Search

Objectives: The aim of this study was to determine if a long versus short interval between preoperative uterine artery embolization (PUAE) and subsequent myomectomy impact perioperative blood loss and the complication rate in cases of enlarged multi-fibroid uterus. Design: In cases of an enlarged multi-fibroid uterus, operative myomectomy can lead to heavy blood loss and consequently increases the risk for transfusion and hysterectomy. PUAE can possibly contribute to a reduction of these risks. Our study was designed to determine if a long versus short interval between PUAE and subsequent surgery impacts perioperative blood loss and complication rate. Participants and Methods: PUAE was performed 24 h before the planned myoma enucleation in 21 patients between January 2011 and March 2016 (group 1) or 19 days before the operation in 23 patients from March 2016 to May 2018 (group 2). A comparison was made to a historical sample of 57 patients with large myomas (>10 cm) without PUAE (group 3). Perioperative blood loss, need for postoperative blood transfusion, and postoperative complications were recorded. Subjective improvement of myoma-related symptoms was assessed for each group by a questionnaire. Results: PUAE was carried out successfully without complications in all patients. Conversion to hysterectomy was not needed in any of the PUAE patients but was necessary in one of the control patients. In the three groups’ comparison, there was a significant lower risk for high blood loss (≥500 mL) in group 1 and a lower but not significant lower risk in group 2 compared to group 3 without an embolization preoperatively. Also, a significant lower risk for postoperative blood transfusion for group 1 (OR 0.02; 0.001–0.328; p = 0.01) and 2 (OR 0.02; 0.001–0.277; p = 0.01) compared to group 3 was observed. The postoperative complication risk was lower in group 2 (model 1: OR 0.12; 0.016–0.848; p = 0.03; model 2 OR 0.07; 0.009–0.588; p = 0.01) compared to group 3. In the context of the postoperative questionnaire, 10 of 11 patients in group 1, 12 of 12 patients in group 2, and 31 of 36 patients from the control group reported an improvement of their complaints. Conclusion: PUAE is beneficial for uterus-preserving removal of myomas from patients with a substantially enlarged uterus. There is a significant reduction of high blood loss (≥500 mL), need for postoperative blood transfusion, and postoperative complications in patients with extensive fibroid disease after PUAE compared to no intervention before myoma enucleation.

Die minimalinvasive Chirurgie (MIC) ist mittlerweile das Standardverfahren bei frühem Zervixkarzinom (early stage cervical cancer, ECC). Die kürzlich veröffentlichte LACC-Studie zeigte jedoch ebenso wie andere Untersuchungen, dass die MIC in Hinblick auf das progressionsfreie Überleben (progression-free survival, PFS) und das Gesamtüberleben (overall survival, OS) gegenüber der offenen radikalen Hysterektomie unterlegen ist. Diese Ergebnisse lösten eine breite Debatte über die beste chirurgische Vorgehensweise bei ECC aus. Mit der vorliegenden Befragung sollten erste Erkenntnisse nach der Veröffentlichung gewonnen werden. Dazu führten die Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie (NOGGO) und die Arbeitsgemeinschaft Gynäkologische Endoskopie (AGE) eine bundesweite digitale Befragung unter 186 gynäkologischen Krebszentren durch. Mithilfe von SPSS wurden deskriptive statistische Kennzahlen ermittelt und t-Tests durchgeführt. Die meisten Zentren hatten eine hohe Expertise und/oder Erfahrung in der Behandlung von ECC und waren über die Ergebnisse der LACC-Studie sehr gut informiert. Die Qualität und die wissenschaftliche Bedeutung der Studie wurden als sehr gut/gut eingestuft. Trotzdem würden immer noch 40 % keine Umstellung der Standardbehandlung auf eine offene Operation vornehmen. Zentren mit höherem Fallvolumen, die zudem an klinischen Studien teilnahmen, waren eher bereit, die Behandlung umzustellen. Diese Befragung gibt Einblicke zu den überraschenden Ergebnissen der kürzlich veröffentlichten Studien zum chirurgischen Vorgehen bei ECC. Wie es scheint, ist die Notwendigkeit zukünftiger Studien und möglicher Erklärungen für die unerwartet schlechteren Outcomes in der MIC-Gruppe weiterhin hoch.

Background/Aims: The supply of docosahexaenoic acid (DHA, 22:6ω–3), important for fetal/infant neurodevelopment, depends on the maternal fatty acid (FA) status, which may be marginal in central Europe. Therefore, we investigated the effect of a daily vitamin/mineral supplement with and without 200 mg DHA from mid-pregnancy through lactation on the DHA concentrations in maternal and infant red blood cell phospholipids (RBC%), and in breast milk FA (%). Methods: At 21 weeks’ gestation, 144 women were enrolled into a randomised, double-blind clinical trial receiving daily: (1) a basic vitamin-mineral supplement (Vit/Min group), (2) Vit/Min plus 4.5 g fructo-oligosaccharide (FOS group), or (3) Vit/Min plus 4.5 g FOS plus 200 mg fish oil-derived DHA (DHA-FOS group). FAs were determined by capillary gas-liquid chromatography. Results: While maternal RBC-DHA% at enrolment was not different, at 37 weeks gestation, and 3 months after delivery RBC-DHA% were significantly higher in the DHA-FOS group. The breast milk DHA% was twice as high in the DHA-FOS group (0.50%) than in the two others (0.25 %) (p < 0.001), and the ratio ARA/DHA in the DHA-FOS group was 1.0 ± 0.43, in the others 2.1 ± 0.43 (p < 0.001). The RBC-DHA% of the infants in the DHA-FOS group was also significantly higher, and correlated significantly with maternal RBC-DHA% before and 3 months after delivery. Conclusions: In central Europe, a dose of 200 mg/day DHA from mid-pregnancy through lactation seems appropriate to improve the DHA status of mothers and infants.