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Introduction Since 01/01/2020, the cervical cancer screening in Germany has been carried out due to the organized early cancer diagnosis guideline (oKFE-RL). In 2007, HPV vaccination was initiated in Germany. The main goal of both initiatives is to further reduce the incidence of invasive cervical cancer. To assess the effect of the new screening strategy in a timely manner, monitoring of short-term changes need to be considered. Ideally, the effects of both prevention methods would be presented together in one model. Materials and methods Because no change in the incidence of invasive cervical cancer is initially expected, the incidence of CIN 3 is used as a surrogate parameter to assess the effects of the prevention efforts. Based on expected additional effects of vaccination and co-testing, a model-based estimation of the expected CIN 3 incidence during the evaluation of the screening program is performed using the CIN 3 incidence in the Saarland population. Modeling results The oKFE-RL provides for two groups: Primary cytodiagnosis continues until 35 years of age. Here, in the next few years, CIN 3 incidence will be reduced not by the oKFE-RL but by the increasing proportion of vaccinated women. In the group over 35 years, co-testing was introduced with a stringent algorithm. Due to the higher sensitivity of the HPV test, significantly more CIN 3 are detected in the first round of 3 years and thus, the CIN 3 incidence initially increases. As these CIN 3 are absent in the second round, significantly fewer CIN 3 cases will be detected then. These effects suggest a global decrease in CIN 3 incidence of 25.8% after 6 years. Conclusion Observation of the age distribution curve of CIN 3 allows both effects of prevention to be assessed in a timely manner and separately. In the future, data from epidemiologic cancer registries should be incorporated into the model to replace modeling with real data.

Since 01/01/2020, the cervical cancer screening in Germany has been carried out due to the organized early cancer diagnosis guideline (oKFE-RL). In 2007, HPV vaccination was initiated in Germany. The main goal of both initiatives is to further reduce the incidence of invasive cervical cancer. To assess the effect of the new screening strategy in a timely manner, monitoring of short-term changes need to be considered. Ideally, the effects of both prevention methods would be presented together in one model.Because no change in the incidence of invasive cervical cancer is initially expected, the incidence of CIN 3 is used as a surrogate parameter to assess the effects of the prevention efforts. Based on expected additional effects of vaccination and co-testing, a model-based estimation of the expected CIN 3 incidence during the evaluation of the screening program is performed using the CIN 3 incidence in the Saarland population.The oKFE-RL provides for two groups: Primary cytodiagnosis continues until 35 years of age. Here, in the next few years, CIN 3 incidence will be reduced not by the oKFE-RL but by the increasing proportion of vaccinated women. In the group over 35 years, co-testing was introduced with a stringent algorithm. Due to the higher sensitivity of the HPV test, significantly more CIN 3 are detected in the first round of 3 years and thus, the CIN 3 incidence initially increases. As these CIN 3 are absent in the second round, significantly fewer CIN 3 cases will be detected then. These effects suggest a global decrease in CIN 3 incidence of 25.8% after 6 years.Observation of the age distribution curve of CIN 3 allows both effects of prevention to be assessed in a timely manner and separately. In the future, data from epidemiologic cancer registries should be incorporated into the model to replace modeling with real data.

Endometriose ist eine weit verbreitete Erkrankung mit vielen Gesichtern. Die operative Therapie ist immer noch nicht standardisiert. In diesem Beitrag sollen die Standardoperationen insbesondere im Hinblick auf die Fertilitat betrachtet werden. Operatives Ziel ist die komplette Entfernung der Endometriose und damit die Verbesserung der Fertilitat. Sollte der Eingriff die Fertilitat als ubergeordnetes Ziel gefahrden, kann es notwendig sein, Residuen zu belassen.

Laparoscopy is playing an increasingly important role in gynecologic oncology. The benefits of minimally invasive surgery for oncology patients and the quality of this treatment are well documented. Outcomes and quality of minimally invasive surgical procedures to treat cervical cancer were evaluated based on retrospective and case-control studies; outcomes and quality after minimally invasive treatment für early-stage low-risk endometrial cancer were also assessed in prospective randomized studies. If indicated, laparoscopic lymphadenectomy is both technically feasible and oncologically safe. Adipose patients in particular benefit from minimally invasive procedures, where feasible. The potential role of laparoscopy in neoadjuvant therapy for ovarian cancer and in surgery for early-stage ovarian carcinoma is still controversially discussed and is currently being assessed in further studies. Using a minimally invasive approach in gynecologic oncology procedures demands strict adherence to oncological principles and requires considerable surgical skill.Der Laparoskopie kommt in der gynäkologischen Onkochirurgie eine zunehmend wichtige Rolle zu. Die allgemeinen Vorteile minimalinvasiver Operationstechniken sind auch für onkologische Patientinnen mittlerweile gut belegt bei gleichzeitiger Wahrung der onkologischen Behandlungsqualität. Dies wurde für die operative Therapie des Zervixkarzinoms anhand retrospektiver und Fallkontrollstudien, für das frühe Low-Risk-Endometriumkarzinom auch prospektiv-randomisiert erfolgreich gezeigt. Eine indizierte Lymphonodektomie lässt sich sowohl technisch als auch onkologisch sicher per Laparoskopie durchführen und gerade adipöse Risikopatientinnen profitieren, wenn durchführbar, vom minimalinvasiven Vorgehen. Beim Ovarialkarzinom wird eine mögliche Rolle des laparoskopischen Zugangs im Rahmen neoadjuvanter Therapiekonzepte und zur operativen Therapie in Frühstadien kontrovers diskutiert und erfolgt daher derzeit unter Studienbedingungen. Die Durchführung gynäkoonkologischer Eingriffe mit minimalinvasivem Zugang setzt nicht nur die Einhaltung onkologischer Prinzipien, sondern auch erhebliches operationstechnisches Know-how voraus.

Chronic pelvic pain is a significant problem in gynaecology, as the causes often cannot be found by a general gynaecologic examination. Subsequently, the women often consult various physicians without a right and precise diagnosis being made. Thus, it is necessary to find a possibility for how to help these women quickly and effectively. As in nearly 1/3 of the cases the reason for the pain is an endometriosis and in another third, adhesions are responsible for the pain, the biggest part can be diagnosed and treated by laparoscopy. If laparoscopically no reason can be found, it is advisable to send the patient to a psychosomatic physician, who then can start a correspondingly differentiated diagnosis and therapy.

Background: Official guideline “indications and methods of hysterectomy” to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

Many women with symptomatic uterine leiomyomata wish to preserve their uterus. Novel organ- and fertility-preserving treatment options such as embolisation of uterine arteries or laparascopic uterine artery ligation have frequently been discussed as viable alternatives to myomectomy. This article strives to bring together the conclusions of major studies on novel organ-preserving treatment alternatives for uterine myoma. Minimally invasive organ-preserving laparascopic myomectomy remains the best treatment option for patients with symptomatic fibroids who wish to retain their uterus. However, in certain cases other options such as embolisation or laparascopic ligation of uterine arteries can serve as viable alternatives A failure rate of up to 39% and complications such as reduced fertility because of ovarian failure after transcatheter embolisation of uterine arteries might restrict the use of this method. For postmenopausal women, transcatheter embolisation of uterine arteries is a possible treatment alternative. Laparascopic ligation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries might also be viable for young women who desire to preserve future fertility. Further data and studies on the long-term follow-up after ligation are yet to come.

I would like to thank Prof. De Wilde for his comment. We particularly appreciate his congratulatory remarks about our work and I would like to take this opportunity to pass on his compliments to all the other members of the Guideline Development Group who voluntarily dedicated so much of their time to bring the task to fruition. I would also like to thank Prof. Kreienberg for suggesting the guideline and thank the board of the DGGG for their decision to ask an external panel to review the guideline (which had already been completed at the end of 2012) and – because of the significance of the guideline for healthcare policies – to commission an evidence report. The fact that we were able to recruit Dr. M. Nothacker with her extensive knowledge of both methodology and gynecology can only be described as a stroke of luck.

Objective To describe our experience with a new operating room drape designed specifically for laparoscopic surgery where changes between the abdominal and the vaginal route are frequent. Design The drape was tested in the 373 laparoscopic operations including 32 laparoscopically assisted vaginal hysterectomies (LAVHs) carried out over a 4-month period. Special interest was given to possible saving of time. Results The amount of time saved depended on the number of changes between the vaginal and the abdominal sites, which varies according to the type of operation performed. In LAVH, the pre- and intraoperative preparation time was reduced by almost 50%. Conclusion Since the drape has been proved to shorten operating time, it may be a benefit to the patient as well as to surgeons and their staff.

Aufgrund der steigenden Inzidenz des Endometriumkarzinoms, insbesondere von Typ II-Karzinomen, ware eine effizientere Fruherkennung bei asymptomatischen Patientinnen wunschenswert. Bei der vaginosonographischen Bestimmung der Endometriumdicke bildet der cut off von 4 mm einen vernunftigen Kompromiss zwischen ausreichender Spezifitat und hoher Sensibilitat. Die Methode versagt aber perimenopausal sowie unter Hormonsubstitution. Die Endometriumzytologie, die Pipelle de Cornier, die Strichcurettage und die Hysteroskopie sind zur Routineuberwachung asymptomatischer Patientinnen nicht geeignet. Wird eine Histologie aus dem Uterus gewonnen, sei es durch Strichcurrettage oder durch D&C, so sollte diese „blinde“ Entnahme stets durch eine diagnostische Hysteroskopie erganzt werden („H&H“ = Hysteoscopy & Histology). Mit Ausnahme der Sonographie von Risikokollektiven gibt es derzeit kein praktikables und finanzierbares Konzept der zuverlassigen Fruherkennung des Endometriumkarzinoms asymptomatischer Patientinnen.

A 21-year old 2 nd -gravida, nulliparous woman, status post miscarriage two years earlier, was admitted for curettage at 12 weeks gestation with a sonographically appropriate yet non-vital pregnancy. Before the curettage, fluid hysteroscopy was performed in the same sitting. An uterine anomaly as a possible cause of the miscarriage could be ruled out. After inspecting the uterine cavity, the amniotic sac was opened with flexible endo-scissors and the hysteroscope was introduced. A gestationally appropriate fetus without signs of autolysis or anomalies was observed. An umbilical cord torsion was found as the probable cause of the miscarriage. To our knowledge, this represents the first ever observed incident in which an umbilical cord complication was diagnosed as the probable cause of miscarriage in early gestation. Based on this case, we discuss the technical details, advantages and risks associated with the procedure which we have labelled abortion hysteroscopy.

The endometrial carcinoma shows an increasing incidence and represents today the most frequent malignoma of the female pelvis. Until now all techniques of detection of this carcinoma or its precursors are invasive and thus are not suitable for screening investigations. Vaginosonography, as the first non-invasive diagnostic method, now supplies knowledge about the state of the endometrium. At the Gynaecological Department of the University of Homburg/Saar, West Germany, 221 patients had been preoperatively subjected to vaginosonography before they underwent surgery. Sonographical and histological findings corresponded in atrophic endometrium in 82%, in regular, perimenopausal endometrium in 91%, in endometrial polyps and hyperplasia of the endometrium in 56%, and in endometrial carcinoma in 79%. With regard to the detection of endometrial cancer, a specificity of 96%, a sensitivity of 93%, a positive predictive value of 79% and an accuracy of 96% were established. Thus, according to our experience, vaginosonography represents a valid, non-invasive diagnostical method as a suitable instrument for screening the endometrium.

In a prospective, randomised study we compared the clinical properties of the established Redon drain with a new type of drain called "slit drain". Both types of drains were examined regarding the amount of drained fluid, the time elapsing until removal of the drain, the frequency of occlusion of the lumen as well as the patient's pain and the required force at extraction of the drain. The statistical analysis showed both drains to have equal abilities in draining of fluid if they were used under vacuum conditions. If used as nonsuction drains, the new device was able to drain more fluid than the established type of drain (p less than 0.05). Statistically relevant advantages of the slit drain were seen in a lower rate of obstruction of the lumen, a higher amount of drained fluid (as non-suction device) as well as an easier and less painful extraction.

Within just a few years, operative hysteroscopy has largely replaced laparotomy in the treatment of submucous myomas. Due to the rapid expansion of hysteroscopic surgery techniques, guidelines must be defined to standardize the procedure and at the same time provide the basis for highly individualized treatment of each patient. The choice of an appropriate therapeutic approach in this context is an issue of logistics, rather than surgery. Factors contributing to the individualized decision regarding the therapeutic approach include indications, individual anatomical conditions encountered, necessity of medical pretreatment, available equipment and adequate premises at the surgical center, and intraoperative procedure of choice. Taking into consideration all these issues, the present article aims at presenting to the surgeon not only a summary of the state-of-the-art techniques, but also a guideline for sophisticated strategy planning for and performance of the hysteroscopic technique of myoma resection.

Greatly thickened endometria are often observed in vaginal sonography in patients taking tamoxifen. The incidence of type I carcinoma of the endometrium is also raised under tamoxifen. Both effects are ascribed to the known partial estrogenic effect of tamoxifen. However, if sonographically hyperplastic endometria are abraded, mostly only atrophic material is obtained. To clarify this contradiction, 89 patients treated with tamoxifen were investigated by means of vaginal sonography at intervals of 6 months. In 33 of them (37%), an endometrial thickness8 mm was found. In order to investigate the endometrial thickness throughout, a hysteroscopic loop resection (polyps n = 18, diffuse hyperplasia n = 15) and afterwards histological work-up of the endometrium in serial sections were carried out in all these patients. Hyperplasia of the endometrial stroma without cellular atypia was found in all cases. However, the glandular epithelium was always atrophic. This explains the contradiction between sonographically thick endometrium (stromal hyperplasia) and the scanty abrasion material (atrophy of the glandular epithelium). The 'hyperplasia' found sonographically is not necessarily estrogen-dependent hyperplasia of the glandular epithelium leading to a carcinoma. This raised the question as to the etiological reasons for the increased incidence of carcinomas. We discuss the hypothesis that tamoxifen may also promote the conversion of pre-existent subclinical lesions into manifest carcinomas.

Whereas cervical carcinoma is reliably detectable by the noninvasive methods of cytological/cervical smear and HPV typing even in the early stages, endometrial carcinoma thus far eludes effective check-up. Neither ultrasound nor invasive procedures such as Pipelle de Cornier, abrasio fracta or hysteroscopy, succeeded in making the majority of endometrial carcinomas detectable at an early stage in systematic screenings. Several factors contribute to this fact: first, only a fraction of these carcinomas develops through early stages of atypical hyperplasia, whereas the majority develops de novo. As the most suitable screening method in general, ultrasound fails in pre- and perimenopausal women, who account for 30% of new endometrial carcinoma cases. Moreover, patient compliance with preventive examinations is especially low in the high risk population of senior women. And, finally, there are issues regarding the clinical consequences of improved diagnosis, since endometrial carcinomas may become clinically significant in only 1 of every 4-6 patients, whereas the majority of these malignomas remains clinically inapparent. Hence, atypical uterine bleeding will continue to be the main symptom prompting hysteroscopic and histological clarification (HH) and ensuing detection of endometrial carcinomas and their early stages.

Die genaue zeitliche Abstimmung zwischen der Reifung eines befruchteten Eies und seinem Transport durch die Tuba uterina, die unter physiologischen Bedingungen dafur sorgt, dass die Zygote just mit dem Eintritt ihrer Implantationsreife das nidationsbereite Cavum uteri erreicht, kann durch eine Vielzahl von Faktoren gestort werden. Die Folge ist die Implantation der Zygote auserhalb des Cavum uteri, die Extrauteringraviditat. In uber 90 % der Falle ist sie in der Tube lokalisiert, daneben aber auch im Ovar, in der Zervix oder in der Bauchhohle.

During a diagnostic CO2-hysteroscopy in general anesthesia, a manifest gas embolism with a resulting drop of the endexpiratory CO2 partial pressure occurred upon insertion of the instrument. By ending the procedure and through appropriate anesthesiological measures, the occurrence was brought under control and the embolism had no clinical consequences. The incidence encouraged us to reconsider the CO2-hysteroscopy examination technique. As a result, we describe an up to now neglected mechanism which may lead to air embolism in gas hysteroscopy: Similar to hysteroscopy with fluid distension, the whole system has to be purged from air by insufflating CO2 prior to examination. If this step is neglected, up to 40 cm3 of room air may be insufflated into the patient, considering a connective tubing of 200 cm length and 0.5 cm lumen. The scientific organisations as well as the endoscopic training centers and the manufacturers of hysteroflators are challenged to deal with this newly described potential cause of complications.

Greatly thickened endometria are often observed in vaginal sonography in patients taking tamoxifen. The incidence of type I carcinoma of the endometrium is also raised under tamoxifen. Both effects are ascribed to the known partial estrogenic effect of tamoxifen. However, if sonographically hyperplastic endometria are abraded, mostly only atrophic material is obtained. To clarify this contradiction, 89 patients treated with tamoxifen were investigated by means of vaginal sonography at intervals of 6 months. In 33 of them (37%), an endometrial thickness > 8 mm was found. In order to investigate the endometrial thickness throughout, a hysteroscopic loop resection (polyps n = 18, diffuse hyperplasia n = 15) and afterwards histological work-up of the endometrium in serial sections were carried out in all these patients. Hyperplasia of the endometrial stroma without cellular atypia was found in all cases. However, the glandular epithelium was always atrophic. This explains the contradiction between sonographically thick endometrium (stromal hyperplasia) and the scanty abrasion material (atrophy of the glandular epithelium). The 'hyperplasia' found sonographically is not necessarily estrogen-dependent hyperplasia of the glandular epithelium leading to a carcinoma. This raised the question as to the etiological reasons for the increased incidence of carcinomas. We discuss the hypothesis that tamoxifen may also promote the conversion of pre-existent subclinical lesions into manifest carcinomas.

Obwohl die Adnextumoren zu den haufigsten gynakologischen Operationsindikationen in der Postmenopause gehoren, ist ihre Behandlung nicht einheitlich. Wahrend die laparoskopische Therapie der Adnextumoren in der Pramenopause ein etabliertes Verfahren darstellt, wird der Einsatz in der Postmenopause weiterhin kontrovers diskutiert. Den unbestreitbaren Vorteilen eines laparoskopischen Vorgehens steht das ungeklarte Risiko der Prognoseverschlechterung durch iatrogen induziertes Zellspilling gegenuber.

Within just a few years, operative hysteroscopy has largely replaced laparotomy in the treatment of submucous myomas. Due to the rapid expansion of hysteroscopic surgery techniques, guidelines must be defined to standardize the procedure and at the same time provide the basis for highly individualized treatment of each patient. The choice of an appropriate therapeutic approach in this context is an issue of logistics, rather than surgery. Factors contributing to the individualized decision regarding the therapeutic approach include indications, individual anatomical conditions encountered, necessity of medical pretreatment, available equipment and adequate premises at the surgical center, and intraoperative procedure of choice. Taking into consideration all these issues, the present article aims at presenting to the surgeon not only a summary of the state-of-the-art techniques, but also a guideline for sophisticated strategy planning for and performance of the hysteroscopic technique of myoma resection.

Das Seminar sollte dem Dialog von Wissenschaft (Labor) und Klinik (Praxis) dienen und sollte auch und vor allem auf die notwendige Kommunikation zwischen Praxis (Anamnese, Diagnostik) und gynakologischer Histopathologie (unter Einschlus neuerer molekularbiologischer Verfahren) hinweisen.

In infertility therapy operative hysteroscopy by means of high-frequency surgery has replaced laparotomy in many cases. Thus today the therapy of intrauterine synechias, septa and myoma is a major sector in hysteroscopic metroplasty. Uterine haemorrhage is another area of indications for transcervical high-frequency surgery. In menstrual disorders caused by polyps, submucous myoma or without any anatomic reason transcervical electrosurgery helps to avoid more and more hysterectomies. The increasing importance of this method becomes obvious in the 1991-AAGL-Survey according to which within three years the number of operative hysteroscopies has risen to 17,298, thus doubled within this period of time. The present article based on literature and personal experience gives an overview of technical equipment available, complications, operative technics and risks. Furthermore, the frequency of success and complications of transcervical resectoscopic surgery are also discussed.

The truly minimal invasive surgeon should always act to the benefit of the patient. Since most of the operative steps of hysterectomy can be performed faster and often better via the vaginal approach than through trocars, minimal invasive surgery does not necessarily mean the employment of endoscopic techniques. Simple vaginal hysterectomy continues to be the least invasive method and 60% of all uteri can be removed this way. If vaginal hysterectomy is not feasible, LAVH should be applied since of all variations of endoscopic hysterectomy. LAVH is the one with the least complications, it is not time-consuming and it is easy to learn. The most effective strategy during the laparoscopic part of LAVH is: As much as necessary--as little as possible. This means, if endoscopic operative steps do not prove to be inevitable during diagnostic laparoscopy, they should be renounced in favour of vaginal hysterectomy (LAVH type I). LAVH type I is the method of choice for about 10% of all uteri. 70% of all uteri can be removed by exclusively vaginal operation if vaginal hysterectomy and LAVH type I are taken together. If operative laparoscopy is unavoidable, is should be limited to those steps which can not be accomplished transvaginally. Another 20% of all uteri can be removed without laparotomy if LAVH type II--LAVH with operative laparoscopy--is employed. If this concept is pursued consequently, only less than 10% of all benign hysterectomies have to be performed via laparotomy.

Durch die Entwicklung kleinlumiger Optiken ist es moglich geworden, das Cavum uteri auch unter ambulanten Bedingungen hysteroskopisch zu untersuchen. Die fruher notwendige Dilatation des Cervikalkanales ist bei den heute zur Verfugung stehenden Instrumenten kaum noch notig (3). Unter diesen Voraussetzungen wurde 1981 in der Universitats-Frauenklinik Homburg eine Hysteroskopie-Sprechstunde eingerichtet, in der die Indikationen fur die Hysteroskopie unter ambulanten Bedingungen evaluiert werden sollten.

Die vaginale Hysterktomie hat gegenuber dem abdominalen Vorgehen entscheidende Vorteile, die sich fur die Patientin vor allem durch eine schnelle Rekonvaleszens und Wiederaufnahme der Arbeitsfahigkeit auszeichnen (1). Daruberhinaus ist die Entscheidung zum vaginalen oder abdominalen Vorgehen, aber auch abhangig von der Erfahrung des Operateurs sowie der operativen Schule der jeweiligen Klinik (1).

Die operative Laparoskopie hat in den letzten Jahren auf der gesamten Welt eine rasante Entwicklung durchlaufen. Hierduch wurde das Indikationsspektrum erheblich erweitert. Gleichzeitig verscharfte sich auch die Diskussion, was endoskopisch operiert werden kann und darf.

Seit zwei Jahren werden in unserem Haus zunehmend operative Bauchspiegelungen durchgefuhrt. Hierbei ist die Adnexchirurgie mit Ausnahme des Ovarialkarzinoms (OC) praktisch vollkommen zur Domane der pelviskopischen Operation geworden. Gegenstand kontroverser Diskussionen ist die Frage, inwieweit ein unbeabsichtigtes pelviskopisches Anoperieren eines okkulten OC FIGO Ia mit Umwandlung in Stadium Ic die a priori gunstige Prognose der Erkrankung in dieser Phase verschlechtern kann.

Neben der Endometriumsdiagnostik ist mit Hilfe der Hysteroskopie auch moglich intrauterine Veranderungen, wie Myome, Septen und Synechien zu diagnostizieren, welche bei der Abrasio nicht erfast werden konnen. Diese konnen heute jedoch hysteroskopisch operiert werden, so das in den meisten Fallen eine Laparatomie vermieden werden kann.

Peritoneale Verwachsungen stellen eine Abwehrreaktion meist nach operativen Eingriffen dar, wobei in den meisten Fallen das grose Netz beteiligt ist. Durch Verklebungen und Verwachsungen mit dem parietalen Peritoneum gelingt es dem grosen Netz in zahlreichen Fallen Entzundungen abzukapseln oder an der Ausbreitung zu hindern.

The endometrial carcinoma shows an increasing incidence and represents today the most frequent malignoma of the female pelvis. Until now all techniques of detection of this carcinoma or its precursors are invasive and thus are not suitable for screening investigations. Vaginosonography, as the first non-invasive diagnostic method, now supplies knowledge about the state of the endometrium. At the Gynaecological Department of the University of Homburg/Saar, West Germany, 221 patients had been preoperatively subjected to vaginosonography before they underwent surgery. Sonographical and histological findings corresponded in atrophic endometrium in 82%, in regular, perimenopausal endometrium in 91%, in endometrial polyps and hyperplasia of the endometrium in 56%, and in endometrial carcinoma in 79%. With regard to the detection of endometrial cancer, a specificity of 96%, a sensitivity of 93%, a positive predictive value of 79% and an accuracy of 96% were established. Thus, according to our experience, vaginosonography represents a valid, non-invasive diagnostical method as a suitable instrument for screening the endometrium.

Pathologische Schwangerschaftsverlaufe gehen oft mit intrauterinen fetalen Wachstumsstorungen einher, die sich m.E. durch sonographische fetale Biometrie oder Doppler-Flusmessungen vorhersagen lassen. Die herkommliche histologische oder morphometrische Untersuchung der Plazenta aus einer wachstumsgestorten Schwangerschaft zeigt jedoch haufig kein schlussiges morphologisches Korrelat.

In der vorliegenden Untersuchung werden die histologischen und zytologischen Ergebnisse der Second-Look-Operation (SLOP) mit dem weiteren Verlauf der Erkrankung korreliert.

In jungeren Untersuchungen ist bei einer Reihe von gynakologischen Tumoren die Amplifikation sog. „Onkogene“ sowie die Expression von entsprechenden Genprodukten und „tumorassoziierten Antigenen“ nachgewiesen worden.

Nachdem heute ein Zusammenhang zwischen der Entstehung plattenepithelialer Neoplasien des weiblichen Genitales und einer Infektion mit HPV-Viren als wahrscheinlich anzusehen ist, war es konsequent, zur Therapie dieser Veranderungen auch viruswirksame Medikamente einzusetzen. Unabhangig voneinander haben hierbei mehrere Autoren in unterschiedlichen Landern mit Interferonen teilweise erstaunliche Remissionsraten erzielt. Je nach Tumorart, -ausdehnung und -sitz werden die Interferone systemisch, topisch, praoperativ oder adjuvant appliziert, um die Befunde in sano operieren zu konnen oder die Rezidivrate zu senken. Oftmals werden komplette Remissionen auch durch die alleinige Interferongabe erreicht.