Denschlag D.,Gynakologie und Geburtshilfe |
Ulrich U.,Klinik fur Gynakologie und Geburtshilfe |
Emons G.,Universitats Frauenklinik Gottingen
Deutsches Arzteblatt | Year: 2011
Background: Endometrial carcinoma is the fourth most frequent type of cancer among women in Germany, with more than 11000 newly diagnosed cases each year. The present lack of clarity about the optimal clinical management of these patients is due in part to inconsistencies in the scientific evidence and in part to recent modifications of the FIGO classification. In this article, the issues requiring clarification are presented and discussed. Methods: This article is based on a selective review of the pertinent literature, including evidence-based guidelines and recommendations. Results and Conclusion: Current scientific evidence does not support the screening of asymptomatic women. On the other hand, women with postmenopausal and acyclic bleeding should undergo histopathological evaluation, particularly if they have risk factors for endometrial cancer. The current FIGO classification di - vides endometrial cancer into stages depending on the findings at surgery. On the basis of risk stratification (e.g., by tumor stage and histological differentiation grade), women who are judged to be at high risk (FIGO IB and above, grade 3) should undergo not just hysterectomy and adnexectomy, but also systematic pelvic and para-aortic lymphade - nectomy. Risk stratification also determines whether adjuvant radiotherapy should be given. The additional or alternative administration of chemotherapy is a particular consideration for women at high risk, although the pertinent clinical trials to date have yielded conflicting evidence on this point.
Rimbach S.,Gynakologie und Geburtshilfe |
Ulrich U.,Klinik fur Gynakologie und Geburtshilfe |
Schweppe K.W.,Endometriose Zentrum Ammerland
Geburtshilfe und Frauenheilkunde | Year: 2013
Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach. © Georg Thieme Verlag KG Stuttgart · New York.
Siedentopf F.,Klinik fur Gynakologie und Geburtshilfe
Geburtshilfe und Frauenheilkunde | Year: 2012
As gynaecologists frequently function as "general practitionerso" for women, gynaecologists are frequently confronted with questions which initially appear to have only a tenuous connection to their field. Chronic pain syndromes represent a particular challenge, especially as pain syndromes are often associated with severe psychosocial stress for the affected woman. This article discusses some of the psychometric aspects of chronic pain in endometriosis and fibromyalgia together with practical therapeutic approaches. © 2013 Georg Thieme Verlag KG · Stuttgart · New York.
Thill M.,Klinik fur Gynakologie und Geburtshilfe
Klinikarzt | Year: 2015
Hormone receptor-positive breast cancers represent the vast majority of early breast cancers. In premenopausal patients tamoxifen is the treatment of choice as aromatase inhibitors are contraindicated due to the endocrine activity of premenopausal patients. In postmenopausal patients aromatase inhibitors are included in the endocrine treatment. Aromatase inhibitors can be used as an initial treatment for 5 years, as sequential treatment after 2-3 years of tamoxifen or as an extended endocrine treatment after 5 years of tamoxifen. However, the optimal treatment of premenopausal patients is currently in the focus of interest. Which patient should undergo a 10-year treatment with tamoxifen and which patient should be treated with a combination of an aromatase inhibitor and a luteinizing hormone-relaesing hormone (LHRH) agonist? New data that had been published in the last 2-3 years presented beneficial results by using a combination of an aromatase inhibitor and a luteinizing hormone-releasing hormone (LHRH) agonist, moreover by utilizing a tamoxifen treatment of 10 years. The aim of this article is to describe the standard of care in endocrine treatment and to put the new data in the right context.
Schafer-Graf U.,Klinik Fur Gynakologie Und Geburtshilfe
Gynakologische Praxis | Year: 2015
Gestational diabetes mellitus (GDM) is one of the most frequent pregnancy disorders. in Germany the recent prevalence was reported to be 4.4% in 2013. Universal screening for GDM was established in 2012 demanding that a 50 g glucose challenge test with 24-28 weeks of gestation has to be offered to every pregnant woman. The challenge test is supposed to identify women at risk for GDM but for diagnosis a 75 g oral diagnostic glucose tolerance has to be performed when glucose reaches a level of 135 mg/dl. The validity of the challenge test is questionable since women with isolated elevated fasting glucose are missed. Diagnosis of GDM is established according to the IADPSG criteria which had been derived from the HAPO study. That means an important step towards a widespread and uniform diagnostic procedure in Germany. Therapy is based on the recent interdisciplinary guidelines of DGGG and Diabetes Association. Fetal growth pattern should be considered to modify glucose goals to target insulin therapy to pregnancies with high risk for the fetus due to maternal hyperglycemia.
Untch M.,Klinik fur Gynakologie und Geburtshilfe |
von Minckwitz G.,German Breast Group
Journal of the National Cancer Institute - Monographs | Year: 2011
Neoadjuvant chemotherapy (NACT) was initially developed as a treatment strategy for patients with locally advanced breast cancer to improve operability and locoregional control. Today, NACT has become an equivalent option along with adjuvanttreatment, and it is regarded as standard treatment approach for patients with locally advanced cancer because it enables breast-conserving therapy to these patients. In addition, there is increasing information on NACT in operable breast disease that supports its use in routine practice for operable tumor stages. According to the German S3 and AGO guidelines, NACT is indicated for every patient with breast cancer, who would need adjuvant chemotherapy after evaluation of radiological, histological, and clinical prognostic factors. Based on a broad range of clinical studies during the last 10 years, it has been demonstrated that NACT leads to an increasing rate of breast-conserving operations, reduced mortality, and less toxicity. A very important issue is to obtain early information about the responsiveness of the primary tumor to chemotherapy, so that individualized therapeutical strategies can be developed. The decision to proceed with NACT is depending on several considerations including surgical aspects, pretreatment diagnostic evaluations, and efficacy monitoring as well as biological aspects to predict response. © The Author 2011. Published by Oxford University Press. All rights reserved.
Schmidt D.,Synlab MVZ Pathologie Mannheim GmbH |
Ulrich U.,Klinik fur Gynakologie und Geburtshilfe
Pathologe | Year: 2014
Endometriosis is a frequent gynecological disease of unknown etiology and pathogenesis. It affects the gynecological organs and the peritoneum with varying frequency and can lead to severe symptoms, mainly pain and to infertility. Despite the fact that causal therapy is not feasible diagnostic and therapeutic procedures are necessary in many cases. In a small percentage of cases endometriosis is associated with neoplastic disease and in some cases it might develop into a neoplasm via the stage of atypical endometriosis, notably in the ovaries. Tumors which are most frequently associated with endometriosis are endometrioid carcinoma, clear cell carcinoma, and low grade serous carcinoma. According to some authors tumors associated with endometriosis have a better prognosis than those without. Other tumors are Mullerian adenosarcoma, endometrioid stromal sarcoma, and seromucinous borderline tumor. In addition to the morphological findings more recent molecular findings serve to demonstrate the origin of the different types of carcinoma from endometriosis. In both endometrioid and clear cell carcinoma, loss of heterozygosity (LOH) can be found in different gene loci. Mutations in CTNNB1 (beta catenin), PTEN, KRAS and ARID1a genes have been demonstrated in endometrioid carcinoma. Cases of clear cell carcinoma have been characterized by mutations of ARID1a gene, PIK3CA and less frequently PPP2R1A and KRAS. © 2014 Springer-Verlag Berlin Heidelberg.
Siedentopf F.,Klinik fur Gynakologie und Geburtshilfe |
Sillem M.,Klinik fur Gynakologie und Geburtshilfe
Schmerz | Year: 2014
Background. Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women. Gynecological causes. Possible gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia. Psychosocial factors. Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear. Diagnostics and therapy. Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage. © 2014 Springer-Verlag.
Surgical techniques in prolapse repair using alloplastic material. When to use which mesh? [Operationstechniken bei deszensus mit verwendung alloplastischen materials. Wann soli welches netz angewendet werden?]
Funfgeld C.,Klinik fur Gynakologie und Geburtshilfe
Gynakologische Praxis | Year: 2014
The application of alloplastic meshes within prolapse surgery has gained increasing significance over the past 10 years. The opportunity to improve stability and endurance in the field of prolapse surgery inspired multiple surgeons. Reports regarding novel complications and two safety warnings released by the U.S. Food and Drug Administration caused substantial uncertainity. Required is a critical however unbiased evaluation of surgical techniques involving alloplastic meshes. Those surgical techniques are a sensible addition to the treatment range in context with preceding urogynaecological diagnostic measurements and after differentiated indication. Implantation of alloplastic meshes conducted by an experienced pelvic surgeon correlate with improved long term outcome and overall augmented quality of life. Looking at the historical development of alloplastic mesh surgery and at the current optimization of respective techniques should disclose in which cases application of meshes should be favored over conventional surgical techniques. Therefore all correlated advantages and possible risks need to be considered.
Emmerl S.,Klinik fur Gynakologie und Geburtshilfe
Gynakologische Praxis | Year: 2014
This case report demonstrates a clinical case about a patient with a suspected ulcerated breast cancer for diagnostic issues and staging examinations. The 16,5x12,5 cm ulcerated tumor on the left breast turned out, after punch biopsy, to be a basal cell tumor. The reconstruction after excision of the tumor on the left side was operated with a latissimus dorsi flap. Excision of the basal cell tumor resulted without any tumor tissue left. After a 3-month follow up, inconspicuous sore conditions and normal scarring in the level of the latissimus dorsi flap in front as well as in the back side could be seen. This case report shows that the basal cell tumor should also be included in the differential diagnosis of an ulcerated breast cancer, although this localization is extremely rare. In the end only the histological examination can provide the entity of the tumor.