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We wanted to evaluate the feasibility and effect of a hands-on loop electrosurgical excision procedure (LEEP) 2.5-day intensive surgical skills workshop, using a novel training model on porcine tissue. Hands-on simulation-based training was conducted to emphasize colposcopy, local anesthesia, uterine cervix and vulva punch biopsy, LEEP, and complication management. Performance of 51 participants' technical skills was assessed before and after training completion. LEEP performance was significantly better after completion of the training (P < .001). Before and after training mean scores (SD) of 18.0 (3.5) and 23.4 (2.1) were assessed. Multivariate analysis revealed that the training effects were independent of previous surgical expertise. The LEEP workshop was feasible and effective and we recommend implementing hands-on LEEP training into gynecology training programs. [ABSTRACT FROM AUTHOR]

Objective: Primary invasive squamous cell carcinoma of the vagina is a rare neoplasm. Investigations concerning the potential of new therapeutic targets are limited. Study Design: A total of 34 patients with primary invasive squamous cell carcinoma of the vagina was identified, who were treated at our institution between 1994 and 2008. Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) expression was assessed using immunohistochemistry from paraffin-embedded tissue blocks. Results: EGFR was expressed in 33 of 34 (97.1%) and VEGF was expressed in 12 of 34 cases (35.3%). There was no statistically significant relationship between clinicopathologic parameters (clinical stage, grading, tumor size), patient survival, and EGFR and VEGF expression. Conclusion: VEGF was moderate and EGFR was frequently expressed in invasive squamous cell carcinoma of the vagina. In our sample size, immunohistochemical staining was not statistically significantly associated with prognosis. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the association between fibrinogen plasma levels on disease-free patients and overall survival in patients with cervical cancer. Study Design: Pretherapeutic fibrinogen plasma levels were examined in 313 patients with cervical cancer who were treated at the Department of Obstetrics and Gynecology, Medical University of Vienna. Fibrinogen plasma levels were correlated with clinical-pathologic findings and patient survival. Results: Mean (± SD) pretherapeutic fibrinogen plasma levels were 417.4 mg/dL (± 130.3 mg/dL). Elevated fibrinogen plasma levels were associated with advanced tumor stage (P < .001) and patient age (P < .001), but not with histologic type (P = .4), histologic grade (P = .1), and pelvic lymph node involvement (P = .9). In a multivariate survival analysis, fibrinogen plasma levels (P < .001 and < .001) and lymph node involvement (P < .001 and = .001), but not patients'' age (P = .8 and .4) and histologic type (P = .7 and .5) were associated with overall or disease-free survival, respectively. Histologic grade was associated with disease-free (P = .01), but not with overall, survival (P = .2). Conclusion: Fibrinogen plasma levels are an independent prognostic parameter in patients with cervical cancer. [Copyright &y& Elsevier]

Background: Four established techniques of distal end-to-side anastomosis (direct anastomosis, Linton patch, Taylor patch and Miller cuff) were compared to investigate the local distribution of anastomotic intimal hyperplasia. The study aimed to elucidate whether mechanical factors or flow alterations are mainly responsible for the improved patency rates reported for vein cuff interposition techniques in infrainguinal arterial reconstructions using prosthetic graft material. Methods: Thirty-two expanded polytetrafluoroethylene (ePTFE) femoropopliteal bypass grafts were implanted in 16 sheep using the four anastomotic techniques. After 6 months the grafts were explanted and examined histologically. The local distribution of intimal hyperplasia was determined, particularly for areas of material transition and of high and low shear stress. Results: The mean amount and distribution of intimal hyperplasia were similar for all anastomotic types. Intimal hyperplasia was greatest along all transitions between ePTFE and venous patches, and between ePTFE and recipient artery. It was lower along the transitions between venous patches and artery, and was lowest at the host artery floor. Conclusion: Vein interposition did not reduce anastomotic intimal hyperplasia and did not change the distribution patterns of hyperplasia, which were influenced mainly by mechanical factors. The effect of vein interposition is to move areas of maximum intimal hyperplasia away from the small recipient artery up to the more capacious graft-patch anastomosis. [ABSTRACT FROM AUTHOR]

Background: The treatment of aortic aneurysms with endovascular stents or stent–graft prostheses is receiving increasing attention as an alternative to major abdominal surgery. To define the clinical value of this technique, we prospectively studied the use of stent–graft endoprostheses made of nitinol and covered with polyester fabric for the treatment of infrarenal abdominal aortic aneurysms. Methods: We treated a total of 154 patients at three academic hospitals. Twenty-one patients with aortic aneurysms not involving the aortic bifurcation received straight stent–grafts, and 133 patients with aortic aneurysms involving the bifurcation and the common iliac arteries received bifurcated stent–grafts. After a unilateral surgical arteriotomy, the endoprostheses were advanced through the femoral arteries and placed under fluoroscopic guidance. Computed tomography and intraarterial angiography were performed during an average follow-up of 12.5 months. Results: The primary success rate, defined as complete exclusion of the abdominal aortic aneurysm from the circulation, was 86 percent in the group receiving straight grafts and 87 percent in the group receiving bifurcated grafts. In three patients the procedure had to be converted to an open surgical operation. Minor (n = 13) or major (n = 3) complications associated with the procedure (including 1 death) occurred in 10 percent of the patients. All patients had a postimplantation syndrome, with leukocytosis and elevated C-reactive protein levels. Conclusions: Our results suggest that endovascular treatment of infrarenal abdominal aortic aneurysms is technically feasible and can effectively exclude abdominal aortic aneurysms from the circulation. With further refinement, endoluminal repair may emerge as an interventional strategy to treat infrarenal aortic aneurysms, especially in patients at high surgical risk. (N Engl J Med 1997;336:13-20.) [ABSTRACT FROM AUTHOR]

This case report is about a 47-year-old patient, who was diagnosed with intracardiac intravenous leiomyomatosis and received treatment at our institution. Intravenous leiomyomatosis is a rare, histologically benign, uterine neoplasm, which is characterized by non-invasive intravascular proliferation of smooth muscle cells. Intravenous leiomyomatosis arises from the myometrium and, in its most extensive form, can reach the heart via the pelvic veins and the inferior vena cava, causing hemodynamic complications. Treatment of choice is the complete resection of the tumor, even though there is no consensus on the optimal surgical approach. In this case, complete resection of the tumor was accomplished in a one-stage procedure. The patient recovered well and CT scan did not show any signs of recurrence after five months., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Background: There is a need to assess the accuracy of continuous glucose monitoring (CGM) systems for several uses. Mean absolute relative difference (MARD) is the measure of choice for this. Unfortunately, it is frequently overlooked that MARD values computed with data acquired during clinical studies do not reflect the accuracy of the CGM system only, but are strongly influenced by the design of the study. Thus, published MARD values must be understood not as precise values but as indications with some uncertainty., Data and Methods: Data from a recent clinical trial, Monte Carlo simulations, and assumptions about the error distribution of the reference measurements have been used to determine the confidence region of MARD as a function of the number and the accuracy of the reference measurements., Results: The uncertainty of the computed MARD values can be quantified by a newly introduced MARD reliability index (MRI), which independently mirrors the reliability of the evaluation. Thus MARD conveys information on the accuracy of the CGM system, while MRI conveys information on the uncertainty of the computed MARD values., Conclusions: MARD values from clinical studies should not be used blindly but the reliability of the evaluation should be considered as well. Furthermore, it should not be ignored that MARD does not take into account the key feature of CGM sensors, the frequency of the measurements. Additional metrics, such as precision absolute relative difference (PARD) should be used as well to obtain a better evaluation of the CGM performance for specific uses, for example, for artificial pancreas.

Background: Reports of secondary modifications into aortouniiliac configuration to salvage-failed endovascular aneurysm repair (EVAR) are limited. We evaluated long-term results after these procedures and compared them with those after primary aortouniiliac endografting (AUE)., Methods: A retrospective review of all EVAR performed from March 1995 until July 2011 was conducted. Patients were included when primary AUE (group I) or modification into aortouniiliac configuration (group II) was done., Results: Data analysis obtained 27 group I and 23 group II patients. Salvage of failed EVAR could be achieved in 96% of group II patients, and mortality was zero. Frequency of adverse events and amount of interventions to maintain aneurysm exclusion were not increased after secondary AUE. Kaplan-Meier estimates for long-term survival between groups were comparable (P = .36)., Conclusions: Secondary AUE allows correction of graft-related endoleaks potentially leading to late aneurysm rupture. Complications and adverse events throughout long-term follow-up were not necessarily increased when compared with primary AUE., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To present long-term results of endoleak/endograft migration treatment by aortomonoiliac (AMI) endografting after failed endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms., Design: Post hoc analysis of a prospectively gathered database at a tertiary care university hospital., Materials and Methods: From March 1995 to November 2010, 23 patients were identified who underwent modification into AMI configuration after failed elective EVAR. Major causes for modification were type I (with/without endograft migration) or type III endoleaks with aneurysm expansion. An average increase in aneurysm size of 1.6 cm (range: -1.5 to 10.5 cm) since initial aneurysm treatment was observed. Interventional outcomes and long-term results were recorded for analysis., Results: Technical success rate of AMI endografting was 95.65% (n = 22). All except two endoleaks could be successfully sealed with this manoeuvre (94.44%). Median time to modification was 5.3 years (interquartile range Q1-Q3: 1.3-9.3 years). No intra-operative conversion to open surgery was necessary and mortality was 0%. Median follow-up was 44 months (interquartile range Q1-Q3: 17-69 months)., Conclusions: Treatment of graft-related endoleaks/endograft migration by AMI endografting after failed EVAR represents a safe and feasible procedure. This approach broadens the minimal invasive opportunities of aneurysm treatment, and open surgical conversion may be avoided except in selected patients., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to investigate whether initial abdominal aortic aneurysm (AAA) diameter influences long-term survival after elective repair., Design: Retrospective analysis of database., Material and Methods: Between March 1995 and December 2006, a consecutive series of 895 patients underwent elective treatment of an AAA either by open surgical or endovascular repair. An AAA diameter of 5.5cm was chosen as threshold to distinguish between small and large aneurysms, according to the definition given by the UK small aneurysm trial. Patient characteristics and distribution of basic risk factors were assessed. Survival estimates (Kaplan-Meier) and Cox proportional hazards regression results are reported., Results: Patients with small aneurysms were more likely to survive the first 6 years after AAA repair, even after adjustment for treatment modality and baseline risk factors. After adjustment for age and sex aneurysms with smaller diameter were related to a lower risk of death (p<0.0016)., Conclusions: Patients with small aneurysms (< or =5.5cm) have an improved long-term survival than patients with larger aneurysms.

Background and Purpose: The noninvasive identification of plaque types prone to cause symptomatic disease is of great interest to improve the effectiveness of surgical or interventional management. The purpose of the present prospective pilot study was to evaluate the association between the results of imaging-the novel sonography technique B-flow imaging (BFI), B-mode, and color Doppler imaging (CDI)-and histopathologic examination in the characterization of internal carotid artery (ICA) plaques., Methods: Twenty-eight consecutive patients with high-grade internal carotid artery stenosis scheduled for carotid endarterectomy were included. BFI, B-mode, and CDI images were used to classify the plaques applying the standardized scores of Beletsky et al and the American Heart Association (AHA), to calculate the gray-scale median (GSM) and to detect potential ulcerations; histopathologic examination results of explanted plaques served as the "gold standard.", Results: Based on the classification of Beletsky et al, BFI and histopathologic examination results agreed in 21 (75%, kappa = 0.61, P < .001) patients, and the corresponding results for B-mode were 19 (68%, kappa = 0.52, P < .001) patients, respectively. Corresponding results for the AHA classification revealed inferior agreements for BFI (19 patients/68%, kappa = 0.38, P = .003) and B-mode (17 patients/61%, kappa = 0.25, P = .045). The median GSM for BFI and B-mode correlated significantly (r = 0.95, P < .001). The sensitivity of BFI for the detection of ulcerated plaques was 100% and the specificity was 95.8%; corresponding values for CDI were 100% and 92.7%, respectively., Conclusion: BFI and the combination of B-mode and CDI exhibit comparable results in the assessment of ICA plaque components and plaque ulceration as well as in the determination of GSM levels.

Background: Ischemia/reperfusion (I/R) injury is characterized by the production of oxygen-free radicals leading to disturbances in vasomotility (microvascular constriction) and microvascular permeability (interstitial edema formation). The objective was to evaluate the effect of the combined antioxidative and enzymatic preparation Phlogenzym on I/R injury of skeletal muscle., Materials and Methods: A rabbit hindlimb model of I/R (2.5/2 h) was used (IR group). Phlogenzym, containing rutin, trypsin, and bromelain, was applied enterally (60 mg/kg body weight) as a bolus 30 min prior to ischemia (Ph group). Sham-operated animals served as controls (CO group). Plasma malondialdehyde, potassium, and microvascular perfusion (monitored by laser flowmetry) were assessed. Histomorphometry and electron microscopy were performed from major adductor muscles., Results: Two hours after reperfusion, potassium levels were significantly elevated in IR compared to Ph group (6.7 +/- 1.2 versus 4.9 +/- 0.9 mmol/l, P < 0.006). Enhanced lipid peroxidation, apparent by increased plasma malondialdehyde levels, was ameliorated in the Ph group (1.0 +/- 0.1 versus 0.7 +/- 0.1 nmol/ml, P < 0.0001). No-reflow (reduction of blood flow by 62% in IR group) was not observed in the Ph group (P < 0.004). Phlogenzym treatment prevented microvascular constriction (17.6 +/- 2.3 versus 12.6 +/- 1.1 microm(2), P < 0.0001) and mollified interstitial edema (21.5 +/- 2.0 versus 26.0 +/- 3.7%, P < 0.017), resulting in mild ultrastructural alterations in contrast to pronounced sarcolemmal and mitochondrial damage in untreated rabbits., Conclusions: Phlogenzym had a protective effect on skeletal muscle during I/R injury expressed by prevention of no-reflow and preservation of muscle tissue.