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Seaweed farming is a growing industry worldwide, and its sustainable management requires detailed knowledge about the environmental implications of detrital release. This study investigates benthic degradation of kelp detritus in defaunated mesocosms. The degradation dynamics were investigated over several weeks by resolving O2 and dissolved inorganic carbon (DIC) fluxes as a function of detritus amendments (0.15 g wet weight [WW] m-2 to 1 kg WW m-2), temperature (8 and 15°C), and presence of O2 for 2 commercially important kelp species: Saccharina latissima and Alaria esculenta. Kelp fragments were deposited in 2 different ways to simulate oxic and anoxic degradation: on the sediment surface (surface amendments) and just below the oxic surface sediment layer (subsurface amendments). All amendments resulted in high initial O2 consumption followed by an exponential decrease in O2 uptake over time. The degradation rates increased linearly with the amount of kelp added for both species and for both types of amendments. S. latissima expressed higher decay constants across all experiments and had a higher percentage turnover of carbon. In some instances, microbial priming apparently enabled enhanced degradation of pre-existing resilient sedimentary carbon. The absolute degradation rates of kelp were reduced in the absence of O2, and sulfate reduction resulted in gradual accumulation of iron sulfide. Lower ambient temperature reduced the benthic mineralization rate of both kelp species, particularly during the initial incubation stages. The current study demonstrates the importance of key variables for microbial kelp degradation in marine sediments and their dynamics—variables that should be carefully considered when assessing environmental implications of seaweed farming.

Purpose Obstetric anal sphincter injuries (OASIS) increase the risk for pelvic floor dysfunctions. The goal of this study was to examine the long-term outcomes after OASIS on pelvic floor functions and quality of life. Material and methods Between 2005 and 2013, 424 women had an OASIS at the Women University Hospital Ulm. Out of these 71 women completed the German pelvic floor questionnaire, which includes questions regarding prolapse symptoms as well as bladder, bowel and sexual function. In addition, 64 women were physically examined, including a speculum examination to evaluate the degree of prolapse, a cough test to evaluate urinary stress incontinence (SI) and an evaluation of both pelvic floor sphincter (modified Oxford score) and anal sphincter contraction. Results A high rate of pelvic floor disorders after OASIS was found, as 74.6% of women reported SI, 64.8% flatus incontinence and 18.3% stool incontinence, respectively. However, only few women stated a substantial negative impact on quality of life. The clinical examination showed that a positive cough test, a weak anal sphincter tone and a diagnosed prolapse correlated with the results of the self-reported questionnaire. Conclusion On one hand, OASIS has an influence on pelvic floor function going along with lots of complaints, while on the other hand, it still seems to be a taboo topic, as none of the participants spoke about the complaints after OASIS with a doctor. Therefore, the gynecologist should actively address these issues and offer therapy options for the women with persisting problems.

Brustkrebs ist eine der haufigsten Krebserkrankungen wahrend der Schwangerschaft. Von schwangerschaftsassoziiertem Brustkrebs spricht man, wenn die Erkrankung wahrend der Schwangerschaft, im ersten postpartalen Jahr oder wahrend der Stillzeit auftritt. Diagnostik und Therapie sind insofern herausfordernd, da nicht nur das Wohl der Patientin, sondern auch das des ungeborenen Feten bedacht werden mussen. Mammographie mit abdomineller Abschirmung, Sonographie und Stanzbiopsie gelten als sichere diagnostische Mittel. Die Indikation zur operativen Therapie wird in Analogie zur nichtgraviden Patientin gestellt: Hier kommen je nach Befund sowohl brusterhaltende Therapieformen (BET) als auch ablative Verfahren in Frage. Die Strahlentherapie nach BET sollte erst nach der Entbindung erfolgen. Sowohl Antrazyklin- als auch Taxan-haltige Standardregime gelten wahrend der Schwangerschaft als relativ sicher und konnen ab dem zweiten Trimenon bis 3 Wochen prapartal eingesetzt werden. Eine HER2-zielgerichtete Therapie sowie eine endokrine Therapie sind wahrend der Schwangerschaft kontraindiziert.

ZusammenfassungEine Hyperprolaktinämie kann idiopathisch bedingt sein oder physiologisch im Rahmen von Schwangerschaft, Stillzeit, Stress, Schlaf oder körperlicher Aktivität vorkommen. Andererseits können eine Hypophysen- oder Hypophysenstielpathologie, Wechselwirkungen durch Medikamente, eine Hypothyreose oder Niereninsuffizienz eine Hyperprolaktinämie verursachen. Die Symptome können ganz gering ausgeprägt sein oder sich sehr vielfältig im Sinne einer Oligo‑/Amenorrhö, einer Galaktorrhö oder eines unerfüllten Kinderwunsches darstellen. In dieser Übersichtsarbeit sollen die verschiedenen Aspekte der Hyperprolaktinämie aus gynäkologischer Sicht dargestellt werden.

Study question Does cryopreservation and transplantation of bovine ovarian medulla-containing cortex tissue improve the viability and vascularization of the graft? Summary answer: Transplantation of bovine ovarian cortex containing medulla has a positive effect on follicular viability and neovascularization of the graft compared to cortex transplantation alone. What is known already For female fertility protection, cryopreservation and retransplantation of ovarian tissue is a widely used method. During cryopreservation, ovarian tissue is exposed to mechanical and hypoxic stress resulting in follicular loss. Moreover, after retransplantation tissue vitality and follicle survival is limited due to ischemia. As follicular viability is of major importance for fertility and hormonal activity, the main focus is on improving vitality and viability of the grafts. In current protocols, ovarian medulla is discarded and merely cortex tissue is preserved. However, medulla tissue predominantly contains blood vessels, thereby obtaining high potential for revascularization processes and thereby supporting tissue vitality. Study design, size, duration This experimental laboratory work was performed during a period of ten months. The rapidly vascularized chorioallantoic-membrane (CAM) of fertilized chicken eggs was used as model system to investigate neovascularization, follicle survival and tissue vitality of different bovine ovarian grafts. In four independent experimental rows four different tissue types (isolated cortex, thick medulla-containing cortex (8 x 10 x 3 mm), thin medulla-containing cortex (5 x 10 x 3 mm) and sole medulla tissue were compared. Participants/materials, setting, methods Out of four bovine ovaries preserved from the slaughterhouse, in total 117 samples of the four different tissue types were primed and cryopreserved by the common slow-freezing protocol. After thawing, grafts were transplanted on separate CAMs at day four of fertilized eggs. After four days of incubation, blood vessels growing towards the grafts were counted. Subsequently, grafts were harvested, digested with collagenase and stained with Neutral Red® to determine the total amount of vital follicles. Main results and the role of chance To investigate the neovascularization, all graft-supplying blood vessels were determined and distinguished between small and thick vessels. Compared to sole cortex, there were more small vessels in the medulla-containing grafts (9,72 vs. 8,65). Especially thin medulla- containing cortex pieces exhibited the highest number of small vessels (9,90). Also in isolated medulla tissue an increased amount of small vessels was observed (9,79). However, the average number of big vessels was not significantly different in all four test groups (Cortex: 2,12; thin medulla-containing cortex: 1,69; thick medulla-containing cortex: 1,5; medulla: 2). The total number of all vessels differed from 10,76 (sole cortex) to 11,75 (medulla-containing grafts), indicating a support of neoangiogenesis by medulla tissue. To further examine whether medulla tissue also alters the amount of vital follicles, Neutral Red® stained vital follicles were determined in all different sample groups. Indeed, in medulla-containing cortex samples was an augmented average number of vital follicles (342,4) compared to sole cortex tissue (256,11). Most vital follicles were detectable in the thick medulla-containing cortex tissue (346,61), closely followed by the thin medulla-containing cortex grafts (338,19). As expected, there was just a rare amount of vital follicles in sole medulla grafts (8,13). Limitations, reasons for caution As the ovarian reserve in cattle is very individual, the prepared ovaries are different in their follicle amount. These individual differences may influence the number of counted follicles. Furthermore, the CAM model is only a short term experimental approach to investigate neovascularization and follicle survival. Wider implications of the findings: According to our results, transplantation of human medulla-containing cortex appears promising. Keeping medulla tissue on the graft seems to improve both follicle viability and revascularization. Our findings need to be proven with human tissue, but might change the preparation of human ovarian tissue for fertility preservation in future. Trial registration number Not applicable

Die Erfullung des Kinderwunsches tritt heutzutage nach kompletter Remission einer onkologischen Erkrankung bei jungen Frauen immer mehr in den Vordergrund. Allerdings ist das Risiko fur eine vorzeitige Ovarialinsuffizienz und damit eine deutlich verminderte Schwangerschaftschance bei Frauen im fertilen Alter unterschiedlich, kann aber je nach Art und Anzahl der Chemotherapiezyklen bei bis zu 90 % liegen. Daher sollte jede pramenopausale Frau vor dem Beginn einer Chemotherapie oder einer Bestrahlung des kleinen Beckens uber dieses Risiko aufgeklart und die Moglichkeiten des Fertilitatserhalts erlautert werden.

Extracardiac rhabdomyomas are rare benign tumors. According to histopathologic and clinical characteristics, they are divided into 3 subgroups: adult, fetal, and genital rhabdomyomas. Various adult extracardiac rhabdomyomas have been reported in the head and neck region, whereas genital rhabdomyomas are uncommon. Here, we report on a uterine genital rhabdomyoma in a 32-yr-old woman with secondary sterility. After myomectomy, the histopathologic analysis showed a slow cycling tumor with striated muscle differentiation and without any evidence of malignancy. Immunohistochemical staining proved coexpression of actin, caldesmon, and desmin. To the best of our knowledge, this is the first case of a uterine-based genital rhabdomyoma.

Background First manifestation of Cushing’s syndrome during pregnancy is rare. The diagnosis of both Cushing’s and primary aldosteronism within a pregnancy has not been previously documented. Diagnosis is especially challenging due to the normal physiological changes that occur during pregnancy. Consequently, many tests that are normally used for diagnosis are not reliable. Tumor based etiologies can be surgically removed. Etiologies that are not tumor based are challenging to treat during pregnancy. Case presentation A 25 year old G1P0 was admitted in the 22 5/7 week of pregnancy with elevated blood pressure (200/100 mm Hg), acne, moon facies, abdominal striae and hirsutism. With five antihypertensive medications her blood pressure remained 190/100 mm Hg. The patient was admitted to the ICU for intravenous medications and monitoring. She was diagnosed with Cushing’s syndrome and primary aldosteronism. In spite of therapy with spironolactone and metyrapone she developed preeclampsia and was delivered in the 26 0/7 week of pregnancy. At her follow up visit eight weeks postpartum she had blood pressure within normal limits, no clinical signs or symptoms, and all medications had been discontinued. Conclusions Early diagnosis of pregnancy induced Cushing’s syndrome and primary aldosteronism requires an interdisciplinary approach. Late detection has been associated with increased perinatal morbidity and mortality including but not limited to placental abruption and intrauterine demise. Collaboration is essential in the optimization of maternal and fetal outcomes.

Treatment side effects, comorbidities, and guideline-adherent treatment (GL+) influence the oncologic outcome of older breast cancer patients (oBCP) (age ≥ 70 years). The focus of this analysis was to investigate the associations among tumor characteristics, guideline adherence, and outcome and to compare these associations between younger breast cancer patients (yBCP) (age 50-69 years) and oBCP.This is a retrospective multicenter cohort study with 17 participating certified breast cancer centers. The analysis of 10,897 patient records collected from 1992 to 2008 for GL+ and clinical outcome was performed. Tumor and patient characteristics and their associations with GL+ were compared between oBCP and yBCP.Nonguideline-adherent treatment (GL-) was associated with higher tumor stages and comorbidities. This effect was stronger in the oBCP group (P .001). GL+ was significantly more common in yBCP than in oBCP (P .001). The oBCP had significantly higher tumor stages, including tumor size (P .001), nodal status (P .001), and positive hormone receptors (P = .001). Tumor grading was lower (P = .001), and HER2neu overexpression was less frequent (P = .003) in oBCP. Overall survival and disease-free survival are significantly impaired if GL- occurred in patients with breast cancer independently of age.GL- is associated with decreased disease-free survival and overall survival in both age groups. GL+ decreases advanced tumor characteristics in all age groups but significantly more in oBCP. If patients received GL+, we were unable to detect a statistical significant difference in the survival parameters.

Purpose The tumor biology of older breast cancer patients (oBCP) is usually less aggressive, however applied adjuvant treatment is often less potent resulting in an impaired disease free survival and overall survival in this group. This study tries to answer the following questions for the biological subtypes of oBCP (70+ y): (1) Is there a significant difference in the distribution of the biological subtypes of oBCP vs younger breast cancer patients (yBCP; 50–69 y)? (2) Which biological subtype has the highest rate of non-guideline-adherent-treatment (GL−) among oBCP? (3) Is a single GL− (i.e. radiotherapy/surgery/endocrine-therapy/chemotherapy) significantly associated with the survival outcome in each biological subgroup? Methods Between 1992 and 2008 the BRENDA (‘BRENDA’ = quality of BREast caNcer care unDer evidence-bAsed guidelines) study group recorded medical data of 17 participating certified breast cancer centers in Germany. We performed a retrospective multi-center database analysis of 5632 patient records. Guideline-adherent-treatment (GL+) of oBCP(n = 1918) was compared to GL+ of yBCP(n = 3714). Results OBCP were more likely to have hormone receptor positive (HR+) and HER2 neu negative (HER2−) breast cancer (77.5% vs 74.5%). The rate of GL− was significantly different (p The survival parameters for HR+/HER2− and TNBC were significantly worse in case of GL− regarding chemotherapy, and if applicable endocrine therapy. A similar association only existed in HR−/HER2+ tumors for GL− for radiotherapy and in HR+/HER2+ tumors for chemotherapy. Conclusions Beside the significantly different distribution of biological subtypes in the age groups there is an association between biological subtype, and GL+ influencing survival parameters in oBCP.

Nach adjuvanter Chemotherapie liegt das Risiko fur eine Ovarialinsuffizienz bei Frauen unter 40 Jahren je nach Art und Anzahl der Chemotherapiezyklen zwischen 10 und 80 %. Daher sollte jede pramenopausale Patientin mit Kinderwunsch uber dieses Risiko und die Moglichkeiten des Fertilitatserhaltes aufgeklart werden. Sowohl die Entnahme und Kryokonservierung von Ovarialgewebe als auch die hormonelle Stimulation mit nachfolgender Kryokonservierung von befruchteten und unbefruchteten Eizellen haben in den letzten Jahren vielversprechende Ergebnisse gezeigt und sollten mit den Patientinnen besprochen werden. Ob GnRH-Agonisten kombiniert oder allein verwendet werden sollten, ist weiterhin kontrovers; fur die einzelne Patientin kann dies in Abhangigkeit vom individuellen Risiko entschieden werden.

Hintergrund Ein Zusammenhang zwischen Endometriose und Infertilitat ist noch nicht zufriedenstellend geklart, auch wenn in letzter Zeit davon ausgegangen wird, dass sowohl die Eizellqualitat als auch die Eizellreserve bei Frauen mit Endometriose verandert ist. Dementsprechend fehlen bisher definierte Behandlungsalgorithmen. Es stehen z. B. individuelle hormonelle Stimulationsprotokolle mit und ohne nachfolgende assistierte Reproduktion zur Verfugung, auserdem stellt sich die Frage, ob eine operative Intervention in Hinblick auf den Kinderwunsch sinnvoll ist, also die Schwangerschaftsrate verbessert.

The current law on the protection of expectant and nursing mothers largely rules out surgical activities during pregnancy for female doctors who perform surgical roles in hospitals. The proportion of female junior staff in gynaecology amounts to 80 %, and, for many of these women, surgical further training is not possible following official notification of an existing pregnancy. In a Germany-wide survey of female gynaecologists and surgeons using a questionnaire, it was determined to what extent female doctors worked in surgery during pregnancy, whether it led to complications in the pregnancy, when the employer was notified about the pregnancy, and what desire for change there is with regard to the law on the protection of expectant and nursing mothers. The data from 164 female doctors, of which 136 are gynaecologists and 28 surgeons, was evaluated. On average, the pregnancy was announced during the 14th week of pregnancy (WOP), and the doctor was not allowed to perform surgical activities in the 21st WOP. Female doctors in higher professional roles tended to announce the pregnancy later and ended their surgical activities later. There was no link between the time of ceasing surgical activities and an increased occurrence of complaints or complications during the pregnancy. In total, only 53 % of respondents had an appraisal during pregnancy and 75 % wanted a change in the law on the protection of expectant and nursing mothers.Das aktuelle Mutterschutzgesetz schließt eine operative Tätigkeit während der Schwangerschaft für in der Klinik operativ tätige Ärztinnen weitestgehend aus. Der Anteil der Berufseinsteigerinnen liegt in der Gynäkologie bei 80 %, für viele dieser Frauen ist die operative Weiterbildung nach offizieller Mitteilung einer bestehenden Schwangerschaft nicht möglich. In einer deutschlandweiten Umfrage unter Gynäkologinnen und Chirurginnen wurde anhand eines Fragebogens u. a. ermittelt, inwieweit Ärztinnen in der Schwangerschaft operativ tätig waren, ob es zu Komplikationen in der Schwangerschaft kam, wann die Schwangerschaft dem Arbeitgeber mitgeteilt wurde und welche Änderungswünsche bez. des Mutterschutzgesetzes bestehen. Die Daten von 164 Ärztinnen, davon 136 Gynäkologinnen und 28 Chirurginnen, wurden ausgewertet. Die Schwangerschaft wurde im Mittel in der 14. Schwangerschaftswoche (SSW) bekanntgegeben, ein Ausschluss aus der operativen Tätigkeit erfolgte in der 21. SSW. Ärztinnen in höheren beruflichen Positionen gaben tendenziell später die Schwangerschaft bekannt und beendeten später die operative Tätigkeit. Es bestand kein Zusammenhang zwischen dem Zeitpunkt des Ausscheidens aus der operativen Tätigkeit und einem vermehrten Auftreten von Beschwerden oder Komplikationen während der Schwangerschaft. Insgesamt führten nur 53 % der Befragten in der Schwangerschaft ein Personalgespräch und 75 % wünschten sich eine Änderung des Mutterschutzgesetzes.

Myome sind die haufigsten Beckentumoren der Frau. Die operative Therapie kann myombedingte Beschwerden zielgerichtet und minimal-invasiv beheben. In ausgewahlten Fallen kann neben der transvaginalen Sonographie auch eine Magnetresonanztomographie sinnvoll sein. Die mininimal-invasive Entfernung der Gebarmutter ist die einzige definitive Therapie des Uterus myomatosus und wird bei Beherrschen geeigneter operativer Verfahren (z. B. Morcellement) minimal-invasiv durchgefuhrt. Bei Kinderwunsch ist die operative Myomenukleation das einzige Verfahren, das die Fertilitat verbessern kann. Die Enukleation kann per Hysterosresektoskopie und Laparoskopie durchgefuhrt werden. Zur abschliesenden Beurteilung neuerer Verfahren, wie operative Interventionen durch nur einen abdominalen Einstich oder Operationen mit Telemanipulatoren, reicht die Datenlage noch nicht aus.

To evaluate the outcome of frozen-thawed embryo transfer (FET) when freezing takes place at the pronuclear stage, a retrospective analysis was performed comparing spontaneous and artificial cycles.148 women received FET in a spontaneous cycle (Group A) and 55 women received FET in an artificial cycle (Group B) induced by administering estrogen (E2) and progesterone (P). Pregnancy rates, endometrial thickness and serum levels of E2, P and luteinizing hormone (LH) were measured. Statistical analysis included the mean, the standard deviation, the Chi-squared test and the T-test.The clinical pregnancy rate was 34.5% for Group A and 21.8% for Group B (p = 0.084), with a live birth rate of 20.9% and 12.7% respectively (p = 0.15). There was no difference in endometrial thickness or the P levels, while LH and E2 levels were significantly higher in group B (p 0.0001).Our retrospective study shows a trend towards higher pregnancy rates and live birth rates with the administration of FET during a spontaneous cycle compared to FET during an artificial cycle. Large randomized controlled trials are needed to confirm this trend.

Die Frauenheilkunde zeichnet sich insbesondere in den letzten Jahren durch einen hohen Anteil an weiblichen Arzten aus, sodass die Vereinbarkeit von Beruf und Familie eine ganz besondere Herausforderung darstellt. Von der Kommission „Familie und Karriere“ der DGGG wurde ein Fragebogen entwickelt, der die aktuelle berufliche Situation der Frauenarztinnen und Frauenarzte widerspiegeln soll, mit dem Fokus auf die familiare und berufliche Situation in Klinik und Praxis. Dabei wird gefragt nach Kindern, danach, wie die personlichen Moglichkeiten der Vereinbarkeit von Beruf und Familie sind, wie weit eine „Work-life-Balance“ besteht und wie es mit der Zufriedenheit uber die eigene Berufswahl steht. In dieser Ubersichtsarbeit werden erste Ergebnisse vorgestellt.

Standard treatment of patients with breast cancer decreases with age and older persons are mostly excluded from clinical trials. We hypothesized that non-adherence to treatment guidelines occurs for women agedor =70 years and changes overall survival (OAS) and disease-free survival (DFS).We enrolled 1922 women agedor =50 years with histologically confirmed invasive breast cancer treated at the University of Ulm from 1992 to 2005. Adherence to guidelines and effects on OAS and DFS for women agedor =70 years was compared with that for younger women (50-69 years).Women70 years less often received recommended breast-conserving therapy (70-79 years: 74%-83%;79 years: 54%) than women agedor =69 years (93%). Non-adherence to the guidelines on radiotherapy (70 years: 9%; 70-79 years: 14%-27%;79 years: 60%) and chemotherapy (70 years: 33%; 70-79 years: 54%-77%;79 years: 98%) increased with age. Omission of radiotherapy significantly decreased OAS [or =69 years: hazard ratio (HR) = 3.29; P0.0001;or =70 years: HR = 1.89; P = 0.0005] and DFS (or =69 years: HR = 3.45; P0.0001;or =70 years: HR = 2.14; P0.0001). OAS and DFS did not differ significantly for adherence to surgery, chemotherapy, or endocrine therapy.Our study confirms that substandard treatment increases considerably with age. Omission of radiotherapy had the greatest impact on OAS and DFS in the elderly population.

Die Stadieneinteilung des Zervixkarzinom erfolgt rein klinisch. Da die bimanuelle Tastuntersuchung einer hohen inter- und auch intraindividuellen Variabilitat unterliegt, werden zunehmend bildgebende Verfahren zur Evaluation hinzugezogen. Zurzeit scheinen weder die Computertomographie (CT) noch die Magnetresonanztomographie (MRT) oder die Positronenemissionstomographie (PET) der klinischen Untersuchung uberlegen. Es ist unklar, ob durch technische Weiterentwicklungen eine Verbesserung der Bildgebung erzielt werden kann und damit die bimanuelle Tastuntersuchung zwar nicht abgelost, aber sinnvoll erganzt werden kann.

Altere Patientinnen mit Brustkrebs werden seltener leitliniengerecht therapiert und seltener in klinische Studien eingeschlossen. Dies fuhrt zu einer Reduktion der rezidivfreien Zeit und des Gesamtuberlebens. Es gilt, die Patientinnen zu definieren, die sich fur eine leitliniengerechte Therapie eignen und den nicht geeigneten Patientinnen die bestmogliche „reduzierte“ Therapie anzubieten. Dazu mussen vernachlassigte Aspekte wie korperliche Fitness und Behinderung im Alltag, soziale Netzwerke, Lebensqualitat und allgemeine Komorbiditaten verstarkt berucksichtigt werden. Hierzu kann ein angepasstes geriatrisches Assessment dienen. In diesem Artikel wird eine Ubersicht uber die aktuelle Datenlage bezuglich Therapiemodalitaten und -nebenwirkungen gegeben sowie eine Auswahl geriatrischer Assessments aufgezeigt.

Cervical carcinoma is clinically staged according to the criteria of the International Federation of Gynecology and Obstetrics (FIGO). Computed tomography (CT) and magnetic resonance imaging (MRI) can also be used in pretreatment evaluation of tumor extension and size; however, the diagnostic value and the impact on clinical decisions of cross-sectional imaging have been questioned. The files of 255 patients with biopsy-proven cervical carcinoma receiving primary surgical treatment at the Department of Obstetrics and Gynaecology of Ulm University between 1992 and 2003 were analyzed retrospectively. All patients had a clinical pelvic examination; additionally, 164 underwent CT, 101 had an MRI, and 90 had both CT and MRI. Surgicopathologic findings were used as the standard of reference. To evaluate detection of parametrial involvement, patients were divided into those with stage IIA or less disease (n = 171; 67%) and those with stage IIB or more disease (n = 84; 33%). The accuracy, sensitivity, and specificity were 75%, 66%, and 81% for clinical staging, 59%, 43%, and 71% for CT, and 58%, 52%, and 63% for MRI, respectively. After stratification for palpation, the results with CT and MRI were no better than with palpation (accuracy: CT 61% and 54%, MRI 61% and 56%, respectively). The sensitivity of CT and MRI for detecting lymph node metastasis was also poor (36% and 35%, respectively). Clinical examination was better than CT and MRI for pretreatment evaluation of early invasive cervical cancer.

Der Gelbkorper, das Corpus luteum, ist ein temporares endokrines Organ, das aus dem Follikel nach dem Eisprung entsteht und 2 Wochen spater eine Regression erfahrt. Seine Hauptaufgabe ist die Produktion und Sekretion von Progesteron. Voraussetzung fur seine regelrechte Funktion ist eine suffiziente Follikelphase mit ausreichender Ostradiolsekretion und einem adaquaten LH-Anstieg. Beim Prozess der Luteinisierung stoppt die Zellteilung, und die Follikelzellen wandeln sich in grose und kleine Lutealzellen mit unterschiedlichen Aufgaben um. Die Rezeptorexpression verandert sich, und neue Gefase sprossen ein. Die GnRH- und LH-Pulsfrequenz nimmt durch das Progesteron in der Lutealphase ab. Damit ein neuer ovarieller Zyklus entstehen kann, muss das Corpus luteum komplett eliminiert werden. Die Blutzufuhr zum Corpus luteum wird gedrosselt, und die Apoptose setzt ein. Kommt es zu einer Schwangerschaft, bleibt die Corpus-luteum-Funktion so lange erhalten, bis die Plazenta die Aufgaben voll ubernehmen kann. Dieser luteoplazentare Shift findet in der 5. Schwangerschaftswoche statt. Eine adaquate Lutealfunktion kann man anhand der Ostrogen- und Progesteronwerte als Surrogatparameter beurteilen. Die Progesteronspiegel sollten uber 8–10 ng/ml liegen.

Das Fettgewebe ist ein endokrines Organ und sezerniert Adipokine, inflammatorische Zytokine und ist auch fur die Aromatisierung von androgenen Vorstufen zu Ostrogen verantwortlich. Vermehrtes Fettgewebe ist mit einem erhohten Krebsrisiko verbunden. Es handelt sich hierbei um ein multifaktorielles Geschehen. Zu diesen Faktoren gehoren Leptin, das zu vermehrtem Tumorwachstum fuhrt, vermindertes Adiponektin, inflammatorische Zytokine wie IL-6 und TNF-α, eine Insulinresistenz mit Hyperinsulinamie und erhohtem IGF-1. Erhohtes Ostrogen, das verminderte SHBG und erhohte Androgene fuhren zu einer Stimulation des Tumorwachstums. Das erhohte Krebsrisiko ist allerdings nur fur bestimmte Malignome und nur in bestimmten Situationen nachweisbar. So ist bisher nur belegt, dass das Mammakarzinomrisiko beispielsweise fur postmenopausale und nicht fur pramenopausale Frauen mit vermehrtem Fettgewebe erhoht ist. In dieser Ubersicht wird das aktuelle Wissen zum Zusammenhang zwischen Adipositas und Krebsrisiko kurz dargestellt.

Bis vor kurzer Zeit gab es lediglich 2 Verfahren, mithilfe derer die Effektivitat von Kryokonservierungsprotokollen fur Ovarialgewebe nach dem Auftauen beurteilt werden konnte: zum einen die Xenotransplantation, zum anderen die In-vitro-Kultur in einem grosen Medienvolumen unter permanenter mechanischer Bewegung. Das Chorioallantoismembran(CAM)-Kultursystem, das eine belgische Arbeitsgruppe von J. Donnez untersucht hat, eignet sich zur Kultivierung von Ovarialgewebe in der ersten Phase vor der Neovaskularisation. Daher kann angenommen werden, dass es sich bei dieser Methode um ein effektives Verfahren zur Kultivierung von kryokonserviertem humanem Ovarialgewebe (CAM-System) handelt. Ziel dieser Studie war es, die Effektivitat des Verfahrens zu beurteilen.

Inflammatory breast cancer (IBC) represents a rare and aggressive form of cancer with negative prognosis and high rate of recurrence. The purpose of this retrospective multi-center study was to evaluate the effect of IBC on overall and disease-free survival. Furthermore we analyzed the influence of hormone and Her2 receptor expression on inflammatory breast cancer cells on the clinical outcome of patients. This retrospective German multi-center study included 11,780 patients with primary breast cancer recruited from 1992 to 2008. In this sub-group analysis we focused on 70 patients with IBC. Despite the relatively small sample size, we could confirm the aggressiveness of inflammatory breast cancer and the different clinical behavior of IBC subtypes. It could be demonstrated that the lack of expression of hormone receptors on tumor cells is associated with a more aggressive clinical course and decreased overall and disease-free survival. Higher incidence of Her2 overexpression, that is typically associated with poor prognostic outcome among women with non-IBC tumors, seems however to have no prognostic significance. This BRENDA sub-group analysis, on a German cohort of breast cancer patients confirmed the negative outcome of IBC and the different clinical behavior of IBC subtypes. The best management of IBC requires intensive coordination and cooperation between various clinical disciplines involved in the treatment of IBC patients. Moreover there is a need to identify IBC-specific targeted therapies to improve the curing prospects of this subtype of cancer.

It is well accepted that innovation in oncology is transported through randomized clinical trials (CT), furthermore there is some evidence that patients profit from participation in CT. However, especially elderly patients aged65 usually do not have access to clinical trials; we therefore used an unselected patient cohort to investigate the following questions: (1) Is there a difference in survival parameters between study participants65 and elderly 65-80 non-participants? (2) Is guideline-adherent adjuvant treatment an equal alternative for elderly patients aged 65-80?This German retrospective multi-center cohort study included 4,142 patients (study participants65 and elderly breast cancer patients 65-80) with primary breast cancer recruited from 1992 to 2008 in 17 participating breast cancer centers.Applying the exclusion criteria, we included 960 (23.2%) study participants (PA)65 and 3,182 (76.8%) elderly65. Elderly non-participants (NPA)65 demonstrate a significantly inferior RFS [RFS: HR = 1.67; p0.001] and OS [OS: HR = 1.98; p0.001] compared to PA65. Within the elderly group, 1,868 (58.7%) patients received guideline-adherent adjuvant treatment. When comparing guideline conform elderly65 versus PA65, we found no significant difference in RFS [RFS: HR = 1.17; p = 0.218] and OS [OS: HR = 1.34; p = 0.054]. In contrast, non-guideline-adherent elderly demonstrated significantly inferior survival parameters [RFS: HR = 2.06; p0.001] [OS: HR = 2.50; p0.001] compared to65 PA.Guideline-adherent adjuvant treatment seems to be an equivalent option for elderly breast cancer patients. There is a strong association between guideline adherence and improved outcome parameters in elderly breast cancer patients.

Objective: Obesity is an important issue among fertile women as it may affect obstetric and neonatal outcomes. Methods: Obstetric and neonatal outcomes of primiparous women were retrospectively analyzed in non-obese (n=11387) and obese (n=943) women. A subgroup analysis was performed in obese women divided into three groups: Grade I obesity (Group A, n=654), Grade II obesity (Group B, n=192), and Grade III obesity (Group C, n=97). Odds ratios (OR) were expressed with the corresponding 95% confidence intervals (CI). Results: The incidence of gestational diabetes (non-obese, 1.9%; obese, 7.6%; Group C, 19.6%) and preeclampsia (non-obese, 3.3%; obese, 13.5%; Group C, 17.5%) increased with rising weight. The risk of non-elective cesarean section was significantly higher in obese women than in non-obese women (21.7% vs. 13.2%). The risk of extreme preterm birth (before 28 weeks of gestation) doubled in the Grade I obesity group (OR, 2.1; 95% CI, 1.4–3.2) and nearly tripled in women with body mass index ≥35 kg/m2 (OR, 2.9; 95% CI, 1.7–4.9). Conclusion: Pre-pregnancy obesity is associated with higher incidences of gestational diabetes and preeclampsia. Our study shows that obese women have a higher risk of non-elective cesarean section and preterm birth.

Female fertility preservation before chemotherapy has become a common issue among postpubertal and premenopausal women who desire children. Von Wolff et al. [1] recently published a practical guideline for different fertility preservation techniques, based on data from the FertiPROTEKT network database. The published practical guideline particularly addresses women with breast cancer, Hodgkin disease, or borderline ovarian tumour. The following are the different fertility preservation techniques covered: (1) hormonal stimulation and cryopreservation of unfertilised and fertilised oocytes, (2) cryopreservation of ovarian tissue, and (3) administration of gonadotropin-releasing hormone agonists (GnRHa). There is one or more than 1 option available for cancer patients, depending on cancer type, partnership, and individual desire. The classical Hodgkin’s lymphoma presents with an enlargement of lymph nodes and unspecific symptoms like night sweats, unexplained weight loss, fatigue and others. It is classified histopathologically by the typical Sternberg-Reed-Cells and may be cured with modern polychemotherapy in more than 80 % [2]. Women with Morbus Hodgkin receiving COPP/ABVD (cyclophosphamide, vincristine [O], procarbazine, prednisolone/adriamycin, bleomycin, vinblastine, and dacarbazine) or BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine [O], procarbazine, and prednisolone) have a high risk of amenorrhoea after chemotherapy [1, 3, 4]. The incidence of Hodgkin disease in pregnancy is low, with an estimated prevalence of 1 per 6,000 pregnancies [5]. If the diagnosis is made during the first trimester, the pregnancy usually needs to be interrupted [5]; however, with low-risk lymphoma, the pregnancy might be prolonged until labour. Even if a woman has given birth to a healthy child, she may still have the desire for more children. Therefore, fertility preservation techniques should be considered, especially for young mothers. To the best of our knowledge, no report has been published on fertility preservation in pregnant women or women who had given birth just a few days before an anti-cancer treatment.

Earlier we reported that the vitality of human sperm cells increased by 20% after 42 hours contact with nanocrystalline diamond coated Petri dishes, as compared to polystyrene Petri dishes. Herein we show that 1 hour contact with the nanodiamond Petri dishes enhanced the number of grade A motility human sperm cells (sperm cells that are swimming in a rapid progressive motility) by ~300%. Notably, the increase of the fraction of sperm cells with optimal motility was on cost of the low and non-motile sperm cells.

Purpose: Nowadays, most gynaecologists are female and the compatibility of job-related career and family life is an upcoming issue. The working group “Gender and Career” of the German Society for Gynaecology and Obstetrics (DGGG) designed a survey to reflect the present situation with a focus on the compatibility of career and family. Material and Methods: A web-based 74-item survey was filled out by members of the DGGG. In total, there were 1037 replies, 75 % female (n = 775) and 25 % male (n = 261) gynaecologists. Results: 62 % of the female and 80 % of the male respondents had already finished their doctoral theses and 2 % female and 13 % male had finished their PhD. Mean number of children was 1.06 (SD 1.08) in female and 1.68 (SD 1.34) in male gynaecologists. The majority of females desired day care for their children, but only 5 to 13 % of employers offer any day care. 88 % of the female and 72 % of the male physicians think that job-related career and family are not compatible. Conclusion: The majority of female gynaecologists wished to have professional child care, but most employers or other institutions do not offer this. This might be one of the reasons why career and family appear incompatible.

In order to decrease surgery-related morbidity, we evaluated the reliability of the evaluation of lymph node metastasis in patients with uterine corpus cancer by positron-emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) before surgical staging.Patients with newly diagnosed uterine corpus cancer scheduled for surgical staging, including lymphadenectomy, underwent PET imaging within 30 days before surgery. PET results and postoperative histopathology were compared for each patient and each nodal site. Sensitivity, specificity, positive and negative predictive value (PPV/NPV) as well as accuracy of FDG-PET in predicting nodal disease was determined by joined meta-analysis of the present data and the data available in the literature.Of 21 patients examined, 13 patients were eligible to enter this pilot study. Only one patient had lymph node metastasis, which was preoperatively detected by FDG-PET scan. Additionally, another patient was considered to have lymph node metastasis according to increased focal FDG uptake; however, all lymph nodes were free of malignant disease upon final pathology. In contrast, all other patients without lymph node metastasis upon final pathology showed negative preoperative FDG-PET scans. The meta-analysis yielded a sensitivity, specificity, PPV, NPV and accuracy of 0.53, 0.91, 0.57, 0.90 and 0.84, respectively.In patients with uterine corpus cancer, FDG-PET had an insufficient positive predictive value in detecting lymph node metastases, indicating that this method cannot replace surgical staging. However, due to its high NPV, FDG-PET might be beneficial in selected patients who are poor candidates for surgical staging.

The in-vitro culture of human embryos in a medium subjected to regular short intervals of mechanical agitation leads to increased development rates. This type of treatment tries to mimic conditions in nature whereby oviductal fluid is mechanically agitated by the epithelial cilia. This phenomenon can be explained by the fact that an embryo developing in vivo is naturally exposed to constant vibrations of around 6Hz with the periodically repeating increase to 20Hz. This review covers the history of this question and in this light offers an explanation through biological concept for one of the most recent developments in this area: in-vitro culture of human embryos with mechanical micro-vibration. The effect of mechanical micro-vibration on embryos during their in-vitro culture was examined. Pregnancy rates after the transfer of embryos in the group with in-vitro culture under mechanical vibration were increased.

Great advances in the oncological therapy of childhood and adolescent cancer patients lead to an increase of young cancer survivors with a normal expectancy of life. The aggressive chemotherapy and/or radiation often compromises endocrine function with consecutive menopausal symptoms and sterility. Recently, new approaches were developed to preserve fertility with different methods to restore the ovarian function. The present review gives an overview of the current possibilities, which may be offered to these young cancer patients, as well as the chances of success and risks and the unsolved issues in special situations.

International audience; Several adipocytokines, such as leptin or adiponectin, are associated with obesity and the risk for breast cancer. Adiopcyte fatty acid binding-protein (A-FABP) is another protein found in adipose tissue; therefore, we investigated the association of A-FABP with the occurrence and prognosis of breast cancer. In our study, 200 women attending the University of Ulm for breast surgery between the years 2005 and 2007 were included; 159 had histologically confirmed breast cancer; 41 had histologically confirmed benign lesions. Serum levels of A-FABP, leptin, and adiponectin were measured, and their relationship to body-mass-index (BMI), breast cancer, and tumor characteristics were analyzed; logistic regression model was adjusted to age, BMI, menopausal status, use of Hormone Replacement Therapy (HRT), and family history of breast cancer. Serum A-FABP levels were found to be significantly higher in obese (BMI ≥ 25) than in non-obese women (BMI ≤ 24.9), 41.16 ng/ml and 24.95 ng/ml, respectively (