Die Entbindung per Forzeps hat sich von 2001 bis 2011 mit einer Abnahme von 1,4% auf 0,5% mehr als halbiert. Diese Entwicklung geschah zu Gunsten der Vakuumextraktion, die von 4,4% auf 5,8% zugenommen hat. Diese Entwicklung ist der antezipierten erhöhten mütterlichen Morbidität der Forzepsentbindung geschuldet. Die Forzepsentbindung bleibt jedoch weiterhin ein unverzichtbarer Bestandteil im Repertoire des Geburtshelfers. Es bestehen weiterhin Indikationen zur Forzepsentbindung bei der Notwendigkeit zur instrumentellen Entbindung und dem gleichzeitigen Vorliegen einer Kontraindikation der Vakuumextraktion. Zu diesen Indikationen gehören die misslungene Vakuumextraktion, die Frühgeburt vor 34+0 SSW (S1 Leitlinie AWMF 015/023), eine große Geburtsgeschwulst und die hintere Hinterhauptshaltung. Um der vaginalen Entbindung des Kindes mittels Forzeps gewachsen zu sein, ist es für die Geburtshelfer wichtig, den normalen Geburtsverlauf, die Geburtsmechanik bei protrahierter Geburt und die Technik der Entbindungsmethode genau zu kennen. In einem Lehrvideo zur Zangenentbindung werden zur Verdeutlichung verschiedene didaktische Techniken, wie Realvideo, Demonstration am Phantom und drei-dimensionale Computeranimationen eingesetzt.

Der chirurgische Verschluss der Zervix uteri zur Verhinderung von Spätaborten und Frühgeburten wird im Vivantes Klinikum Neukölln, Berlin seit 1991 in der vorgestellten Technik mit zunehmender Häufigkeit durchgeführt.

Die Uterusruptur ist eine peripartal lebensbedrohliche Komplikation für Mutter und Kind. Sie ist eine seltene Komplikation in der Geburtsmedizin. Als mögliche intrinsische Faktoren sind Muliparität, Plazentationsstörungen, Uterusfehlbildungen, Adenomyosis uteri, protrahierte Geburtsverläufe, fetale Makrosomie und kindliche Fehlbildungen zu nennen. Die medikamentöse Geburtseinleitung sowie eine vaginal operative Entbindung sind iatrogene Risikofaktoren.Ohne vorausgegangene Uterusoperation ist mit einer Inzidenz von 0,006% für das Auftreten einer Uterusruptur zu rechnen. Nach vorausgegangener Uterusoperation wird mit 0,52% –0,8% ein deutlich höheres Risiko beschrieben. Dabei findet man in der Literatur keine Risikoeinschätzung für das Auftreten einer Uterusruptur nach Kürettage. In 90% ist das untere Uterinsegment betroffen.

Ziel: Eine Uterustorsion ist eine Rotation des Uterus von mehr als 45 Grad um die Längsachse. Sie ist eine seltene geburtsmedizinische Komplikation, die häufig erst während einer Sectio caesarea diagnostiziert wird. Die Ursache bleibt meist ungeklärt.

Schätzungen gehen davon aus, dass etwa 18% der Schmerzen, die die mütterliche Brust und/oder die Brustwarzen betreffen, durch eine Infektion mit Candida albicans verursacht sind. Obwohl die Frauen einen übermäßigen und unerträglichen Schmerz, nicht nur beim Stillen selbst, sondern häufig auch noch lange nach dem eigentlichen Saugakt beschreiben, erhalten sie oft keine adäquate Hilfe.Der Grund dafür besteht vermutlich darin, dass augenscheinliche Hautläsionen der Brust und der Brustwarzen häufig fast völlig fehlen.Generell treten nur sehr diskrete Veränderungen wie schwache Rötung der Areola, trockene und squamöse Haut oder geringe Schwellung der Montgommery-Drüsen auf. Dazu kommt erschwerend hinzu, dass der mikrobiologische Nachweis von Candida extrem schwierig ist, weil die Lysozyme in der Muttermilch den Pilz zerstören können. Deshalb sind spezielle Kulturmedien erforderlich.Ein möglicher Infektionsweg scheint die Übertragung von vaginaler Candida während des Geburtsvorgangs und die anschließende Infektion der mütterlichen Brust beim Stillvorgang zu sein.Es ist absolut notwendig diese Infektion mit Antimykotika zu behandeln, um eine deutliche Schmerzreduktion zu erzielen. Man kann zunächst eine gleichzeitige Behandlung der mütterlichen Brust und des Babies mit lokaler Applikation von Miconazol erwägen. Ergibt das aber keinen unmittelbaren Behandlungseffekt, muss auf eine systemische Behandlung mit initialer Aufsättigungsdosis von 400mg Miconazol und danach mit 100–200mg für mindestens 10–14 Tage gewechselt werden. Eine Stillpause für diesen Zeitraum oder ein Abstillen ist nicht notwendig.Wir glauben, dass viele Frauen nicht abstillen und ihre Kinder weiter stillen würden, wenn wir Ihnen sofortige und adäquate Hilfe anbieten.

Studienziel: Methode: Ergebnisse: Schlussfolgerung: Aim: Method: Results: Conclusion:

A dynamic recirculation apparatus has been used to determine the isobaric phase equilibria of binary 1-propoxy-2-propanol mixtures with water and different alcohols (methanol, ethanol, 2-butanol and 1-hexanol). The systems exhibit both positive and negative deviations from Raoult’s law. No azeotropic mixture is found in any of the systems under investigation. The binary diagram of water/1-propoxy-2-propanol (PnP) shows the well-known liquid–liquid-separation. The experimental results are correlated with the Wilson, NRTL and UNIQUAC model and also compared to the COSMO-RS predictive model and the modified UNIFAC group-contribution method. Additionally, the vapour pressure of PnP has been determined experimentally up to 140° C as prerequisite for modelling of the data.

An ion-pair high-performance liquid chromatography assay involving solid-phase scintillation detection was established for rapid identification and quantitation of all major metabolites of tritium-labeled cytosine arabinoside (ara-C) in an in vitro system. In a single run of 55 min ara-C, ara-CMP, ara-CDP-cholin, ara-CDP, ara-U, ara-UMP, ara-CTP, ara-UDP, and ara-UTP can be measured and quantitated. The presented method is fast, sensitive, with various limits of detection ranging from 40 to 200 pg (absolute), and highly reproducible. Metabolic profiles of HL60 and Raji cells following incubation with ara-C were established using this technique.

Introduction: Medical cannabis’ importance in Poland increased dramatically following its legalization as the 12th country in Europe in 2017. However, no studies have been published to give insight into Polish physicians’ opinions about medical cannabis. Objectives: To investigate physician’s opinions about cannabinoids’ utility in clinical practice, concerns regarding their safety profile, and their clinical experience with cannabinoids. Methods: The survey using a self-developed tool was conducted online; participants were physicians with or without specialist training. Participation was voluntary. Physicians were recruited through personal networks, palliative care courses, and Medical Chambers. Results: From June to October 2020, we recruited 173 physicians from 15/16 voivodeships. The largest age group (43.9%; n = 76) was 30–39 year-olds. A similar proportion declared they never used cannabis and did not receive any training regarding cannabinoids (60% for both). Only 15 (8%) ever prescribed medical cannabis, although about 50% declared knowing suitable patients for such therapy, and 53.8% had at least one patient proactively asking for such treatment in the last 6 mo. The most common indication chosen was pain: chronic cancer-related (n = 128), chronic non-cancer (n = 77), and neuropathic (n = 60). Other commonly chosen conditions were alleviation of cancer treatment side-effects (n = 56) and cachexia (n = 57). The overall safety profile of THC was assessed as similar to most commonly used medications, including opioids; NSAIDs and benzodiazepines were, however, perceived as safer. Conclusions: Polish physicians favored the legalization of medical cannabis. However, it is of concern that a limited number have any experience with prescribing cannabis. The creation of clear guidelines to advise physicians in their routine practice and education about pain management and the risks related to the consumption of recreational cannabis for medical conditions are needed.

Cytarabine ocfosfate (YNK01) is a novel orally applicable prodrug of cytosine arabinoside. Recent pharmacokinetic studies have revealed a prolonged release of the cytotoxic agent cytosine arabinoside (araC) from hepatocytes into the systemic circulation, resulting in a half-life of approximately 24 h for araC. The specific pharmacokinetic characteristics of cytarabine ocfosfate lead to a prolonged exposure of leukemic cells to this antineoplastic agent during the 14-day cycle. The oral applicability during outpatient treatment and the sustained antineoplastic activity of araC against slowly proliferating leukemic B-cells suggest that cytarabine ocfosfate might be a useful drug in the treatment of chronic lymphocytic leukemia. Four years after diagnosis of B-CLL, a 50-year-old patient was started on cytarabine ocfosfate. Sequentially, the patient's disease had proved refractory to treatment with chlorambucil/prednisone (31 months), fludarabine (5 months), and prednimustine/mitoxantrone (3 months). These established regimens were discontinued because of increasing lymphocytosis, significant thrombocytopenia, and progressive B-symptoms. Following three cycles of cytarabine ocfosfate B-symptoms resolved, lymphadenopathy disappeared, and thrombocytopenia was significantly reduced. The patient has been free of these symptoms on a dosage of 1500 mg cytarabine ocfosfate/day (cycle of 14 days with intervals of 14–21 days) for 24 months and remains in an ongoing partial remission.

Ara-CMP-Stearate (1-beta-D-Arabino-furanosylcytosine-5′-stearylphosphate, YNK 01, Fosteabine) is an the orally applicable prodrug of cytosine-arabinoside (Ara-C). During a recently started phase-I study in patients with advanced low-grade non-Hodgkin lymphomas or acute myeloid leukemia the pharmacokinetic parameters of Ara-CMP-Stearate (kindly provided by ASTA Medica, Frankfurt, FRG) were determined by HPLC analysis. 72 hours after a first starting dose which served for the determination of baseline pharmacokinetic parameters, Ara-CMP-Srearate was administered over 14 days by once daily oral application. Ara-CMP-Stearate was started at a dose of 100 mg/d and was escalated in subsequent patients to 200 mg/d, 300 mg/d and 600 mg/d. Plasma and urine concentratiions of Ara-CMP-Stearate, Ara-C and Ara-U were measured during the initial treatment phase and within 72 hours after the end of the 14 day treatment cycle. So far six patients have been treated with 100 mg/d, three with 200 mg/d and another six with 300 mg/d. One patient was treated consecutively with 100 mg, 300 mg and 600 mg. Fitting the results of the plasma concentration measurements of Ara-CMP-Stearate to a one compartment model, the following pharmacokinetic parameters were obtained (average and variation coefficient VC). Ara-CMP-Stearate dose independent parameters: Lag time = 1.04 h (0.57), tmax=5.72 h (0.30), t1/2 = 9.4 h (0.36). Dose dependent parameters: at 100 mg : AUC = 1099 ng·ml/h (0.31), concentrationmax=53.8 ng/ml (0.28), at 200 mg: AUC = 2753 ng·h/ml (0.32), concentrationmax = 154.8 ng/ml (0.46), at 300 mg: AUC = 2940 ng·h/ml (0.66), concentration max = 160.0 ng/ml (0.59). The long lag time and latemax can be explained by resorption in the distal part of the small intestine. No Ara-CMP-Stearate was detected in urine samples (limit of detection = 500pg/ml). Pharmacokinetcic parameters of ARA-C following Ara-CMP-Stearate application showed the following characteristics: t1/2 = 24.3 h (0.39), AUC (100mg) = 262 ng·h/ml (0.93), AUC (200mg) = 502 ng·h/ml (0.87), AUC (300mg) = 898 ng·h/ml (1.07). Since Ara-CMP-Stearate causes intravascular hemolysis after i.v. administration, it was not possible to determine its bioavailability by comparing the AUC after oral and i.v. application. Instead, the renal elimination of ARA-U, as the main metabolite of ARA-C was measured during the first 72 h period and after the last application. This approach allowed to estimate that an average of 15.8% of Ara-CMP-Stearate (VC 0.82) had undergone resorption and final metabolism to ARA-U. The observed half lifes for ARA-C(t1/2 = 24,4h, VC = 0,39) and Ara-U (t1/2 = 22,0 h, VC = 0,35) after Ara-CMP-Stearate administration were substantially longer than those after intravenous application of Ara-C suggesting a prolonged release of Ara-C from the prodrug due to a slow hepatic metabolism of Ara-CMP-Stearate. These data show that Ara-CMP-Stearate is able to maintain prolonged ARA-C plasma levels and suggest that ARA-C concentrations as in low dose and probably in standard dose ARA-C therapy can be achieved by oral application of Ara-CMP-Stearate.

An ion-pair HPLC method for the determination of 1-beta-D-arabinofuranosylcytosine-5'-stearyl phosphate (cytarabine-ocfosfate I) was developed, using a phenyl-bonded column under reversed-phase conditions with a mobile phase of acetonitrile-buffered water (pH 6.8) (50:50) for isocratic elution. A reproducible sample clean-up was achieved by solid-phase extraction. In order to reach the low limit of detection of 2 ng/ml, an enrichment switching system was used. The present validation leads to a limit of quantification of 5 ng/ml with a coefficient of variation (C.V.) of 10%. The total time of measurement was shortened by a back-flush procedure to restore the conditions after each run. UV detection at 275 nm was applied. The recoveries for plasma samples ranged from 56.4 to 64.1%, regardless of drug concentrations. The intra-assay C.V. was about 4% (40 measurements at four different concentrations). The inter-assay recovery (ten measurements over ten days) at a plasma concentration of 50 ng/ml was 57% with a C.V. of 8.25%. Based on this HPLC method, the pharmacokinetics of I were measured during a clinical phase I/II study.