Introduction/Background Laparoscopic/robotic radical hysterectomy (RH) has been considered oncologically adequate to open RH for patients with early cervical cancer. However, a recent prospective randomised trial (LACC) demonstrates significant inferiority of minimally-invasive approach. Thereupon we have updated our prospective database of combined laparoscopic-vaginal RH with respect to oncologic outcome. Methodology Between 1994 and 2018 1952 consecutive patients with invasive cervical cancer have been treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to LACC trial were identified. In contrast to laparoscopic/robotic technique used in LACC trial all patients in our cohort underwent combined transvaginal-laparoscopic approach that does not use any uterine manipulator and comprises creation of a tumor-adapted vaginal cuff by transvaginal approach. Results Initial FIGO stage was IA1 LVSI+, IA2 and IB1 in 32 (8%), 43 (11%) and 314 (81%) respectively, and histology was squamous cell cancer in 263 (68%), adenocarcinoma in 117 (30%) and adenosquamous tumor in 9 (2%). LVSI was confirmed in 106 patients (27%). Median number of harvested lymph nodes was 24 (2–86). Lymph nodes were tumor-free in 379 (97%) of patients. Following radical hysterectomy 71 (18%) of patients underwent adjuvant chemoradiation (CRT) or radiation (RT). After a median follow up of 99 (1–288) months 3, 4.5 and 10-ys DFS were 96.8%, 95.8%, 93.1% and 3, 4.5 and 10-year OS were 98.5%, 97.8%, 95.8%, respectively. Recurrences were diagnosed in 50% (n=10) loco-regional. Interestingly, 9/20 recurrences occurred later than 39 months following surgery. Conclusion Combined laparoscopic-vaginal technique for RH with consequent avoidance of possible spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery respecting laparoscopic oncologic hygiene is oncologic safe and should be validated in further randomised trials. Disclosure Nothing to disclose.

5062 Background: Cervical cancer is the most frequently encountered malignancy during pregnancy. The presence of nodal metastasis is the most important negative predictor factor and its assessment represents a crucial parameter to decide if the pregnancy can safely continue. We describe the results of 18 pregnant patients with cervical cancer who have their nodal status accessed by means of laparoscopy. Methods: Eighteen patients undergoing laparoscopic pelvic lymphadenectomy during pregnancy at Charité – Universitätsmedizin Berlin and Friedrich-Schiller-Universität Jena between 1999 and 2009 were included. Results: The mean age at diagnose was 32 years-old (26–40) and gestational age was between 6 and 23 weeks of pregnancy. The FIGO stage of cervical cancer was between 1a1 and 2a (1a1 for two women, 1a2 for one woman, 1b1 for thirteen women, 1b2 for one woman and 2a for one woman). The histologic type was SCC in nine cases and adenocarcinoma also in nine cases. All of the laparoscopic procedures were successful; there was no mortality, morbidity, or conversion. There were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 17 (6-46). Cancer treatment was delayed for fourteen out of eighteen patients until after delivery, during an average time of 17 ( 9-28) weeks. Lymph nodes were positive in three cases and these patients received immediate cancer treatment. One patient decided to interrupt the gestation before delivery even with negative nodes. All patients were alive without recurrence at a mean follow-up time of 36 (3-126) months. Eleven patients out of fourteen reached fetal maturity and gave birth by caesarean section to healthy babies, and 3 still are in the course of gestation. Conclusions: We could demonstrate the feasibility and the safety of laparoscopic pelvic lymphadenectomy during pregnancy and no complications neither to mothers nor to infants were observed. We showed that when cervical cancer complicates gestation, a planned delay of oncologic treatment can be considered a safe option after tumor metastasis to lymph nodes has been histopathologically ruled out. No significant financial relationships to disclose.

Das weithin sichtbare Parkhaus gilt mittlerweile als Erkennungszeichen der Neuen Landesmesse Stuttgart und bietet mit einer Gesamtfläche von 125000 m2 4100 Fahrzeugen eine Parkmöglichkeit. Das wesentliche Prinzip der Stahl‐Verbundkonstruktion besteht in einem weitgehend lager‐ und fugenlosen Bauwerk. Die fachwerkartigen Hauptträger mit Spannweiten von knapp 100 m sind dabei in ein räumliches Gesamtsystem ähnlich dem Chassis‐Prinzip im Fahrzeugbau integriert und annähernd biegesteif mit den Hauptstützen verbunden. Dieser Grundgedanke der semi‐integralen Bauweise war für die Stahlverbundbrücken der Messe‐erschließung ebenfalls entwurfsbestimmend. Wiederkehrende Gestaltungselemente vermitteln einen in sich geschlossenen Gesamteindruck der Ingenieurbauwerke für die Verkehrserschließung der neuen Landesmesse.

There is an ongoing debate about whether hard plaques (in particular calcified lesions) are associated with constrictive or expansive remodeling. Previous intravascular ultrasound (IVUS) studies of stenoses with significant lumen narrowing that were targets for percutaneous coronary interventions 1 Mintz G.S. Kent K.M. Pichard A.D. Satler L.F. Popma J.J. Leon M.B. Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses an intravascular ultrasound study. Circulation. 1997; 95: 1791-1798 Crossref PubMed Scopus (304) Google Scholar , 2 Tauth J. Pinnow E. Sullebarger J.T. Basta L. Gursoy S. Lindsay Jr, J. Matar F. Predictors of coronary arterial remodeling patterns in patients with myocardial ischemia. Am J Cardiol. 1996; 80: 1352-1355 Abstract Full Text Full Text PDF Scopus (93) Google Scholar , 3 Weissman N.J. Sheris S.J. Chari R. Mendelsohn F.O. Anderson W.D. Breall J.A. Tanguay J.F. Diver D.J. Intravascular ultrasonic analysis of plaque characteristics associated with coronary artery remodeling. Am J Cardiol. 1999; 84: 37-40 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar , 4 Fuessl R.T. Kranenberg E. Kiausch U. Baer F.M. Sechtem U. Hopp H.W. Vascular remodeling in atherosclerotic coronary arteries is affected by plaque composition. Coron Artery Dis. 2001; 12: 91-97 Crossref PubMed Scopus (31) Google Scholar , 5 Beckman J.A. Ganz J. Creager M.A. Ganz P. Kinlay S. Relationship of clinical presentation and calcification of culprit coronary artery stenosis. Arterioscler Thromb Vasc Biol. 2001; 21: 1618-1622 Crossref PubMed Scopus (183) Google Scholar have shown that hard plaques are typically associated with constrictive remodeling. In contrast, a recent histologic study in atherosclerotic coronary vessels with varying degrees of lumen narrowing suggested otherwise. 6 Burke A.P. Kolodgie F.D. Farb A. Weber D. Virmani R. Morphological predictors of arterial remodeling in coronary atherosclerosis. Circulation. 2002; 105: 297-303 Crossref PubMed Scopus (452) Google Scholar For that reason, we used 3-dimensional IVUS 7 von Birgelen C. de Vrey E.A. Mintz G.S. Nicosia A. Bruining N. Li W. Slager C.J. Roelandt J.R.T.C. Serruys P.W. de Feyter P.J. ECG-gated three-dimensional intravascular ultrasound feasibility and reproducibility of the automated analysis of coronary lumen and atherosclerotic plaque dimensions in humans. Circulation. 1997; 96: 2944-2952 Crossref PubMed Scopus (180) Google Scholar , 8 von Birgelen C. van der Lugt A. Nicosia A. Mintz G.S. Gussenhoven E.J. de Vrey E. Mallus M.T. Roelandt J.R.T.C. Serruys P.W. de Feyter P.J. Computerized assessment of coronary lumen and atherosclerotic plaque dimensions in three-dimensional intravascular ultrasound correlated with histomorphometry. Am J Cardiol. 1996; 78: 1202-1209 Abstract Full Text PDF PubMed Scopus (67) Google Scholar to carefully examine 130 focal coronary plaques with a wide range of lumen narrowings to compare plaque composition and vascular remodeling in vivo.

Die Planung der in unmittelbarer Nähe zum Stuttgarter Flughafen liegenden Neuen Landesmesse Baden‐Württemberg sieht u. a. eine Überbauung der Autobahn und der Neubaustrecke Stuttgart‐Ulm der Deutschen Bahn AG mit einem Parkhaus vor. Mit der verkehrstechnischen Integration der 350 m langen und 90 m breiten, sechsgeschossigen Parkhauskonstruktion innerhalb eines vollwertigen Autobahnanschlusses werden neue Wege bei der Verkehrserschließung beschritten.

The mechanisms of lumen enlargement during stent implantation may be significantly affected by arterial remodeling. To assess effects of lesion remodeling, we performed 3-dimensional intravascular ultrasound (IVUS) analyses in 55 coronary lesions before and after deployment of balloon-expandable stents. Standard quantitative analysis was performed, and arterial remodeling was assessed by the remodeling index (target site divided by mean of proximal and distal reference segment vessel areas), which classified lesions into group A (remodeling index ≤1, negative or intermediate remodeling, n = 40) or group B (remodeling index >1, positive remodeling, n = 15) lesions. Characteristics of the 55 patients and the interventional procedures were similar in the 2 groups. IVUS demonstrated that stenting resulted in increased lumen and vessel dimensions and in a reduced plaque size (p ≤0.001 each) in both group A and group B lesions. The extent of lumen increase inside the stents was almost identical, but resulted from different mechanisms: (1) vessel stretch was greater in group A (p <0.002 at minimum lumen site); (2) plaque compression (or embolization) tended to be greater in group B (p = 0.05, along entire stented segment); (3) plaque redistribution within the stent was observed in both groups (p <0.005 both); and (4) significant (p <0.01) plaque extrusion into the distal reference segment was found in group B only. Thus, the remodeling pattern of coronary lesions has a significant impact on the mechanisms of lumen enlargement during stent deployment. Lesions with positive remodeling show more plaque extrusion into the distal reference and less stent-induced vessel stretch than those with negative remodeling.

Objective: To identify the incidence and clinical significance of myocardial injury following elective stent implantation. Design: Prospective clinical study with 278 consecutive patients undergoing stenting of de novo coronary or saphenous vein graft lesions. Incidence of periprocedural myocardial injury was assessed by analysis of 12 lead ECG, creatine kinase (CK; upper limit of normal (ULN) 70 IU/l for women, 80 IU/l for men), and cardiac troponin T (cTnT; point of care test; threshold 0.1 ng/ml) before and 6, 12, and 24 hours after the intervention. Major adverse cardiac events (MACE: acute myocardial infarction, bypass surgery, and cardiac death) were recorded during clinical follow up (mean (SD) 7.8 (5.3) months). Results: Following elective stenting, the rate of a positive cTnT status was 17.3%, the rate of CK increase of 1–3× ULN 14.7%, the rate of CK increase of > 3× ULN 1.4%, and the rate of Q wave myocardial infarction 0.4%. Cardiac mortality during follow up was higher in patients with postprocedurally increased CK (7.1% v 1.3%, p = 0.01, log rank) and cTnT (9.1% v 0.9%, p < 0.001, log rank). In addition, postprocedurally increased cTnT was associated with a higher overall incidence of MACE (13.1% v 4.0%, p < 0.01, log rank) and was identified as an independent factor for MACE during follow up (hazard ratio 3.27, 95% confidence interval 1.14 to 9.41, p = 0.028). Conclusions: Following elective stent implantation, a positive cTnT status identified patients at risk of a worse long term outcome. Treatment strategies have to be developed that lead to prognostic improvement by reducing periprocedural myocardial injury.

Hintergrund Vorangehende klinische Studien haben die Effektivität einer vor perkutaner Koronarintervention initiierten Glykoprotein-IIb/IIIa-Rezeptor-(GP IIb/IIIa)Inhibitionstherapie zur Reduktion ischämischer Komplikationen aufgezeigt. Für die klinische Effektivität einer erst nach Auftreten interventioneller Komplikationen begonnenen GP-IIb/IIIa-Inhibition („Rescue”-Therapie) liegen vergleichsweise wenige Studiendaten vor. Fragestellung Inzidenz ischämischer Myokardschädigungen bei komplizierter koronarer Intervention mit und ohne „Rescue”-Therapie mit dem GP IIb/IIIa Inhibitor Abciximab. Methoden Fall-Kontroll-Studie mit 66 Patienten mit und ohne „Rescue”-Abciximab-Therapie wegen Dissektion (92,4%), Seitenastverschluss (16,7%), distaler Embolisation (6%) und No-Reflow (15,2%) bei koronarer Stentimplantation. Der Nachweis myokardialer Schädigungen basierte auf der Analyse von EKG, Creatinkinase-Serumaktivität (CK, Norm 70IU/l für Frauen, 80IU/l für Männer) und Troponin-T-Schnelltest (cTnT, Grenzwert 0,1ng/ml) vor sowie 6, 12 und 24 Stunden nach der Koronarintervention. Ergebnisse Die Inzidenz eines positiven post-interventionellen cTnT-Status war in der „Rescue”-Therapiegruppe höher als in der Patientengruppe ohne „Rescue”-Therapie (66,7 versus 30,3%, p<0,01). Im Vergleich zur Kontrollgruppe war die Inzidenz von CK-Erhöhungen (57,6 versus 33,3%, p=0,05) und Q-Wave-Myokardinfarkten (12,1 versus 3,0%, p=0,2) in der Fallgruppe tendentiell höher. No-Reflow war unabhängiger Prädiktor für post-interventionelle CK- (p=0,02) und cTnT-Erhöhung (p=0,03) sowie für das Auftreten eines Q-Wave-Myokardinfarktes (0,01). Mehrfachstentimplantation und „Rescue”-Therapie waren unabhängig mit dem post-interventionellen cTnT-Status assoziiert (p=0,01 und p<0,01). Schlussfolgerung GP-IIb/IIIa-Inhibition mit Abciximab, begonnen im Herzkatheterlabor nach dem Auftreten einer interventionellen, nicht dem akuten thrombotischen Gefäßverschluss entsprechenden Komplikation, vermag es nicht, die Inzidenz und das Ausmaß ischämischer Myokardschädigungen substantiell zu reduzieren.

OBJECTIVES This study was designed to identify potential differences between the intravascular ultrasound (IVUS) characteristics of spontaneously ruptured and nonruptured coronary plaques.BACKGROUND The identification of vulnerable plaques in vivo may allow targeted prevention of acute coronary events and more effective evaluation of novel therapeutic approaches.METHODS Intravascular ultrasound was used to identify 29 ruptured plaques in arteries containing another nonruptured plaque in an adjacent segment. Intravascular ultrasound characteristics of these plaques were compared with plaques of computer-matched controls without evidence of plaque rupture. Plaque distribution was assessed by measuring the eccentricity of lumen location (inside the total vessel). Lumen cross-sectional area narrowing was calculated as [1 - (target/reference lumen area)] x 100%. A remodeling index was calculated as lesion/reference arterial area (>1.05 = compensatory enlargement, <0.95 = shrinkage).RESULTS Among the three groups of plaques, there was no significant difference in quantitative angiographic parameters, IVUS reference dimensions and IVUS lumen cross-sectional area narrowing. There was a difference in plaque distribution; lumen location by IVUS was significantly more eccentric in ruptured than in nonruptured (p = 0.002) and control plaques (p < 0.0001). The are of disease-free vessel wall was larger in ruptured than in control plaques (p < 0.0001). The remodeling pattern of ruptured and nonruptured plaques differed significantly fr om that of the control plaques (p = 0.0001 and 0.003); compensatory enlargement was found in 66%, 48%, and 17%, whereas shrinkage was found in 7%, 10% and 48%, respectively.CONCLUSIONS Intravascular ultrasound assessment of plaque distribution and vascular remodeling may help to classify plaques with the highest probability of spontaneous rupture. (J Am Coll Cardiol 2001;37:1864-70) (C) 2001 by the American College of Cardiology.

BACKGROUND Biochemical markers have been an integrative part of non-invasive diagnostic strategies in cardiology for nearly 50 years, experiencing a renascence by the recently acknowledged prognostic potential of cardiac troponins in acute coronary syndromes. DIAGNOSIS According to the guidelines of the National Academy of Clinical Biochemistry and the International Federation of Clinical Chemistry cardiac troponin T and cardiac troponin I should be considered as the new "gold markers" of ischemic myocardial injury. One characteristic feature of these new markers is the improved diagnostic potential, reflected by the choice of two cut-off values to distinguish minor myocardial injury from acute myocardial infarction. In addition, cardiac troponins allow risk stratification in the clinical setting of acute coronary syndromes: approximately threefold higher mortality rate for patients with rest angina or ST segment elevation and cardiac troponin elevation on admission. Other indications for cardiac marker analysis are monitoring of therapeutic success in case of invasive and non-invasive reperfusion strategies and non-invasive diagnosis of non-ischemic myocardial injury (myocarditis, cardiac contusion and chemotherapy). CONCLUSION Biochemical cardiac markers are a useful tool in the diagnosis of both ischemic and non-ischemic myocardial injury. Among these, cardiac troponins seem to become the gold markers for the new millennium.

Background—Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied. Methods and Results—A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (r =−0.498, P <0.001) and CK outcome (r =−0.406, P =0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (n=19) and 5.6% in patients without (n=36) a postprocedural rCVR <0.78 (P <0.001), associated with a CK elevation >1 times the ULN in 36.8% and 5.6% (P =0.005) of patients, respectively. Conclusions—Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.

The paper deals with investigations concerning potential structures of documents that will be subject to automated information extraction. The focus is on folding principles and their influence on the recognition of certain data in a document undergoing the extraction.