in addition to spasmolytics and the preventive action of hormonal contraceptives. PGs and peptide-LT could be shown in relative high concentrations in the endometrium of dysmenorrheic women. An analytic method in which menstrual blood was used as test material was developed. Women were given standardized tampons and holders filled with acidified alcohol. The holders were weighed for determination of the amount of blood. A special high performance liquid chromatography separation system was developed for purification, and radioimmunoassay was subsequently used for analysis of 60keto-PGF1alpha, and PGE2. 103 tampons of 14 subjects from 24 menstrual cycles were evaluated in 4 groups; no hormonal contraceptive use, contraceptive use, no pain, and pain. The taking of a pill significantly affected the blood volume; it was only 1/2 as much as in the control group without the taking of a pill. In the control group with a pill and pain 12 HETE was quantitatively the most important eicosanoid with a 60% share. F2alpha dominated among PGs. In patients with pain without pill use the average values of 6-keto, PGE2, 12-HETE, and LTB 4 were 50% higher. After pill use PG concentrations dropped significantly by 80% compared with controls. 12-HETE and PGF2alpha were the main metabolites of arachidonic acid in menstrual blood, in pain some metabolites were higher, and OCs reduced eicosanoid excretion significantly.^ieng

[The role of intestinal resection in primary surgery of ovarian carcinoma]. / Die Rolle von Darmresektionen bei der Erstoperation des Ovarialkarzinoms.

In most ovarian cancer cases complete resection of the tumour masses is not possible, and tumour reduction at the primary operation has been shown to improve survival. In some cases optimal tumour reduction is only possible by resecting intestinal structures, and it remains to be shown whether aggressive approaches are justified. The impact of intestinal resection, among other prognostic factors, was analysed in 104 patients undergoing primary operation for ovarian cancer. Tumour spread to bowel, exceeding 2 cm in diameter occurred in 39% of the cases. Debulking to a maximal tumour diameter less than 2 cm was achieved in 68 (65%) cases. Successful debulking was achieved by performing large (n = 20) and small bowel (n = 4) in 22 patients with massive bowel involvement. Two patients died during the hospital stay, one after bowel resection. Four independent prognostic variables emerged from Cox's multiple proportional hazards regression: ascites (p = 0.001), massive bowel involvement (p = 0.007), residual tumour size (p = 0.002), and intestinal resection (p = 0.11). The authors contend that intestinal resection to achieve optimal tumour debulking at the primary operation will improve the survival of ovarian cancer patients.

[Therapeutic aspects of trichomonas infection of the female genitals]. / Therapeutische Aspekte der Trichomonadeninfektion des weiblichen Genitale.

Infection with trichomonas is a common event in patients in gynecologic practice. In patients in an outpatient department the incidence of trichomonas infection was 7%, in cases with other genital infections 16%. Especially in alcalic vaginal milieu and in Gardnerella infections higher rates of trichomonas could be observed. The recurrence rate after monotherapy was 8%.

[Effect of nitrendipine on the function of the upper gastrointestinal tract]. / Einfluss von Nitrendipin auf die Funktion des oberen Gastrointestinaltrakts.

A double-blind crossover-trial comparing the influence of orally administered nitrendipine and placebo on the function of the upper gastrointestinal tract was carried out in ten healthy volunteers. Esophageal motility, intestinal transit time, size and motility of the gallbladder, serum gastrin levels and gastric secretion (basal and after stimulation with pentagastrin) were determined. No statistically significant differences between nitrendipine and placebo could be observed. Most parameters remained unchanged in both groups. Serum gastrin levels slightly increased after nitrendipine but did not exceed the normal range. The results demonstrate that nitrendipine given in an antihypertensive dosage, in contrast to other calcium antagonists, does not influence the function of the upper gastrointestinal tract.

[Surgical correction of uterus abnormalities: experiences with the Tompkins method]. / Die operative Korrektur von Uterusmissbildungen: Erfahrungen mit der Methode nach Tompkins.

In the last 10 years, 12 abdominal metroplasties (Tompkins) were performed at the 2nd Department of Obstetrics and Gynaecology, Vienna. All patients had a history of at least 2 spontaneous abortions, caused by a deformity of the uterus. The operation according to Tompkins, is technically simple and does not result in a defect in the uterus. There were no intraoperative or postoperative complications. Follow-up was possible in 10 patients, 8 of whom had a persisting wish for a child. 5 of these women became pregnant again, one had an abortion. All children were delivered by elective Caesarean section after the 36th week; the fetal outcome was satisfactory. In our experience, Tompkins' operation is the surgical therapy of choice in habitual abortion cause by Müllerian anomalies.

Evaluation of a simple and fast self-test for urine luteinizing hormone.

Ovulation can be predicted by measuring the midcycle urine luteinizing hormone surge with a simple 5-minute enzyme-immunoassay. This assay has proved to be suitable for self-tests with a sensitivity of about 90% and a specificity of 100% in unstimulated and clomiphene citrate stimulated cycles. Whereas a reference method (hemagglutination test) yielded better sensitivity, its specificity was markedly worse. Self-tests carried out by patients and control laboratory tests showed an excellent correlation. Patient compliance with self-tests should not be taken for granted.