Premenopausal women carrying a BRCA1 or BRCA2 mutation are frequently advised to undergo risk-reducing bilateral salpingo-oophorectomy (BSO) to lower their significantly increased lifetime risk of ovarian cancer. However, this procedure induces abrupt estrogen deprivation, resulting in premature menopause with well-documented consequences including vasomotor symptoms (e.g., hot flashes, night sweats), urogenital atrophy, and long-term risks such as osteoporosis, cardiovascular disease, and cognitive decline (Nelson in Lancet 371(9614):760–770, 2008; Shuster et al. in Maturitas 65(2):161–166, 2010). To alleviate symptoms and prevent sequelae, hormone replacement therapy (HRT) remains the most effective intervention. However, the issue becomes complex when the patient has a personal history of triple-negative breast cancer (TNBC). Although TNBC lacks hormone receptor expression, systemic HRT has traditionally been contraindicated in breast cancer survivors, as early studies indicated an increased risk of recurrence with hormone therapy, even in receptor-negative subtypes (Kenemans et al. Lancet Oncol 10(2):135–146, 2009a). This leads to a critical question: Is HRT appropriate in BRCA mutation carriers with a history of TNBC following BSO, and if so, under what clinical conditions? What do current international guidelines, evidence, and expert recommendations suggest?
Ziel Offizielle Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (ÖGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Die Schulterdystokie ist eine seltene, aber gefürchtete Komplikation bei der Geburt mit potenziell weitreichenden medizinischen Konsequenzen für Mutter und Kind. Ziel dieser Leitlinie ist es, die Prozesse zur individuellen Lösung der Schulterdystokie zu standardisieren, innerhalb derer das geburtshilfliche Handeln dem derzeitigen Stand der Wissenschaft und der aktuellen klinischen Praxis entspricht. Insbesondere soll unterstrichen werden, dass das Ereignis Schulterdystokie und die damit verbundenen Komplikationen – auch bei noch so guter medizinischer Betreuung – nicht vollständig vermeidbar bzw. beherrschbar sind. Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag des Leitlinienprogramms der DGGG, OEGGG und SGGG entwickelt. Empfehlungen Die Leitlinie gibt Empfehlungen zu Definition und Diagnosestellung, Epidemiologie, Risikofaktoren und Prävention, Logistik, Maßnahmen bei Schulterdystokie inkl. eines Handlungsalgorithmus, Komplikationen, Dokumentation, Debriefing und forensischen Aspekten, Schulung, Training und Simulation sowie der Nachbesprechung der Schulterdystokie.
BACKGROUND:The Breast Cancer LocatorTM (BCL) has been demonstrated to be a safe and effective guidance system for breast-conserving surgery (BCS) in patients with palpable breast cancer, but its effectiveness in patients with nonpalpable breast cancer has not been evaluated. PATIENTS AND METHODS:Supine magnetic resonance imaging (MRI) images were used to generate (1) an interactive three-dimensional (3D) virtual image of the tumor in the breast and (2) a plastic bra-like form (BCL) that enabled the surgeon to place wires that bracketed the tumor volume. The primary objective was to determine the proportion of patients undergoing margin negative resections. RESULTS:A total of 35 subjects were enrolled at 5 sites by 9 surgeons. In the 33 patients treated per protocol, 31 had margin negative resections (94%). All 31 patients with negative margins had negative margins on the primary lumpectomy specimen resected with BCL guidance. Additional shave margins were taken in 4 of the 31 patients; no cancer was present in the shaves. A total of 25 patients had invasive ductal carcinoma, 7 invasive lobular carcinoma, and 3 ductal carcinoma en situ (DCIS). The mean tumor diameter was 3.1 cm and specimen volume was 56 ml. The median actual/targeted specimen volume ratio was 1.18. There was no significant difference in preop versus postop Breast-Q scores: 66.5 versus 64.0, p = 0.58. Surgeons judged the BCL guidance system to be easy to use in 91% of cases. CONCLUSIONS:The BCL guidance system enabled surgeons to do precise BCS: margin negative resections were obtained in a high proportion of cases, resected specimen volumes were relatively low, and patients' satisfaction with their breasts was not adversely effected by surgery.
To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR). 295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses. The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6 https://drks.de/search/de/trial/DRKS00034493 .
Background: Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common female pelvic neoplasms globally. Treatments may be invasive, such as hysterectomy and myomectomy, non-invasive, such as medical therapy or focused ultrasound, or minimally invasive, such as transcervical radiofrequency ablation (TFA). To date, more than 12,000 women have been treated worldwide using TFA with the Sonata® System. Case Presentation: We present the first case report of TFA on a presumptive fibroid that was initially reclassified as a STUMP (smooth muscle tumor of uncertain malignant potential) and, after additional surgical treatment, leiomyosarcoma. Conclusion: This case highlights that, while uterine sarcoma is rare, inadvertent treatment may still result due to a lack of reliable diagnostic modalities. Nonetheless, TFA with the Sonata System represents a minimally invasive option that might not alter the prognosis of an undiagnosed uterine sarcoma as this treatment is not intraperitoneal and does not resect/morcellate tissue.
