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Rabe T.,Universitats Frauenklinik Heidelberg | Petraglia F.,University of Siena | Kiesel L.,Universitatsklinikum Munster
Journal fur Reproduktionsmedizin und Endokrinologie | Year: 2013

In the last few years, considerable progress has been made understanding endometriosis and developing diagnostic procedures and therapeutic options. Sophisticated endoscopic instruments allow laparoscopic surgery even in progressed stages and deep infiltrating endometriosis of the bowel and bladder. The introduction of GnRH analogues with add-back medication and the development of new progestins have widened the range of options for effective medical therapy. Nevertheless new prospective studies have demonstrated in the last decade that the success is temporary and the recurrence rates are high even when the surgery was adequate. Often medical treatment is effective during the time of application only. This means that customised long-term therapy concepts based on guidelines developed by medical societies play a central role in the alleviation of pain, the reduction of recurrence rates, the avoidance of repeat operations and the improvement of the patients' quality of life.

Bachmann A.,Universitatsklinikum Frankfurt | Rabe T.,Universitats Frauenklinik Heidelberg | Merkle E.,Rinckstrasse 2 | Sanger N.,Universitatsklinikum Frankfurt
Gynakologische Endokrinologie | Year: 2016

Background: In February 2016 the World Health Organization (WHO) declared Zika virus a public health emergency of international concern (PHEIC) due to its association with severe fetal brain defects. The efficacy and safety of contraception while traveling in various high-risk areas is at the center of attention. Objectives: Which birth control methods are necessary and suitable for the various travel destinations? What precautions should be taken when traveling through several time zones to assure continued efficacy of contraception? Results: Expert advice from specialists in travel medicine as well as the recommendations of the ministry of foreign affairs and the embassy of the country of destination regarding guidelines for carrying personal medicines are prerequisites. When traveling through different time zones, the scheduling of combined oral contraceptives and ovulation inhibiting gestagens has to be adjusted to local time for time differences greater than 10 h. If taking the classical minipill, an additional pill has to be taken after 12 h for time differences of more than 3 h. There are certain advantages for the long cycle when traveling. © 2016 Springer-Verlag Berlin Heidelberg

Schwenkhagen A.,University of Lubeck | Rabe T.,Universitats Frauenklinik Heidelberg
Journal fur Reproduktionsmedizin und Endokrinologie | Year: 2010

Epilepsy is one of the most common neurologic disorders. For women with epilepsy (WWE) collaboration between neurologist and gynaecologist is crucial, since the epilepsy and/or the antiepileptic drug (AED) treatment may have a negative impact on a woman's life in many respects: Fertility, reproductive and sexual function may be impaired. The bidirectional interactive potential between AEDs and hormonal contraceptives needs to be taken into account in order to avoid unplanned pregnancies as well as seizure control deterioration. Teratogenic risks associated with AED treatment (including potential negative effects on neurocognitive development) must be weighed against seizure control. In women with childbearing potential a switch to less teratogenic regimens should be considered, if possible. Proactive pre-conceptional counselling is mandatory to optimize maternal and fetal outcome. The risk of major congenital malformations is possibly decreased by folic acid supplementation in WWE. Thus high dose prenatal folate supplementation is recommended in general. During pregnancy therapeutic drug monitoring and dose adjustments may be necessary. Surveillance for obstetric complications as well as birth defects should be part of routine clinical management in WWE.

Minimally invasive surgical interventions and techniques belong to the standard repertoire of gynecologic surgery and provide a multitude of possibilities to treat typical and seldom gynecologic diseases in an elegant and less traumatic way. Gynecology has gathered a great deal of experience in this field and many endoscopic surgical techniques have been established as standard procedures; new, innovative therapeutic approaches are continuously being evaluated. To make sure that this important surgical specialty can be offered in a safe and successful manner, knowledge about potential complications is of greatest importance for the gynecologic surgeon. This has to be considered within informed consent of the patient as well as within surgery itself. This review article provides an overview of typical, currently reported complications of gynecologic oncology as well as recommendations for gynecologic surgeons about correct management. © Springer-Verlag 2012.

Rank A.,Ludwig Maximilians University of Munich | Delker R.,Ludwig Maximilians University of Munich | Pihusch V.,Ludwig Maximilians University of Munich | Wilkowski R.,Ludwig Maximilians University of Munich | And 4 more authors.
Clinical Transplantation | Year: 2011

Increasing evidence suggests that circulating microparticles (MP) exposing CD61 originate predominantly from megakaryocytes. Dramatic changes in megakaryocytic homeostasis are regularly observed following allogeneic hematopoietic stem cell transplantation (HSCT) and associated with transplantation-associated complications. We studied MP plasma levels prospectively in healthy subjects (n=10) and allogeneic HSCT recipients (n=19) twice weekly from the start of conditioning therapy up to day 30. A total of 224 measurement points were evaluated. MP were isolated, double-stained with annexin V and anti-CD61, and analyzed by flow cytometry. In uncomplicated HSCT, we found a correlation between platelet and CD61-exposing MP count, which resulted in a constant ratio of MP per platelet. The ratio was increased in patients with active hematological malignancies before transplantation and normalized during conditioning therapy. After take, the MP ratio increased, whereas infections and microangiopathic hemolytic anemia did not affect the ratio. In patients with GvHD, a decreased MP ratio was observed depending on the grade of GvHD, possibly indicating megakaryocytic damage. The MP ratio was able to discriminate between toxic, septic, and GvHD-induced hyperbilirubinemia. We first describe CD61+MP levels during allogeneic HSCT and postulate that the MP ratio might be a useful biomarker for the surveillance of megakaryocytes during HSCT. © 2011 John Wiley & Sons A/S.

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