[Minimally invasive video-assisted thyroidectomy: establishment in a thyroid center]. / Minimalinvasive, videoassistierte Schilddrüsenresektion: Etablierung in einem Schilddrüsenzentrum.

BACKGROUND: This study retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) during the introduction stage of this surgical technique at the Martha-Maria Hospital in Nuremberg. PATIENTS AND METHODS: The eligibility criteria for MIVAT were a thyroid volume < 25 ml, nodules < 30 mm, no thyroiditis, no preoperative evidence of carcinoma and no previous neck surgery. A retrospective evaluation was performed together with a control group of patients who underwent conventional thyroid surgery during the same time period and included a follow-up for general patient satisfaction and cosmetic results. RESULTS: Between August 2008 and July 2009 a total of 55 patients underwent MIVAT including 8 conversions to open surgery and 45 patients who underwent conventional surgery served as matched controls. No significant differences in terms of perioperative complication rates were found (e.g. recurrent laryngeal nerve palsy, hypocalcemia or secondary hemorrhage). The mean operating time was significantly longer in the MIVAT group (96.8 ± 3.7 min vs. 69.8 ± 2.3 min, p = 0.001) whereas a significant decrease in the mean operating time for hemithyroidectomy after 5 months was observed (98.1 ± 3.77 min vs. 76.0 ± 4.98 min, p = 0.013). Patients in the MIVAT group were more satisfied with the cosmetic outcome (8.5 ± 0.3 vs. 8.2 ± 0.2, p = 0.05) as well as with the overall surgical procedure (9.0 ± 0.3 vs. 8.6 ± 0.2, p = 0.02). CONCLUSION: During introduction of the MIVAT procedure a learning effect can be observed which is hallmarked by a decrease in operating time and conversion rate to open surgery. Moreover, no significant differences in terms of main postoperative complications were found so that MIVAT can be considered a safe and feasible technique under the conditions of correct eligibility criteria.

P-Recovery from sewage by seeded crystallisation in a pilot plant in batch mode technology.

P-Recovery from actual sewage by P-RoC-technology (Phosphorus Recovery by Crystallisation of phosphate mineral phases from waste- and processwater) was studied in a pilot scale. Therewith the practicability of the pilot plant was tested and the quality of the so generated products was investigated.

Differences in the coalescence kinetics of fat emulsions in dependence on the amount of fat and age.

The destabilizing effect of calcium ions on emulsions was studied as a function of the age of the emulsions and the degree of emulsion dilution (2%, 0.2% an 0.02% fat). Particle size measurements were performed both in the Coulter counter and a laser diffraction device equipped with PIDS technology. The data of both instruments showed a good correlation. zeta-Potential was determined by laser doppler anemometrie. The physical stability of the emulsions in 6 mmolar Calcium Chloride decreased with increasing dilution--despite the diminished rate of collision in diluted systems. In addition, and increased electrolyte sensitivity was observed with increasing age of the emulsions--despite enhanced electrostatic stabilization by an increased zeta-potential. Both effects were attributed to an increased binding of calcium ions per surface area of the droplets, i.e. increased ratio calcium ions to surface by dilution and increased binding by the increased charge of aged emulsions.

[Significance of uterine contractions for adaptation of the newborn infant before cesarean section]. / Die Bedeutung der Wehentätigkeit für die Adaptation des Neugeborenen vor Sectio caesarea.

UNLABELLED: There are quite a few publications on the influence of labour on the adaptation of neonates after elective cesarean sections. Many authors recommend the induction of labor prior to the cesarean section. They found that this improves the adaptation of the infants. MATERIAL AND METHOD: All cesarean sections between 1991 and 1996 are recorded. Mature neonates (> 36 weeks of pregnancy) were evaluated separately from premature infants (< 36 weeks of pregnancy). As target-parameters we chose 1. the condition of the neonates (characterized by the Apgar-Score, the pH of the umbilical cord artery, and the requirement of artificial respiration). 2. the necessity of transfer to the neonatologic intensive care unit. Concerning these parameters, the immature neonates (> 36 weeks of pregnancy) were evaluated separately from the mature infants (< 36 weeks of pregnancy). In the latter group we finally evaluated the data of those who were not delivered by a cesarean section because of intrauterine fetal distress. RESULTS: The adaptation of the premature neonates was so closely related to the gestational age that all the other variables were of no statistically significant influence. Thus also the factor "labour" was of no influence. The results in the group of the mature infants were completely different. Between week 36 und 42 of pregnancy the gestational age was of no influence on the adaptation of the neonates. Statistically noticeable however was the influence of preoperative labour: The adaptation of infants delivered by cesarean-section after labour was remarkably worse than the adaptation of those who were delivered without labour prior to the operation. This statement is also correct when one rules out those infants who were delivered by a so called emergency cesarean section. When evaluating the group of neonates in which the cesarean section was not performed because of intrauterine fetal distress we could find no influence of preoperative labour on the adaptation of the infants. All other variables examined (e.g. maternal age, parity, duration of labour, method of anaesthesia, twin-pregnancy) were no factors of influence on the adaptation of the babies. CONCLUSION: From our results we cannot support the recommendation to induce labour prior to any elective cesarean section by infusion of oxytocin or to wait for the spontaneous onset of labour. There ist no reason to change our policy to perform an elective cesarean section as near as possible to term before the onset of labour.

International round-robin experiment to test the International Organization for Standardization total-scattering draft standard.

An international round-robin experiment has been conducted among laboratories in different countries to test the measurement and the data-analysis procedures in the International Organization for Standardization draft standard ISO/DIS 13696 for measuring total scattering from low-scatter laser optics. Ten laboratories measured total backscattering from high-reflectance mirrors, 50% beam splitters, and antireflection-coated windows. Results were sent to the Laser Zentrum Hannover, which acted as coordinator and analyzed all the backscattering data. The results showed that the procedure in the draft standard was useful for measuring and reporting backscattering for low-scatter optics. Problems encountered in the round-robin experiment included the accumulation of particles on the surfaces, particularly on the high-reflectance mirrors.

[The value of aspiration cytology within the scope of triple diagnosis of palpable breast changes]. / Der Stellenwert der Aspirationszytologie im Rahmen der Tripel-Diagnostik tastbarer Mamma-Veränderungen.

The diagnostic value of aspiration cytology and the overall diagnostic quality of the so-called triple test (aspiration cytology, mammography and physical examination) in the evaluation of palpable breast masses were investigated in a retrospective study. 608 histologically evaluated cancers and 224 benign lesions were investigated. A main purpose of the study was to find out whether the triple diagnostic test can replace surgical biopsy and thereby reduce the number of unnecessary biopsies. All lesions triple-diagnosed as malignant were histologically proved to be malignant, i.e. there were no false positive results. The rate of false negative results was found to be within the range reported for false negative results in fresh frozen sections. Based on these results we state that the dogmatic statement "every palpable mass in the breast must be excised" should be replaced by the recommendation "every palpable mass must be assessed and clarified". A great number of retrospectively unnecessary biopsies can be avoided by a systematic use of the triple diagnosis. The diagnostic safety of this method is close to that of open biopsy. In all cases where positive or negative concordant triplets are found, histological confirmation by biopsy can be avoided. Patients with benign lesions can be thoroughly followed up by repeated physical and radiological examinations. Patients with triple diagnostic malignant results can be adequately treated. Lesions for which triple diagnosis yields neither benign nor malignant, must be biopsied: This is also necessary in all cases with suspicious findings in mammography without a palpable mass, if the equipment for stereotactic or ultrasound- guided biopsies is not available.(ABSTRACT TRUNCATED AT 250 WORDS)

[Twin pregnancy in uterus didelphys]. / Gemini-Gravidität bei Uterus didelphys.

A case of twin pregnancy in uterus didelphys is reported. This rare event is discussed from obstetric aspects as well as that of dizygotic twins.

Morphohistometric investigations in placentas of gestational diabetes.

Perinatal morbidity and mortality are increased in both overt and gestational diabetes. Since retardation of placental development has been documented in overt diabetes, we, thus, examined morphometrically the terminal villi of 26 patients with gestational diabetes in order to determine if there is an immaturity of placental development. Investigation of villous surface, degree of vascularization, and development of epithelial plates yielded values lying somewhere between those of non-diabetic patients and those of patients with overt diabetes. Only the surface areas of the vessels were reduced to levels lower than in overt diabetes. Our findings appear to explain the occasional development of acute placental insufficiency.

Morphohistometric investigations of placentas of diabetic patients in correlation to the metabolic adjustment of the disease.

In order to determination if an interdependence exists between the well-known maturational disturbances in placentas of diabetics and the quality of metabolic adjustment, a morphometric study covering 7,500 terminal villi of 50 placentas was performed. The diabetic mothers were divided into two groups according to satisfactory or unsatisfactory blood glucose values. Significant differences in placental retardation were observed between both diabetic groups and a normal control group. Although outcomes did not differ greatly between the two diabetic groups, macrosomia and the ratio of malformations in the newborns correlate with unsatisfactory metabolic management. Small-for-date babies, the need for early termination of pregnancy as well as pre-eclampsia are related to the severity and duration of the disease.

The development of the placental villus during normal pregnancy: morphometric data base.

The morphological structures of the terminal villus of the normal human placenta were evaluated morphometrically throughout pregnancy. The Videoplan (Kontron) system was used to measure a total of 6000 villi. The cross-sectional surface and circumference of the villus decrease continuously until the 28th week and remain stable thereafter. The cross-sectional surface, number, and circumference of villous vessels only increase until the 20th week. The relative degree of vascularization, however, increases further until 28th week together with a continuous decrease in villous size. Epithelial plates start to appear in the 18th to 20th week, and their development is essentially completed by the 28th week. According to the data presented, the development and differentiation of the placental villus are completed by the 28th week of gestation. Any further increase in nutritional capacity can only be provided by an increase in the number of villi and not their individual maturation. These results represent a morphometric data base for the quantification of retarded placental development in placental insufficiency.

[Pelviscopic tubal coagulation]. / Pelviskopische Tubenkoagulation.

1771 laparoscopic tubal sterilisations were analysed from 1972-1982 at the UFK Ulm. The control period extended to 1986. The median age was 35.2 years with a constant increase over the decade. The overall complication rate was 1.86%; however, laparotomy became necessary in only 0.39% of the cases. There was an increased risk of complications with the more difficult procedures and with simultaneous elective abortion, whereas no association with the number of preceding laparotomies was observed. The failure rate was 0.34% by the end of 1986.

[Correlation between maternal hemoglobin levels and placental morphology and findings in newborn infants]. / Korrelation zwischen maternem Hämoglobingehalt und Plazentamorphologie sowie Befunden der Neugeborenen.

According to the criteria formulated by the WHO a hemoglobin concentration of 11 g/% represents an anaemia requiring treatment. 28 placentas of patients with hemoglobin concentrations of 7.2 to 10.9 g/% were examined morphometrically to detect possible disturbances of placental development. The patients had all delivered between the 37th and 41st week. Weight, hematocrit and HbA content of the newborn were correlated with the maternal hemoglobin content. There was no influence of maternal hemoglobin concentration on weight and size of the placenta, degree of vascularization and epithelial plates of the terminal villi. In patients with severe anaemia villous areas were smaller and villous vascular areas appeared larger than usual. The ratio of weight of the newborn to weight of the placenta was more commonly decreased in patients with anaemia. In some cases of severe anaemia fetal HbA values were elevated. All newborns with a hematocrit of 50 or more were delivered of mothers with haemoglobin concentrations of 9.5 g/% or less. The weight of all newborns in this study were above the 10th percentile. 7 of 9 newborns with a weight of 3,200 g or less were delivered of patients with a hemoglobin concentration of 9.5 g/% or less. These results indicate that placenta and fetal organ systems are able to compensate for the maternal anaemia without any major complications.

[Histometric case report of a placenta following intra-uterine therapy of rhesus incompatibility]. / Histometrische Kasuistik einer Plazenta nach intrauteriner Therapie einer Rhesus-Inkompatibilität.

In Rh-incompatibility the human placenta shows a prominent retardation of maturation. The placental insufficiency caused by these changes, combined with the existing hemolysis, represents an additional danger to the fetus. In a patient with severe Rh-incompatibility several Rh-negative blood transfusions were performed between the 26th and 30th weeks of gestation via sonographically guided puncture of the umbilical vein. Morphometric studies of the placenta were performed and the results compared with data already obtained from normal mature placentas and placentas from pregnancies complicated by Rh-incompatibility. Small terminal villi with a surface area identical to normal mature placentas were found. There was no improvement in vascularization when compared with other placentas from Rh-incompatible pregnancies. Nevertheless, isolated rebuilding of epithelial plates was found. The authors interpret these morphological phenomena as a "partial postmaturation" of the placenta as regards the development of the terminal villi. The absence of reproliferation of the villous vessels as well as the lack of any extensive regeneration of the epithelial plates could be due to the short time which elapsed between transfusion therapy and the inevitable indication for caesarean section. Intensive intrauterine therapy reduces the risk to the fetus due to immunologic complications, as well that due to placental insufficiency, as evidenced by the additional differentiation of villi.

[Histometric studies of placental villi in Rh incompatibility]. / Histometrische Untersuchungen an Plazentazotten bei Rh-Inkompatibilität.

The delay in maturation of placental terminal villi in cases of Rh-incompatibility has often been described. The terminal villi of sixteen placentas from pregnancies complicated by Rh-incompatibility histometric were studied. Twenty-two placentas of healthy mothers who had born healthy babies after normal pregnancies served as a control group. The severity of the Rh-incompatibility was classified according to the clinical histories of the newborns and the criteria of Liley. The average area of a cross-section of a terminal villus was 3402 microns 2 (control group 2150 micronsoff; the degree of vascularization was calculated to be 6.5% (control group 30.5%). The other villous parameters measured or calculated show that maturation of the placenta is extremely retarded in cases of Rh-incompatibility. This failure in differentiation can not be compensated for by an enlargement of the organ as a whole. It was shown that the changes in the placental villi are closely correlated to the severity of the fetal disease.

Morphometric investigations of terminal villi of diabetic placentas in relation to the White classification of diabetes mellitus.

In this morphometric study, terminal villi of 22 placentas of maternal diabetes mellitus were compared with the results in terminal villi of 22 normal placentas. The results demonstrate that there is a distinct retardation in maturation, statistically significant with bigger cross sectional surfaces of the terminal villi, particularly, when classified in 3000 mu2-steps, the number of the villous vessels and number of epithelial plates. Only slightly decreased in diabetic placentas is the villous vessels cross sectional surface as well as the degree of vascularization. The correlation between the degree of histometric changes and the severity and duration of the disease was separately investigated (classification was done according to White). It could be shown, that the degree of morphologic changes in the terminal villi does not run strictly parallel to the severity and duration of diabetes. The retardation in maturation of the terminal villi increases from White group A to C. In White group D, which is the most severe stage of diabetes mellitus which we investigated, the values of measured parameters are close to the normal placentas. This observation is interpreted as a compensatory reaction of the fetal organ placenta to the reduction in utero placental blood flow in diabetes caused by the diabetic angiopathy.

[Histometric studies of placentones of the human placenta]. / Histometrische Untersuchungen an Plazentonen menschlicher Plazenten.

Regionally different structures of placental terminal villi in the placentones have been shown in earlier publications. In this study the earlier results should be tested by means of histometry. The earlier results could be proved. It was shown that the villi in the centers of the circulation units are less differentiated than those in the peripherie of the placentones. The results were statistically significant. The reasons for the regionally different architecture of the placental villi are discussed with respect to the results of other authors working in the same field.