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Endometriosis represents nowadays a real burden for the patients as well as for the physicians, as it requires surgical and/or medical treatment, often long – termed and repeated. Moreover, the high costs necessary to diagnose and treat endometriosis represent a real economic burden, being comparable to other chronic diseases like diabetes or rheumatoid arthritis. Therefore, the physicians dealing with this disease should take into account not only the efficacy of the treatment, but also the economic aspects and patients compliance. The present paper analyses the efficiency of progestins (lynestrenol and medrogestone) in endometriosis as a cost – effective, but forgotten medical therapy of the disease. Our study underlines the good tolerability of progestins, as they have limited side effects, the compliance of patients being high. They are also low-cost medications, which could represent an effective alternative method in the endometriosis treatment, especially in less – developed countries that cannot afford the higher therapeutic costs.

Background Immune checkpoint blockade (ICB) has been approved for the treatment of triple-negative breast cancer (TNBC), since it significantly improved the progression-free survival (PFS). However, only about 10% of TNBC patients could achieve the complete response (CR) to ICB because of the low response rate and potential adverse reactions to ICB. Methods Open datasets from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were downloaded to perform an unsupervised clustering analysis to identify the immune subtype according to the expression profiles. The prognosis, enriched pathways, and the ICB indicators were compared between immune subtypes. Afterward, samples from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset were used to validate the correlation of immune subtype with prognosis. Data from patients who received ICB were selected to validate the correlation of the immune subtype with ICB response. Machine learning models were used to build a visual web server to predict the immune subtype of TNBC patients requiring ICB. Results A total of eight open datasets including 931 TNBC samples were used for the unsupervised clustering. Two novel immune subtypes (referred to as S1 and S2) were identified among TNBC patients. Compared with S2, S1 was associated with higher immune scores, higher levels of immune cells, and a better prognosis for immunotherapy. In the validation dataset, subtype 1 samples had a better prognosis than sub type 2 samples, no matter in overall survival (OS) (p = 0.00036) or relapse-free survival (RFS) (p = 0.0022). Bioinformatics analysis identified 11 hub genes (LCK, IL2RG, CD3G, STAT1, CD247, IL2RB, CD3D, IRF1, OAS2, IRF4, and IFNG) related to the immune subtype. A robust machine learning model based on random forest algorithm was established by 11 hub genes, and it performed reasonably well with area Under the Curve of the receiver operating characteristic (AUC) values = 0.76. An open and free web server based on the random forest model, named as triple-negative breast cancer immune subtype (TNBCIS), was developed and is available from https://immunotypes.shinyapps.io/TNBCIS/. Conclusion TNBC open datasets allowed us to stratify samples into distinct immunotherapy response subgroups according to gene expression profiles. Based on two novel subtypes, candidates for ICB with a higher response rate and better prognosis could be selected by using the free visual online web server that we designed.

Hintergrund und Stand (inter)nationaler Forschung: Während eines Krankenhausaufenthalts haben Patient*innen wichtige gesundheitsrelevante Entscheidungen zu treffen. Sie müssen Informationen finden, verstehen, beurteilen und anwenden – also gesundheitskompetent agieren. Jeder zweiten[zum vollständigen Text gelangen Sie über die oben angegebene URL], 19. Deutscher Kongress für Versorgungsforschung (DKVF)

Preservation of fertility in cancer patients of reproductive age is a concern for both the patient and the clinician. In this study, we aimed to study the effectiveness of laparoscopic ovarian transposition or ovariopexy in preserving ovarian function in women undergoing pelvic radiotherapy with or without chemotherapy for pelvic tumours.The records of patients who underwent laparoscopic ovarian transposition or ovariopexy prior to pelvic radiation therapy between 2002 and 2018 were reviewed retrospectively.Thirty-nine women or adolescent girls with a diagnosis of cervical cancer (n=15), Hodgkin's lymphoma (n=6) or other types of pelvic tumours (n=18) were included in the study. The majority of patients had bilateral (n=25) or unilateral (n=8) ovarian transposition prior to radiotherapy. Nine out of 10 (90%) patients with soft tissue tumors, Ewing sarcoma or ependymoma, five out of seven (71.4%) patients with Hodgkin's lymphoma, two patients (100%) with rectal and anal cancer, and six out of 15 (40%) with cervical cancer retained ovarian function. Patients with cervical cancer, those who received concomitant chemotherapy and those older than 30 years were more likely to experience ovarian failure. Five patients conceived spontaneously and two women had four live births.Laparoscopic repositioning of the ovaries out of the radiation field in order to protect ovarian function in patients receiving radiotherapy appears to be effective in the majority of patients. The procedure seems safe and should be considered either as a sole procedure or in association with other fertility preservation methods prior to pelvic radiotherapy.

Introduction: There is a lack of reported evidence about side effects and sequelae of therapies of early invasive uterine cervical cancer. We describe the surgical and oncological outcomes of 60 patients with disease stage IB to IIB treated at Pius Hospital from 2009 to 2013. Methods: Retrospective, single cohort. Surgical and oncological outcomes estimated by descriptive statistics. 5-years survival rate estimated by Kaplan-Meier method. Results: 25% of cases were upstaged after surgical staging. 32% underwent radical surgery, 64% received adjuvant or neoadjuvant therapy. 57% achieved complete tumor reduction after neoadjuvant therapy. Adverse events such as ureteral lesions (9%), hematological, renal and electrolytic toxicities (25%) occurred mostly after neoadjuvant chemoradiation. 25% of cases recurred and 22% died within the first three years after treatment, mainly after neoadjuvant chemoradiation, yielding a 5-years overall survival rate of 78%. Conclusion: Neo-adjuvant chemoradiation achieve a good antitumor efficacy but lead to a moderate rate of adverse events.

Rajesh Devassy,1 Sadaf Hanif,1 Harald Krentel,2 Hugo C Verhoeven,2 Luz Angela Torres-de la Roche,2 Rudy Leon De Wilde2 1Dubai London Clinic & Specialty Hospital, Dubai, UAE; 2Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Carl von Ossietzky University, Pius-Hospital Oldenburg, Oldenburg, Germany Abstract: The evolution of minimally invasive surgery has brought forward the appearance of new advances in the course of the most recent couple of years and has introduced energy-based devices. The newest among them today are the ultrasonically activated devices, which are utilized with a great deal of components in-play, including ergonomics and financial aspects amid surgery. The methodology embraced was finding significant investigations through studies from PubMed, Medline and Google Scholar on current ultrasonic dissectors, which are Ethicon’s Harmonic Scalpel (ACE®), Covidien’s Sonicision™ (SNC), Conmed’s SonoSurg® (SS) and Olympus’s Thunderbeat®, to describe their efficacy in terms of vessel sealing speed, vessel burst pressure, visibility, operation time and thermal speed. We found postmarketing evidence to determine which device exhibits the better performance. Animal studies showed that emissivity values and maximum temperatures for coagulation are similar among devices but maximum cutting temperatures are significantly different: ACE = 191.1°C, SNC = 227.1°C, SS= 184.8°C (p

The association between endometriosis and infertility is widely recognized, but several studies demonstrate that endometriosis also affects pregnancy rates in different ways other than anatomical distortion of internal reproductive organs; however the evoking mechanisms are complex. In mild to advanced stages of disease, peritoneal adhesions, tubal obstruction, destruction of ovarian tissue or distortion of the uterine wall are evident originating factors of infertility or miscarriage.

Background Uterine perforation is the most common complication of curettage and may result in bleeding. Therefore, urgent control of bleeding from the uterine wall perforation is necessary to avoid an emergency hysterectomy or blood transfusion, to prevent peritoneal adhesion formation, possible chronic pelvic pain, and infertility. In the present case, an active bleeding secondary to a perforation of the uterus during curettage, for diagnosis of endometrial carcinoma, was instantaneously and successfully treated with only the application of a novel modified polysaccharide powder. This is, to the best of our knowledge, the first time that the agent 4DryField® has been used for this purpose. Case presentation A 71-year-old German woman with serometra and endometrial hyperplasia suffered a perforation of the anterior wall of the uterus during the hysteroscopic resection of submucosal polyps and a fractional curettage. Subsequently, an immediate laparoscopy showed an active bleeding from the wound, which was promptly stopped with only the application of the hemostatic and anti-adhesion polysaccharide powder, 4DryField®. There were no postoperative complications. Nine weeks later, a laparoscopic hysterectomy with bilateral salpingoophorectomy for endometrial carcinoma (histology: stage IA, pT1a, cN0, L0 V0 M0/G2) was performed. The former injured area looked slightly prominent, was completely healed, and showed a shiny serosa. All her pelvic organs were free of adhesions, and there was one 0.5-mm calcified granuloma in the Douglas pouch. Conclusions The efficient hemostasis combined with the adhesion prevention effect of 4DryField®, allowed a fast control of the uterine wall bleeding, saved operation time, avoided the risks of other procedures for bleeding control and contributed to the normal healing of the uterine wall without any adhesion formation.

The Intrauterine Contraceptive Device (IUD) is an acceptable and common form of contraception worldwide. The objective of this study was to report the case of an asymptomatic missing intrauterine contraceptive (IUD) inserted to prevent intrauterine adhesions after synechiolysis. A patient presented with missing IUD threads. Ultrasound of the pelvis showed an empty uterine cavity with the missing IUD probably anterior to the uterus. We present a stepwise approach in the management of the “lost IUD”, where the strings of the device are not visible at the time of speculum examination. We suggest first determining sonographically whether the IUD is within the cavity. If it is in situ, options for retrieval are including hysteroscopic retrieval. If the IUD is not within the cavity, X-rays are recommended. The device will not be present on X-ray if expulsion has occurred. If the device is present on the X-ray, cystoscopic or laparoscopic retrieval is required. IUD-providers should not only screen potential users and insert IUD correctly, but also ensure adequate follow-up with localization.

Benign peritoneal cystic mesothelioma is a rare disease of the abdominal cavity with grape – like cystic lesions, solitary or disseminated. The etiology is unclear, with a neoplastic or reactive origin being the prominent considerations. Because of its high recurrence rate and occasional malignant transformation, radical surgical approaches with optional hyperthermic intraperitoneal Chemotherapy have increasingly been advocated with mixed results. We present a case report with a new conservative approach using the Cavitron ultrasonic surgical aspirator for the first time in benign cystic mesothelioma of the peritoneum and a review of the literature about the treatment of this condition. A 47-year-old female with a history of abdominal surgery, including endometriosis excision and hysterectomy presented with upper abdominal discomfort. Ultrasound and magnetic resonance imaging showed two peritoneal tumors with multiple thin–layered cysts. Exploratory laparoscopy revealed multiple cystic masses. Biopsies showed no malignant cells, no positive markers for borderline – tumors (HEA125) but calretin in positive lining cells as well as PAX8 – positive covering cells, making a benign cystic mesothelioma the most likely diagnosis. The patient exhibited adhesions due to prior surgeries. Because of the high recurrence risk of benign mesotheliomas and the small chances of malignant transformation, we destroyed all cysts using ultrasound vaporization. The patient recovered without complications. Laparoscopic use of the Cavitron ultrasonic surgical aspirator system is a safe procedure with low risks and comorbidity, which minimizes adhesions formation and can be performed as a conservative alternative to currently popular radical therapy in benign peritoneal cystic mesothelioma.