Zentralblatt fur Gynakologie最新文献

Background: Ovarian vein thrombosis is a known complication in the peri- and postpartum phase. Its incidence is documented as 1:600 to 1:2000. Concerning ovarian vein thrombosis in earlier stages of pregnancy there are only very few case reports.

Case report: We report on a woman in her third pregnancy who presented with acute abdominal pain in the 27th week of gestation. After a long car drive she felt an acute pain in the upper right abdomen which moved down to the right lower abdomen. On admission the obstetrical examination showed no pathology. There were no contractions. Clinical and sonographic examination could not reveal the cause of the pain. As adequate analgesia failed to relieve the pain, an explorative laparotomy was performed. It showed a dilated right ovarian vein of 3 cm diameter with a thrombus reaching the confluence to the vena cava. The ovarian vessels were resected and the adnectomy on the right side performed. Anticoagulation was initiated. There were no complications during the postoperative course. The pregnancy proceeded normally. After 10 days the patient could be dismissed in good condition. Laboratory diagnostic showed an deficiency in protein C. At 39 weeks of gestation a planned caesarean section was performed without any complications.

The expression expert patient appeared about ten years ago. It defines the role of patients who are actively involved in their disease management. Most clinical oncologists are challenged by expert patients. Patient's expertise and complementary medicine are closely linked. Physicians respecting expert patients have to find a positive attitude towards patient self aide concepts. The medical skill to manage expert patients is increasingly important and new tools are being developed for support.

Fluorescence diagnosis and photodynamic therapy with 5-aminolevulinic acid induced protoporphyrin IX are promising new options in the diagnosis and therapy of diseases in a wide spectrum of medical disciplines such as urology, dermatology, gastroenterology, surgery, neurosurgery and gynecology. The techniques are based on the application of the heme biomolecule precursor 5-aminolevulinic acid which induces the endogenous accumulation of the photosensitizer protoporphyrin IX in designated tissues. After external excitation with blue light a strong red fluorescence can be initiated particularly in tumorous tissues. In gynecology many studies have been performed evaluating the usefulness of fluorescence based detection of cervical dysplasias, breast cancer, endometrial diseases, ovarian cancer and endometriosis. This work aims on the principles of fluorescence detection as an important tool in biomedical optical imaging and its current status in gynecology.

Introduction: A body stalk anomaly is a rare congenital defect. The anomaly is one of the anterior abdominal wall defects. It is characterized by severe clefts of the abdominal wall with absence of or very small, umbilical cord.

Case report: We report on a patient in the 21st week of gestational age with the ultrasonographic findings of multiple fetal anomalies including a singular umbilical artery and an ahydramnion. She was sent to hospital for termination of the pregnancy. The karyotype was normal (46 XX). Ultrasonographic evaluation of the fetal anterior abdominal wall was impossible due to ahydramnion. Clinical examination showed an omphalocoele with herniation of the stomach, the small intestine, the liver and the spleen. A very short umbilical cord was observed which was attached to the omphalocoele. The lower limbs were deformed. Furthermore, anal atresia with an extroverted coele was found. Autopsy confirmed the clinical diagnosis of a body stalk anomaly.

Discussion: It is important to distinguish a body stalk anomaly from other types of anterior abdominal wall defects because of their prognosis and an appropriate medical management. A body stalk anomaly is a sporadic defect and not associated with chromosomal abnormalities. This congenital defect is invariably lethal.

In a statistical significance test a scientific problem is expressed by formulating a null hypothesis and an opposite alternative. Construction of an empirical decision rule usually focuses on control of the alpha-error, i.e. the probability of erroneously refusing the null hypothesis. Contrary to the alpha-error, the beta-error is not controlled and in general is of unknown size. Thus in case of a non-significant result the validity of the null hypothesis still may be highly questionable. Such an unwanted outcome of an applied test the researcher should try to avoid by choosing an appropriate study design. In case it occurs nevertheless, it is advised to further evaluate the (non-significant) result. This can be done by calculating confidence intervals of the tested effects. Furthermore the p-value can be interpreted as a metric measure of evidence against the null hypothesis. By means of a posterior power analysis the probability of a significant test result is estimated under the given circumstances. Thus possibly the applied test--under the assumption of actual validity of the alternative--turns out to have had hardly a chance of rejecting the null hypothesis. In this case the non-significant result (pointing towards the null hypothesis) is relativized substantially. On the other hand a large power points to a small probability of a beta-error.

Objective: The incidence of vulvar intraepithelial neoplasia (VIN) has increased in the last decades. The therapy of VIN is the in toto resection. Still some patients develop VIN recurrence. The aim of this retrospective study is the identification of risk factors for VIN recurrence.

Material and methods: 68 Patients with VIN III has been examined in an univariate and multivariate analysis for the following parameters (follow-up: median 27 months): age, HPV, HIV, multicentricity, resection margins (1-4 mm, 5-9 mm, > or = 10 mm).

Results: In the univariate analysis positive HPV and HIV status correlated with VIN recurrence. Also resection margins < 5 mm showed a significant correlation with VIN recurrence. Multivariate analysis demonstrated that HPV, HIV and resection margins < 5 mm are independent risk factors. No statistically association was found for age and multicentricity.

Conclusion: The aim of VIN therapy must be the total resection with a negative resection margin of > or = 5 mm. HPV- and/or HIV-positive patients have a significantly higher risk for VIN recurrence and need therefore an intensive follow up.

The Organgruppe Mamma der Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) conducted a nationwide 3-phase analysis of the care structure and standard of therapy given to patients with breast cancer from 2002 (4th quarter) to 2004 (4th quarter). The analysis includes 1069 patients from 257 institutions; 34% with early breast cancer and 66% with metastatic disease. No reliable data on the pattern of care of these patients have been published to date in Germany. The extent to which national and international therapy recommendations were implemented in routine clinical practice was unclear. Evaluation of the data shows that treatment based on the guidelines is now being implemented very reliably in certain sectors. This is of particular relevance to the pattern of adjuvant treatment in early breast cancer. At that time 68 % of the patients received an anthracyclin based chemotherapy and in addition 18% received an anthracycline and taxane based chemotherapy. Participation in clinical trials peaked with 30% in the neoadjuvant setting. The problem with metastatic breast cancer is the complexity of the interdisciplinary treatment involved. The present analysis conducted by the AGO was the first attempt to analyse the treatment given to metastatic patients and to systematise the approach to treatment. The fundamental problem remains, irrespective of the stage of the tumour, namely that too few patients are treated in randomised clinical studies.

Background: Bone metastases belong to the most frequent metastases in breast cancer. Currently there exist no serum markers which allow early detection of bone metastases.

Patients and methods: 89 patients with primary breast cancer have been investigated for parathyroid-hormone-related peptide (PTHrP) in the tumour and bone sialoprotein (BSP) in the serum. Both markers have been correlated with classical prognostic factors and survival.

Results: The median age of the patients was 56 years. 17 of the 89 patients developed bone metastases and 25 died during the observation period of 5 years. PTHrP correlated significantly with bone metastases free survival (p = 0.0004) and overall survival (p = 0.0005), whereas BSP correlated only with the bone metastases free survival (p = 0.03). Both markers were shown to be independent prognostic factors for the bone metastases free survival in the multivariate analysis. PTHrP was also found to be an independent prognostic factor for the overall survival.

Conclusion: The investigation of PTHrP could be a prognostic marker for the presence of bone metastases while BSP could be a marker for the early detection of bone metastases.