Universitats Frauenklinik Heidelberg

Heidelberg, Germany

Universitats Frauenklinik Heidelberg

Heidelberg, Germany
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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.

PubMed | Klinikum Offenbach, Universitats Frauenklinik Rostock, Sankt Gertrauden Krankenhaus, Charité - Medical University of Berlin and 10 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

Pathologic complete response after neoadjuvant chemotherapy (NACT) correlates with overall survival (OS) in primary breast cancer. A recently described staging system based on pre-treatment clinical stage (CS), final pathological stage (PS), estrogen receptor (ER) status and nuclear grade (NG) leads to a refined estimation of prognosis in unselected patients. Its performance in luminal type breast cancers has not been determined. This study investigates the clinical utility of this CPS+EG score when restricted to hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) patients and compares the results to a cohort of unselected patients.The CPS+EG score was calculated for 6637 unselected patients and 2454 patients with HR+/HER2- tumours who received anthracycline/taxane-based NACT within 8 prospective German trials.Five-year disease-free survival (DFS) and OS were 75.6% and 84.1% for the unselected cohort and 80.6% and 87.8% for the HR+/HER2- subgroup, respectively. The CPS+EG system distinguished different prognostic groups with 5-year DFS ranging from 0% to 91%. The CPS+EG system leads to an improved categorisation of patients by outcome compared to CS, PS, ER or NG alone. When applying the CPS+EG score to the HR+/HER2- subgroup, a shift to lower scores was observed compared to the overall population, but 5-year DFS and OS for the individual scores were identical to that observed in the overall population.In HR+/HER2- patients, the CPS+EG staging system retains its ability to facilitate a refined stratification of patients according to outcome. It can help to select candidates for post-neoadjuvant clinical trials in luminal breast cancer.

Bohlmann M.K.,Universitatsklinikum Schleswig Holstein | Hunold P.,Universitatsklinikum Schleswig Holstein | Rabe T.,Universitats Frauenklinik Heidelberg | Ahrendt H.-J.,Praxis fur Frauenheilkunde | And 5 more authors.
Journal fur Reproduktionsmedizin und Endokrinologie | Year: 2013

Background: Symptomatic uterine fibroids are a frequently encountered, important cause of morbidity in women in their reproductive period. Due to only limited conservative therapeutic approaches surgical intervention - including hysterectomy - has played a major part to control and treat uterine fibroids. The use of high-intensive focused ultrasound ("HIFU") displays a non-invasive alternative in the treatment of fibroid. Methods: Indications, requirements, side-effects, outcome as well as the procedure itself are presented in this review, with a special focus laid on fertility aspects. Results: More than 8.000 women with symptomatic uterine fibroids have been treated with HIFU worldwide so far. This therapeutic option is efficacious and well tolerated by the patients. Current data suggests that pre- and perinatal complications are less frequently seen in pregnant women after having undergone a HIFU treatment compared to fibroid embolisation. Conclusion: The application of high-intensive focused ultrasound can be regarded as an effective, well tolerated, non-invasive therapeutic option in women with symptomatic uterine fibroids.

Schweiger U.,University of Lübeck | Wischmann T.,Universitatsklinikum Heidelberg | Strowitzki T.,Universitats Frauenklinik Heidelberg
Nervenarzt | Year: 2012

Approximately 5-10% of women in the reproductive years are affected by infertility which is associated with depression, anxiety and disturbed eating behavior. Part of this association can be explained by the emotional stress resulting from infertility. As mental disorders, such as depressive disorder or eating disorders are also prospectively associated with infertility, a bidirectional relationship is assumed. A special relationship exists between mental disorders and the main causes of ovulatory infertility, hypothalamic amenorrhea and polycystic ovary disease. The results of pilot studies support the assumption that psychotherapy may constitute an important component of the treatment of infertility. © Springer-Verlag Berlin Heidelberg 2012.

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

Gemzell-Danielsson K.,Karolinska University Hospital | Rabe T.,Universitats Frauenklinik Heidelberg | Cheng L.,Shanghai Institute of Planned Parenthood Research
Gynecological Endocrinology | Year: 2013

There have been numerous attempts to control fertility after unprotected sexual intercourse (UPSI). From very bizarre methods like the vaginal application of Coca Cola to the more serious attempts using calcium antagonists influencing fertility parameters in sperm to hormonal methods or intrauterine devices. So far, hormonal methods preventing or delaying ovulation have proved to be the most popular starting with the combination of ethinyl estradiol and levonorgestrel (LNG), known as the Yuzpe regimen. The first dose had to be taken within 72 hours of UPSI, a second one 12 hours later. Later on, LNG alone, at first in a regimen similar to the Yuzpe method (2×0.75mg 12 hours apart) showed to be more successful, eventually resulting in the development of a 1.5mg LNG pill that combined good efficacy with a high ease of use. Several efficacious and easy to use methods for emergency contraception (EC) are available on the market today with the most widely spread being LNG in a single dose of 1.5 mg (given as one tablet of 1.5 mg or 2 tablets of 0.75 mg each) for administration up to 3 days (according to WHO up to 5 days) after UPSI. Its limitations are the non-optimal efficacy which is decreasing the later the drug is taken and the fact that it is only approved for up to 72 hours after UPSI. This regimen has no effect on the endometrium, corpus luteum function and implantation, is not abortive and don't harm the fetus if accidentally taken in early pregnancy. It has no impact on the rate of ectopic pregnancies. It has become the standard method used up to this day in most countries. Since the mid 1970s copper IUDs have been used for EC, which show a high efficacy. Their disadvantages lie in the fact that EC is considered an off label use for most IUDs (not for the GynFix copper IUD in the European Union) and that they might not be acceptable for every patient. Furthermore IUD-insertion is an invasive procedure and it is required trained providers and sterilized facilities. Mifepristone in the dosages of 10 or 25mg is used with good results as an emergency contraceptive in China for up to 120 hours after UPSI, but has never received any significant consideration in Western countries. While high doses of mifepristone has an effect on endometrial receptivity and will inhibit ovulation if given in the follicular phase and prevent implantation if given in the early luteal phase, low doses such as 10mg has no impact on the endometrium. Mifepristone does not increase the rate of ectopic pregnancies. The most recent development is the approval of the selective progesterone receptor modulator ulipristal acetate (UPA) in the dosage of 30 mg for EC up to 5 days after UPSI, combining the safe and easy application of the single dose LNG pill with an even higher efficacy. It has shown to be more efficacious than LNG and can be used for up to 120 hours after UPSI; the difference in efficacy is highest for 0-24 hours, followed by 0-72 hours following UPSI. No VTE has been reported following UPA-administration or any progesterone receptor modulator. No effect on endometrium, corpus luteum function and implantation has been observed with doses used for EC. Independent of the substance it should be noted that, if there is a choice, the intake of an oral emergency contraceptive pill should happen as soon as possible after the risk situation. A preexsisting pregnancy must be excluded. Possible contraindications and drug interactions must be considered according to the individual special product informations. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Montag M.,Universitats Frauenklinik Heidelberg | Toth B.,Universitats Frauenklinik Heidelberg | Strowitzki T.,Universitats Frauenklinik Heidelberg
Gynakologe | Year: 2013

Chromosomal aberrations such as aneuploidies are usually diagnosed by polar body biopsy or biopsy of the blastomeres or trophectoderm cells. However, several other methods are available for further diagnosis. Trophectoderm biopsy followed by array-CGH is the most favored diagnostic method, although next-generation sequencing is becoming a viable alternative. All these techniques are invasive but enable a proper diagnosis of aneuploidy. Alternate methods are discussed that may avoid the invasive removal of embryonic cells. The purpose of these new tools is to give a risk estimate for aneuploidy by correlation of different markers. Some of these technologies are still experimental; for example, gene expression in cumulus cells or concentration of certain metabolites in culture medium. A new method that is currently applied is time-lapse imaging, which allows one to correlate morphokinetic parameters with the aneuploidy risk. © Springer-Verlag Berlin Heidelberg 2013.

Frank-Herrmann P.,Universitats Frauenklinik Heidelberg | Strowitzki T.,Universitats Frauenklinik Heidelberg
Austrian Journal of Clinical Endocrinology and Metabolism | Year: 2013

Amenorrhea is the lack of men strual bleeding before (primary) or after menarche (secondary). After excluding a physiological cause amenorrhea can be classified into etiological groups: amenorrhea due to hyperandrogenemia, amenorrhea due to hyperprolactinemia, hypergonadotropic amenorrhea, normo-/hypo gonadotropic amenorrhea, and amenorrhea due to anatomic reason. The cause of amenorrhea can be identified in 95 % with simple diagnostic tools, with further levels of diagnosis identifying rare diseases. The therapeutic decision depends on the prognosis of amenorrhea, the need for therapy and factors to consider such as a desire for conception or need for contraception. Indications for hormonal replacement therapy are induction of pubertal development, bone mineralisation and protection, general well-being, prevention of climacteric symptoms, atrophic vaginitis, and dyspareunia.

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.

Goeckenjan M.,Universitats Frauenklinik Heidelberg | Rabe T.,Universitats Frauenklinik Heidelberg
Gynakologische Endokrinologie | Year: 2013

Young women in Germany become sexually active far earlier then formerly. Recently due to various initiatives of gynecologists in Germany girls and young women have the first consultation with the gynecologist often before active sexuality is initiated. Currently the most common and safest methods of contraception recommended by the parents and the gynecologist are oral contraceptions to avoid unwanted pregnancies and condoms to protect against sexually transmitted infections both applied preferably in combination. Good knowledge about and easy access to emergency contraception is an additional chance to reduce the amount of unwanted pregnancies. The individual and empathetic gynecological councelling of female adolescents constituts the mutual trust to clarify issues relating to bodily functions and sexuality. Subsequently it may open the door to discuss other aspects of health-prevention, e.g. regular health screening-services and HPV-vaccination as well as aspects of lifestyle improvement. Current data and guidelines for contraception in girls and young women are presented. © 2013 Springer-Verlag Berlin Heidelberg.

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