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Hamburg, Germany

Vaginal bleeding and/or pain during early pregnancy are a diagnostic challenge in order to define the integrity and localization of the pregnancy. The combination of serial human chorionic gonadotropin beta (HCG beta) testing and vaginal sonography enables the early discrimination between an ongoing pregnancy, an abortion and an ectopic pregnancy. These diagnostic tools have provided a significant reduction of mortality in cases of ectopic pregnancy. The currently available diagnostic measures allow selection of the optimal individual treatment including the options of watchful waiting, expectant management, surgical intervention and medicinal therapy. Besides the excellent diagnostic and therapeutic possibilities, the psychological strain in women with early pregnancy loss also has to be taken into account. © 2015, Springer-Verlag Berlin Heidelberg. Source

The "painful vulva" is a rather common and important gynaecological entity. In spite of the fact that a comprehensive history and clinical examination using the colposcope will lead to a correct diagnosis in practice this problem remains underdiagnosed. A broad spectrum of medical and alternative treatment methods is available for the management of generalized vulvodynia. Localized and provoked vulvodynia or vulvar vestibulitis syndrome usually asks for a different approach. Whereas medical treatment is rarely successful surgical excision and careful reconstruction of the area involved will most often solve the problem. Source

Salmen J.,Heinrich Heine University Dusseldorf | Banys-Paluchowski M.,Frauenklinik | Fehm T.,Heinrich Heine University Dusseldorf
Geburtshilfe und Frauenheilkunde

Bisphosphonates and denosumab are well established components of the therapy for osteoporosis and osseous metastases. Their relevance in the adjuvant situation for breast cancer patients is being discussed in part controversially due to the heterogeneous nature of the available data. In particular, it appears that post-menopausal women benefit from an adjuvant therapy with bisphosphonates. In the present contribution we discuss the clinical relevance of osteoprotective therapy in the metastatic and adjuvant settings. Above all the current AGO guidelines on osteo-oncology and bone health have been taken into consideration for recommendations to implement the available data. © 2015 Georg Thieme Verlag KG Stuttgart New York. Source

Juhasz-Boss I.,Universitatsklinikum des Saarlandes | Mallmann P.,Frauenklinik | Moller C.P.,Tagesklinik Altonaer Strasse | Solomayer E.F.,Universitatsklinikum des Saarlandes
Geburtshilfe und Frauenheilkunde

Introduction: Endoscopy has begun to play an increasingly important role in the surgical therapy of uterine cancers. To date, there is no data on the use of laparoscopy to treat endometrial cancer (EC) and cervical cancer (CC). Method: A Germany-wide, anonymised survey was done of all gynaecological clinics/endoscopy clinics, using a standardised questionnaire. Results: A total of 128 clinics responded: 16 university clinics (12.5 %), 30 hospitals offering maximum care (23.4 %), 66 general hospitals (51.5 %), 5 outpatient clinics (3,9 %), 4 physicians in private practice affiliated to hospitals (3.1 %) and 7 hospitals (5.4 %) which did not indicate status. Laparoscopy was used in the treatment of 82 % of all EC and 54 % of CC. Surgery for EC was done completely laparoscopically in 58 % of cases and with laparoscopic assistance using a vaginal approach in 32 % of cases. If lymphadenectomy (LNE) was additionally performed, this was done abdominally in 42 % of cases and laparoscopically in 53 %. Cervical cancer was treated by laparoscopic radical hysterectomy (HE) in 44 % of cases and by radical HE using a vaginal approach in 14 %. 4 % of hospitals reported the use of other endoscopic methods (e.g. DaVinci). While the majority of hospitals (43.3 %) treated more than 75 % of EC patients using laparoscopy, in many clinics (38.3 %) less than 25 % of CC patients were treated using endoscopy. Discussion: Laparoscopy is used more often in EC surgery as compared to surgery for CC. However, there are still major differences between hospitals with regard to case numbers, the number of uterine cancers treated using endoscopic surgery, and the type of endoscopic surgery. © Georg Thieme Verlag KG Stuttgart · New York. Source

Endometrial cancer is the most common genital malignant tumor in women in industrial countries. The typical symptoms are postmenopausal bleeding or metrorrhagia. Following anamneses, clinical examination and transvaginal sonography, histological confirmation is obtained by dilation and curettage. Hysterectomy, bilateral salpingo-oophorectomy and according to tumor stage pelvic and paraaortic lymphadenectomy are the mainstay of surgical treatment that is performed more and more often by laparoscopy. Adjuvant pelvic external beam radiation or vaginal brachytherapie are added if indicated. In certain situations adjuvant chemotherapy is necessary. Follow-up by clinical examination and transvaginal sonography are reasonable for the first few postoperative years. © 2011 by Verlag Hans Huber, Hogrefe AG, Bern. Source

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