Gynakologisch-geburtshilfliche Rundschau最新文献

Molecular staging of breast cancer with microarray technologies leads to different gene expression profiles distinguishing 4 special groups: luminal A and B subtype, HER2 subtype and basal subtype. These 4 groups show a different prognosis as well as different behaviours and responses to adjuvant therapy. The development of gene expression profiles to classify breast cancer may contribute to the targeted institution of adjuvant therapies. Especially the 21-gene recurrence score (Oncotype DX) and the 70-gene profile (Mamma-print) have become intensively examined prognostic and predictive tools. As chemotherapy is an integral component of adjuvant therapy in early breast cancer but estrogen-receptor-positive breast cancer is the most common type, patient selection for adjuvant chemotherapy is of particular interest. In instances when the benefit from chemotherapy seems modest, there is a decision making tool beside traditional histopathological parameters that might provide additional objective prognostic and predictive information. Those genomic decision making approaches may yield more rational treatment choices and may keep patients from systemic treatment modalities of lower value.

Numerous epidemiologic studies in different populations reveal an association between intrauterine growth restriction and the occurrence of arterial hypertension, arteriosclerosis, hyperlipidemia, type 2 diabetes mellitus and mental diseases later in life. Animal studies confirm these associations to be independent from genetic conformation and postpartum influences. However, both the mechanisms of intrauterine programming and the critical time of an insult to result in fetal problems are unclear. Therefore, the results of large-scale, prospective studies are needed before therapeutic interventions during pregnancy or post partum to prevent adverse effects of fetal programming are scientifically justified.

Background: In the last few years, the therapy of cervical carcinoma has progressed substantially due to the use of simultaneous platinum- containing radiochemotherapy. However, there are no data which evaluate an individualized treatment adapted to tumor biology, in spite of the fact that patients show remarkably different responses to chemotherapy. Therefore this preclinical phase I study aims at finding therapeutic alternatives to the current cytostatic drugs to treat cervical carcinoma.

Material and methods: In a tumor chemosensitivity assay, 8 drugs were tested on freshly isolated tumor cells of 16 patients [carbo- and cisplatin, topotecan, paclitaxel as well as the 2 tyrosine kinase inhibitors imatinib (Glivec) and gefitinib (Iressa (R) ) and the 2 monoclonal antibodies cetuximab (Erbitux) and trastuzumab (Herceptin (R) )].

Results: Overall the test was evaluable for 16 specimens (100%). Ten of 15 tumor samples (66.6%) were sensitive to imatinib. A sensitive therapeutic response could be demonstrated in all tested FIGO stages. An interindividual comparison could establish sensitivity to cetuximab in 12.5% of cases, to gefitinib in 6.25%, to trastuzumab in 6.6%, to cisplatin in 13.3%, to carboplatin in 7.6%, to paclitaxel in 93.8% and to topotecan in 25%.

Conclusion: Imatinib seems to be an efficacious therapeutic option for patients with cervical carcinoma, independently of tumor subtype.

In the last few decades, the notion of breast cancer has developed from a local disease rather to a systemic illness. Today radical operations can mostly be avoided by breast-conserving techniques and sentinel lymph node dissection. By the use of cytostatic and endocrine systemic therapies, an essential gain in overall survival could be obtained, too. High-risk situations can be determined and dealt with accordingly by adequate systemic therapies. Current approaches include the sequential or simultaneous use of anthracyclines and taxanes, the combination with antimetabolites, antibodies and tyrosine kinase inhibitors as well as dose-dense chemotherapeutic regimens. In the adjuvant treatment of breast cancer of postmenopausal receptor-positive patients, tamoxifen is not the gold standard anymore. An aromatase inhibitor should be used at any rate.

Breast-conserving surgery combined with radiotherapy has become the treatment of choice for the majority of women presenting with primary breast cancer over the last 20 years. The extent of local excision remains a controversial issue in breast-conserving surgery. The wider the margins of clearance, the lower the risk of incomplete excision and thus of local recurrences, but the greater the amount of tissue removed, the higher the risk of visible deformity leading to an unacceptable cosmetic result. This clash of interests is most evident when attempting breast-conserving surgery in patients with smaller breast-tumor ratios. The widespread popularity of breast-conserving surgery has focused attention on new oncoplastic techniques that can avoid unacceptable cosmetic results. Partial mastectomy defects can be reconstructed by volume displacement, recruiting and transposing local glandular or dermoglandular flaps into the resection site, or by volume replacement, importing volume from elsewhere to replace the amount of tissue resected.

It is important for any woman undergoing mastectomy to make an informed decision about reconstruction and to be provided with information about the technique, advantages and disadvantages. There is a high degree of patient satisfaction with breast reconstruction, but high levels of preoperative information and psychological support are necessary. Close collaboration between oncological and reconstructive surgeons or management by an oncoplastic breast surgeon, careful patient selection and counseling, and refinements in surgical techniques can provide a range of safe and predictable techniques for breast reconstruction. After modified radical mastectomy breast reconstruction involves replacement of breast skin and breast volume; after skin-sparing mastectomy only the replacement of breast volume is necessary. The most commonly used surgical techniques are tissue expansion, latissimus dorsi myocutaneous flap with or without implants, and the use of lower abdominal tissue. Until today, the pedicled TRAM flap is the standard method for autologous breast reconstruction.

This study was performed in order to evaluate the changes in uterine fibroid symptoms and their impact on the quality of life after uterine fibroid embolization (UFE). The patients source of information about this novel treatment and their reasons for choosing UFE were also studied. Health-related quality of life and the status of uterine fibroid symptoms were assessed in 44 patients before and after treatment using a validated questionnaire. After 33.5 months on average, a significant change in symptoms of -60.4% and a change in health-related quality of life of +74.39% were reported. Over 50% of patients had heard about UFE for the first time through the media, and 62.9% of patients had opted for this form of treatment because it enabled them to keep their uterus; 91.5% of patients would recommend it. UFE is a novel, effective and minimally invasive alternative to more invasive, open or laparascopic treatment procedures in cases of uterine fibroid symptoms.

A 53-year-old woman suffering for 20 years from chronic genitourinary pain was seen in our urogynecological unit. Quality of life assessment by King's Health Questionnaire showed a highly negative impact on quality of life. Clinical examination revealed a painful and swollen distal urethra, and a small fistula was seen located 12 mm proximal to the meatus externus. Perineal ultrasound and magnetic resonance imaging showed multiple cystic formations bilaterally located in the suburethral and paraurethral regions. A diverticulectomy was performed using the vaginal approach. Twelve months after surgery the woman is completely satisfied and only complaining about slight alguria.

The intrauterine environment not only influences fetal well-being and behaviour during pregnancy, but also predisposes the fetus in many health aspects of later life. The terms 'fetal programming' and 'developmental origins of health and disease' reflect the enormous impact of pregnancy-related factors on the individual and the health.