The significance of retrograde menstruation as a risk factor for endometriosis has been confirmed by numerous clinical observations. Integrins mediate both cell-cell and cell-matrix adhesion, and it is therefore suspected that integrins are involved in the development of endometriosis. Using immunohistochemistry, integrin expression in eutopic and ectopic endometrium is examined in endometriosis patients and control individuals. In nearly all cases, the glandular epithelial cells in the endometrium showed expression of alpha (2-), alpha (3)-, alpha (6)- and alpha (v)- integrin and a low percentage of expression of alpha (1)-, alpha (4)-, and alpha (5)-integrin. In comparison with eutopic endometrium, ectopic endometrium shows reduced expression of alpha (2)- and alpha (v)-integrin. Since no differences in alpha (2)- and alpha (v)-integrin expression were observed in eutopic endometrium between endometriosis patients and control individuals, it may be suspected that the reduced expression of these in ectopic endometrium is explained by influences in the altered environment -- e. g., in the peritoneal fluid -- on the ectopic endometrium.
PURPOSE To evaluate the cause and management of paraurethral abscess developing after injection of a mixture of hyaluronic acid and dextranomer (Zuidex) for treating stress urinary incontinence. PATIENTS AND METHOD A total of 127 women having undergone midurethral Zuidex injection and 34 women after endoscopically guided Deflux injection into the tissue around the bladder neck were followed up 1 to 24 months after the intervention. At follow-up, the paraurethral tissue was evaluated clinically by gynecologic examination and by introital ultrasound. RESULTS Thirteen of 127 women (10 %) having undergone midurethral Zuidex injection had a sterile paraurethral abscess that was treated by transvaginal puncture (1 to 3 punctures with removal of 10-60 ml of fluid per patient). No case of postoperative paraurethral abscess formation was demonstrated in the control group treated by Deflux injection into the area around the bladder neck. CONCLUSIONS Paraurethral abscess must be excluded in the postinterventional follow-up of patients after Zuidex injection. Patients in whom an abscess is demonstrated can be treated by transvaginal puncture. Abscess formation can be avoided by injecting dextranomer/hyaluronic acid into the area around the bladder neck.
OBJECTIVE Preeclampsia is associated with significant maternal and fetal morbidity and mortality. The etiology remains unclear. For the accurate diagnosis and the prevention of preeclampsia it seems to be important to find a diagnostic tool that identifies risk patients before symptoms occur. With a new approach, the cDNA-Array analysis, human placentas and blood from preeclamptic and healthy pregnant women were examined for differentially expressed genes to find typical genes expression profiles. MATERIAL AND METHODS In this pilot study, cDNA array analysis with a 19 200 gene array of placenta and blood samples from three preeclamptic patients have been performed to classify this samples based on expression patterns. RESULTS Comparing normal placenta and blood from healthy delivered women (n = 4), a subset of 200 genes repeatedly found to be differentially expressed in preeclampsia. The placenta and blood samples from preeclampsia were accurately grouped by their individual gene expression patterns. CONCLUSIONS These results suggest that the use of cDNA array is a tool to identify gene expression patterns in preeclampsia. With this set of differentially expressed genes in conjunction with sample clustering algorithms the identification of preeclampsia in placenta or blood samples is possible.
The Task Force Group "Uterus of the Association of Gynecologic Oncology" has recently published the interdisciplinary S2 guidelines on diagnostics and therapy of cervical cancer. In view of quality development strategies of the German Cancer Society and the German Society for Obstetrics and Gynecology, a practicable concept with clear algorithms for gynecologists has been presented. Nevertheless, both development of oncologic sciences and daily practice, lead to new questions which should be answered by prospective studies. In this respect, women with cervical cancer should be treated on the same level of quality as patients with breast cancer. As discussed both nationally and internationally, laparoscopic staging, the development of laparoscopic surgical techniques (i. e., laparoscopic-assisted radical vaginal hysterectomy), the safety and efficacy of the sentinel concept, and TMMR, and finally, the indication for trachelectomy are main scientific questions. Also, innovative vaccination studies that might increase hope of a breakthrough even in cervical cancer prevention, the implementation of nerve-sparing surgical techniques, the radical parametrectomy or current strategies on exenteration are main focuses of clinical gynecologic oncology.
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.
INTRODUCTION Antibiotic prophylaxis is a standard procedure in obstetric surgery and has been discussed in various investigations. Use of treatment is judged by high efficacy and good tolerance. METHOD In 300 patients undergoing cesarean sections we compared results of application of Piperacillin 4 g and Piperacillin/Tazobactam 4.5 g after cut of umbilical cord. Tazobactam/Piperacillin is a combination of a broad-spectrum penicillin and a beta-lactamase inhibitor with increased toxicity against staph. aureus, enterobacter, and other germs responsible for local and systemic infections in obstetric surgery. RESULTS We did not observe any severe adverse effects. Rate of severe wound infections was 1.3 % (Tazobactam/Piperacillin) and 2 % (Piperacillin alone). The difference showed no statistic significance (p > 0.01). During postoperative course we found a higher increase of CRP (p < 0.01) in the Piperacillin group. CRP proved to be a useful objective parameter to distinguish between patients with or without postoperative infections. No differences were found in the number of leucocytes, time in hospital and other parameters.
Albert Döderlein and his son Gustav had as professors in Munich and Jena a formative influence on the German gynecology in the first half of the 20(th) century. Albert Döderlein discovered the lactobacillus named after him and its function, he was one of the first who employed radiotherapeutics in cancer therapy and introduced the rubber glove in obstetrics and gynecology. But he also wrote the gynecologic text to the "Bill for prevention of progeny suffering from an inherited disease dated 14(th) June 1933". After his time at the university hospital Charité, between 1936 and 1945 he was medical superintendent of the department of gynecology and obstetrics at the Police Hospital in Berlin. He can be regarded as the founder of antenatal care in Germany. Both scientific and historic aspects of the biographies of these two professors are critically looked right past.
OBJECTIVE Cervical cancer screening guidelines stated recently that the screening interval of healthy women can be extended up to 3 years. Can those recommendations be applied for high risk populations? MATERIAL AND METHODS In a prospective setting 305 HIV-positive women have been enrolled in this analysis between September 2000 and December 2003. Patients have been characterized according to HPV (human papilloma virus) prevalence, CIN (cervical intraepithelial neoplasia) incidence and CD4 cell count. RESULTS 41 % of all HIV-positive women were HPV positive (oncogene subtypes). In patients with diminished CD4 cells the HPV prevalence increased to 60 % (54/90). CIN was found in 27 % (83/305) women. CIN was more frequent by HPV-positive women with a CD4 cell count < 200 mm (3) (52 %, 38/72). The CIN incidence was also high in HIV-positive women with negative HPV infection and diminished CD4 cell count (39 %, 7/18 vs.7 %, 11/161). CONCLUSIONS The current cervical cancer screening guidelines are not helpful in HIV-positive women. The CIN incidence is significantly higher as in the HIV-positive population. For this reason this high risk population as e. g. HIV-infected women need an intensive care of diagnostic tools and short screening intervals to detect CIN.
In the field of gynecologic oncology, the beginning of the 20(th) century was dominated by a dispute between Wertheim and Schauta over the best surgical approach for cervical cancer in general, and the role of lymphonodectomy in particular. Since that time, important progress has been made with respect to diagnosis and therapy. This refers a) to the inclusion of patients with malignant diseases into clinical studies with the subsequent design and development of evidence based therapy strategies and b) on the important role of endoscopic techniques in gynecologic oncology. Some of the controversies of the "Wertheim/Schauta" era such as the "lymph node problem" are not fully resolved to date. The future will be most likely not based on diagnosis and therapy of cervical cancer, but on primary prevention with the introduction of a potent vaccination against HPV, which will be commercially available soon.
Surgical therapy is the mainstay of the treatment of endometrial cancer. Apart from total abdominal hysterectomy und bilateral salpingo-oophorectomy, complete pelvic and paraaortic lymphadenectomy has become an integral part of the primary surgical procedure, allowing for definite surgical/histopathological staging. In surgically staged patients, adjuvant measures including external radiotherapy can be applied with a clear indication and unnecessary toxicity can be avoided. In addition complete lymphadenectomy has probably a relevant therapeutic effect. As so far no randomized trials have been completed and lymphadenectomy in the often multi-morbid and obese endometrial cancer patients requires a certain amount of expertise, it is not accepted by all experts or is accepted only if a variety of parameters obtained pre- and intraoperatively are present. On the other hand, the National Comprehensive Cancer Network of the USA recommends a complete pelvic and paraaortic lymphadenectomy for all patients with endometrial cancer, except for those with Stage IA, Grade 1 disease where this procedure is optional. The efficacy of an adjuvant pelvic teletherapy in Stage I patients has been questioned by several randomized trials. In patients having a complete surgical staging, external radiotherapy is often not necessary and can be replaced by vaginal brachytherapy. In advanced stages of endometrial cancer chemotherapy has been shown to be superior to whole abdominal radiotherapy. New multimodal concepts including surgical staging, adjuvant chemo- and targeted radiotherapy have to be evaluated. In the palliative setting novel endocrine strategies are being assessed in addition to the well established progestagen therapy. The efficacy of the standard chemotherapy with adriamycin/cisplatin could be somewhat improved by adding paclitaxel, at the expense of a markedly increased toxicity. Women with the diagnosis of endometrial cancer should be treated in the context of certified clinical trials as it has become the standard for patients with breast or ovarian cancer.
Pregnancy, leading to new life, on one hand, and life threatening malignancies an the other hand, are per se diametric subjects. Symptoms of malignancies are ignored more frequently during pregnancy by patients and physicians, often resulting in delayed diagnosis. Diagnosis and treatment of gynaecological malignancies, however, are increasingly important for four reasons: the peak incidence of several malignancies occurs during the reproductive age; late pregnancies present more often in an age group with increased risk for cancer, intensified care for pregnant women leads to more thorough diagnosis, and, curative treatment of malignancies gives women the potential chance for becoming pregnant. For these reasons, special features of the diagnosis and treatment of gynaecological malignancies will regularly part of routine patient care. This review article covers certain practice related features of gynaecological malignancies.
OBJECTIVE It is not always possible to clearly differentiate the symptoms of overactive bladder and interstitial cystitis. A prospective randomized study was performed to determine whether instillation of sodium chondroitin sulphate for treatment of interstitial cystitis is also effective in treating overactive bladder. The expected benefit of this therapeutic approach in overactive bladder is based on the assumption that the glycosaminoglycan layer may be damaged in overactive bladder as well. MATERIAL AND METHODS Patients with chronic overactive bladder were randomized to one of two study groups each including 41 patients. Group A was treated with an anticholinergic agent (tolterodine), group B with sodium chondroitin sulphate (Uropol S). The diagnosis was established on the basis of a gynecologic examination and history, urodynamic testing, introital ultrasound, and cystoscopy. Patients were treated for 12 months. RESULTS An improvement of symptoms was reported by 15/35 (43 %) of the patients in group A (p = 0.000) as compared with 23/32 (72 %) of the patients in group B. The subjective outcome was corroborated by means of urodynamic testing, number of pads used, voiding frequency, and nycturia (voiding diary). Quality of life increased significantly in both groups in the course of treatment but there was no significant difference between both groups. CONCLUSION The results of the study presented here suggest that restoring the glycosaminoglycan layer also improves or cures the symptoms in patients with overactive bladder. Patients clearly benefit from instillation of sodium chondroitin sulphate. These results must be confirmed in larger studies before a wider use of this therapeutic option can be recommended.
We report on a 26-year old female patient with thoracic pain and dyspnea, in whom a large tumorous mass in the anterior medias-tinum with a pleural effusion was diagnosed by computed tomography and magnetic resonance imaging. After rapid progression of tumor growth and detection of malignant cells within the pleural effusion operative intervention including resection of the tumor was performed. Histologic examination of the tumor revealed the typical morphology of a large mediastinal choriocarcinoma. The excessively high hCG-levels returned to normal values post-operatively. A thorough history making revealed an ectopic pregnancy which had made unilateral salpingectomy necessary. Although primary histologic examination of the tubari-an tissue had shown no malignancy, a secondary look revealed a choriocarcinoma with identical histological features compared to the mediastinal tumor. Thus, final diagnosis of a mediastinal metastasis of a tubarian choriocarcinoma
Prävention und Vorsorge: Mammakarzinom: Prostatakarzinom: Kolorektale Karzinome: Breast cancer (BC): Prostate cancer (PC): Colorectal cancer (CC):
BACKGROUND Bone metastases belong to the most frequent metastases in breast cancer. Currently there exist no serum markers which allow early detection of bone metastases. PATIENTS AND METHODS 89 patients with primary breast cancer have been investigated for parathyroid-hormone-related peptide (PTHrP) in the tumour and bone sialoprotein (BSP) in the serum. Both markers have been correlated with classical prognostic factors and survival. RESULTS The median age of the patients was 56 years. 17 of the 89 patients developed bone metastases and 25 died during the observation period of 5 years. PTHrP correlated significantly with bone metastases free survival (p = 0.0004) and overall survival (p = 0.0005), whereas BSP correlated only with the bone metastases free survival (p = 0.03). Both markers were shown to be independent prognostic factors for the bone metastases free survival in the multivariate analysis. PTHrP was also found to be an independent prognostic factor for the overall survival. CONCLUSION The investigation of PTHrP could be a prognostic marker for the presence of bone metastases while BSP could be a marker for the early detection of bone metastases.
: Medicine, and so within also gynecology and obstetrics is shaped in the process of the last decade by changes of interaction between female-patient and physician in "Arbeitszeitgesetz" (law upon daily working time), the introduction of payment-system an case by case based lump-sums and intrusion (interference) of the political administration into autonomy of medical faculties. The contribution concerns with these prevailing economical required changes, interacting and beyond inter-disciplinarity. The progress in medicine by research is causing potential capacity and secondary costs explosion. Including financing of health service and decisive determinants: the demographic development of society, the change in working sphere and particularly law-dominated prenatal-medicine. This, future of medicine determining political, ethical and legal challenge must be accepted by medical professions. Solutions are pointed out.
