Zentralblatt für Gynäkologie
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Worldwide, long-acting bupivacaine is most commonly used for spinal anesthesia in parturients undergoing elective Cesarean delivery. However, advances in surgical technique and shorter duration of surgery make short-acting local anesthetic like mepivacaine appropriate, particularly if combined with opioids to enhance postoperative maternal pain relief. ⋯ Particularly with short duration of surgery (21 +/- 5 min) intrathecal mepivacaine combined with fentanyl offers a favorable clinical alternative in parturients undergoing elective Cesarean delivery.
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Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. ⋯ Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.
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Comparative Study
Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs. control group.
We evaluated the efficacy of a temporarily placed porous catheter with continuous application of a local anaesthetic(ON-Q( by l-Flow-Corp., Lake Forest, CA, USA) post mastectomy vs. patients without this device regarding postoperative need for opioid medication. ⋯ Use of an ON-Q pain management pump could significantly reduce or even eliminate postoperative need for opioids analgesics.
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In patients with breast-conserving surgery of carcinoma and radiotherapy pain rarely is an issue between patient and physician because the operation is considered to be well tolerable and radiotherapy to have few side- effects. There are very few data about frequency and management of pain in these patients. Therefore we evaluated a group of 180 patients after breast-conserving surgery during radiotherapy using a new Likert-scaled questionnaire. ⋯ Furthermore, we evaluated the side effects of radiation in an RTOG scale. 85% of patients had pain during radiation which by most was attributed to cancer treatment (surgery and radiation). More than 50% reported light to moderate pain during the entire six-week treatment. Thus pain is a more common symptom in breast cancer patients during radiation therapy than normally assumed and therefore should receive more attention by gynecologists and radiotherapists.
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Historical Article
[Patients as "living manikins"? Göttingen University's maternity hospital ca. 1800].
The maternity hospital in Göttingen, founded in 1751, is considered to be the first in the world which was part of a university. Its main purpose was to train male medical students. ⋯ Almost all patients were not married, and the overwhelming majority were servants. This article makes use of printed as well as archival material, mainly from the period when Professor Friedrich Benjamin Osiander was the hospital's director, i. e. 1792-1822, in order to show how the patients were used for developing and teaching 'scientific' obstetrics and man-midwifery.