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Fertility sparing and organ preservation in patients with gynecological tumours
No full textIn dieser Arbeit untersuchten wir fertilitätserhaltende operative Strategien
bei benignen und malignen gynäkologischen Erkrankungen. Operative
Organentfernungen ziehen funktionelle, somatische und psychologische
Konsequenzen für die betroffenen Patientinnen nach sich. Bei malignen
Erkrankungen des Beckens stand lange Zeit ausschließlich der onkologische
Aspekt im Vordergrund. Bei Patientinnen mit Zervixkarzinom war operativ kein
Uteruserhalt möglich. Mitte der 90er Jahre wurde die Methode der radikalen
vaginalen Trachelektomie (RVT) etabliert. Deren onkologische Sicherheit ist
gewährleistet, denn die untersuchten Rezidivraten nach RVT entsprechen denen
der radikalen Organ entfernenden Operationen. Weltweit sind Daten zu ca. 1000
Patientinnen nach RVT publiziert. Mit 320 operierten Patientinnen und deren
Langzeitdaten überblicken wir von diesen das größte beschriebene Kollektiv.
Von den Frauen, die nach RVT eine Schwangerschaft anstrebten, wurden 85%
schwanger. Die Hälfte der Kinder wurde vor der 37. SSW geboren. Nur 20% der
Frühgeborenen kamen vor der 28. SSW zur Welt. Die Hauptursache der
Frühgeburtlichkeit war der vorzeitige Blasensprung. Die neonatologischen
Ergebnisse der Kinder, die nach operativem Fertilitätserhalt von
Zervixkarzinompatientinnen geboren wurden, ist nicht alteriert. Gemessen an
ihren Entwicklungsscores ein Jahr nach ihrer Geburt trugen die Kinder kein
erhöhtes Risiko durch die Operation ihrer Mütter. Obwohl der Fertilitätserhalt
bei Patientinnen mit Zervixkarzinom Einzug in die Leitlinien gefunden hat,
werden weit weniger als 10% der Frauen, die mit Zervixkarzinom für einen
Erhalt ihrer Fertilität in Frage kommen, nach dieser Methode operiert. Dies
liegt an der technischen Komplexität der Methode, aber auch an der
Unsicherheit, die gegenüber der RVT sowohl bei den Patientinnen als auch ihren
behandelnden Ärzten besteht. Dabei treten vor allem Unklarheiten bezüglich der
onkologischen Nachsorge der anatomisch veränderten Situation im Becken und
bezüglich des Managements der Schwangerschaften auf. Wir entwickelten aus
diesem Grund ein Nachsorgeprotokoll zur onkologischen Diagnostik und
Rezidivprophylaxe sowie Empfehlungen zur Prävention von Frühgeburten in der
Schwangerschaft nach RVT. Bei benignen Erkrankungen tritt immer mehr der
Wunsch der Patientinnen nach einem Organerhalt in den Vordergrund. Wir
etablierten eine nervensparende vaginal-abdominelle Operationsmethode zur
Therapie der rektovaginalen Endometriose mit der Möglichkeit des
Fertilitätserhaltes. Die Analyse der perioperativen Ergebnisse zeigte, dass
die Komplikationsrate durch die Standardisierung der Methode gering ist. Es
kam zu keinen schweren Komplikationen, wie Anastomoseninsuffizienzen oder
rektovaginalen Fisteln. Vor allem durch die Präservation des Mesos und der
vegetativen Nerven des Beckens waren auch die längerfristigen Nachwirkungen
der Operation gering. In der Langzeitbeobachtung fanden wir keine
rektovaginalen Rezidive der Endometriose und nur bei 7% der Patientinnen ein
Wiederauftreten von Endometriose anderer Organe. Weitere Analysen der Kohorten
und Untersuchungen zu klinischen Symptomen, Fertilitätsraten, der QOL und zur
Sexualität nach Fertilitätserhalt sind derzeit in Arbeit. Um die
fertilitätserhaltenden Therapien weiter in den Fokus der Therapieoptionen zu
stellen, sollten randomisierende Studien zu den zur Verfügung stehenden
fertilitätserhaltenden Konzepten folgen.In this study we investigated the possibility of fertility and organ
preservation in patients with benign and malign gynecological illnesses.
Operative removal of reproductive organs leads to functional, somatic and
psychological consequences for the patients concerned. In patients with malign
diagnosis the oncological aspect was considered for a long time only.
Especially in patients with cancer of the cervix operative uterus preservation
was not possible or considered. In the nineties the organ preserving technique
of radical vaginal trachelectomy (RVT) was established. Its oncological safety
has been proven and found equivalent to radical hysterectomy. Worldwide data
for 1000 patients who underwent RVT is available and has been published. We
overlook the biggest collective of patients described with a number of over
320 women. Pregnancy rates are up to 85% in women who wish to become pregnant
after RVT. One of the challenges is the high number of preterm delivered
babies to women without a cervix. 50% of the children are delivered before 37
GW and 20% before 28 GW. The main cause of preterm delivery after RVT is the
premature rupture of the membranes due to the missing cervical barrier for
ascending bacteria. Neonatological performance of the children is not altered
negatively evaluated by developmental scores after RVT however. Even though
organ preservation in patients with early cervical cancer has found its way
into the European guidelines, less than 10% of the patients who could be
offered organ preservation are operated by RVT. This is partially due to the
technical complexity of the method and thus the resulting reservation in the
treating doctors. An uncertainty remains of how to monitor the patients and
how to manage pregnancies. We developed a follow-up protocol to improve the
oncological situation and to reduce the rate of preterm deliveries for
patients and their treating doctors. In patients with benign pathologies of
the reproductive organs organ preservation becomes more and more important,
too. Fertility preservation in patients with rectovaginal endometriosis can be
achieved by applying a vaginal-abdominal resection of the endometriotic
nodula. Analysis of perioperative data shows good results if the operation
method is standardized. Long term follow up shows the severity of the disease
with remaining symptoms but low recurrence rates of rectovaginal or
endometriosis itself. Further analysis of the patients regarding clinical
symptoms, fertility rates, QOL and sexuality after organ preservation is
conducted at the moment. To strengthen the role of organ preserving
strategies, randomized controlled studies should be undertaken in the future
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Fertilitätserhaltende laparoskopische Therapiestrategien bei Patientinnen mit gynäkologischen Erkrankungen
No full textkoamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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