Gynakologisch-geburtshilfliche Rundschau最新文献

{"title":"[Complications of hormonal contraception with estrogen and gestagens in the climacteric and in the postmenopausal period. 39th Congress of the \"Zurich Discussion Group\", October 2007].","authors":"M Birkhäuser, W Braendle, H Kuhl, J Neulen, C J Thaler","doi":"10.1159/000184446","DOIUrl":"https://doi.org/10.1159/000184446","url":null,"abstract":"Psychopharmaka haben ihre eigene Indikation; sie sind primär nicht zur Behandlung von Beschwerden geeignet, die auf einen Östrogenmangel zurückzuführen sind. 2. Östrogene fördern die Durchblutung und Rehydratisierung vieler Organsysteme, steigern Bildung und Umsatz von Kollagen und haben dadurch eine günstige Wirkung auf Muskeln und Gelenke. Darüber hinaus haben sie vorteilhafte Auswirkungen auf Haut und Schleimhäute (Mund, Nase, Augen). Sie wirken Androgenisierungserscheinungen entgegen, die wegen des Überwiegens der Androgenwirkung bei einem Östrogenmangel auftreten können (Akne, Seborrhö, Hirsutismus, Haarausfall). Mit der erwünschten Rehydratisierung des Gewebes kann eine leichte Gewichtszunahme verbunden sein. Dem altersabhängigen Anstieg des Körpergewichts wird eher entgegen gewirkt. 3. Atrophische Veränderungen im Urogenitaltrakt und deren Folgeerscheinungen (z.B. vulvovaginale Beschwerden, Dyspareunie, Kolpitis, Urethrozystitis) werden durch eine systemische oder lokale Östrogentherapie gebessert. Die durch einen Östrogenmangel hervorgerufenen Beschwerden können günstig beeinflusst werden. Zur alleinigen Therapie atrophischer Erscheinungen im Urogenitaltrakt ist lokal appliziertes Östradiol in sehr niedriger Dosierung geeignet. Bei höheren Dosierungen ist mit systemischen Wirkungen zu rechnen. 4. Einzelne Pflanzenextrakte können offenbar leichtere klimakterische Beschwerden bessern. Grundsätzlich müssen solche Wirkungen plazebokontrolliert untersucht werden. Einige der Extrakte enthalten in nicht geringen Mengen östrogenwirksame Substanzen (Phytoöstrogene), deren Effekte im Einzelnen nicht ausreichend untersucht sind. 5. Eine sachgerechte Substitution (auch in niedriger Dosis) verhindert den durch ein Östrogendefizit bedingten Knochenmasseverlust und senkt die Frakturrate. Einige Gestagene (z.B. Norethisteron) können hierbei die Wirkung der Östrogene verstärken. Durch diese osteoprotektive Wirkung wird das Erreichen der Frakturschwelle entsprechend verzögert, sodass die Gabe von Östrogenen in den ersten Jahren nach der Menopause das Mittel der Wahl zur Osteoporoseprävention ist. Körperliche Aktivität und eine ausreichende Versorgung mit Kalzium und Vitamin D (1500 mg Kalzium, 800 IE Vitamin D) sind entscheiSexualhormone haben nicht nur eine essentielle Bedeutung für die Fortpflanzung, sondern auch für den Stoffwechsel, das Herz-Kreislauf-System sowie das körperliche und seelische Wohlbefinden. Nach Ausfall der reproduktiven Ovarialfunktion kann es daher als Folge des Östrogendefizits und von Änderungen des Endokriniums zu Störungen im Bereich des vegetativen und zentralen Nervensystems, der allgemeinen Befindlichkeit und zu Stoffwechselveränderungen mit möglichen Folgeerkrankungen kommen (klimakterisches Syndrom inklusive Sexualstörungen, postmenopausale Osteoporose, Diabetes mellitus Typ II, kardiovaskuläre Erkrankungen, Morbus Alzheimer). Bei Östrogenmangelsymptomen ist eine Hormonsubstitution aus therapeutischen Gründen indiziert; eine","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000184446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27975359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of laparoscopy in gynecological oncology].","authors":"Daniel Fink,&nbsp;Uwe Lang,&nbsp;Rainer Kimmig","doi":"10.1159/000213058","DOIUrl":"https://doi.org/10.1159/000213058","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 3","pages":"109-10"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000213058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28241951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental growth factor: a predictive marker for preeclampsia?","authors":"Markus Schmidt,&nbsp;Canan Dogan,&nbsp;Cahit Birdir,&nbsp;Ulrich Kuhn,&nbsp;Alexandra Gellhaus,&nbsp;Rainer Kimmig,&nbsp;Sabine Kasimir-Bauer","doi":"10.1159/000197908","DOIUrl":"https://doi.org/10.1159/000197908","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 2","pages":"94-9"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000197908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28169650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Swiss guidelines for the indication for hysterectomy in relation to patient outcome.","authors":"J Schilling,&nbsp;M Abou Hadeed,&nbsp;D Fink,&nbsp;P D Hagmann,&nbsp;T Hess,&nbsp;E Infanger,&nbsp;M Müller,&nbsp;P Wyss","doi":"10.1159/000301104","DOIUrl":"https://doi.org/10.1159/000301104","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Goals: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"315-9"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29040276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current treatment options in postpartum hemorrhage. Expert correspondence no. 26 of 26 May 2009. ].","authors":"","doi":"10.1159/000301118","DOIUrl":"https://doi.org/10.1159/000301118","url":null,"abstract":"Risikofaktoren Nebst den bekannten Risiken wie hohe Multiparität, vorausgegangene PPH oder Uterus myomatosus ist insbesondere das hohe Risiko für Placenta accreta/increta/percreta bei vorausgegangener Sectio mit gleichzeitigem Vorliegen einer Placenta praevia zu beachten. Dieses beträgt bei Placenta praevia nach Sectio 25%, bei 2 vorausgegangenen Sectiones fast 50%. In diesen Fällen sollte pränatal eine ausführliche Diagnostik mittels spezialisiertem Ultraschall und eventuell MRI durchgeführt werden. Bei Verdacht auf Placenta increta/percreta ist die Durchführung der Sectio an einer Zentrumsklinik zu empfehlen, da mit hohem Blutverlust, Massentransfusionen und einer erheblichen mütterlichen Morbidität und Mortalität gerechnet werden muss.","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"337-40"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29040689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Physical integrity versus oncological safety: synthesis of important aspects in the treatment of breast cancer].","authors":"R Kimmig,&nbsp;D Fink,&nbsp;U Lang","doi":"10.1159/000118931","DOIUrl":"https://doi.org/10.1159/000118931","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"48 2","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000118931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27399753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intraoperative radiotherapy of breast cancer].","authors":"Jens Uwe Blohmer,&nbsp;Rainer Kimmig,&nbsp;Sherko Kummel,&nbsp;Serban-Dan Costa,&nbsp;Stefan Kramer,&nbsp;Mahdi Rezai","doi":"10.1159/000118933","DOIUrl":"https://doi.org/10.1159/000118933","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"48 2","pages":"63-7"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000118933","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27399755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[\"Off label use\" of pharmaceutical preparations in gynecology and obstetrics. Expert letter Nr. 23 from 19 October 2007].","authors":"","doi":"10.1159/000118938","DOIUrl":"https://doi.org/10.1159/000118938","url":null,"abstract":"Zunächst muss es sich um ein verwendungsfertiges Medikament handeln, welches von der Swissmedic für das In-Verkehrbringen in der Schweiz zugelassen wurde. Im Rahmen der Zulassung erhält jedes Medikament eine Etikette («label»), welche nebst den zugelassenen Indikationen auch Dosierung (Einzeldosis, Zeitintervall), Patientenpopulation (Alter, Geschlecht) und technisch-pharmazeutische Vorgaben (z.B. Haltbarkeit) beschreibt. Entspricht nun der Einsatz eines solchen Medikamentes nicht der Fachinformation (z.B. für eine nicht zugelassene Indikation), so erfolgt er gewissermassen ausserhalb der (behördlich genehmigten) Etikette, also «off label». Nicht zu verwechseln ist der «off label use» mit dem «unlicensed use», welcher die Verwendung eines Medikamentes betrifft, das nicht in der Schweiz zugelassen ist.","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"48 2","pages":"103-4"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000118938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27408085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vesicovaginal fistulas - birth complications which can lead to death. The risk of developing fistulas in Western Africa].","authors":"Manuela Di Marco","doi":"10.1159/000127396","DOIUrl":"https://doi.org/10.1159/000127396","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"48 3","pages":"143-5"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000127396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27509784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Current adjuvant endocrine treatment of breast cancer].","authors":"Konstantin J Dedes,&nbsp;Natalie Gabriel,&nbsp;Daniel Fink","doi":"10.1159/000127394","DOIUrl":"https://doi.org/10.1159/000127394","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"48 3","pages":"130-7"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000127394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27509782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}