Search

Objective To evaluate the safety, feasibility, and tissue response of a novel device for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia, using the first-generation Urocross Expander System (Mercury Expander System). Methods The implant was deployed and retrieved using flexible cystoscope in 8 adult male canines, separated into three study arms by retrieval date (1-, 6-, and 12- months post-deployment). Cystoscopy and urethrograms verified implant position/diameter; bladder neck and external sphincter function/changes; prostatic tissue response; and implant condition. One-month post-retrieval, the prostate and surrounding tissue was sectioned and evaluated by a veterinary pathologist. Results All implants were successfully deployed in the prostatic urethra. Urethral width was increased (6.9±1.8 mm to 10.2±0.6 mm, p=0.012) and preserved through the dwell period. Urethral length and sphincter diameters didn't significantly change. All subjects (n=8) remained continent without obstruction or retention. Adverse events included incisional site bleeding (n=2) and transient hematuria (n=3). One implant migrated into the bladder and spontaneously repositioned into the prostatic urethra. Post-retrieval, explant surfaces demonstrated no tissue growth, encrustation or stone formation. Imaging revealed contact site erythema and indentation, but no stones, strictures, perforations, erosions, nor ulcerations. Histopathology revealed glandular acinar changes, inflammation, and fibrosis. Conclusions The first generation of the Urocross Expander System demonstrated a favorable safety profile in the canine model. Changes in the prostatic urethra shape were noted with an increase in urethral width during the dwell period with minimal tissue changes. Further, the implant didn't demonstrate any encrustation, tissue growth or stone formation.

The geometrical parameters of natural folds are used by structural geologists to estimate finite strain and rheological properties of deformed rocks. The relation between geometry and rheology is well understood in cases of cylindrical folds, but is still limited for non-cylindrical folds, although the latter are frequent in nature. The sparsity of quantitative geometrical data of non-cylindrical folds can be explained by the small number of 3D exposures and by the lack of robust methods to quantify their geometrical parameters in 3D space. We present a new workflow, which can be used to quantify geometrical parameters of non-cylindrical folds. 3D fold geometry is described using fold wavelength, λ, arc-length, L, and amplitude, A. As most natural folds do not show ideal shapes, but are affected by various types of discontinuities, the new procedure is not fully automatic, but requires the manual selection of measuring profiles along which the geometrical parameters are constrained. The new workflow is tested using natural and experimentally produced non-cylindrical folds. The geometric parameters obtained can be used to improve our understanding of fold kinematics and fold mechanics and should assist the quantitative analysis of non-cylindrical folds present in gneiss and salt domes and in rocks containing reservoirs of hydrocarbons and minerals deposits.

Ubelkeit und Erbrechen sind haufig beobachtete Symptome in der (Fruh-)Schwangerschaft, und Studien belegen, dass nichtpharmakologische Therapieansatze fur Hyperemesis regelmasig von Schwangeren nachgefragt und von Hebammen wie Arzten empfohlen werden. Ziel des Beitrags war es, mogliche alternative bzw. komplementare Behandlungen zusammenzufassen, auch unter dem Aspekt der Uberprufung nach den Kriterien der evidenzbasierten Medizin. Ferner sollten, soweit bei der derzeitigen Datenlage moglich, konkrete Empfehlungen gegeben werden. Nach Ausschluss schwerwiegender Ursachen sollte prinzipiell versucht werden, alternative Therapieoptionen einzusetzen, z. B. Akupunktur/-pressur, Krauter oder Nahrungserganzungsmittel.

Purpose. Surface microtopography offers a promising approach for infection control. The goal of this study was to provide evidence that micropatterned surfaces significantly reduce the potential risk of medical device-associated infections. Methodology. Micropatterned and smooth surfaces were challenged in vitro against the colonization and transference of two representative bacterial pathogens – Staphylococcus aureus and Pseudomonas aeruginosa. A percutaneous rat model was used to assess the effectiveness of the micropattern against device-associated S. aureus infections. After the percutaneous insertion of silicone rods into (healthy or immunocompromised) rats, their backs were inoculated with S. aureus. The bacterial burdens were determined in tissues under the rods and in the spleens. Results. The micropatterns reduced adherence by S. aureus (92.3 and 90.5 % reduction for flat and cylindrical surfaces, respectively), while P. aeruginosa colonization was limited by 99.9 % (flat) and 95.5 % (cylindrical). The micropatterned surfaces restricted transference by 95.1 % for S. aureus and 94.9 % for P. aeruginosa, compared to smooth surfaces. Rats with micropatterned devices had substantially fewer S. aureus in subcutaneous tissues (91 %) and spleens (88 %) compared to those with smooth ones. In a follow-up study, immunocompromised rats with micropatterned devices had significantly lower bacterial burdens on devices (99.5 and 99.9 % reduction on external and internal segments, respectively), as well as in subcutaneous tissues (97.8 %) and spleens (90.7 %) compared to those with smooth devices. Conclusion. Micropatterned surfaces exhibited significantly reduced colonization and transference in vitro, as well as lower bacterial burdens in animal models. These results indicate that introducing this micropattern onto surfaces has high potential to reduce medical device-associated infections.

Initiiert durch eine Anfrage der Sektion „Notfallund Katastrophenmedizin“ der Deutschen Interdisziplinaren Vereinigung fur Intensivmedizin und Notfallmedizin (DIVI) sowie der „Bundesarbeitsgemeinschaft Erste Hilfe“ (BAGEH) nimmt die Sektion „Schock“ der DIVI hiermit Stellung zum Beitrag „Schocklage – das Ende einer Legende?“ von F. Scheinichen und F. Kuhl in der Zeitschrift „Rettungsdienst“ 2011, 34: 540–546 [1]. Die Sektion „Schock“ der DIVI begrust es grundsatzlich, dass als scheinbar gesichert geltende Masnahmen hinterfragt werden. Der genannte Artikel weist jedoch inhaltliche und formale Mangel auf und wird den Kriterien guter wissenschaftlicher Praxis nicht gerecht.

Blutungen wahrend der Schwangerschaft sind fur Mutter und Kind vital bedrohlich und verlaufen oft fulminant. Sie sind fur etwa 25% aller peripartalen maternalen Sterbefalle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hamostaseologischen Veranderungen, wie das erhohte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivitat und starke Alterationen des fibrinolytischen Systems mussen dem interdisziplinaren Behandlungsteam bekannt sein, um eine zielgerichtete und konsequente Therapie durchfuhren zu konnen. Zu den wichtigsten therapeutischen Eckpfeilern bei peripartalen Blutungen zahlen neben der schnellen zielgerichteten interdisziplinaren Therapie die kausale gynakologischen Therapie, die fruhzeitige Detektion und Durchbrechung einer Hyperfibrinolyse, die Optimierung von Fibrinogen und Thrombozyten als Endstrecke der Gerinnung und die Kenntnis der Moglichkeiten einer erweiterten Gerinnungstherapie.

Adipositas und Uberernahrung sind inzwischen weltweit zu einem der bedeutendsten Gesundheitsprobleme geworden. Die Rate ubergewichtiger Frauen im gebarfahigen Alter nimmt stetig zu, ohne dass ein Ende dieses Trends in Sicht ware. Dabei ist die direkte und indirekte Assoziation zwischen Adipositas und negativem Schwangerschaftsoutcome in Hunderten von Studien belegt. Zu den nachgewiesenen Schwangerschaftskomplikationen zahlen unter anderem Gestationsdiabetes, hypertensive Schwangerschaftserkrankungen, maternale Thromboembolien, Fruhgeburt und eine erhohte Fehlbildungsrate. Die Geburt selbst ist haufiger mit ernsten Komplikationen wie beispielsweise Schulterdystokie, verlangerter Geburtsdauer, Rissverletzungen und einer hoheren Kaiserschnittrate vergesellschaftet. Daruber hinaus stellt extreme Ubergewichtigkeit hohe Anforderungen an die personelle und apparative Ausstattung einer Klinik und die eingehende Planung der Geburt. Zu guter Letzt bedeuten Ubergewicht und Fettleibigkeit in der Schwangerschaft ungefahr eine Verfunffachung der schwangerschaftsassoziierten Gesundheitskosten. Dabei sind Langzeiteffekte, wie beispielsweise die hohere Rate an Adipositas und Diabetes mellitus bei den Kindern dieser Patientinnen, bislang unberucksichtigt. Der gewissenhaften Beratung durch die Frauenarzte im Hinblick auf Aspekte der Ernahrung und der korperlichen Bewegung kommt eine besondere Bedeutung zu, die wahrscheinlich zur Gesundheitspravention der ganzen Familie beitragt.

Blutungen wahrend der Schwangerschaft sind oft fulminant und fur Mutter und Kind vital bedrohlich. Sie sind fur etwa 25% aller peripartalen maternen Sterbefalle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hamostaseologischen Veranderungen, wie das erhohte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivitat und starke Alterationen des fibrinolytischen Systems, mussen dem Behandlungsteam bekannt sein, um eine zielgerichtete, konsequente und interdisziplinare Therapie durchfuhren zu konnen. Zu den wichtigsten therapeutischen Eckpfeilern bei peripartalen Blutungen zahlen neben der kausalen gynakologischen Therapie die fruhzeitige Detektion und Durchbrechung einer Hyperfibrinolyse, die Optimierung von Fibrinogen und Thrombozyten als Endstrecke der Gerinnung und die Kenntnis der Moglichkeiten einer erweiterten Gerinnungstherapie.

Background context No previous study has assessed the effect of monopolar radiofrequency (RF) heating on intradiscal pressure. Purpose To determine the decrease in lumbar intradiscal pressure after monopolar RF heating. Study design/setting Intradiscal pressure was measured in sheep lumbar discs treated with monopolar RF heating. Methods Two monopolar RF heat treatments at 90°C were applied for 2 minutes each to lumbar intervertebral discs of sheep. Intradiscal pressure was measured in live sheep at 0, 7, 14, 21, and 28 days posttreatment. Pressure measurements were taken with a microtip pressure transducer. Electrodes were inserted but not activated in separate discs as a sham control. In vitro sheep spine of different age groups, loading conditions, and electrode orientations were similarly heat treated and intradiscal pressures were measured. Results Intradiscal pressure was significantly reduced 1 week after monopolar RF heating and remained stable through the 4-week observation period. The RF electrode orientation, the age, and the type of disc loading have significant effects on the amount of initial intradiscal pressure reduction. Conclusions Monopolar RF heating can reduce intradiscal pressure in the lumbar spine of sheep.

The prevention and treatment of preterm birth remains an unsolved problem in modern obstetrics. Progesterone has a variety of actions on the myometrium and the cervix, among others inhibition of myometrial contractility and a cervix strengthening effect by inhibiting the production of proinflammatory cytokines and prostaglandins as well as by reducing the synthesis of proteins, which play a crucial role in initiating labour. Consequently, progesterone may be a promising candidate for the prevention of preterm birth.We searched PubMed from 1956 to August 2014 using a combination of key words and text words related to preterm birth and progesterone. ('progesterone', progestins, 17-OHPC). The aim of the literature search was to determine evidence-based indications for the use of progesterone in the prevention of preterm birth.(i) Patients with a singleton pregnancy and history of preterm birth should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) from 16+0 to 36+0 weeks of gestation (alternatively 250 mg intramuscular 17-OHPC weekly): level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone reduces the incidence of preterm birth34 and37 weeks of gestation and perinatal mortality significantly. (ii) Patients with singleton pregnancies and a sonographically short cervix (≤25 mm) before 24 weeks of gestation should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) until 36+6 weeks of gestation: level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone leads to a significant reduction in the incidence of preterm birth28,33, and35 weeks of gestation and is associated with a significant reduction of neonatal morbidity. (III) There is a lack of evidence to recommend vaginal progesterone or intramuscular 17-OHPC for primary tocolysis or for "adjunctive" tocolysis (in combination with conventional tocolytic agents). (IV) There is a growing body of evidence that vaginal progesterone (400 mg/day) after successful tocolysis ("maintenance therapy") is a promising option for prolongation of pregnancy: level of evidence 1b, grade of recommendation +. (V) Data from the literature are insufficient to recommend progesterone in patients with preterm rupture of membranes or in the perioperative management of patients requiring transvaginal cervical cerclage. (VI) The vaginal administration of progesterone is well-tolerated by the patients and has only minor maternal side effects, whereas intramuscular injections of 17-OHPC are associated with a significant higher rate of side effects (e. g. local pain, nausea, diarrhoea). It is mandatory to inform patients on the off-label use of progesterone in pregnancy.Prophylactic progesterone administration is an evidence-based method for the prevention of preterm birth in women with a previous preterm birth and in pregnant women with a sonographically short cervix (≤25 mm) before 24 weeks of gestation. Vaginal progesterone is favoured over intramuscularly applied 17-OHPC, especially because of the lower rate of maternal side effects. Whether progesterone is an effective approach for the treatment of preterm birth as a tocolytic agent (primary, adjunctive) or for maintenance therapy after arrest of preterm labour has to be shown in further well-designed randomised and controlled trials with adequate statistical power.

In March 2012, the screening for gestational diabetes was included as a 2-step screening into the German maternity directive. However, up to now it is unclear what resident gynaecologists, who are affected directly by this change in the maternity directive, think about the inclusion of the screening and the kind of screening introduced.In order to approach this topic from a scientific point of view, gynaecologists in the German cities Mannheim, Ludwigshafen, and Heidelberg were interviewed face-to-face using a semi-structured interview guide with open-ended questions (mean interview length: 33:12 min). The interviews were audiotaped, transcribed verbatim (191 pages), coded by 2 independent reviewers, and analysed using qualitative content analysis.The majority of the gynaecologists supported the introduction of the screening into the maternity directives. However, some gynaecologists felt that this amendment is not strong enough criticising the GCT with 50 g glucose. Many gynaecologists would prefer an oral glucose tolerance test (OGTT, 75 g glucose). But there were also some gynaecologists who thought that the OGTT would strain pregnant women too much and thus deemed it unsuitable for a screening. Additionally, the gynaecologists named difficulties concerning the implementation of the test such as, for example, the non-availability of a ready-made glucose syrup for the GCT and the delayed introduction of billing codes.In the framework of this qualitative study, resident gynaecologists--the main actors in the conduct of the screening--had the possibility to offer their opinion on this current topic. The results provide a first insight into the conduct of the screening and may serve as a basis for larger, quantitative studies.

Introduction Radiofrequency ablation (RFA) is used for the local treatment of liver cancer. RFA is effective for small ( 3 cm, there is a tendency to leave viable tumor cells in the margins or clefts of overlapping ablation zones. This increases the possibility of incomplete ablation or local recurrence. Lyso-Thermosensitive Liposomal Doxorubicin (LTLD), is a thermally sensitive liposomal doxorubicin formulation for intravenous administration, that rapidly releases its drug content when exposed to temperatures >40°C. When used with RFA, LTLD releases its doxorubicin in the vasculature around the zone of ablation-induced tumor cell necrosis, killing micrometastases in the ablation margin. This may reduce recurrence and be more effective than thermal ablation alone. Purpose The purpose of this study was to optimize the RFA procedure used in combination with LTLD to maximize the local deposition of doxorubicin in a swine liver model. Pigs were anaesthetized and the liver was surgically exposed. Each pig received a single, 50 mg/m2 dose of the clinical LTLD formulation (ThermoDox®). Subsequently, ablations were performed with either 1, 3 or 6 sequential, overlapping needle insertions in the left medial lobe with total ablation time of 15, 45 or 90 minutes respectively. Two different RFA generators and probes were evaluated. After the final ablation, the ablation zone (plus 3 cm margin) was dissected out and examined for doxorubicin concentration by LC/MS and fluorescence. Conclusion The mean Cmax of plasma total doxorubicin was 26.5 μg/ml at the end of the infusion. Overall, increased heat time from 15 to 45 to 90 minutes shows an increase in both the amount of doxorubicin deposited (up to ~100 μg/g) and the width of the ablation target margin to which doxorubicin is delivered as determined by tissue homogenization and LC/MS detection of doxorubicin and by fluorescent imaging of tissues.

In der Ultraschallausbildung bestehen nach wie vor weitreichende Probleme hinsichtlich Qualitatsverbesserung und -kontrolle. In der Pranataldiagnostik beispielsweise mussen viele extreme seltene Fehlbildungen mit akzeptabler Sicherheit erkannt werden konnen. Um sich entsprechend kompetent ausbilden zu lassen, stehen derzeit nur wenige hochspezialisierte Zentren zur Verfugung, die entsprechend hohe Fallzahlen fetaler Fehlbildungen aufweisen. Hier konnte ein Ultraschallsimulator-basiertes Training (z. B. Sonofit Sonotrainer) zumindest teilweise Abhilfe schaffen. In ihrem Artikel schildern die Autoren ihre Erfahrungen nicht nur mit der Anwendung des Simulators, sondern auch mit der Evaluation der Methode und des Lernerfolgs in unterschiedlichen Settings sowie hinsichtlich der Akzeptanz durch die Lernenden. Daruber hinaus wird ein Uberblick gegeben uber die Moglichkeiten zur Verbesserung der Qualitat auf dem Gebiet der gynakologischen und pranatalen Ultraschalldiagnostik.

Ultrasound has become indispensable in prenatal diagnosis. Ultrasound training, however, still lacks proper quality assessment and control. Moreover, most fetal anomalies which must be diagnosed during pregnancy are extremely rare. Ultrasound simulators could provide an opportunity to overcome this dilemma. This review summarizes the potential benefits of simulator-based ultrasound training, briefly describes the properties of a variety of ultrasound simulators that have been developed for various applications including prenatal diagnosis, and presents the SonoTrainer sonography simulation system which makes it possible to run a real-time simulation of a complete prenatal ultrasound examination. We evaluated the system for the training of first- and second-trimester screening for both normal and pathological findings and found that physicians who received theoretical training and were additionally trained with the simulator (T + S) significantly improved their skills in measurements of nuchal translucency thickness (NT) and crown–rump length (CRL) as compared with colleagues who only underwent theoretical instruction (T) [mean ± SD NT deviation: 0.31 ± 0.1 mm (T + S) vs. 0.62 ± 0.2 mm (T), P < 0.05; mean ± SD CRL deviation: 1.48 ± 2.0 mm (T + S) vs. 3.27 ± 2.5 (T), P < 0.05]. Simulator-based training enabled physicians to diagnose rare fetal anomalies in the second trimester with a sensitivity of 86% and a specificity of 100%. In a study in which second-trimester scans including fetal anomalies were presented to physicians, 96% of the participants subjectively estimated their training effect as being good. We therefore conclude that simulator-based training would provide an ideal educational tool to test, improve and monitor a physician's or technician's ultrasound skills in detecting fetal anomalies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Fluorescent lamps are becoming popular as an indoor light source in many commercial sites. While high speed video cameras can detect variations in the illumination levels from such light sources, they can be quite costly to operate. Moreover, most popular security video cameras can only operate up to a maximum speed of 30 frames per second. Would the camera be able to detect such variations in the scene caused by the inconsistent level of illumination from the fluorescent lamps? This paper examines several image quality measures to detect flickering on video signals from the video cameras at low frame rates. Future research is outlined at the end of the paper.

To gain insight into the unique pathogenicity of simian immunodeficiency virus (SIV) variant PBj14, which produces an acutely lethal enteropathic syndrome in infected pigtail macaques, we investigated the cell and tissue tropisms of a highly pathogenic biologic clone (bcl.3) of SIVsmmPBj14. To compare the relative amount of viral antigen in lymphoid organs of infected macaques we used an objective semiquantitative immunohistochemistry (sQIHC) assay. We found that in all animals viral antigen load was greater in alimentary-associated lymphoid tissues (gut-associated lymphoid tissue [GALT], tonsil, mesenteric and retropharyngeal lymph nodes) than in non-alimentary-associated lymphoid tissues (spleen, thymus, inguinal and axillary lymph nodes). Moreover, in six of nine animals examined, virus load in GALT was greater than that in any other lymphoid tissue. To determine whether the acute pathogenicity and prolific replication of SIVsmmPBj14 might be explained by a broader in vivo cell tropism than is typical of SIVs, we used cell subset separation and nested PCR. We found that the primary target cells in mesenteric lymph node for SIVsmmPBj14 were CD4+ T lymphocytes. However, the virus also infected macrophages, as well as CD8+ T cells and B cells, albeit at low frequencies. These results suggest that alimentary lymphoid tissue localization rather than unusual cell phenotype tropism distinguishes the singular pathogenesis of SIVsmmPBj14.

Simian immunodeficiency virus (SIV) variant SIVsmmPBj14 is unique in producing an acutely lethal enteropathic syndrome in pigtail macaques. To determine whether the nature of the PBj14 disease would be attenuated by decreasing virus input and to relate tissue virus burden to the severity of disease, we infected pigtail macaques with serial 10-fold doses of SIVsmmPBj14 clone bcl.3 spanning 10(-2) through 10(4)TCID50. The results revealed a strikingly narrow difference between minimum infectious and fatal disease-inducing doses and a close association between enteric lymphoid tissue virus burden and disease. All animals infected with as much as 10(4) TCID50 through as little as 100 TCID50 of virus died of the lethal PBj14 syndrome between 7 and 13 days postinfection. Animals receiving 10(-1) TCID50 became infected (PCR+) but did not develop clinical disease. Animals receiving 10(-2) TCID50 did not become infected. The clinical syndrome was surprisingly similar in all affected macaques, although the time to disease onset and total survival time increased slightly as virus input decreased from 10(4) to 10 degrees TCID50. Highest terminal virus loads in plasma, gut-associated lymphoid tissue (GALT), and lymph nodes and greatest lesion severity were attained at intermediate levels of virus input (10(1) to 10(2) TCID50), probably owing to optimal time for virus amplification in target tissues. The present study reinforces others on the PBj14 system, suggesting that once a threshold level of virus replication is attained in intestinal lymphoid tissues, the cascade of events precipitating the lethal PBj14 syndrome is triggered irreversibly.

This paper describes a simulation model of nanoparticle assemblies formed by spray deposition. The simulation deposits nanoparticles via a semi-mechanistic process, which in spite of its simplicity generates morphologies of considerable complexity. The experiments reveal several relationships between nanoparticle parameters such as their relative proportions in mixtures, and resulting surface properties, such as roughness and superhydrophobicity. According to the simulation results, for mixtures involving nanoparticles with diameters 7 nm and 14 nm, a relative proportion of 40% vs. 60% respectively, produces the surfaces with largest contact angle. Refereed/Peer-reviewed

We have studied the early pathogenesis of infection by molecular clone 1.9 of SIVsmmPBj14 in pig-tailed and cynomolgus macaques. Like the uncloned PBj14 parent, SIVsmmPBj14-1.9 consistently induced an acute clinical syndrome characterized by behavioral depression, fever, profuse diarrhea, dehydration, lymphadenopathy, splenomegaly, and mucocutaneous exanthema that began at 7 days postinfection (DPI). The acute clinical disease coincided with a marked cell-associated and cell-free viremia, during which SIV p27 was demonstrated in 4 to 68% of circulating mononuclear leukocytes between 4 and 17 DPI. Also characteristic were monocytosis and reductions in CD4+ and CD8+ T lymphocytes, as well as CD20+ B lymphocytes. The most profound depletion occurred in the CD44hi subset of CD4+ T cells. Unlike animals infected previously with uncloned or biologically cloned PBj14, however, all SIVsmmPBj14-1.9-infected macaques survived the acute-phase disease to progress to a chronic, largely asymptomatic phase of infection. Recovery from the acute-phase disease correlated with down modulation of virus replication and the appearance of antibodies to SIV Env and Gag proteins. Similar to the PBj14 parent, PBj14-1.9 targeted to intestine, spleen, bone marrow, lymph node, and cerebellum. Saliva contained substantial quantities of infectious virus and no viral antibodies during the early phase of infection. By contrast, saliva from chronically infected animals usually contained antibodies but no virus. This study extends previous work demonstrating that the acute clinical syndrome produced by SIVsmmPBj14 in pig-tailed macaques represents a unique model of lentiviral pathogenesis.

In the German emergency medical system (EMS) obstetrical emergencies are rarely encountered, but are highly emotional situations for all concerned and form a special challenge for the emergency physician. The aim of this study was to evaluate the incidence, the course and the performance of rescue missions in a ground-based EMS system.In a retrospective study the prehospital emergency charts concerning obstetrical emergencies over a 5-year period (10/2002-09/2007) were analysed.A total of 40 physician-staffed rescue missions with obstetrical emergencies were identified. On average seven rescue missions were performed per year. The majority of cases with 73% of the rescue missions was performed during the night service (16:00-07:00 h). On average the emergency patients (26th-41st week of gestation) were classified by the National Advisory Committee for Aeronautics (NACA) score as NACA III. Of the 40 obstetrical emergencies delivery occurred out of hospital in 18 cases (33rd-41st week of gestation), while the emergency physician was present in only 3 cases during childbirth. In 15 cases prehospital childbirth took place in the domestic environment of the patient, in 2 cases in an ambulance and in 1 case in the medical office of a gynecologist. In 20 cases the pregnant women were transported to hospital while labor had already begun. The emergency physicians on scene applied intravenous access, guided through labor and delivery, and administered tocolysis and in cases of prehospital delivery the emergency physicians also applied oxytocin, cut the umbilical cord and performed primary care of the newborn.Obstetrical emergencies are rare but recurrent in the ground-based EMS. However, prehospital management of women in labor, supervision of spontaneous prehospital delivery and the initial management of a newborn form a challenge for the emergency physician responsible. Consequently, prehospital management of obstetrical emergencies needs intensive consideration during education and training of emergency medical personnel.

In order to prepare for the introduction of a universal newborn hearing screening program on a larger scale, TEOAE and ABR were recorded on automated screening instruments from both ears of 501 newborns at the University Hospital Heidelberg over a period of 13 months. The parents of children in whom OAE and ABR could not be detected in both ears, were requested to allow a complete exploration of the auditory status of the children at the department of pediatric audiology.Internally available data networks were used for the acquisition and evaluation of data and for the organization of tracking and follow-up. Of the children 35% exhibited risk factors for congenital hearing impairment.The pass rate was 98.7% for the exclusion of binaural and 91.6% for monaural hearing disorders (TEOAE or ABR detectable). On the basis of the data it can be shown how pass rates can be optimized by selecting a suitable moment for the examination and by prescribing a minimum number of test repetitions (3 for TEOAE and 2 for AABR).Quality control of screening programs should include these parameters and, in particular the number of repetitions of test measurements in all screening steps.

Hemorrhaging during pregnancy is often fulminant and life-threatening for mother and child. Of maternal deaths occurring during pregnancy, 25% are caused by hemorrhaging. All physicians involved in the interdisciplinary treatment of hemorrhaging during pregnancy need to be familiar with the specific pathophysiology of hemostatic changes during pregnancy, e.g. elevated hemostatic capacity, reduced anti-coagulation activity and severe alterations of the fibrinolysis system. Therapists must be able to perform a consequent, goal-directed interdisciplinary approach to prevent adverse maternal and fetal outcomes. The major issues of therapy are causal obstetric treatment of the bleeding, early detection and therapy of hyperfibrinolysis, optimization of fibrinogen and platelet levels and knowledge of the possibilities of a targeted coagulation therapy.

In the past decades prenatal care has lead to a reduction in maternal and fetal-neonatal morbidity and mortality. However, the number of examinations that should be recommended - especially in low-risk pregnancies - is still unclear.Women not taking part in prenatal care resemble a subgroup of pregnant women at risk. The objective of this study was to define characteristic parameters based on patient's history and clinical outcome and which maternal and fetal-neonatal morbidity has to be taken into account.From 913 255 data sets of the Perinatal Registry Lower Saxony, Germany, between 1987 and 1999 n = 2 208 pregnancies (0.24 %) were documented as 'not taken part in prenatal care', while n = 163 143 pregnancies were identified as having undergone optimal prenatal care according to the recommendations. Both groups were compared regarding pregnancy associated and obstetrical parameters. Data are given as odds ratio (OR) and 95 % confidence interval (CI) for pregnancies without any prenatal care vs. pregnancies with standard prenatal care.History of still birth: OR 1.750 (1.175 - 2.609), p0.05; mother single: 7.271 (6.603 - 8.006), p0.01; maternal age18 yrs: 9.904 (7.771 - 12.624), p0.01; maternal age40 yrs: 3.781 (2.900 - 4.907), p0.01; German vs. other origin: 0.214 (0.196 - 0.234), p0.01; preterm birth: 2.667 (2.380 - 2.989), p0.01; cesarean section: 0.728 (0.644 - 0.823), p0.05; birth weight5 %: 2.552 (2.140 - 2.943), p0.01; APGAR at 1 min3: 5.463 (4.521 - 6.602), p0.01; umbilical artery pH7.0: 2.941 (1.753 - 4.932), p0.01; neonatal intubation: 3.945 (3.244 - 4.797), p0.01; still birth: 6.089 (4.731 - 7.838), p0.01; death post partum: 4.444 (3.008 - 6.567), p0.01.Pregnant women not taking part in prenatal care are younger or older, more frequently foreigners, and present characteristics of a lower socioeconomic status. These pregnancies are associated with a very high potential of neonatal morbidity. From a both medical and economic point of view, it appears to be reasonable to specifically look after those women before or during pregnancy.

Obstetric and diabetic societies recommend an intensive care of pregnancies in women with pregestational diabetes, an early hospitalization in case of obstetric and internal complications as well as delivery in a perinatal center.To evaluate the number and duration of hospitalization of pregnant women with pregestational diabetes in comparison with non-diabetic women and further more the type of clinics in which both groups were delivered. We also investigated if there were any differences in anamnestic risk factors in correlation with the type of hospital.The data of the Perinatal Registry of Lower Saxony, Germany, between 1990 and 1999 were analyzed retrospectively. The pregnancies of 2 543 women with pregestational diabetes were compared with the pregnancies of 707 695 non-diabetic women.There was at least one admission to hospital in 40 % of diabetic and 18.6 % of non diabetic women and more than one admission in 11.9 and 3.6 %, respectively (p0.001). The number and duration of hospitalization in both groups decreased significantly within the observation period. 57.7 % of all hospitals performed 1 to 4 and 11 % of the hospitals 5 to 9 deliveries of diabetic women per year. In the group of pregnant women with pregestational diabetes 45 % were delivered in clinics with 1 to 4 and 26.4 % in clinics with 5 to 9 deliveries of diabetic women per year.A higher number and duration of hospitalization was observed in the diabetic group, but both decreased significantly in each group during the observation period. No significant trend for delivering diabetic women in specialized high-risk units could be detected.

Pregnancies of women with glucose tolerance disorders are still associated with high maternal and perinatal morbidity. In the present population-based study, we investigated the fetal and neonatal risks and complications in pregnancies of women with preconceptional and gestational diabetes in comparison with pregnancies of non-diabetic women.A total of 913,255 pregnancies with 926,685 newborns documented by the Perinatal Registry of Lower Saxony, Germany, between 1987 and 1999 was retrospectively evaluated. In particular, the obstetric parameters of 3439 women with preconceptional diabetes mellitus (PDM, n = 3485 neonates), 4051 women with gestational diabetes mellitus (GDM, n = 4155 neonates) and 905,765 non-diabetic women (NDM, n = 919.053 neonates) were analysed.The diabetes groups had a higher rate of preterm birth31st week of gestation (PDM vs. NDM odds ratio [OR] 2.341; GDM vs. NDM OR 1.483) and between the 32nd and 37th weeks of gestation (OR 3.688 and 2.418, respectively). The incidences of pathological cardiotocograms (OR 1.519 and 1.258, respectively) and acidosis as indication for operative delivery (OR 5,015 and 2,102, respectively) were increased in the diabetes groups. There was a higher prevalence of birth weight4500 g (OR 2.775 and 2.742, respectively) and95. percentile (OR 4.268 and 3.610, respectively) in newborns of diabetic women. The higher rate of umbilical arterial pH7.00 (OR 2.481 and 1.195, respectively) as well as Apgar score at 1 minute7 (OR 2.971 and 1.897, respectively) indicated a poorer neonatal outcome in pregnancies of women with diabetes mellitus. The frequency of necessary intubation of the infants was significantly higher in the diabetes group (OR 3.384 and 1.317, respectively). There also was an increased prevalence of intrauterine fetal death in pregnancies of diabetic women (OR 4.197 and 2.511, respectively).Pregnancies of women with diabetes mellitus are still correlated with higher perinatal risks and complications. The neonatal morbidity in pregnancies with gestational diabetes mellitus was more similar to that of pregnancies with preconceptional diabetes mellitus than to the morbidity in the group of non-diabetic women. Changes of the parameters within the observation period were the same in all three groups and therefore cannot be attributed to a primary more intensive prenatal care of diabetic women.

The prevalence of intrauterine fetal death as well as the relevant risk factors in pregnancies of women with preconceptional and gestational diabetes mellitus and non-diabetic women were investigated.The data of the Perinatal Registry of Lower Saxony between 1987 and 1999 for pregnancies of women with preconceptional diabetes mellitus (PDM, n = 3351), gestational diabetes mellitus (GDM, n = 3954) and women without diabetes mellitus (non-diabetic pregnancies, NDM, n = 887,779) were retrospectively analysed.Intrauterine fetal death occurred in 46 women with PDM (1.35 %), 32 women with GDM (0.79 %) and 2756 non-diabetic women (0.31 %). The odds ratio (OR, 95 % CI) for PDM vs. NDM was 4.468 (3.332 - 5.992; p0.01) and for GDM vs. NDM it was 2.595 (1.829 - 3.682; p0.01). The percentage of death, which occurs before the 32nd week of gestation, was 13 % in pregnancies with PDM, 12.5 % in pregnancies with GDM and 27.7 % in non-diabetic pregnancies. 50 % of fetal deaths in the PDM group, 43.8 % of those in the GDM group and 39.3 % of those in the NDM group occurred after the 36th week of gestation. The percentages of dead fetuses who were under the 10th percentile of growth (small for gestational age, SGA), in pregnancies with PDM, GDM and NDM were 15.2 %, 6.3 %, and 28.7 %, respectively. The percentages of dead fetuses above the 90th percentile of growth (large for gestational age, LGA) were 41.3 % (PDM), 37.5 % (GDM), and 8.7 % (NDM), (p0.01 for PDM vs. NDM and for GDM vs. NDM).The risk of intrauterine fetal death in pregnancies of diabetic women is still increased. It seems that especially the LGA fetuses of diabetic mothers and SGA fetuses of non-diabetic mothers are at greater risk of intrauterine death.