In gynecological oncology, patients particularly with early-stage endometrial or cervical carcinomas can benefit from minimally invasive procedures. In cases of cervical carcinoma, laparoscopic lymphonodectomy can help identify patients who should first undergo chemoradiotherapy. In cases of advanced ovarian carcinoma, laparoscopy is only a diagnostic option and not a therapy of its own. The use of robot-assisted laparoscopy (DaVinci) in gynecological oncology is currently evaluated.
Background: An imbalance between angiogenic and antiangiogenic factors plays a fundamental role in the pathogenesis of preeclampsia. Serum levels of placental growth factor (PLGF), a factor promoting angiogenesis, in patients with preeclampsia are significantly lower than in nonpreeclamptic pregnancies. This study was designed to answer the question whether the measurement of PLGF at the beginning of the second trimester might be a predictive factor for the appearance of preeclampsia.
Methods: Serum samples of 61 women were collected between 15 and 18 weeks of pregnancy. PLGF levels were measured using a human PLGF ELISA and correlated with the outcomes of pregnancy.
Results: 7 women (11.47%) developed preeclampsia during pregnancy. Their PLGF levels between 15 and 18 weeks of pregnancy were significantly lower (p < 0.001) compared to the nonpreeclamptic pregnancies. Using a PLGF level of 41.84 pg/ml as a cutoff, this test has a sensitivity of 0.87 and a specificity of 0.83.
Conclusion: Women who will develop preeclampsia in the course of pregnancy already have a significantly lower expression of PLGF between 15 and 18 weeks of pregnancy compared to those who will not. This test offers new possibilities in the prediction of preeclampsia.
Background: The application of national guidelines which specify the appropriateness for hysterectomy is believed to lead to improved patient outcomes. However, there was no evidence to support this assumption by outcome data.
Goals: To evaluate adherence to guidelines and the validity of the 1997 Swiss guidelines for the appropriateness of hysterectomy based on changes in patients' functional and psychosocial status.
Method: Multicentre study of 370 consecutive cases from 18 public hospitals assessing data on appropriateness and changes in patient status following hysterectomy. Data on appropriateness were obtained before the procedure (n = 286). Changes in patient status following hysterectomy were assessed using an adapted and weighted score. Baseline data were collected up to 8 weeks prior to hysterectomy. Outcome data were obtained 16-32 weeks after surgery (n = 237). Patients for whom appropriateness data were available (n = 286) were categorized into three groups: (1) 214 patients (74.82%) with an indication for hysterectomy, (2) 36 patients (12.58%) classified as having an indication with regard to their preference, and (3) 36 patients (12.58%) classified as not being appropriate for surgery according to national guidelines.
Results: In 87% the indication for hysterectomy was judged as appropriate according to the guidelines. The status of all three groups of patients after hysterectomy was found to be significantly improved compared to baseline levels. Patients with an appropriate indication tended to profit more from hysterectomy.
Conclusion: The appropriateness rating found may be interpreted as an example of justified use of medical procedural intervention. There was a positive correlation between appropriateness and outcome. The 1997 guidelines still seem to be valid.
Oncological safety and preservation of a patient's physical integrity are the milestones of modern breast cancer therapy. This can be achieved by an optimized combination of therapy modalities, such as surgery, radiation therapy and systemic (chemo-)therapy. In this context the gynaecological oncologist is of central importance.
In the systemic therapy of breast cancer, the tumor itself has become the specific target. If possible the surgical excision of breast carcinoma is restricted to the tumor site and aims at an R0 resection of the invasive and preinvasive portions of the carcinoma. Only percutaneous whole-breast radiotherapy irradiates the whole breast. The additional boost irradiation is targeted and significantly improves local control in all age groups. Due to the increased detection of small breast carcinomas in postmenopausal patients by mammographic screening, it is necessary to consider a change of the existing therapeutic practice. Published results of partial irradiation of the breast (intra- as well as postoperatively) show a very high degree of local control with follow-ups of up to 11 years. At present prospective and randomized studies investigate for which patients an intraoperative radiotherapy is sufficient as the sole irradiation method after previous surgery. Intraoperative radiotherapy as a boost preceding percutaneous whole-breast irradiation should already be possible according to a relevant statement of the DEGRO.
A vesicovaginal fistula develops when the blood supplying the tissues of the vagina and the bladder is cut off during prolonged obstructed labour. The tissues necrotize, and a hole forms through which urine passes uncontrollably. Women who develop fistulas are often abandoned by their husbands, rejected by their communities and forced to live an isolated existence. Fistula is called 'the single most dramatic aftermath of neglected childbirth'. In addition to complete incontinence, a fistula victim may develop nerve damage to the lower extremities after a multi-day labour in a squatting position. Fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity. Severe social isolation is a result of the incontinence. Poverty, long distances and long waiting lists deter women from travelling to major health centres.
Hormone-receptor-positive cancer is the most common tumor subtype in women with breast cancer. Endocrine treatment in this subgroup is essential for premenopausal as well as postmenopausal patients. Tamoxifen substantially improves disease-free survival and overall survival in combination with chemotherapy or alone in adjuvant therapy. In recent years, a number of large-scale, randomized trials have evaluated the role of the aromatase inhibitors (AI) in postmenopausal women with hormone-receptor-positive breast cancer. These studies tested one of three approaches: (1) an upfront AI, (2) a sequential approach after 2-3 years of tamoxifen and (3) an extended endocrine therapy beyond 5 years. The positive results of these studies have challenged the previous standard of a 5-year course of tamoxifen alone. While the AI have become a standard component of treatment for most postmenopausal women, many questions still remain regarding the optimal endocrine treatment.
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