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Background Re-operation for involved margins in breast conserving surgery is associated with worse cosmetic outcome, increased medical costs, and patient anxiety. Therefore, obtaining negative margins during primary BCS is essential. In our prior non-interventional study, published in October 2021 (Thill M et al., J Surg Oncol 2021) the re-operation rate would have been reduced by 83% for invasive carcinoma, from 10% to 2%, and 50% for DCIS, from 30% to 15% re-operations, if results had not been blinded for the surgeon. The results suggested a potential reduction of the re-operation rate by up to 80% for patients undergoing BCS. Aim of the study Aim of our current study is to evaluate the interventional performance of the ClearCoast™ system (ClearCut Medical, Ltd.) in assessing surgical margins for IBC in breast conserving surgery (BCS) and reducing the re-excision rates. Material and Methods The ClearCoast™ system utilizes a diffusion-weighted-imaging (DWI) protocol to create 2D surface maps showing T2*, a MR parameter related to the tissue’s apparent diffusion coefficient (ADC), with a depth penetration of 1mm. ADC is a highly accurate differentiator for irregular versus normal tissue. From May 2021 till to date a prospective, non- blinded post marketing study (N=93), evaluating the performance of the ClearCoast™ system is currently ongoing in the Breast Centre at the AGAPLESION MARKUS KRANKENHAUS, Frankfurt, Germany. After standard evaluation with ultrasound and/or X-ray with or without wire or clip marking, the specimens are intraoperatively scanned with the ClearCoast™ system, and positive margins will lead to a direct re-resection by decision of the surgeon applying a simple T2* threshold to flag irregular tissue. The final histopathology results will be compared with the scan results on a margin per margin bases. In addition, the rates of recurrent surgery of the interventional group will be compared with those of a historical group on the bases of matched pairs. Primary endpoint of the study is the re-excision rates in both the interventional and the historical standard of care group. To date, 64 patients are enrolled in the trial, therefore, results of the trial may be presented at the SABCS 2022. Citation Format: Marc Thill, Katharina Kelling, Viviane van Haasteren, Tina Schnitzbauer, Petia Kiene, Anna Levin, Eyal Kolka, Zachi Peles, Sebastian Aulmann. MRO PMS study - Intraoperative Specimen Magnetic Resonance Imaging System for Intraoperative Margin Assessment for Invasive Breast Cancer Using the ClearCoast™ System in Breast Conserving Surgery [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-12-04.

Background and objectives Breast-conserving surgery (BCS) is followed by reoperations in approximately 25%. Reoperations lead to an increased risk of infection and wound healing problems as well as a worse cosmetic outcome. Several technical approaches for an intraoperative margin assessment to decrease the reoperation rate are under evaluation, some of them are still experimental. Methods A prospective single-arm post-marketing study with 60 patients undergoing BCS for ductal carcinoma in situ (DCIS) and invasive breast cancer was conducted. The specimen was intraoperatively examined by the ClearSight™ system, a mobile magnetic resonance imaging system that is based on a diffusion-weighted imaging protocol. However, the results were blinded to the surgeon. Results The ClearSight™ system was performed for both ductal and lobular breast cancer and DCIS, with a sensitivity of 0.80 (95% confidence interval [CI]: 0.44-0.96) and a specificity of 0.84 (95% CI 0.72-0.92), with an overall diagnostic accuracy of 80%. Conclusion Had the ClearSight™ been known to the surgeon intraoperatively, the reoperation rate would have been reduced by 83% for invasive carcinoma, from 10% to 2%, and 50% for DCIS, from 30% to 15% reoperations. A trial designed to examine the impact on reoperation rates is currently ongoing.

Eine interdisziplinare Vulvasprechstunde wird seit Mitte des Jahres 2008 in der Hochschulambulanz der Lubecker Klinik fur Dermatologie in Zusammenarbeit mit der Klinik fur Frauenheilkunde angeboten. Bis Anfang 2019 wurden insgesamt 1000 Patientinnen in diese Sprechstunde uberwiesen, darunter 72 Kinder und 15 Jugendliche. Bei 866 Patientinnen wurde der Dermatologische Lebensqualitatsindex (DLQI) bestimmt. Die Lebensqualitat war bei Vulvaerkrankungen deutlich eingeschrankt, mehr als bei anderen chronischen Hauterkrankungen, wie Neurodermitis oder Psoriasis. Die grose Anzahl der Patientinnen erlaubt es, die Dermatosen der Vulva genauer zu beschreiben, mit denen Praktizierende sowohl in der Gynakologie als auch in der Dermatologie konfrontiert werden und deren Diagnose im Gegensatz zu den gut bekannten Infektionen schwierig sein kann. Die Akzeptanz der von uns eingerichteten Vulvasprechstunde spiegelt sich in den hohen Patientinnenzahlen wider, aber auch in den verbesserten Lebensqualitatsdaten, die im Verlauf bei Wiedervorstellung gemessen wurden.

Aim: Evaluation of safety, cosmetic outcome and patients satisfaction following nipple sparing mastectomy with prepectoral direct to implant reconstruction using the TiLOOP® Bra Pocket. Background: TiLOOP® Bra Pocket is a new surgical tool consisting of a large-pore, non-absorbable synthetic mesh made from titanized monofilament polypropylene thread. It is used for immediate prepectoral implant reconstruction to fix the implant on the pectoralis major muscle and to avoid implant rotation. Material and methodes: Between October 2017 and February 2019, 57 patients underwent nipple sparing mastectomy in the certified breast cancer centre, at the AGAPLESION Markus Hospital, Frankfurt, Germany. Data was collected in a prospective registry. All of the patients underwent a prepectoral direct to implant reconstruction using the new TiLOOP® Bra Pocket. We present the first analysis of this prospective unicentric registry. To measure and to analyse the cosmetic outcome and patients’ satisfaction, the BREAST-Q questionnaire was used, an established modular questionnaire to assess patient reported outcome (PRO). Results: All of the 57 patients were available for postoperative analysis. In 35/57 (61%) of the cases a seroma occured and was worth to be punctured. The median number of punctures was 4. The volume was 70 ml in average. Seven patients had a postoperative hematoma and had to undergo another surgical procedure. Three patients developed a skin necrosis or severe wound healing problem due to bad quality of the soft tissue and skin mantle and had to undergo implant explantation. One patient suffered from implant infection but could be treated conservatively. The analysis of patients’ reported outcome via the BREAST-Q resulted in a high satifaction rate regarding the cosmetic outcome. Conclusion: Direct to implant reconstruction with prepectoral implant position by using the TiLOOP® Bra Pocket is a very promising surgical approach. In comparison to a subpectoral implant reconstruction it reduces the duration of surgery, avoids a jumping breast phenomenon and causes less postoperative pain, moreover, it leeds to a high patient satisfaction rate and shows a moderate complication rate. Follow up of our patients will continue. The next analysis will be done after 24 months. Citation Format: Marc Thill, Viviane van Haasteren, Katharina Kelling. Prepectoral direct to implant reconstruction following nipple sparing mastectomy using the TiLOOP bra pocket [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-06.

Skin/nipple-sparing mastectomies (SSM/NSSM) have been reported to have acceptable complication rates and good aesthetic outcomes with high patient satisfaction. However, in this relatively young and rapidly expanding field of reconstructive plastic surgery, differences in perioperative management are noted between breast centers. Prospective studies of complication rates using a titanized polypropylene mesh (TiLOOP® Bra) are currently lacking.A prospective subgroup analysis was performed based on the data set of the prospective, single-arm, multicenter observational study (PRO-BRA). Early complication rates after skin/nipple-sparing mastectomy with implant-based immediate or secondary reconstruction using a titanized polypropylene mesh (TiLOOP® Bra) subpectorally were investigated in relation to demographic factors, as well as intra-and postoperative management. The subgroup consists of 258 patients. Complications were categorised into necrosis, infection, postoperative bleeding or hematoma, seroma, wound healing delays and R1-situations.Early complication rates of SSM/NSSM using titanium-based meshes are comparable to complication-rates using ADM's. Logistic regression shows significantly higher risk for wound healing delays, necrosis and seroma with increasing BMI, abladat- and implant-weight (OR 1,17 -1,66, p-value0,001). Smokers have significantly higher necrosis rates (20.7%) compared to non-smokers (5.5%) (p-value = 0.002). Discharge with drainage results in a trend toward higher rates of wound healing complications.The use of TiLOOP® Bra meshes was shown to have acceptable complication rates. Complication rates depend on certain demographic and intraoperative risk factors and should be considered in indications and information of patients.

Aim Aim of our study is to evaluate the performance of the ClearSight™ system (ClearCut Medical, Ltd.) in assessing surgical margins for DCIS and IBC in breast conserving surgery Material and Methods The ClearSight™ system utilizes a diffusion-weighted-imaging (DWI) protocol to create 2D surface maps showing T2*, a MR parameter related to the tissue's apparent diffusion coefficient (ADC), with a depth penetration of 1.5mm. ADC is a highly accurate differentiator for irregular versus normal tissue. From November 2017 a prospective, blinded post marketing study (N=63), evaluating the performance of the ClearSight™ system has been conducted in the Breast Centre at the Agaplesion Markus Krankenhaus, Frankfurt, Germany. After standard evaluation with ultrasound and/or X-ray, the specimens were scanned with the ClearSight™ system, and results were compared with the final histopathology results on a margin per margin bases, applying a simple T2* threshold to flag irregular tissue. Results Breast specimens' margins from 60 patients were analyzed. Pursuant to the breast conserving surgery (BCS), 348 margins were scanned by the ClearSight™ system. A rigid T2* threshold comparison with the pathology findings resulted in a sensitivity of 80% and specificity of 84%. Accuracy for invasive and in-situ cancers was found to be similar for tissues scanned within one hour after excision. After that sensitivity for DCIS started to drop and was found to be 56% after 2 hours. Further accuracy improvements can be achieved if the reading physician is free to apply an intuitive diffusion map interpretation rather than adhere to a fixed threshold. Conclusion The data suggest that ClearSightTM can reduce excision rates by a robust 80% if the excised breast tissue is scanned within one hour. Tissue drying impacts sensitivity for DCIS negatively. Free map interpretation leads to better results than a fixed threshold. Citation Format: Thill M, Kelling K, van Haasteren V, Traub L, Nölke J, Szwarcfiter I, Shapiro M, Schon A, Aulmann S. Successful intraoperative margin assessment in DCIS and invasive breast cancer with diffuison-weighted MRI using the Clearsight™ system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-23.

Summary Background: Diseases of the vulva often cause severe impairment and long-term problems for the affected women. Adequate treatment requires expert knowledge on the part of treating dermatologists and gynecologists. This was the reason for the initiation of an interdisciplinary consultation service for vulvar diseases at the University Hospital of Lubeck. Patients and methods: Over a period of 2½ years, 208 patients were seen in the new consultation service. Cases were classified as inflammatory diseases, neoplastic diseases, infectious diseases, vulvodynia, or genodermatoses. The effectiveness of treatment was documented by photography, biopsy and – whenever applicable – a quality of life assessment using the Dermatology Life Quality Index (DLQI). Results: Inflammatory dermatoses were diagnosed in 133 patients and neoplas-tic diseases in 32 patients. Infection was diagnosed in 25 patients, vulvodynia in 8, genodermatoses in 3 and other diseases in 7. The DLQI was assessed in 140 patients. Of these, 55 patients had a DLQI > 10 (0–30), indicating severe or extreme impairment of quality of life. A follow-up DLQI was collected in 81 patients, showing a significant improvement. Conclusions: The patients and both hospital facilities benefitted from the interdisciplinary consultation service. The initial high costs in terms of medical staff and time was compensated by the development of diagnostic and treatment algorithms. Overall, the concept received positive feedback from patients and medical staff members.

In case of non-gynecological solid tumors and hematological malignancies diagnosed during pregnancy, individual diagnostic and treatment options must be established by an interdisciplinary team.In part II of the present review we report on diagnostic and therapeutic principles in distinct entities of solid and hematological malignancies.On the basis of a review of the current literature, clinical guidelines and algorithms have been established for diagnosis and therapy of maternal cancer during pregnancy.The prognosis of the malignancy and the patient's informed consent must be taken into consideration when the well-being of the expectant mother is weighed against the well-being of the unborn child in case of maternal cancer during pregnancy.

Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related malignant neoplasms, usually affecting the skeletal system. Extraosseous ES/PNETs are uncommon, with occasional reports of tumors affecting the genitourinary tract. Only few cases of primary vulvar Ewing's sarcoma/PNET have previously been reported.We present a patient with primary vulvar Ewing's sarcoma with pulmonary metastasis who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck.The present report is the third case of a primary vulvar Ewing's sarcoma and the first constellation with pulmonary metastasis at diagnosis in the current literature. We present the diagnostic and therapeutic management including surgery, chemotherapy and radiation.The treatment of the Ewing's sarcomas and PNETs requires a multidisciplinary systemic approach. Despite its rarity, the differential diagnosis of vulvar sarcoma must be considered in young women.

To describe the management of a ruptured uterus caused by placenta percreta in the 21st week of gestation. We present a case report of a 33-year-old patient with a ruptured uterus in the 21st week of gestation who presented at the Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck. Therapeutic management was performed by laparoscopy, and consecutive laparotomy and hysterectomy. A 33-year-old patient presented with severe abdominal pain in the 21st week of gestation at the department of abdominal surgery. A laparoscopy was performed to exclude appendicitis. There was about one liter of blood in the peritoneal cavity and a small, bleeding lesion in the fundus uteri was found which was coagulated. The blood was evacuated and the patient returned to department of gynecology. One hour after the first operation, the patient developed signs of hypovolemic shock and ultrasound showed absent fetal heart beat. An immediate laparotomy was performed and a ruptured uterus was detected. The fetus was removed and a hysterectomy performed. Pathology results showed a placenta percreta. After a few days in hospital and transfusion of 4 liters of blood the patient was discharged in a healthy condition. In a pregnant woman with severe abdominal pain even in the 21st week of gestation a placenta percreta has to be considered as a differential diagnosis. If there is no evidence of other causes, laparoscopy may help to confirm the diagnosis and hysterectomy is a life saving intervention.

Ectopic pregnancy is one of the most important risk factors for maternal morbidity and mortality in early pregnancy. Cervical ectopic pregnancy is the rarest localization of ectopic pregnancy, although it constitutes a high-risk situation. On the one hand, there is a high rate of incorrect diagnosis; on the other, the clinician might be faced with severe therapeutic complications – for example, life-threatening hemorrhage. There are a variety of therapeutic alternatives but no standard guidelines exist regarding the ideal treatment. In most cases, successful treatment is achieved by a combination of therapeutic options. Conservation of fertility has priority, while massive hemorrhage also needs to be prevented. In this article, we present pitfalls and current strategies for diagnosis and management in patients with cervical pregnancy by introducing a classical constellation in an affected patient.

Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases.Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps.There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g.Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.

Die in den 1990er-Jahren entwickelte laparoskopische suprazervikale Hysterektomie (LASH) gewinnt zunehmend an Bedeutung; dennoch gibt es bis heute keine prospektiv randomisierte Studie, welche die LASH mit den anderen Hysterektomietechniken vergleicht. Die Vorteile einer laparoskopisch im Vergleich zu einer abdominal durchgefuhrten Hysterektomie sind hinreichend bekannt. Trotzdem ist die abdominale Methode, auch fast 20 Jahre nach Durchfuhrung der ersten laparoskopischen Hysterektomie, weiterhin weltweit die dominierende. Befurworter der LASH sind der Meinung, dass die Operation leichter durchzufuhren ist, weniger invasiv ist und, im Vergleich zur totalen laparoskopischen Hysterektomie (TLH), eine geringere Rate an operationsbedingten Ureterverletzungen und Infektionen aufweist. Kritiker hingegen halten die postoperativ auftretenden Zervixstumpfprobleme, wie persistierende Blutungen und Schmerzen, und die daraus resultierenden Folgeoperationen fur zu belastend fur die Patientin. Ziel dieser Arbeit ist es, eine Ubersicht uber die aktuelle Datenlage zum Stellenwert der LASH zu geben.

Aus der minimal-invasiven Diagnostik hat sich die minimal-invasive Chirurgie entwickelt. Kleinere Eingriffe wie Arthroskopien mit ggf. Resektion von Knorpel, Cholezystektomien und Eingriffe an den weiblichen Geschlechtsorganen gehoren heute zum operativen Standard. Um das kosmetische Ergebnis weiter zu verbessern und die Invasivitat noch mehr zu senken, wurde ein Trokar entwickelt, mit welchem nur noch eine einzige laparoskopische Inzision notwendig ist. Die Technik und erste Erfahrungen sollen in diesem Artikel beschrieben werden.

Maligne Melanome des Genitales sind sehr selten. An der Vulva machen sie etwa 8–10% aller Vulvatumoren aus. Sie haben ihren Altersgipfel in der Postmenopause. Obwohl der kausale Zusammenhang zwischen ultravioletter Strahlung und der Genese von Melanomen sehr gut bekannt ist, scheint die Sonnenexposition bei malignen Melanomen der Vulva keine Rolle zu spielen. Chronisch-entzundliche Reize, virale Infektionen und chemische Noxen werden hauptsachlich fur die Entstehung von Melanomen der Vulva verantwortlich gemacht. Die Therapieoptionen sind vielfaltig, sie reichen von lokaler Tumorexzision und Sentinel-Node-Biopsie uber eine radikale Resektion, mit En-bloc-Vulvektomie und inguinofemoraler Lymphadenektomie, bis hin zur Therapie mit Interferon-α. Einheitliche Empfehlungen finden sich in der aktuellen Literatur nicht. Die Prognose ist durch die hohe Metastasierungsrate und die oft erst sehr spat gestellte Diagnose schlecht. Angaben zur Funfjahresuberlebensrate liegen zwischen 22 und 54%. Das jeweilige Therapiekonzept sollte in jedem Fall den individuellen Bedurfnissen der einzelnen Patientin angepasst sein. Wir berichten uber eine 83-jahrige Patientin, die sich mit einem asymptomatischen unklaren Tumor der Klitoris zur therapeutischen Intervention vorstellte.

The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime. The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany. 2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma. The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28–52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease.

Diseases of the vulva often cause severe impairment and long-term problems for the affected women. Adequate treatment requires expert knowledge on the part of treating dermatologists and gynecologists. This was the reason for the initiation of an interdisciplinary consultation service for vulvar diseases at the University Hospital of Lübeck.Over a period of 2½ years, 208 patients were seen in the new consultation service. Cases were classified as inflammatory diseases, neoplastic diseases, infectious diseases, vulvodynia, or genodermatoses. The effectiveness of treatment was documented by photography, biopsy and - whenever applicable - a quality of life assessment using the Dermatology Life Quality Index (DLQI).Inflammatory dermatoses were diagnosed in 133 patients and neoplas-tic diseases in 32 patients. Infection was diagnosed in 25 patients, vulvodynia in 8, genodermatoses in 3 and other diseases in 7. The DLQI was assessed in 140 patients. Of these, 55 patients had a DLQI10 (0-30), indicating severe or extreme impairment of quality of life. A follow-up DLQI was collected in 81 patients, showing a significant improvement.The patients and both hospital facilities benefitted from the interdisciplinary consultation service. The initial high costs in terms of medical staff and time was compensated by the development of diagnostic and treatment algorithms. Overall, the concept received positive feedback from patients and medical staff members.

Prostaglandin metabolism plays a pivotal role in inflammatory processes and has also been demonstrated to have a role in carcinogenesis, tumor differentiation and tumor growth in breast cancer. Cyclooxygenase-2 (COX-2) is the key involved enzyme, as it triggers prostaglandin synthesis. We reviewed the current literature regarding the impact of prostaglandin metabolism on breast cancer and illustrated the current evidence of the COX-2 influence on breast cancer, delineating possible future prophylactic and therapeutic strategies.

The main interest of this study was to assess the rate of intraoperative and perioperative complications of laparoscopic supracervical hysterectomy (LASH) in a teaching hospital. A retrospective analysis of 1,584 laparoscopic assisted hysterectomies between 2005 and 2010 by different surgeons. In 2,577 patients undergoing simple hysterectomy, an indication for LASH was present in 1,584 cases. Indications were uterine myomas (71.6%), dysfunctional uterine bleeding (12.6%), suspicion of adenomyosis uteri (8.9%), descensus uteri (2.8%), dysmenorrhea (2.8%), hysterectomy on demand (1.2%) and benign hyperplasia of the endometrium (0.2%). Mean duration of the procedure was 76.5 ± 33.4 min (95% CI, ±1.66). The average age of patients was 45.9 ± 5.4 years (95% CI, ±0.27). Mean body mass index (BMI) was 25.3 ± 4.9 (95% CI, ±0.24). Adhesiolysis due to earlier surgery had to be performed in 190 (12%) cases. The total complication rate was 1.07%. The total conversion rate to laparotomy was 0.88%. The rate of conversion after laparoscopic assessment of the situs was 0.57%. In five cases, conversion to laparotomy was necessary due to intraoperative complications (0.32%). On the whole, six bleedings (0.38%), four bladder injuries (0.25%), three intestinal injuries (0.19%), one ureter injury (0.06%), one injury of the epigastric vein (0.06%) and two omental incarcerations (0.13%) occurred. In this retrospective analysis, the rate of complications for LASH was very low in a hospital of standard care and residency. LASH has to be considered as a minimally invasive method with a low perioperative morbidity to treat benign uterine pathologies even in a teaching setting and should therefore be the method of choice if the cervix can be preserved.

Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports.This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy.In part I, we report on diagnosis and therapy of gynecological tumors.The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.

Objective: To elaborate the antenatal sonographic findings of fetuses with the suspicion of fetal akinesia, thereby focusing on the accuracy of prenatal differentiation between subtypes of fetal akinesia, namely Pena-Shokeir phenotype (PSP) and arthrogryposis multiplex congenita (AMC). Methods: We herein present our experience of 21 patients with PSP and AMC diagnosed antenatally at a tertiary prenatal referral center. During the study period 30,485 consecutive high- and low-risk pregnancies were examined. The prenatal sonograms, pediatric charts and autopsy data of affected individuals were reviewed. Our findings were analyzed together with findings retrieved from the literature. Results: The diagnosis of AMC has been established between 12+0 and 30+1 gestational weeks, whereas cases found to have PSP were all diagnosed in advanced pregnancy. In accordance to previous findings, our data suggest that pulmonary hypoplasia is obligatory in PSP and cannot be found in AMC. Therefore, all pregnancies (9/9) affected by PSP were terminated on parental request. Of those fetuses with AMC, 3/12 were liveborn, 2 of which have neuromotoric disabilities. Conclusions: Establishing the correct prenatal diagnosis of PSP and AMC at an early stage and its diligent prognostic evaluation play a crucial role in order to provide adequate advice to the afflicted parents and to enable appropriate intervention at an early stage.

Breast cancer is associated with inflammatory processes based on an up-regulation of cyclooxygenase-2 (COX-2) expression. The antiproliferative effects of calcitriol (1,25(OH)(2)D(3)) mediated via the vitamin D receptor (VDR) render vitamin D a promising target in breast cancer therapy. First data suggest a correlation between vitamin D and prostaglandin metabolism.We determined the expression of VDR, COX-2, 15-PGDH and the prostaglandin receptors EP(2)/EP(4) in normal and malignant breast tissue by real-time PCR and Western blot analysis, as well as 25(OH)(2)D(3) and PGE(2) plasma levels from healthy and breast cancer patients.Significantly higher COX-2, lower VDR and lower EP(2) and EP(4) receptor protein levels in the malignant tissue and a significantly lower 15-PGDH protein level in normal breast tissue were detected. Breast cancer patients older than 45 years, diagnosed and sampled in the winter time had significantly lower 25(OH)(2)D(3) and higher PGE(2) serum levels.The inverse correlation between VDR and both COX-2 and 15-PGDH, as well as between PGE(2) and 25(OH)(2)D(3) levels, suggests a possible link between VDR-associated target genes and prostaglandin metabolism.

The present study analyzed the epidemiology and outcome of ectopic pregnancy during a 9-year period on a total of 473 women. Our follow-up shows that laparoscopic salpingostomy, performed in 84.9% of the patients, is a safe and effective treatment for ectopic pregnancy.

Laparoscopy has become a common tool in modern gynaecological surgery. Almost 30 years have passed since the first laparoscopic appendectomy was performed by Semm in 1983. Basic standards are missing though laparoscopic interventions are performed worldwide. The objective of this paper was to report on our experience in laparoscopic surgery and education of young trainees. During 16 years of laparoscopic surgery, we have performed about 15,000 interventions. Inspired by the possibility of videotaping operative sequences, we built up an internal school of laparoscopy. As a function of the result of steady work and education in laparoscopic surgery, we have worked out a common security standard which is to be considered at any intervention performed at our centre. We call this standard ‘The 12 golden rules’. We now report for the first time on our security aspects the 12 golden rules publicly.