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Introduction Cervical cancer screening programs all over the world are being radically revised; preventive screening is increasingly based on detecting infection with human papillomavirus (HPV). This change was driven by large international studies (comparing cytological and HPV-based screening), which were then summarized in systematic reviews or HTA reports. We carried out a systematic comparison of these meta-analyses, comparing their contents, quality, results and recommendations. Material and Methods A systematic search in MEDLINE identified eight meta-analyses. Seven more papers were also included in our analysis. The quality of these publications was reviewed using the AMSTAR criteria and presented in tabular form. Results There were significant differences with regard to the primary studies included in the meta-analyses, the quality of the meta-analyses, the endpoints, and the outcomes and recommendations based on these endpoints. Conclusion Different meta-analyses on the same or similar issues sometimes came to quite different conclusions because they used different approaches. This is quite significant because the underlying primary data did not change. The data indicated that HPV-based screening was superior. The heterogeneity of the meta-analyses affects the decisions taken by policymakers in the healthcare system. © Georg Thieme Verlag KG Stuttgart New York.


Felberbaum R.E.,Klinik fur Frauenheilkunde und Geburtshilfe
Gynakologische Endokrinologie | Year: 2017

Background: Morbid obesity is increasing epidemically in all countries of the Western world. In the United States, the incidence of obesity among women in reproductive age has increased by up to 70% since 1991. Objectives: The causes and epidemiological data of obesity are briefly summarized. The effects of obesity on the obstetric situation and in particular on the surgical management of cesarean sections are described. Results: The epidemiological developments have an important impact on the obstetric situation—also in Germany. While the obesity of the mother influences the health of born child with a life-long compromise of their metabolic situation, it also has a direct influence on the obstetric management in the delivery room. Morbid adipose pregnant women with a BMI >30 kg/m2 show a markedly increased risk of gestational diabetes, pregnancy-induced hypertonus, preeclampsia, fetal macrosomia, fetal malformations, protracted opening periods, surgical vaginal deliveries, shoulder dystocia, emergency cesarean section, postpartum increased blood loss, thrombosis and thromboembolism, and also of maternal death. The incidence of cesarean section in extremely obese pregnant women is 48%. Conclusion: Obstetric departments must develop an “obesity strategy” to avoid fatal outcomes. This includes the planned, elective cesarean section. However, this is also challenging and difficult, both technically and postoperatively. © 2017 Springer Medizin Verlag GmbH


Kuhn T.,Klinik fur Frauenheilkunde und Geburtshilfe
Breast Care | Year: 2011

The role of axillary surgery for the treatment of primary breast cancer is in a process of constant change. During the last decade, axillary dissection with removal of at least 10 lymph nodes (ALD) was replaced by sentinel lymph node biopsy (SLNB) as a staging procedure. Since then, the indication for SLNB rapidly expanded. Today's surgical strategies aim to minimize the rate of patients with a negative axillary status who undergo ALD. For some subgroups of patients, the indication for SLNB (e.g. multicentric disease, large tumors) or its implication for treatment planning (micrometastatic involvement, neoadjuvant chemotherapy) is being discussed. Although the indication for ALD is almost entirely restricted to patients with positive axillary lymph nodes today, the therapeutic effect of completion ALD is more and more questioned. On the other hand, the diagnostic value of ALD in node-positive patients is discussed. This article reflects today's standards in axillary surgery and discusses open issues on the diagnostic and therapeutic role of SLNB and ALD in the treatment of early breast cancer. Copyright © 2011 S. Karger AG, Basel.


Ledig S.,University of Munster | Schippert C.,Klinik fur Frauenheilkunde und Geburtshilfe | Strick R.,Universitatsklinikum | Beckmann M.W.,Universitatsklinikum | And 2 more authors.
Fertility and Sterility | Year: 2011

Objective: To identify genetic causes of Mayer-Rokitansky-Küster- Hauser (MRKH) syndrome. Design: Prospective laboratory study. Setting: University hospital. Patient(s): Fifty-six patients with MRKH syndrome. Intervention(s): Identification of microdeletions and -duplications in a group of 48 MRKH patients by array-CGH. Results obtained by array-CGH were confirmed by RT-qPCR. Sequential analysis of two candidate genes LHX1 and HNF1B in a group of 56 MRKH patients. Main Outcome Measure(s): Identification of chromosomal regions and genes (recurrent and private) associated with MRKH syndrome. Result(s): We could delineate three definitively relevant regions (1q21.1, 17q12, and 22q11.21) and suggest that LHX1 und HNF1B are candidate genes for MRKH syndrome, because we identified recurrent deletions affecting these genes and a possible causative missense mutation in LHX1. Conclusion(s): Our findings suggest that different chromosomal regions are associated with MRKH syndrome. Copyright © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc.


Pelvic inflammatory disease (PID) in general and salpingitis in particular are caused by a broad spectrum of bacteria dominated by Chlamydia trachomatis. Laparoscopy is considered the scientific gold standard for diagnosing as well as for collecting relevant microbiological specimens, especially since C. trachomatis can completely ascend from the cervix to the fallopian tubes. Between 1994 and 2010 a total of 1247 women with pelvic pain or suspected PID was examined at the Erfurt gynecological hospital by laparoscopy and 363 (29.1 %) were diagnosed with PID. In these patients C. trachomatis was found in 103 (28.4 %) and in 45.6 % of them exclusively in the fallopian tubes. This high proportion would have been missed if laparoscopy and endoscopic sampling had not been performed. These patients could also not have been detected and the risk of adverse reproductive outcome could not have been reduced only by taking cervical swabs or carrying out urine-based screening programs. The risk of infection associated with an intrauterine device (IUD) in situ is low. There is increasing evidence that the major risk factor is the cervicovaginal infection itself and not the IUD; therefore, insertion of an IUD is contraindicated in all cases of inflammation. On the other hand, because of the high contraceptive reliability an IUD can be indicated even in nulliparous females under 20 years old. © 2015, Springer-Verlag Berlin Heidelberg.


Gatje R.,Klinik fur Frauenheilkunde und Geburtshilfe
Gynakologische Praxis | Year: 2015

Transvaginal sonography has an important role in diagnosis of uterine pathology. However, still open questions are e.g. differentiation between uterine fibroids and uterine sarcoma, improvement of screening for endometrial cancer. The purpose of this paper is to present the potential and limits of sonography in uterine pathology.


Kandenwein J.A.,Universitatskliniken Bonn | Park-Simon T.-W.,Klinik fur Frauenheilkunde und Geburtshilfe | Schramm J.,Universitatskliniken Bonn | Simon M.,Universitatskliniken Bonn
Journal of Neuro-Oncology | Year: 2011

The extent of resection and the intrinsic biological aggressiveness of the tumor have been repeatedly identified as the primary determinants of meningioma recurrence. Invasive growth limits the resectability of meningiomas. Tumor invasion is mediated by matrix metalloproteases and their inhibitors such as uPA and PAI-1. In some cancers uPA expression is controlled in part by promoter methylation. In the work reported in this paper we investigated the role of uPA/PAI-1 expression and methylation of the uPA promoter in meningiomas. Sixty-five tumor tissue samples (WHO grade I: 26, grade II: 27, grade III: 12) from 58 patients were analyzed for uPA and PAI-1 protein content using a commercially available ELISA kit. For uPA promoter methylation analysis, a 365-bp promoter fragment was amplified by PCR after bisulfite treatment and subjected to a methylation-sensitive restriction digest with AciI. Pertinent clinical data were retrieved from the patients' charts. uPA and PAI-1 protein expression correlated significantly with WHO grade (uPA: P < 0.033, PAI-1: P < 0.001). High (>6 ng/ml = median) PAI-1 levels were seen more frequently in tumors with brain invasion (P = 0.006) and proved a significant predictor of the patients' prognosis (Kaplan-Meier estimates of progression-free survival: P = 0.004). Increased methylation of the uPA promoter was found to correlate significantly with lower levels of uPA expression. Our data suggest PAI-1 (and possibly to a lesser degree uPA) as potential prognostic markers in meningiomas. uPA expression in meningiomas might, in part, be controlled by promoter methylation. © 2010 Springer Science+Business Media, LLC.


Soergel P.,Klinik fur Frauenheilkunde und Geburtshilfe
Gynakologe | Year: 2015

Background: The incidence of invasive cervical cancer in Germany has been greatly decreased due to cytological screening. For a further reduction it seems to be primarily meaningful to achieve a higher participation rate, which is now on the political agenda. This could be realized through an organized screening program. On reaching the age for screening, the rate of cervical intraepithelial neoplasia (CIN) is reduced in the generations who received human papillomavirus (HPV) vaccination, which leads to a reduced positive predictive value and increased rate of false positives in cytology. Discussion: An implementation of HPV testing in primary screening, as is currently the case in most western countries, is expected to lead to further improvements. The therapy of CIN is associated with pregnancy complications and should be carried out only when indicated after adequate diagnostic measures, such as colposcopy with biopsy. The new nonavalent HPV vaccine which expected to be released in 2016 may lead to a big step forward in vaccination effectiveness. Conclusion: If the results of recent vaccination studies can be confirmed and high vaccination rates can be achieved, this vaccine has the potential to portend the beginning of the end for some gynecological diseases, such as cervical cancer, vaginal cancer and condylomata acuminata. © 2015, Springer-Verlag Berlin Heidelberg.


Anthuber C.,Klinik fur Frauenheilkunde und Geburtshilfe
Gynakologische Praxis | Year: 2015

Guidelines are increasingly defining our daily work in clinical and out patient gynecology. They provide the evidence which is mandatory for today's diagnostic and therapeutic measurements thus making patient's therapies safer and more transparent. Nevertheless, in individual cases it is possible or even mandatory to deviate from the guidelines. The new S2e-guide-lines on stress urinary incontinence were published by the german working group for urogynae-cology and pelvic floor reconstruction (Prof. Dr. CHRISTL REISENAUER, Tübingen) in July 2014. It replaces the S2k-guidelines which have been valid so far (Prof. Dr. THOMAS DIMPFL, Kassel). This article describes the most important new developments in diagnostics, conservative and operative therapy and gives specific evidence levels and the different grades of recommendation. Special situations such as recurrent stress urinary incontinence, mixed stress and urge incontinence and stress incontinence with simultaneous genital prolapse are described as well.


Hillemanns P.,Klinik fur Frauenheilkunde und Geburtshilfe
Chirurgische Praxis | Year: 2014

An infection of the cervical epithelium by high-risk genotypes of the human papillomavirus (HPV) is the cause of cervical cancer, the second most frequent cancer among women worldwide. The most important high-risk HPV genotypes are HPV 16 and 18 which cause about 70% of all cervical carcinomas, more than 50% of high-grade cervical intraepithelial neoplasia and are associated with vulvar, vaginal, anal, penile and oropharyngeal neoplasms. Both available HPV vaccines Gardasil and Cervarix contain non-infectious «virus-like particles» (VLP) without viral DNA against HPV 16 and 18, and against HPV 6 and 11 (Gardasil). These VLPs are powerful inductors of the humoral and cellular immune response Several studies have proven excellent prophylactic (but no therapeutic) efficacy in young and mid-aged women, in men, and in children against type-specific anogenital disease. The security profile is excellent for both vaccines after more than a decade of use. Long-term surveillance in the Nordic vaccine and cancer registries are ongoing. Countries with high vaccination coverage have reported a considerable decrease of genital warts (>90%) and a slow reduction of cervical intraepithelial neoplasia among young women.

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