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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. Source

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. Source

Friedrich M.,Klinik fur Frauenheilkunde und Geburtshilfe
Chirurgische Praxis | Year: 2013

The propability for appearance of locoregional recurrence of breast cancer is increased if there are risk factors like lymph node metastasis or low differenciation. The yearly incidence of locoregional recurrence of breast cancer is 1% and the five-year-survival is 65%. Circumference of recurrence and characteristics of the primary cancer are important concerning prognosis. If the tumor is located in the medial area of the breast the risk for a local recurrence is about 2,48 times higher than a central or lateral location of tumor. After recurrence appears, a re-staging should be followed. If there are distant metastasis the systematic therapy is the first choice. When operation is required, the RO operation is the primar aim. Most of the cases, after breast-conserving therapy, need mastectomy. Axillary dissection is not required if the clinical examination of the axilla is inconspicous. Relating overall situation there are also cases of M1 situation when operation seems to have good influence concerning overall survival. Anyway, the hormone receptor status should be ascertained again, so that endocrine therapy could be started yet. Especially for HER2/neu positive patients or in other individual cases a chemotherapy should be considered. In a palliative situation, topic medicine like miltefosin or radiochemotherapy are highly significant. Source

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. Source

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. Source

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