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The most important diagnostic test for clarification of an adnexal mass is ultrasonographic evaluation. The prognostic value of an ultrasonographic examination is higher in combination with the patient history and clinical findings. In order to achieve high diagnostic accuracy certain requirements are mandatory. Firstly a high level of expertise, meticulousness and patience of the examiner is crucial. Secondly the use of a high-end ultrasound machine is essential. Thirdly a thorough evaluation and interpretation of sonomorphologic findings are necessary. Furthermore, these skills have to be trained continuously. This is fundamental for subjective, sonographic pattern recognition and the successful use of tumor scores resulting in a correct classification of adnexal tumors. Most adnexal tumors (approximately 75%) can be correctly (sensitivity 95% and specificity 91%) classified as benign or malignant using a set of simple rules. Tumors which cannot be classified (approximately 25%) can be differentiated by ultrasound examination by an expert examiner on the basis of subjective evaluation in about 90% of cases. © 2011 Springer-Verlag. Source

Stickeler E.,Universitatsfrauenklinik Freiburg
Breast Care

Breast cancer clinically represents a heterogeneous disease. Over the last decades, the integration of prognostic and predictive markers in treatment decisions has led to a more individualized and optimized therapy. While prognosis describes the risk of disease recurrence and diseaserelated death after diagnosis without the influence of therapy, prediction illustrates the probability of efficacy or response of a specific therapeutic measure. The substantial decline in breast cancer mortality seen over the last 20 years is primarily due to the delivery of adjuvant systemic therapy. It is important that clinical decisions are made to minimize overtreatment, undertreatment, and incorrect treatment. Improved understanding of breast cancer biology together with the utilization of classical biomarkers and the identification of new markers or profiles is increasingly defining who should receive cancer therapy and what therapy offers the best efficacy. The molecular targets as the prerequisite for successful concepts of specific therapies like antiestrogens, antibodies, or small molecules, have therefore high clinical value in regards to prognosis as well as prediction. Copyright © 2011 S. Karger AG, Basel. Source

Niesel A.,Klinik Preetz | Richter D.-U.,Universitatsfrauenklinik Rostock Am Klinikum Sudstadt | Watermann D.,Universitatsfrauenklinik Freiburg
Geburtshilfe und Frauenheilkunde

Purpose: Suburethral tapes are widely used in urogynecology. Aim of the study was to evaluate the mechanical characteristics of frequently used implants for the treatment of urinary stress incontinence. Material and Methods: The static and dynamic characteristics of seven tapes used in urogynecology were compared with each other. Parameters included breaking strength, flexural stiffness, weight, pore size, porosity, distension, width of support with and without tension, thickness of the thread and capillary properties. Results: The mechanical characteristics of the implants differ considerably. These differences were present with regard to both static and dynamic properties, and the differences are influenced by the quantity of filaments within the thread. In addition to the mono- or oligofilamentary, macroporous structure of the tapes there is a tendency in recent implants to a higher porosity and reduced distension. Conclusion: To date, the mechanical criteria for implants in urogynecology have not been extensively defined. Although all tested tapes consist of polypropylene, this study indicates a great variability with regard to individual mechanical characteristics. © Georg Thieme Verlag KG Stuttgart - New York. Source

Markfeld-Erol F.,Universitatsfrauenklinik Freiburg | Farthmann J.,Universitatsfrauenklinik Freiburg | Prompeler H.,Universitatsfrauenklinik Freiburg | Kunze M.,Universitatsfrauenklinik Freiburg
Deutsche Medizinische Wochenschrift

History and aim: A 36-year-old woman (primigravida, nullipara) at 25 + 3 weeks of gestation and a 27-year-old (primigravida, nullipara) at 22 + 7 weeks of gestation presented with oligo-/anhydramnios at our department of obstetrics. Both patients suffered from diabetes type 1 and 2, respectively, complicated by diabetic nephropathy, renal hypertension and retinopathy. The first woman had received an ATreceptor antagonist and a beta blocker, the other one an ACE inhibitor and a beta blocker. At initial clinical examination both patients were in a good general state of health. Respiration, pulse and blood pressure were within normal limits. Investigations: Sonography showed oligy-/anhydramnion with enlarged echogenic kidneys of both fetuses. Having ruled out premature rupture of the membranes the reduced amount of amniotic fluid was interpreted as a consequence of the antihypertensive medication. Treatment and course: The medication was changed to methyldopa which resulted in an adequate and moderate increase of amniotic fluid in both patients. At post partum examination renal failure was confirmed in both infants. The first infant, now a boy at the age of two years, still suffers from chronic renal failure, needing antihypertensive medication with an ACE blocker. Follow-up of the second baby has so far shown normal growth of the kidneys and normotensive blood pressure. Conclusion: When planning a pregnancy, a preexisting hypertension should be treated with either methyldopa (1st choice) or a beta blocker as a second choice (e. g. Metoprolol). In patients who are treated with ACE blockers or ATantagonists, medication should be changed as soon as the pregnancy is ascertained. Source

Untch M.,HELIOS Klinikum Berlin Buch | Untch M.,Frauenklinik des Universitatsklinikums Erlangen | Untch M.,Ludwig Maximilians University of Munich | Untch M.,Technical University Mu Nchen | And 186 more authors.
Journal of Clinical Oncology

Purpose: To evaluate efficacy and safety of epirubicin and cyclophosphamide followed by paclitaxel and trastuzumab as neoadjuvant treatment in patients with human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer. Patients and Methods: Patients with centrally confirmed HER2-overexpressing breast cancer (≥ 2 cm or inflammatory) received four 3-week cycles epirubicin and cyclophosphamide (90/600 mg/m2) followed by four 3-week cycles paclitaxel (175 mg/m2) and trastuzumab (6 mg/kg) before surgery. Trastuzumab was continued after surgery to complete 1 year of treatment. Primary end point was pathologic complete response (pCR) defined as no residual invasive tumor in breast and lymphatic tissue. Results: Thirty-nine percent of 217 enrolled patients achieved a pCR. Breast conservation was possible in 64% of patients. Three-year disease-free survival (DFS) was 88% in patients with pCR compared to 73% in patients without pCR (P = .01). Three-year overall survival (OS) was 96% in patients with pCR compared to 86% in patients without pCR (P = .025). pCR was the only significant prognostic factor for DFS (hazard ratio [HR] 2.5; 95% CI, 1.2 to 5.1; P = .013) and OS (HR, 4.9; 95% CI, 1.4 to 17.4; P = .012) in multivariable analysis. Cardiac toxicity was reported in eight patients (3.7%) of whom six presented with an asymptomatic left ventricular ejection fraction decrease and two with symptomatic chronic heart failure. Conclusion: Neoadjuvant combination of trastuzumab and chemotherapy resulted in a high pCR rate in HER2-overexpressing primary breast cancer. Patients with a pCR after neoadjuvant anti-HER2 therapy in combination with chemotherapy followed by maintenance trastuzumab have an improved long-term outcome. Patients without a pCR had an increased risk for relapse and death. © 2011 by American Society of Clinical Oncology. Source

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