Die Anwendung von Komplementärer Medizin kann Nebenwirkungen von modernen onkologischen Therapien lindern, Symptome der Krebserkrankung selbst reduzieren [1] und die Lebensqualität von Mammakarzinompatientinnen verbessern [2] [3]. Allerdings sind komplementäre Therapieverfahren in der Regel sehr heterogen und nicht routinemäßig in die alltägliche klinische Patientinnenversorgung integriert [4] [5]. Ziel dieser Studie war es daher, die Verbesserungen der Nebenwirkungen, des Managements und der Lebensqualität im Zusammenhang mit der Integrativen Medizin in der modernen Versorgung von Mammakarzinompatientinnen zu untersuchen.

INTRODUCTION:Endometriosis is a heterogeneous disease characterized by a range of different presentations. It is usually diagnosed when patients present with pain and/or infertility, but it has also been diagnosed in asymptomatic patients. Because of the different diagnostic approaches and diverse therapies, time to diagnosis can vary considerably and the definitive diagnosis may be delayed, with some cases not being diagnosed for several years. Endometriosis patients have many unmet needs. A systematic registration and follow-up of endometriosis patients could be useful to obtain an insight into the course of the disease. The validation of biomarkers could contribute to the development of diagnostic and predictive tests which could help select patients for surgical assessment earlier and offer better predictions about patients who might benefit from medical, surgical or other interventions. The aim is also to obtain a better understanding of the etiology, pathogenesis and progression of the disease.MATERIAL AND METHODS:To do this, an online multicenter documentation system was introduced to facilitate the establishment of a prospective multicenter case-control study, the IEEP (International Endometriosis Evaluation Program) study. We report here on the first 696 patients with endometriosis included in the program between June 2013 and June 2015.RESULTS:A documentation system was created, and the structure and course of the study were mapped out with regard to data collection and the collection of biomaterials.CONCLUSION:The documentation system permits the history and clinical data of patients with endometriosis to be recorded. The IEEP combines this information with biomaterials and uses it for scientific studies. The recorded data can also be used to evaluate clinical quality control measures such as the certification parameters used by the EEL (European Endometriosis League) to assess certified endometriosis centers.

Die Anwendung von integrativer Medizin erfreut sich bei Anwendern und Ärzten zunehmender Beliebtheit. Aktuell nutzen 38–60 % aller Krebspatienten in den westlichen Industrieländern komplementäre und alternative Medizin (CAM) im Krankheitsverlauf zur Therapieunterstützung. Beim Mammakarzinom sind es stadiumabhängig sogar bis zu 90 %.

Zielsetzung: Die Anwendung integrativer Heilmethoden in der gynäkologischen Onkologie ist weit verbreitet. Um eine qualitätsgesicherte Behandlung von Patientinnen in der integrativen Medizin (IMed) zu ermöglichen, ist es notwendig, systematisch Informationen über die Anwendung konventioneller und integrativer Therapieverfahren, Symptome und individuelle Patientenwünsche im Sinne einer ganzheitlichen Betrachtung zu erheben.

Aim: The combination of mechanical and drug procedures for the induction of labour seems to be beneficial. Accordingly, the normal procedure in clinical routine has been changed and induction of labour by means of a balloon catheter has been implemented. The aim of this study was to find out if this procedural change has resulted in a more effective induction of labour.Materials and Method: In this historical cohort study 230 inductions of labour at term in the year 2012 were compared with 291 inductions of labour in the year 2013, all at the University of Erlangen Perinatal Centre. Exclusion criteria were, among others, a multiple pregnancy, a premature rupture of membranes and a prior Caesarean section. In 2012 births were induced solely by use of the drugs dinoprostone and misoprostol, in 2013 not only with misoprostol but also mainly by use of a balloon catheter. The primary target parameter was the rate of failed labour inductions, defined as "no birth within 72 hours".Results: Altogether 521 inductions of labour were analysed. The rate of failed inductions of labour could be reduced by the changes in induction method (first-time mothers: 23 vs. 9%, p = 0.0059; multiparous women: 10 vs. 1%, p = 0.0204). Furthermore, the rate of primary Caesarean sections due to failed induction of labour (5.7 vs. 1.4%, p = 0.0064), that of the observation of green amniotic fluid (first-time mothers: 23 vs. 9%, p = 0.0059; multiparous women: 10 vs. 1%, p = 0.0204) and of infantile infections (first-time mothers: 23 vs. 9%, p = 0.0059; multiparous women: 10 vs. 1%, p = 0.0204) were all reduced as well.Conclusion: The routine use of a balloon catheter for induction of labour has markedly improved the procedure. There were fewer failed labour inductions and fewer Caesarean sections due to failed induction of labour.

Endometriose betrifft 4 – 30% der Frauen im reproduktionsfähigen Alter und ist damit eine der häufigsten benignen gynäkologischen Erkrankungen. Die konventionelle Therapie umfasst die Operation, die medikamentöse hormonelle und analgetische Therapie.

Question: Ulipristalacetate (UPA) has been previously demonstrated to inhibit the estradiol and progesterone induced proliferative response of normal endometrial cells in culture. We predicted that UPA would inhibit proliferation of endometriosis cells.

Background: Xenografting of human ovarian tissue into mice has proved to be a useful model for examining ovarian function and follicle development in vivo. Moreover, with human follicles that have matured through xenografting, the possibility of cancer transmission and relapse can be eliminated, as cancer cells are not able to penetrate the zona pellucida. However it is speculated that ovarian xenotransplantation could be used for the production of fertilisable oocytes.

Background: The aim of this study was to evaluate how many embryos will develop if more than 3 2-pronuclei-stage oocytes (2-PNOs) are cultured at the patient's request and in accordance with the Germany Embryo Protection Law. Methods: A total of 106 cycles of patients undergoing their 1st, 2nd or 3rd cycle of IVF or ICSI treatment in 2010 were prospectively included in the study. In each individual case, a decision was taken prior to treatment about the number of 2-PNOs to be cultured after each cycle. Results: Ninety female patients were treated for a total of 106 cycles. A mean of two to six 2-PNOs were cultivated for a period of between 3 and 6 days for each patient. After culture, no viable embryo was identified for 5 patients (4.7 %), a single viable embryo was identified for 37 cycles (34.7 %), and 2 viable embryos were identified for 52 cycles (48.8 %). Eleven patients (10.3 %) had 3 viable embryos after a further 11 cycles and 1 patient had 4 viable embryos in a single cycle. Ten of the patients with 3 embryos each opted to have all 3 embryos transferred in the same cycle. This meant that a single embryo from one patient with 3 viable embryos and a single embryo of the patient with 4 viable embryos were cryopreserved after culture. The pregnancy rate was 19 % per embryo transfer and 25 % per blastocyst transfer (20 pregnancies in total). All cryopreserved embryos were transferred in a subsequent cycle. Discussion: Based on this study it is possible to make a statement about the number of viable embryos which should be cultivated to obtain, at best, two embryos for transfer without running an unacceptably high risk of producing too many embryos which would then need to be cryopreserved. Only 12 patients (13.3 %) had more than 2 viable embryos. The number of supernumerary pre-implantation-stage embryos was acceptably low (only 2 patients had additional viable embryos, 2.2 %). This means that it is possible to fulfil the wishes of individual patients while complying with the German Embryo Protection Law.

Einleitung: Zur Geburtseinleitung werden traditionsgemäß medikamentöse Verfahren wie Oxytocin, Prostaglandin E2 (Dinoproston) und das synthetische Prostaglandin E1-Analogon Misoprostol verwendet. Die international etablierte mechanische Geburtseinleitung mit Ballonkathetern findet in den letzten Jahren zunehmend auch in Deutschland Einzug. Insbesondere die Kombination mechanischer und medikamentöser Verfahren zeigt eine bessere Effektivität der Geburtseinleitung. Aufgrund dieser Erkenntnisse wurde das bisherige Regime der Geburtseinleitung an der Frauenklinik des Universitätsklinikums Erlangen geändert. Das Ziel dieser Studie war es herauszufinden, ob diese Änderung zu einer effektiveren Geburtseinleitung geführt hat.

Fragestellung: Ein Kind bekommen zu können ist integraler Bestandteil der Lebensplanung. Daher ist es wichtig die Fertilität bei gonadotoxischer Therapie zu erhalten. Bei Frauen gilt die Kryokonservierung von Ovarialgewebe als eine der vielversprechendsten Methoden.

Hintergrund: Endometrioseherde können an multiplen Lokalisationen auftreten. Peritoneale, ovarielle und tiefinfiltrierende Läsionen kommen vor. Operationsindikationen können Schmerzen, eine Sterilität oder beides sein. Die Frage, ob die Lokalisation der Endometrioseläsionen mit der Operationsindikation korreliert, soll die vorliegende Arbeit klären.

Aggressive medikamentöse Therapien und Radiotherapie führen häufig zu Infertilität. In den vergangenen Jahren wurden deshalb Strategien zur Fertilitätsprotektion entwickelt. Dazu gehören die Kryokonservierung von unbefruchteten Eizellen und die Kryokonservierung von Ovarialgewebe. Die Kryokonservierung von unbefruchteten Eizellen ist technisch schwieriger als die von Embryonen, hat aber für jüngere Patientinnen den Vorteil, dass zum Zeitpunkt der Eizellentnahme kein männlicher Partner benötigt wird. Neuere Studien zeigen, dass zur Konservierung der unbefruchteten Eizellen die Methode der Vitrifikation der des langsamen Einfrierens vorzuziehen ist. Eine größere Anzahl von Eizellen kann jedoch erst nach Stimulationstherapie gewonnen werden, was eine Verschiebung der Therapie bedingt. Zudem ist die Methode nicht für präpubertäre Mädchen geeignet. Dabei und um eine Verschiebung der Chemotherapie zu vermeiden bietet sich die Kryokonservierung von Ovarialgewebe an. Dies ist technisch gut durchführbar und erfolgreich, was die ersten Geburten von Kindern in Deutschland 2011/2012 nach Anwendung der Methode belegen. Auch bei der Gefahr der Kontamination des Gewebes mit Krebszellen, die eine Retransplantation verbietet, ist die Kryokonservierung des Ovarialgewebes sinnvoll, da die Entwicklung innovativer Methoden zur In-vitro-Reifung sehr wahrscheinlich ist, sodass künftig auch diesen Frauen zu einem eigenen Kind verholfen werden kann.

Endometriosis is one of the most common benign diseases of the mature woman. In spite of characteristic symptoms like dysmenorrhea-often in combination with accompanying symptoms such as chronic pelvic pain, dyschezia, dysuria and dyspareunia-it still takes too long for the correct diagnosis to be made. Simple methods like rectovaginal exam are indicative. Laparoscopy to confirm the diagnosis should be sought at an early stage. Postoperative recurrence prevention can-if there is no desire for children-make sense. In recurrent endometriosis, therapy must be individually made in consensus with the patient to find the optimal treatment plan. Besides recurrence operations, pharmacological treatment is often used. In addition to pain medications, progestins, oral contraceptives in long-cycle and gonadotropin-releasing hormone (GnRH) analogues are used.