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PubMed1995

Management of sterile necrosis in instances of severe acute pancreatitis.

BACKGROUND: The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically. STUDY DESIGN: Between May 1982 and December 1993, 249 patients with necrotizing pancreatitis (NP) entered this study, of which 172 (69 percent) had intraoperatively or fine needle aspiration-proven sterile NP. One hundred seven of 172 patients underwent surgery (S group) with necrosectomy and continuous postoperative closed lavage and 65 of 172 were treated by nonsurgical means (NS group). RESULTS: Median Ranson and admission APACHE II scores were 4.7 (range, 1 to 10) and 11 (range, 1 to 29) in the S group, significantly higher than those in the NS group with 3.0 (range, 0 to 6) (p = 0.022) and 8 (range, 1 to 23) (p = 0.036). After 48 hours of intensive care treatment, APACHE II scores persisted at 10.5 (range, 1 to 29) in the S group and decreased to 6 (range, 0 to 15) (p = 0.013) in the NS patients. Median C-reactive protein (CRP) levels on admission were 179 mg/L and 68.5 mg/L (p = 0.023), respectively. Within 72 hours, 61 (94 percent) of 65 NS-managed patients responded to intensive care therapy, whereas organ complications persisted or increased and thus led to surgery in the S group. Mortality rates were 13.1 percent in the surgically treated patients and 6.2 percent in the nonsurgically treated patients (p = NS). CONCLUSIONS: Most patients with limited and sterile pancreatic necrosis respond to intensive care treatment. Indication for surgery in sterile NP should be based on persisting or advancing organ complications despite intensive care therapy. APACHE II scores and admission CRP levels represent a helpful tool in decision making for surgical or nonsurgical management of NP.

APACHE↗
PubMed1996

Changes in cerebrospinal fluid and cerebrovascular endothelin concentrations during hypotension and hypertension in newborn piglets with induced sterile meningitis.

The effects of sterile meningitis on endothelin-1 (ET-1) and big ET-1 concentrations during hypotension and hypertension were studied in the cerebrospinal fluid and plasma of newborn piglets. Cerebrospinal fluid was obtained via cisterna magna puncture, and blood was obtained from the sagittal sinus vein and left subclavian artery. The study group consisted of 14 newborn piglets injected with 0.5 mL heat-killed group B streptococcus (GBS) (10(9) colony forming unit (cfu) equivalents), into the right cerebral lateral ventricle; the control group consisted of 10 newborn piglets injected with sterile normal saline, in a similar fashion. Hypotension (mean arterial blood pressure (MABP) 20-59 mmHg; 1 mmHg = 133.3 Pa) and hypertension (MABP 110-140 mmHg) were induced 1.5-2 h apart in random sequence in each animal, by inflating balloon-tipped catheters placed at the aortic root and descending aorta, respectively. Cerebral blood flow (CBF) was measured using radiolabeled microspheres, 15 min before and after injection of GBS or saline (normotension), during the hypotension and hypertension episodes, and during recovery normotension, immediately prior to cerebrospinal fluid and blood sampling. ET-1 and big ET-1 concentrations (pg/mL) were measured using radioimmunoassay kits. The combined effect of induced sterile meningitis and induced hypotension resulted in a significant rise in the concentration of cerebrospinal fluid ET-1 (control, 5.1 +/- 0.1; GBS, 9.3 +/- 0.2 pg/mL; p < 0.01), cerebrospinal fluid big ET-1 (control, 0; GBS, 18.1 +/- 2.7 pg/mL; p < 0.01), and sagittal sinus (cerebrovascular) big ET-1 (control, 15.5 +/- 4.2; GBS, 47.5 +/- 9.6 pg/mL; p < 0.01). In contrast, the combined effect of induced sterile meningitis and induced hypertension resulted in a marked elevation in cerebrovascular ET-1 concentrations (control, 9.5 +/- 0.9; GBS, 28.5 +/- 6.1 pg/mL; p < 0.01), with no significant change in cerebrospinal fluid concentrations. In addition, cerebrovascular production of ET-1 increased dramatically during hypertension in the GBS group (control, 0; GBS, 161.7 +/- 13.2 pg.min-1.100 g-1; p < 0.001), and was maintained during the recovery period (133.7 +/- 10.8 pg.min-1.100 g-1). Cerebrovascular ET-1 concentrations correlated significantly with total CBF and MABP in both groups of animals (control, r = 0.49, p < 0.002; GBS, r = 0.64, p < 0.0001), but the response was of a much greater magnitude in the GBS group. There was an inverse relationship between cerebrovascular big ET-1 concentrations and total CBF (r = -0.53, p < 0.0001) and MABP (r = -0.71, p < 0.0001) in the GBS group. In the MABP range of 60-110 mmHg a positive relationship was observed between cerebrovascular ET-1 concentrations and cerebral vascular resistance, in the control group only (r = 0.59, p < 0.002). The combined insult of induced sterile meningitis and induced hypotension or hypertension may be associated with increased cerebrovascular ET-1 and (or) big ET-1 concentrations. Changes in these vasoactive agents may contribute to pressure passivity of CBF in the newborn with meningitis.

Animals↗
PubMed1977

Uterotubal implantation and obstetric outcome after previous sterilization.

The liberalization of sterilization policies has resulted in an increased number of patients requesting tubal reconstructive surgery. From 1973 through 1975, a total of 18 patients were operated upon by the authors for tubal reconstructive surgery following sterilization. These patients had had either postpartum sterilization of the Pomeroy technique or interval laparoscopic cauterization and cutting. The operative technique with an open uterine approach is described in detail. This technique warrants further evaluation, particularly following laparoscopic sterilization when end-to-end anastomosis is precluded.

Adult↗
PubMed1981

Deaths associated with laparoscopic sterilization by unipolar electrocoagulating devices, 1978 and 1979.

In 1978 and 1979, two women in the United States were reported to have died from electrical complications following sterilization with unipolar coagulating devices. Both deaths followed apparent bowel injuries occurring at the time of sterilization. Numerous reports have documented the electrical accidents associated with unipolar electrocoagulation. Because unipolar electrocoagulation has greater risk for these complications than alternative sterilization techniques, without proved greater benefits, we question the need for continuing its use in female sterilization.

Adult↗
PubMed1985

Effects of sterilization on menstruation.

We surveyed 551 women more than a year after they or their husbands had had a sterilization operation. According to menstrual data from before and after the operation, a much greater proportion of women who had been sterilized had longer periods after the operation than before, but so did women whose husbands had had a vasectomy. Women who had taken an oral contraceptive before operation, had more days of bleeding and heavier bleeding than women who had been using other methods of contraception; those who had an intrauterine device removed had fewer days of bleeding after the sterilization operation. Discontinuing the previous contraception probably had a greater effect on menstruation than had the operation, for the effect was the same for those who had sterilization and the women whose husbands had an operation.

Contraception↗
PubMed1961

Sterilization of regenerated collagen sutures with beta-propiolactone.

Data are presented to show that beta-propiolactone when properly applied is a very effective agent for sterilization of regenerated collagen sutures. The chemical sterilization is accomplished with little or none of the loss in strength encountered with heat sterilization. The finished sterile suture is obtained without any harmful residue that might be detrimental to the patient.

Collagen↗
PubMed2004

[Reproductive rights of women and men in light of new legislation on voluntary sterilization in Brazil].

This paper aims to analyze the impacts and possible changes that the implementation of a new Brazilian family planning law has on reproductive practices, especially voluntary sterilization, and to determine whether men's and women's reproductive rights are being respected. The methodological approach is based on a six-month follow-up survey taken monthly, applied to a sample of 159 individuals in six contextually different State capitals. Besides verifying whether the health sector is complying with the criteria set by the law, we analyze the waiting time between the request for sterilization and the surgery itself, utilizing survival analysis. We also conduct interviews with health professionals, shedding light on the procedures adopted in the practice of sterilization. For various reasons, the law has produced little change in the usual practice of sterilization, besides failing to satisfy individual reproductive rights.

Brazil↗
PubMed1989

Reversal of female sterilization using macro technique.

The pregnancy rate of 63 women who underwent macrosurgical reversal of sterilization is reported. The pregnancy rate is based on life table estimates. The present material is the largest reported with this method. No statistically significant correlation was found between pregnancy outcome and tube length, anastomotic site, technique of sterilization, day of refertilization in menstrual cycle, or time interval between sterilization and refertilization. Using life tables, the cumulative probability of intra-uterine pregnancy 6, 12, 24, 36, 48 and 66 months after surgery was 14%, 26%, 39%, 39%, 43%, and 51% respectively. Our results of macroscopic sterilization reversal are comparable to the reported results of microsurgical methods. They support the contention that atraumatic technique rather than the microscope is important for good results.

Anastomosis, Surgical↗
PubMed1980

Sterilization reversal by macrosurgical tubal anastomosis.

A simple macrosurgical technique developed by the writer in 1974, and used specifically for the reversal of sterilization by tubal anastomosis, is presented. The technique has been employed where facilities have been no more sophisticated than those used for the original sterilization. In terms of intrauterine pregnancy, a success rate of 43% has been achieved from a series of 14 unselected patients who requested tubal reconstruction after sterilization. A plea is made for the employment of sterilizing techniques which cause minimal tubal damage, and thereby allow the greatest likelihood of success with any future reconstructive procedure.

Adult↗
PubMed1999

Voluntary and involuntary sterilization: medical, ethical, legal and religious aspects.

Surgical voluntary sterilization has become one of the most widely used methods of contraception, with vasectomy and tubal sterilization being the most commonly employed techniques, associated with a low failure, morbidity, mortality, and long-term sequelae rate. As sterilization is related with the elimination of the possibility for procreation, a number of ethical, legal and religious issues have arisen, leading often to personal misjudgements, legal disputes, and failures in applying family planning. Involuntary sterilization is currently not practiced, except in cases of severely mentally retarded people, who are unable to appreciate the consequences of their acts or care for their children and who may have a high likelihood of propagating hereditary disease.

Ethics, Medical↗
PubMed1990

[Sterilization of the mentally handicapped according to section 1905 of the German Civil Code in relation to developing a patient management regulation].

Discussions on the sterilization of the mentally handicapped are still overshadowed to a great extent by the dire consequences of National Socialist policies which were only poorly concealed in the legislation of the period. These laws have meanwhile been rescinded but that has not eradicated the phenomenon itself. In fact, in recent years about 1,000 mentally handicapped persons have been sterilized--without their consent and without any firm legal basis for such action--shortly before reaching the age of 18. In most cases, the parents and the physicians involved joined forces in taking the matter into their own hands. Against this background there is a clear need for legislative action. Virtual agreement has been reached on this between the political groupings represented in the Bundestag and the organizations working for the welfare of the handicapped. Nonetheless, the recently submitted draft of a new bill is for the most part unacceptable. It is an improvement of earlier drafts in asmuchas the attempt to establish a close and often inappropriate link with Sect.218 a of the Penal Code (concerning abortion) has at least partly been given up. But the fact remains that handicapped women are still subjected to greater burdens than their male counterparts. Under the planned amendment to Sect.1905 Para. 1 (4) of the Civil Code, the act itself will define the requirements for a sterilization to be carried out "for medical reasons" (i.e. if life or health of the expectant mother are in jeopardy). Sect.1905 of the Civil Code contains no specific regulations as to when a sterilization is permissible "for eugenic reasons," but the fact remains that it can still be quite easily carried out under the general grounds. Pursuant to Sect.218a of the Penal Code an abortion can be exempt from punishment under special circumstances (i.e. on "social grounds") if the mother is at the time in a desperate situation which cannot be rectified in any other way. It certainly reflects very poorly on us if we do not succeed in giving the handicapped the help and support they need in their life situations which are so completely different from ours.

Child↗
PubMed1982

The choice of sterilization procedure among married couples.

Surgical sterilization is playing a growing role in contraception among married couples. Both vasectomy and tubal ligation can be done as outpatient procedures. Neither procedure has overwhelming advantages over the other. This study sought to determine why one member of a couple, rather than the other, decided to undergo the sterilization procedure. There do not seem to be any significant demographic differences between those couples who choose vasectomy and those who select tubal ligation. Men may undergo vasectomy because they feel it is the easier procedure. A significant number of women also feel that vasectomy is easier, yet for various reasons they are motivated to undergo tubal ligation. In many couples, the choice is made because one partner will not consider becoming sterilized, and this is twice as likely to be the husband. Family physicians can play an important role in assisting couples to choose the best alternative.

Adult↗
PubMed1988

Microsurgical reversal of female mechanical sterilization techniques.

This study presents the patient characteristics, the reason for requesting a reversal operation, the surgical technique and pregnancy rates after a microsurgical reanastomosis following a mechanical (ring or clip) method of sterilization in 55 women. A corrected intrauterine pregnancy rate of 90% was obtained. Ectopic pregnancy occurred in 7% of the patients. Human female sterilization presently has a very high probability of being reversible on the condition that a careful mechanical sterilization has been performed.

Abortion, Spontaneous↗
PubMed1985

Sterilization failures and their causes.

To say that a sterilization failure rate is expected does not answer why. Forty-seven cases of repeat sterilization have undergone such surgical and pathologic scrutiny. Resection methods failed most frequently because of spontaneous reanastomosis or fistula formation. Fimbriectomy was particularly vulnerable to reanastomosis because the fimbria ovarica was not removed. Mechanical devices failed when the device was defective, placed improperly, or placed in an improper location. Tissue damage was evident but incomplete when the bipolar electrocoagulation method failures were reviewed, and the endosalpinx remained viable. Unipolar method injuries, in contrast, were complete; they failed by fistula formation. Thus bipolar method failures may occur because of the limited range of electrical power available when using bipolar generators. Some sterilization failures are preventable, but many are not. When medicolegal questions arise, these findings may help answer the question, Why?

Contraceptive Devices, Female↗
PubMed1989

Recent trends in contraceptive sterilization in Flanders.

Elective sterilization started to spread rather late in Flanders. Despite the sharp increase of this contraceptive method since the end of the 1970s, its frequency is still lower than in many neighbouring countries and much lower than in the US and Canada, mainly due to the lag in male sterilization. Further increase in contraceptive sterilization and a greater participation of men is expected in the near future.

Adult↗
PubMed1982

[Operative complications of laparoscopic tubal sterilization with Bleier clips (author's transl)].

The operative complications of 1613 laparoscopic tubal sterilization with Bleier clips were evaluated in a prospective study at the Stadtkrankenhaus Offenbach/M from March 1978 to July 1981 (1239 interval and 374 postabortal procedures; two-puncture technique under general endotracheal anaesthesia). No major complications requiring laparotomy occurred. Minor intraoperative complications were observed in 8.4% of cases. Clip-related problems were encountered in 1.9% (slight tubal or mesosalpingeal bleeding). Other complications included haemorrhage at the puncture site (2.4%), preperitoneal emphysema (1.8%) and uterine perforation during curettage (1,6%). Technical difficulties were recorded in 8,4% of sterilizations; in 6.6% more than one clip per tube was placed to effect complete tubal occlusion. Adnexal pathology prohibited bilateral clip application in 4 women (0.3%). Postoperative complications were negligible. No pregnancies have yet been reported during a mean follow-up period of 17 months. A successful refertilization procedure was performed on one patient. It is concluded that this technique represents a commendable alternative to convention methods of tubal sterilization due to its low operative morbidity, acceptable contraceptive safety and potential reversibility.

Abortion, Legal↗
PubMed1983

[Microsurgical reversal of sterilization: experiences and results in 119 cases].

From January 1976 to March 1982 119 microsurgical reversals were performed. Most of these women were not older than 30 years at the time of sterilization. A new partnership was the main reason for a request of reversal. Up to now 69 patients (58,0%) achieved an intrauterine pregnancy. Ectopic pregnancies occurred in 3 women (2,5%). The prognosis of a reversal depends mainly on the remaining length of the fallopian tube and the site of the anastomosis. For isthmo-isthmic anastomoses the intrauterine pregnancy rate was 80%. Due to today's high divorce rates tubal sterilization in women younger than 30 years should be based on a well founded indication. In younger patients only such sterilization techniques should be performed, which offer the highest chances for reversal.

Age Factors↗
PubMed1983

Histopathologic changes in fallopian tubes subsequent to sterilization procedures.

Longitudinal serial and serial step sections of fallopian tubes from more than 100 patients, subsequent to tubal sterilization procedures, were examined. Thirteen of these patients had pregnancies following their sterilizations. The histologic findings at the previous surgical sites were compatible with what would be expected for a normal healing process. Evidence for a unique tubal epithelial process, as suggested by the terms "endosalpingiosis" or "recanalization," was lacking. Likewise, the author found no evidence of tuboperitoneal fistula formation and/or the subsequent occurrence of pregnancy secondary to localized endometriosis. The histologic notations of proximal luminal dilatation, plical attenuation, chronic inflammatory infiltrates with pseudopolyp formation, and the findings of plical thickening in the distal segment of remaining tube after an interruption type of procedure seem to be associated with the length of time from the sterilization procedure. These may be factors related to the apparent reduced success rate, with time, of microsurgical reanastomotic procedures.

Adult↗