[Show abstract][Hide abstract] ABSTRACT: Afterbirth tissues, which include the umbilical cord, placenta, amnion, and cord blood, are usually discarded. Recent progress in regenerative medicine suggests that we re-evaluate these tissues and assess their therapeutic potential.
Firstly the unique properties of afterbirth tissues and their current use in regenerative medicine are summarised. Then we introduce the cooperation of our institutions and our experiences regarding the collection and utilisation of afterbirth tissues.
A literature survey suggests that besides the well-known transplantation of hematopoietic stem cells from cord blood, afterbirth tissues were also used as a source of stem cells, progenitor cells, differentiated cells, and blood vessels for tissue engineering purposes. According to our own experience, the two participating OB/GYN departments and the blood donation service were able to organise a sufficient supply of umbilical cords for research purposes. The yield correlated with incentives for the midwives. A total of more than 4,300 cords was collected for experiments designed to create small caliber vessel grafts. The contamination rate was low. Birth mode significantly affected umbilical vein function, whereas ischaemia for up to 40 h did not have any deleterious effects. Umbilical veins were cryopreserved with a moderate loss of function. Fresh umbilical veins were endothelium-denuded and reseeded with endothelial cells harvested from coronary artery disease patients to generate an autologous surface.
Afterbirth tissues have unique properties which make them ideally suited for regenerative medicine. These tissues can be procured and utilised in research facilities even in the absence of an in-house birthing centre.
Zeitschrift für Geburtshilfe und Neonatologie 02/2012; 216(1):27-33. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Human umbilical veins (HUV) have recently been suggested as a starting material for vascular tissue engineering. HUV possess
a functional smooth muscle layer and could be turned into an immunologically inert graft with contractile properties by creating
a neoendothelium from the recipient’s own cells. This study investigated methods to remove the native endothelium without
impairing the contractile function of the smooth muscle layer. These denuded HUV were then seeded with endothelial cells in
a perfusion bioreactor, demonstrating the creation of a confluent, shear-resistant neoendothelium.
[Show abstract][Hide abstract] ABSTRACT: Die zunehmende Ökonomisierung der Medizin in Deutschland durch Einführung der stationären Pauschalvergütung durch DRGs impliziert
eine wirtschaftlichere Patientenversorgung. Optimale und vollständige Kodierung von ICD-10-Diagnosen und Prozeduren nach OPS
sind zur Erlössicherung nur die Grundvoraussetzung. Ein Abgleich von klinikinternen Kosten und Erlösen, Identifikation und
Elimination von Kostentreibern, Modellanalysen von Abrechnungsalternativen, vor allem aber die Integration von Informationen
über Kosten und Erlöse auf der Ebene der Ressourcenentscheider, der Ärzte, sowie die gemeinsame Ableitung von Handlungsanweisungen
für eine qualitativ hochwertige, aber zugleich wirtschaftlichere Patientenversorgung sind ein neuartiger, bisher nur unzureichend
genutzter Ansatz. Ein Abrechnungsexperte in der Frauenklinik ist ein System- und Schnittstellenoptimierer und kann durch aktives
medizinisches wie operatives und strategisches Controlling vor Ort diese Prozesse steuern und gestalten.
Reorganization of health care according to economic principles in Germany after introduction of a flat rate reimbursement
for in-patients by diagnosis-related groups (DRGs) implies a more cost-efficient patient care. Optimal and complete coding
of ICD-10 diagnosis and procedure codes according to OPS301 are just one essential aspect. A comparison of clinic internal
costs and revenues, identification and elimination of cost drivers, modelling of reimbursement alternatives, but especially
integration of information about costs and revenues at the level of resource decision, the physicians, as well as joint decision-making
on rules for high quality of care at lower costs, is a new as yet insufficiently used approach. An expert for coding and reimbursement
in a gynecology clinic is an optimizer of system and interfaces and can actively use medical as well as operative and strategic
controlling to steer and shape these processes on-site.
SchlüsselwörterÖkonomisierung der Medizin-Wirtschaftlichkeit-Kostentransparenz-Controlling-Klinikmanagement
KeywordsReorganization of health care-Cost-effectiveness-Cost transparency-Controlling-Clinic management
[Show abstract][Hide abstract] ABSTRACT: Summary An efficient insufflation technique is essential for laparoscopy. Up to now physicians have had to rely on their experience and intuition when putting together an insufflation system. Comparable, objective data about the insufflation properties of all insufflation components used has not been available. In this study, details of the insufflation properties of disposable and reusable Veress needles and trocars and Luer lock connectors and the particular meaning of flow resistance for function and efficiency of the entire insufflation system have been measured and compared. In an independent laboratory study, a computer-based data acquisition measurement model was developed. Specific pressure dependent flow and resistance curves of insufflation components from manufacturers such as Auto Suture, Dexide, Ethicon, HiTec, Olympus, Origin, Richard-Allan, Volzer, Wiest, Wolf and Storz were evaluated by measurement of physical parameters pressure, CO2 gas flow and resistance. Through the introduction of reference values, different insufflation properties for all studied components were characterised for the first time and can be compared. Despite similar type of construction, remarkable differences of CO2 gas flow were found in Veress needles (0.85–2.38 L mim−1, disposable (3.91–9.61 L mim−1) and reusable trocars (5.27–21.07 L min−1) at reference pressure of 12 mmHg, if used for insufflation only. It further decreased after insertion of a 10 mm optic for disposable (1.53–7.08 L min−1) and reusable trocars (1.22–14.03 L min−1). All insufflation components have different flow properties, due to the space left for insufflation. The largest resistance is usually the diameter size at the insufflation supply (1.5–4.3 mm). In general, disposable trocars are not useful for high flow insufflation (> 10 L mim−1) at PRef = 12 mmHg). Only two reusable trocars studied deliver high flow with a 10 mm optic inserted (HiTec 1013, Olympus A 5359). Resistance, especially of disposable trocars, needs to be improved by enlarging the insufflation diameter. Resistance-optimised insufflation components are more efficient, faster and could save time and money. Users need to demand resistance-improved products from manufacturers, who should publish reference values about specific flow and resistance properties of their products.
[Show abstract][Hide abstract] ABSTRACT: Umbilical cord blood (UCB) of a newborn contains stem cells with a remarkably high differentiation and regeneration potential. They are therefore useful for application in regenerative medicine. In this review current clinical applications are summarised and the necessity for the storage of UCB stem cells is derived and discussed. A Medline search for publications regarding clinical application of UCB stem cells was carried out and other data bases were reviewed. The transplantation of UCB stem cells, a special class of adult stem cells, has not only been established successfully in a variety of haematoblastoses but could also improve the prognosis in diseases which are related to degeneration and/or injuries of body cells and organs. The current focus in worldwide research is tissue engineering of bioartificial heart valves and vessels as well as applications of UCB stem cells in acute myocardial infarction, diabetes mellitus type 1 and neurodegenerative diseases. In urology the first results regarding the successful application of UCB stem cells in incontinence have been published. This definite progress in adult stem cell research as well as in clinical application requires a more rational handling of the resource UCB stem cells. Personal strategies as well as governmental concepts for storage of UCB stem cells for personal precautions, for donation to others or for research, respectively, have to be developed.
Zeitschrift für Geburtshilfe und Neonatologie 05/2009; 213(2):49-55. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the last decades, many changes have occurred in oncology with new chemotherapy combinations and more complex application schemes becoming available. Central venous catheters and implantable venous port systems have become widely used and have facilitated the problem of vascular access. However, important complications are associated with permanent central venous catheters. Material and methods: This review summarizes evidence on venous port system use published in Medline up to February 2007. Moreover, recent guidelines for the prevention and management of catheter-related infections issued by the Infectious Diseases Society of America, the American College of Critical Care Medicine, the Society for Healthcare Epidemiology of America, the Center for Disease Control and Prevention, Atlanta, and the Infectious Diseases Working Party of the German Society of Hematology and Oncology are included.
Sterile precautions are essential when implanting and accessing port systems. Infections must be treated with adequate antimicrobial therapy. Catheter-related thromboembolic complications were found at a rate of 12-64% in retrospective studies. Five current clinical trials investigated the effect of prophylactic anticoagulation with either low molecular weight heparin or warfarin in cancer patients with central venous devices. On the basis of these results, routine anticoagulation cannot be recommended.
This article reviews the current literature on long-term complications of venous port systems, focusing on infection and thrombosis. In addition, it summarizes the evidence regarding routine maintenance of port systems in follow-up care.
Annals of Oncology 02/2008; 19(1):9-15. · 7.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Für den Einsatz in der Gynäkologie stehen heute eine Vielzahl unterschiedlicher, biokompatibler Materialien und Implantate
zur Verfügung. Auf eine Auswahl soll hier näher eingegangen werden, die die verschiedenen Materialien und Bauweisen repräsentieren.
So sind Brustimplantate seit fast vier Jahrzehnten im Gebrauch für die Brustvergrösserung und den Brustwiederaufbau. Material,
Bauweisen und medizinische Aspekte einschliesslich der kontroversen Diskussion um Silikon werden im folgenden erläutert. Neuere
Entwicklungen von Verhütungstechniken für permanente Sterilisation wie den Filshie Clip™ für transabdominalen und den STOP™
für intraluminalen Verschluss der Eileiter oder die intrauterin plazierte Hormonspirale Mirena™ für zeitlich begrenzte Verhütung
werden beschrieben. Eine neue Perspektive zur Verhinderung postoperativer intraabdominaler Adhäsionen stellt Spray-Gel™, ein
Zweikomponenten Hydrogel aus Polyethylenglykol, dar.
[Show abstract][Hide abstract] ABSTRACT: To find associations between knowledge about risk factors for breast cancer and the socioeconomic status of healthy women, as well as their attitude toward taking chemopreventive drugs.
Between April and September 1999, 7135 healthy women completed questionnaires providing information about their willingness to take chemopreventive drugs. Items in the questionnaire included the sources of the information they had, their estimates of the population and personal lifetime risk, and risk factors for breast cancer.
A total of 6597 questionnaires were evaluable. The responders' median age was 44. Fifty-five percent of the women were willing to consider receiving chemopreventive drugs to lower their risk for breast cancer. Participants who estimated the population risk as being very high were more disposed to receive chemoprevention (65.3%), as were women who estimated their own breast cancer risk as being high (74.1%). A family history of breast cancer only had a low impact on willingness to receive chemoprevention. Women with a family history of breast cancer were willing to take chemopreventive agents in 57.2% of cases. The multivariate analysis showed that knowing about risk factors and having a lower educational level were factors positively correlated with willingness to consider chemoprevention.
These findings emphasize the role of estimations of the risk of breast cancer for patients considering whether to accept chemoprevention treatment. To date, only a few modern models of risk estimation have been evaluated in relation to chemoprevention. There is a need for better integration of professional risk estimations into clinical practice.
Breast Cancer Research and Treatment 02/2007; 101(1):95-104. · 4.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die Mamillensekretion ist ein hufig assoziiertes (je nach histologischem Befund 1–33%) Symptom bei Brusterkrankungen, das Karzinomrisiko wird dabei mit 1,3–47% angegeben. Die Sekretion der weiblichen Brustdrse ist eine besondere diagnostische und therapeutische Herausforderung, denn die Vielzahl der diagnostischen Verfahren (Inspektion, Palpation, Zytologie, Mammographie, Galaktographie, Sonographie einschlielich Duktsonographie, MRT, Duktallavage) lassen nicht immer eine Dignittsdifferenzierung (maligne vs. benigne) zu. Alle bisher eingesetzten Methoden sind indirekte Verfahren zur Darstellung des Milchgangssystems und intraduktaler Prozesse. Mit der minimal-invasiven endoskopischen Milchgangsspiegelung (Duktoskopie, syn. Galaktoskopie) steht erstmalig eine Methode zur Verfgung, die eine direkte Visualisierung intraduktaler Vernderungen bei pathologischer Sekretion zulsst. Die ungezielte Milchgangsexstirpation knnte durch eine gezielte Probeentnahme unter duktoskopischer Sicht bald der Vergangenheit angehren. Die Machbarkeit der Duktoskopie ist grundstzlich erwiesen, ihr Stellenwert in der Diagnosekette bei Mamillensekretion wird derzeit weltweit geprft. In Deutschland wird sie zunehmend eingesetzt, zunchst aber noch als zustzliches Diagnostikum auf experimenteller Basis. Der unkritische breite Einsatz dieser neuen Methode kann vor dem Vorliegen valider Ergebnisse im Rahmen von Studien aktuell noch nicht empfohlen werden.Breast diseases are frequently associated with nipple discharge. Depending on the histology of the underlying process, this occurs with a frequency of 1–33%. Cancer risk from nipple discharge is reported to be anywhere from 1.3% to 47%. It therefore represents a real diagnostic challenge, especially in view of the fact that the various diagnostic methods (inspection, palpation, cytologic analysis, mammography, galactography, ultrasonography including ductal evaluation, MRI, ductal lavage) cannot always elucidate whether the respective lesion is benign or malignant. All common standard diagnostic techniques take an indirect approach to visualizing the duct system and potential intraductal lesions, whereas ductoscopy (galactoscopy) is a minimally invasive technique permitting direct visualization of intraductal anomalies in cases of pathologic nipple discharge. The remaining methods will frequently lead to blind open biopsies (duct excision). With targeted biopsies under ductoscopic visualization, however, blind duct excision may become a method of the past. The feasibility and practicability of ductoscopy have been proven. At present, studies are being conducted worldwide, aimed at clarifying the role of ductoscopy as part of the diagnostic tree in the evaluation of nipple discharge. Before valid study results become available, one should caution against the indiscriminate, widespread use of this new method.
[Show abstract][Hide abstract] ABSTRACT: Umbilical cord blood (UCB) is an important source of hematopoietic stem and progenitor cells (HSC/HPC) for the reconstitution of the hematopoietic system after clinical transplantation. Cryopreservation of these cells is critical for UCB banking and transplantation as well as for research applications by providing readily available specimens. The objective of this study was to optimize cryopreservation conditions for CD34+ HSC/HPC from UCB.
Cryopreservation of CD34+ HSC/HPC from UCB after mononuclear cell (MNC) preparation was tested in a research-scale setup. Experimental variations were concentration of the cryoprotectant, the protein additive and cell concentration. In addition, protocols involving slow, serial addition and removal of DMSO were compared with standard protocols (fast addition and removal of DMSO) in order to avoid osmotic stress for the cryopreserved cells. Viability and recoveries of MNC, CD34+ cells and total colony-forming units (CFU) were calculated as read-outs. In addition, sterility testing of the collected UCB units before further processing was performed.
The optimal conditions for cryopreservation of CD34+ HPC in MNC preparations were 10% DMSO and 2% human albumin at high cell concentrations (5 x 10(7) MNC/mL) with fast addition and removal of DMSO. After cryopreservation using a computer-controlled freezer, high viabilities (89%) and recoveries for CD34+ cells (89%) as well as for CFU (88%) were observed. Microbial contamination of the collected UCB samples was reduced to a rate of 6.4%.
Optimized cryopreservation conditions were developed for UCB MNC in respect of the composition of the cryosolution. In addition, our results showed that fast addition of DMSO is essential for improved cryopreservation and post-thaw quality assessment results, whereas the speed of DMSO removal after thawing has little influence on the recoveries of CD34+ cells and CFU.
[Show abstract][Hide abstract] ABSTRACT: Private umbilical cord blood (UCB) banking after delivery has increased over the last decade. For adult/somatic stem cell research UCB is an essential source of stem cells and researchers question if the number of UCB samples for research might be reduced by private banking.
A survey among seven private blood banks in Germany and analysis and comparison of the number of UCB samples donated for research within the STEMMAT project with private blood banking were performed from 03/2003 to 06/2005 at the Frauenklinik (OB/GYN), Technical University Munich, Germany.
Within 27.5 months 1,551 UCB samples were collected for research purposes; the effective recruitment rate was higher than expectations at an effective 66.2 %. Private UCB banking [n = 24] was distributed among three cord blood banks [n = 16, 6 and 4]. The rate of private blood banking was 0.99 % for all deliveries, thus reducing the effective rate for research purpose by only 1.5 %.
Under the assumption of active and successful recruitment of scientific UCB samples, private blood banking does not significantly reduce this rate and therefore is a negligible rival in the competition for sufficient numbers of UCB samples for research.
Zeitschrift für Geburtshilfe und Neonatologie 01/2006; 209(6):223-7. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adult stem cells from umbilical cord and cord blood are an interesting alternative to embryonic stem cells because such research is commonly recognized as ethical undisputed and many aspects are still insufficiently investigated. In the context of the STEMMAT research project (STEM = Stem Cell and MAT = Material) different aspects of stem cells from umbilical cord and cord blood are investigated, to improve basic science understanding and potentially leading someday to a clinical application.
Zentralblatt für Gynäkologie 01/2006; 127(6):368-72.