Gynakologisch-geburtshilfliche Rundschau最新文献

Objective: The objective of this study was to assess the expectations of the patients regarding prenatal examination and assisted reproductive treatment.

Methods: The first sample included patients and their partners at the commencement of assisted reproductive treatment. The couples were asked to predict the success of in vitro fertilization on a scale ranging from 0 to 100%. The second sample included pregnant women and their partners prior to prenatal examination (level III). These couples were asked what expectations they had regarding the prenatal examination.

Results: On average, 57% of the women and 61% of their partners expected a successful pregnancy in the course of the ongoing reproductive treatment. The expectations at the prenatal examination indicated that both the women and their partners wished, in the first instance, a reassuring outcome and a positive diagnosis of pregnancy. Lower down the scale in third and fourth position were safety and assurance.

Discussion: The patients focused their expectations mainly on the technical possibilities of the reproductive techniques. It is therefore necessary in psychosomatic medicine to introduce personal concepts for discussion in order to avoid being subordinated to prevalent facts.

High-risk situations in early breast cancer concern patients with less than 3 involved lymph nodes but additional risk factors as well as patients with more than 3 involved lymph nodes. For the first group, new risk assessment methods to better identify the need for chemotherapy with or without a taxane or with a taxane instead of an anthracycline are needed. For the second group, further improvement of anthracycline- or taxane-containing chemotherapy regimens is warranted. Current approaches include the sequential or simultaneous use of these groups of agents, the combination with antimetabolites, antibodies or small molecules, the neoadjuvant use of chemotherapy as well as dose-dense and dose-escalated chemotherapy regimens.

Androgens and insulin are endocrine key players in the pathophysiology of polycystic ovary syndrome (PCOS), a heterogenic condition of unexplained etiology and a suspected genetic background. Androgens mediate the clinical phenotype of the disease. Therefore,all criteria of the recent PCOS consensus definition are based on their biological effects. Insulin resistance, followed by compensatory hyperinsulinemia, is frequently found in patients with PCOS. Insulin resistance is correlated with a risk of metabolic complications of PCOS, and recent research has focused on possible long-term health consequences of the syndrome. Newest molecular genetic findings at the receptor level of both androgens and insulin support their pivotal role in PCOS. These results could help to better characterize the heterogenic disorder, enabling a refinement of existing individualized therapeutic strategies.

With the approval of trastuzumab (Herceptin) in 1998, a new era of breast cancer treatment has been heralded. This antibody is directed at the intracellular domain of a member of the epidermal growth factor receptor family, the so-called HER2 receptor. About 25-30% of all breast cancers overexpress this factor, which is associated with a more unfavorable prognosis. Trastuzumab is indicated for patients whose tumor overexpresses HER2. All previous studies on the adjuvant therapy with trastuzumab show very consistent results and provide evidence that the risk of recurrence can be reduced by half by the antibody. Nevertheless, there are still numerous open and controversially discussed questions concerning the use of trastuzumab in adjuvant therapy.

Objectives: The study investigates in what way physicians integrate their desire to have children into their career planning.

Methods: Within the framework of a prospective cohort study of Swiss medical school graduates on career development of young physicians, beginning in 2001, 534 participants (285 women, 249 men) were assessed in January 2007, in terms of having children, planning to have children, the career aspired to and the work-family balance used or planned.

Results: Among the study participants, 19% (54) of the women and 24% (59) of the men have children. Of the others 88% plan to start a family in the future. Female physicians with children are less advanced in their careers than women without children; for male physicians no such difference can be observed. Of the female physicians with children or the desire for children 42% aspire to work in a practice, 28% to a clinical and only 4% to an academic career. Of the male physicians with children or the desire for children one third aspire to work in a practice, one third to a clinical and 14% to an academic career. The preferred model of work repartition of female physicians with children is father full time/mother part time or both parents part time; the preferred model of male physicians is father full time/mother part time or not working.

Conclusion: Children are an important factor in the career and life planning of physicians, female physicians paying more attention to an even work-family balance than male physicians.

This review article describes the procedure of magnetic resonance (MR) mammography in patients with breast implants. The spectrum of breast implants in MR imaging and local implant complications are illustrated. MR mammography should be used for the diagnosis of implant complications and suspected malignant lesions in patients with breast implants.