Gynakologisch-geburtshilfliche Rundschau最新文献

Objective: The aim of this study was to validate a German pelvic floor questionnaire that integrates bladder, bowel and sexual function, pelvic organ prolapse, severity, bothersomeness and condition-specific quality of life.

Methods: Full psychometric testing of a self- and an interviewer-administered questionnaire was performed in 63 urogynaecological patients.

Results: Missing data did not exceed 4% for any question. The questionnaire clearly distinguished between urogynaecological and other gynaecological (n = 24) populations. Urodynamics, stress test and prolapse quantification correlated with the questionnaire. Cronbach's C values in the self- and interviewer-administered questionnaires were: bladder domain 0.86 and 0.77, bowel function 0.76 and 0.77, prolapse symptoms 0.82 and 0.83, sexual function 0.80 and 0.71. kappa values in the test-retest analyses varied from 0.61 to 1.0.

Conclusions: The pelvic floor questionnaire assessed all aspects of pelvic floor function in a reproducible and valid fashion.

Paget disease is a rare disorder of the skin of the vulva, comprising less than 1% of vulvar neoplasms. Surgical excision is considered the standard of care. While the invasive variant of Paget disease is rare, frequent local recurrences from non-invasive disease, which are inoperable, constitute a major clinical problem. In this article we report on a 71-year-old patient with recurrent disease treated successfully with imiquimod cream. Symptoms such as local itching subsided shortly after initiation of treatment. Four weeks later, first signs of resolution could be demonstrated colposcopically. Within 8 weeks, complete clinical remission was achieved. Thus, topical imiquimod is not only effective as treatment of vulvar intraepithelial neoplasia, but may also be used for selected patients with recurrent Paget disease as an alternative to repeat surgical interventions.

Objective: Despite the fact that gestational diabetes mellitus (GDM) is a common problem in pregnancy, a good proportion of cases of GDM is either not recognized or treated only inadequately. The main problems are a general trend of underestimating the risk of morbidity, the lack of integration into obstetric care regulations and heterogeneous guidelines regarding the screening and treatment of GDM.

Methods: For decades, the Graz concept of diagnosis and therapy of GDM has offered a 1-step general screening of all pregnant women between gestational weeks 24 and 28; in addition, the option of measuring the amniotic fluid insulin concentration via amniocentesis at gestational weeks 31-32 allows to detect hyperinsulinemic fetuses who represent an obstetric high-risk group.

Conclusion: Lower cutoff levels in the oral glucose challenge test as well as the measurement of amniotic fluid insulin concentrations, which have been implemented in the Graz model for a long time, offer a higher detection rate of GDM and allow a targeted therapy of fetuses at high risk. Screening and therapy of GDM are cost-effective instruments to improve obstetric outcomes, therefore obligatory screening and treatment for GDM should be recommended emphatically.

We report on a 33-year-old female patient with invasive ductal breast cancer. Despite breast augmentation with injected hydrophilic polyacrylamide gel in her history, she was successfully treated with breast-conserving therapy. The widespread migration of the gel conglomerates first complicated diagnostic imaging, surgical treatment and tumour aftercare. Removing the gel proved a difficult task. Nevertheless, the gel was macroscopically totally removed allowing a breast-conserving therapy. Wound healing took place without complications. After adjuvant chemotherapy, radiotherapy and hormonal therapy, the patient stays tumour free with a satisfactory cosmetic result.

Antenatal care in Germany is regulated by so-called national maternity health guidelines. The aim is to detect pregnancies at risk and potential high-risk deliveries in order to initiate risk-adapted treatment. The guidelines include 3 sonographic examinations as well as serological and infectious diagnostics. So far the glucose tolerance test is not integrated and needs individual indication.

Aims: To provide a detailed description of abdominal sacrocolpopexy and to present a retrospective evaluation of the outcomes.

Methods: 78 patients underwent sacrocolpopexy between January 2004 and July 2006; 72% had concomitant procedures; 53 patients participated in the follow-up. Anatomical success was defined as any leading point of the vaginal wall remaining >1 cm above the hymen. Failures were split into 3 groups: (1) asymptomatic, no further treatment; (2) symptomatic, conservative treatment; (3) symptomatic, requiring repeat surgery. The key points of the surgical technique were standardized mesh shape, reasonable choice of fixation of the mesh to the anterior and posterior vaginal walls as well as to the longitudinal ligament at S(2), and short operating time.

Results: Standardization kept the mean operating time short (72.7 +/- 14.5 min for sacrocolpopexy only, 86.4 +/- 21.0 min if combined with the Burch procedure; p = 0.03). At the follow-up, none of the 53 patients (100%) presented with a recurrent apical prolapse; 17% (n = 9) had stage II anterior wall prolapse, and 69.8% (n = 37) did not show symptoms specific to anterior wall prolapse. Regarding the posterior compartment, 38% (n = 20) had stage II and 1 stage III posterior wall prolapse; 86.8% (n = 46) did not show symptoms specific to posterior wall prolapse. Questionnaire items showed improvement of quality of life. Nine patients required reinterventions: suburethral sling (3), excision due to erosion (2), anterior (1) and posterior (1) repair, stapled transanal rectal resection (1), botulinum toxin injection (1). Every fourth woman presented with symptoms requiring further treatment.

Conclusions: Sacrocolpopexy is a valid technique to treat apical and anterior vaginal wall prolapse.

Weight gain is one of the side effects often attributed to the use of hormonal contraception. Concern about weight gain can hinder particularly young women to use a safe contraceptive method or may be a reason for early discontinuation. In the following review, we present studies examining the influence of different contraceptive methods on weight change and discuss the results and methodological problems. During use of hormonal contraceptives, weight fluctuates by about 3 kg over an observation interval from 6 to 24 months. Only in a subgroup of Depo Provera users is the increase in weight higher: the proportion of women gaining >3 kg/year is higher compared with the other hormonal contraceptives. Interestingly users of intrauterine devices experience a weight gain too, which is approximately double that of the average female population. The age-associated weight gain has been described to be 0.1 kg/m(2) annually, corresponding to about 300 g/year.

The placenta is a fetal organ located at the interface between mother and fetus. Therefore, the placenta is susceptible to maternal and fetal derangements. In gestational diabetes, various hormones, growth factors, cytokines and metabolites have altered levels in the maternal, the fetal compartment and the placenta. Prominent determinants of placental and fetal growth and development are insulin and the insulin-like growth factors (IGF) 1 and 2. Their levels in the maternal and/or fetal circulation are altered resulting from gestational diabetes. This article will describe placental changes in gestational diabetes and discuss the role of insulin, IGF1 and IGF2 therein.

Endometrial cancer is the most common gynecologic malignancy in Switzerland. Nowadays the gold standard for the treatment of endometrial cancer is total abdominal hysterectomy, bilateral salpingo-oophorectomy and in most cases pelvic and para-aortic lymphadenectomy. However, the use of minimally invasive surgical techniques has increased in recent years. Several prospective, randomized trials demonstrate the safety, feasibility and effectiveness of laparoscopy; the impact on survival and disease-free survival is equivalent to that of laparotomy. In future, laparoscopy and maybe robotic surgery could be effective in a selected population. Until then, further large-scale, prospective multicenter studies with longer follow-ups are required to confirm the current data.

Apart from long-term cardiovascular and metabolic effects of intrauterine deficiency or oversupply situations of the fetus, cerebral, renal and reproductive functions also seem to be influenced by a disturbed intrauterine environment.