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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.

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.

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.

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.

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