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Maternale Hepatopathien stellen eine Bedrohung in Schwangerschaft sowie Wochenbett und eine Herausforderung fur behandelnde Arzte dar. Die Leberaffektionen konnen ein breites Spektrum an schwangerschaftsassoziierten und –unabhangigen Erkrankungen wie HELLP-Syndrom, Leberentzundungen oder akute Schwangerschaftsfettleber zur Ursache haben. In dieser Studie stellen wir eine Serie von 3 lebensbedrohlichen Verlaufen peripartaler Hepatopathien vor und diskutieren diesbezuglich den aktuellen Wissensstand mit einem speziellen Augenmerk auf pathogenetische Zusammenhange und mogliche Differenzialdiagnosen. Pathologische und radiologische Begutachtungen wie auch gynakologische oder chirurgische Masnahmen wurden entsprechend den geltenden Leitlinien durchgefuhrt. Laborchemische Untersuchungen wurden in den Routinediagnostik-Abteilungen der Universitatskliniken durchgefuhrt. Literatur wurde uber das durch die US National Library of Medicine bereitgestellte Verzeichnis „PubMed.gov“ selektiv recherchiert. Im ersten Fall kam es nach Entbindung bei fulminantem HELLP-Syndrom in der 32. Schwangerschaftswoche (SSW) zu einem subtotalen Leberinfarkt mit folgender schwerer Gerinnungsstorung und septischer Peritonitis. Die zweite Patientin wurde bei mildem HELLP-Syndrom in der 36. SSW entbunden. Postpartal verschlechterte sich die Erkrankung rasant und mundete in einen hamorrhagischen Schock mit akutem Nierenversagen. Die dritte Geburt fand mit 36 SSW bei asymptomatischer Hepatitis B statt. Die Hepatitis exazerbierte nach Entbindung mit der Entwicklung einer subakuten Leberdystrophie mit ausgepragter Gerinnungsstorung. Wenn mutterliche Leberaffektionen im Zusammenhang mit Schwangerschaften auftreten gilt es, verschiedene Diagnosen und unterschiedlicher Pathogenese zu berucksichtigen. Diagnostische und therapeutische Ansatze mussen rasch abgewogen werden. Ferner ist eine schnelle, effektive interdisziplinare Zusammenarbeit notwendig, um Folgeschaden zu minimieren und das Uberleben der betroffenen Patientinnen zu sichern, weil fulminante bis todliche Verlaufe auch heute immer noch moglich sind.

Der vorliegende Beitrag behandelt die medikamentose Tumortherapie, basierend auf dem Einsatz von Antagonisten des Gonadotropin-Releasing-Hormon (GnRH) und des Growth-Hormon-Releasing-Hormon (GHRH) sowie Analoga des GnRH als Tragersubstanz fur Chemotherapeutika. Mammakarzinome exprimieren Rezeptoren fur GnRH in 50% und fur GHRH in 35% der Falle. Die Expression und der wachstumsstimulierende Effekt der jeweiligen Liganden GnRH und GHRH sind in dieser Tumorentitat ebenfalls nachgewiesen, sodass sich hier eine „targeted therapy“ mit antagonistischen Analoga dieser Peptidhormone anbietet. Andererseits konnen GnRH-Rezeptoren auf Mammakarzinomzellen auch als Zielstrukturen fur eine rezeptorvermittelte Chemotherapie mit zytotoxischen Hybriden, bestehend aus einem GnRH-Analogon und einem zytotoxischen Radikal, dienen. Durch diese Therapieform soll eine hohere Wirkstoffkonzentration des Chemotherapeutikums im Tumor erreicht werden. So soll die antitumorale Wirkung gesteigert und gleichzeitig sollen die Nebenwirkungen minimiert werden. Im Folgenden werden die zu diesem Thema durchgefuhrten praklinischen und klinischen Studien zusammengefasst.

Intestinal infection due to the pinworm Enterobius vermicularis is the most prevalent helminthiasis in Europe and North America. Humans are the only known reservoir and young children are most often affected. The disease is highly contagious and is transmitted via the faecal-oral route. Insufficient hand hygiene, contaminated bed linens and clothes may play a role in transmission. Clinical symptoms often encompass severe nocturnal anal pruritus, when female worms deposit an abundance of eggs in the perianal region. The infection is diagnosed by applying an adhesive tape on the perianal region, followed by microscopic examination. Serious complications, such as extraintestinal infections, occur only rarely. Infections of the female genital tract and the peritoneum are described in the literature, also in pregnant women. We describe a case of a pregnant patient in the 33 (rd) week of gestation with intense anal pruritus in whom an enteral pinworm infection was diagnosed. The patient was successfully treated with mebendazole, an anthelminthic agent. Analysis of the data currently available for the administration of mebendazole during pregnancy did not show an elevated rate of congenital anomalies. However, further studies still have to be performed.

Umbilical cord blood is being increasingly used as an alternative stem cell source in the treatment of children and adults with malignant and non-malignant diseases. Data regarding the outcome of children show promise. Furthermore, transplantation of cord blood from an unrelated donor should be considered as an acceptable alternative for adults in the absence of an HLA-matched bone marrow donor. In the past 10 years cord blood banking has become a world-wide reality. However, problems in cord blood banking are caused by the controversial and conflicting interests of public and private cord blood banks. The financial gains of certain private banks hinders the growth of stored units for public use and makes it difficult to find full matches for some patients, especially those groups with a high diversity of HLA types. Future trends should implement an increased capacity for multilineage differentiation of cord blood stem cells. Pluripotentiality might lead to therapeutic applications in regenerative medicine.

The endometrial carcinoma is meanwhile the most common malignant tumor of the female genital tract. 2 subtypes can be divided according the pathogenesis: the classical estrogen related endometroid type and the nonclassical estrogen unrelated serous type. The endometrial adenomatous hyperplasia as a precancerous lesion must be identified by subjective criteria. Therefore the histological diagnosis is worse reproducible. An improvement would be helpful by morphometric and molecular genetic methods. The golden standard of diagnosis of the endometrial carcinoma is fractional dilatation and curettage. Immunohistochemical staining with a limited panel of antibodies can discriminate between an endometrial and an endocervical origin of an adenocarcinoma. The corner stone of the therapy is surgery. An individual decision about postoperative treatment is very important and depends on histological criteria. The adjuvant postoperative whole pelvic radiation is under discussion whereas the vaginal brachytherapy is established as standard therapy. This article outlines an overview of the actual situation for pathogenesis, diagnosis and treatment endometrial cancer.

Im Gegensatz zu Frauen mit ausgetragenen Schwangerschaften finden sich bei Frauen mit wiederholten Aborten typische Veranderungen des zellularen und humoralen Immunsystems, die in erster Linie das uterine Kompartiment betreffen, jedoch in der peripheren Zirkulation nur zum Teil nachweisbar sind. Manche dieser Phanomene sind wahrscheinlich kausal am ungunstigen Ausgang der Schwangerschaft beteiligt, andere durften auf eine veranderte endokrine und parakrine Regulation im Verlauf des Abortgeschehens zuruckzufuhren sein. Zum Zeitpunkt der Implantation, in der Lutealphase des Konzeptionszyklus, findet man bei Frauen mit wiederholten Aborten, im Vergleich zu fertilen Frauen ohne Aborte, eine veranderte Population von Lymphozyten im Endometrium, eine erhohte Zahl und Aktivitat von CD16 + CD56 + -naturlichen Killerzellen (NK) und eine Verschiebung der von den T-Helferzellen (Th) produzierten Zytokine in Richtung der inflammatorischen Th-1-Zytokine (IL-2, IL-12, Interferon-γ). In der peripheren Zirkulation ist zum Zeitpunkt der Konzeption ebenfalls die Aktivitat der NK-Zellen und die Produktion von Th-1-Zytokinen durch T-Effektorzellen erhoht. Organspezifische, nichtorganspezifische und gerinnungsaktive Antikorper weisen auf eine generelle Aktivierung des humoralen Immunsystems hin. Zum Zeitpunkt eines erneuten Abortes ist die Tiefe der Trophoblastinvasion in das Myometrium meist ungenugend. Die Implantationsstelle enthalt eine erhohte Zahl von NK-Zellen, und die Produktion der antiinflammatorischen und protektiven Th-2-Zytokine (z. B. LIF, IL-4, IL-10) durch deziduale T-Zellen ist reduziert. Die genannten Phanomene sind zum Teil durch Immunisierung mit allogenen Lymphozyten, Gabe von Immunglobulinen oder Medikamente (Acetylsalicylsaure, Heparin, Prednison) therapeutisch beeinflussbar.

Die Implantation ist ein ausergewohnlicher Vorgang in der Natur. Dabei sind der Embryo mit den Trophoblastzellen und das maternale Endometrium beteiligt. Der Trophoblast bildet Gefasverbindungen zur Versorgung des Fetus aus. Der molekulare Dialog zwischen dem implantierenden Konzeptus und der uterinen Dezidua betrifft Zell-Zell- und Zell-Extrazellularmatrix-Interaktionen, die durch Lektine, Integrine, matrixabbauende Enzyme und ihre Inhibitoren sowie durch eine Reihe von Zytokinen bewerkstelligt werden. Die Dezidua wird durch eine Population von CD56+CD16− naturlicher Killer(NK-)zellen mit einem distinkten Phanotyp infiltriert. Diese Zellen sind besonders bei der Implantation in groser Zahl vorhanden und treten in engen Kontakt mit dem invasiven Trophoblasten. Die selektive Expression des ungewohnlichen Klasse-I-human-leukocyte-antigen-(HLA-)Molekuls HLA-G durch den extravillosen Trophoblasten schutzt wahrscheinlich den invasiven Trophoblasten vor dem potentiellen Angriff maternaler NK-Zellen. Diese Ubersicht soll in Umrissen unseren derzeitigen Wissensstand uber die Implantation des Embryos auf zellularer und molekularer Ebene beschreiben.

Various mechanisms are necessary for regulating the survival of the semiallogenic embryo in the maternal organism. In addition to the lack of classical MHC class I and II antigens at the trophoblast the cytokines play an important role at the fetomaternal interface. Different cytokines regulate the immunological processes with an emphasis on the Th1/Th2 balance. In contrast to the peripheral blood there is a certain composition of immune competent cells at the fetomaternal interface. There are many different interactions between the endocrine and immunological system. Hormones modulate the secretion of certain cytokines and vice versa. In reproductive medicine it is of specific interest to evaluate these functions for treating problems during the early pregnancy.

Genital findings in sexually abused prepubertal girls. Childhood sexual abuse is defined as the involvement of dependent, developmentally immature children and adolescents in sexual activities that they do not fully comprehend, to which they are unable to give informed consent or that violate the social taboos of family roles. Essential to the diagnosis of sexual abuse is an awareness of the problem and acknowledgement of its manifestations. The evaluation of the sexually abused girl usually is performed in a pediatric and adolescent gynecology outpatient department. Thus, the gynecologist will be part of a multidisciplinary approach to the problem and will need to be competent in the basic skills of history taking, physical examination, selection of laboratory tests und differential diagnosis. Findings secondary to sexual abuse are often subtle. Acute tears or bruisings are rare, because force is seldom part of sexual acts committed against a child. A vaginal opening of greater than 5 mm is not common and may indicate vaginal penetration. An intact hymen not necessarily exclude vaginal intercourse. Lack of physical evidence never rules out abuse because sexual acts may leave no physical findings. Language: de

The histologic status of the regional lymph nodes draining the site of a malignant tumor is signifikant for the patient's prognosis. But for most gynecologic malignancies, particularly early stage lesions, the therapeutic benefit of lymphadenectomy is unclear. From a physiologic standpoint, removal of negative lymph nodes can be considered a reduction of immunocompetent tissue and might compromise the immunologic response. Can the prognostic information provided by the lymph node status also be gained through detailed pathomorphology of the primary tumor? Is lymphadenectomy justified for all gynecologic malignancies? We review the current status of lymphadenectomy in gynecologic cancer.

In endometriosis urinary tract involvement occurs in about 1 percent. While bladder involvement is more common, ureteral endometriosis can contribute to hydronephrosis and renal failure. We here report on two cases of ureteral endometriosis diagnosed due to hydronephrosis. In both cases we first relieved the kidney in placing a percutaneous nephrostomy tube into the renal pelvis. Then a laparotomy with resection and reimplantation of the ureter was performed. In one patient a resection of a segment of the rectum was also necessary because of excessive endometriosis. This patient was treated pre- and postoperatively with GnRH-agonists.

We report on a 60 year old patient with a 6 month history of vulval pruritus and an erosive vulval lesion which was mistaken for lichen sclerosus et atrophicus. Histologically the diagnosis of an amelanotic malignant melanoma of the vulva was established. We review the literature about this rare malignant tumor.

Background: In the general population, uterine sarcoma (US) is an uncommon tumor, which accounts for approximately 1–3% of all uterine neoplasms. Its biological behavior is characte

The anatomy of the ilioinguinal nerve makes it vulnerable to entrapment near its exit from the superficial inguinal ring, where it lies almost directly superior to the pubic tubercle. Ilioinguinal nerve entrapment is a documented complication of inguinal herniorrhaphy, inguinal lymph node dissection, appendectomy, Pfannenstiel incision and the needle suspension procedure. It has not previously been described as a complication of the tension-free vaginal tape (TVT) procedure, which is the most recent technique for the treatment of genuine urinary stress incontinence. This paper describes a clinical history to illustrate the diagnosis and management of ilioinguinal nerve entrapment occurring as a complication of tension-free vaginal tape procedure.

Obstetrics services in Europe are dominated by a persistently low birth rate, the average number of children born to a woman in her lifetime now being 1,45 for the European Community in general. This low rate has persisted for the last 20 years. During the past 10 years, childlessness has been steadily increasing. Maternal age at first delivery has also increased. Obstetric departments are increasingly subject to market principles and the trend towards centralization, which has been developing for some years, will continue.

The diagnostic value of cystoscopy and intravenous pyelography in the staging of carcinoma of the corpus uteri was evaluated in a retrospective study of 218 patients. The primary treatment in all patients was surgical. Cystoscopy was performed preoperatively in 71 (33%) of the patients and postoperatively in 90 (41%); 57 (26%) patients were not subjected to this investigation. Intravenous pyelography was performed in 95 (44%) of the patients and postoperatively in 70 (32%); 53 (24%) patients were not subjected to this investigation. In no patient did cystoscopy reveal invasion of the bladder by tumor. In one patient with a stromal sarcoma (stage IV), there was no flow of dye through the ureteral orifices. Intravenous pyelography revealed unilateral ureteral obstruction in one case of stromal sarcoma (stage III) and complete bilateral ureteral obstruction in another case (stage IV). These findings show that cystoscopy and intravenous pyelography are unnecessary in carcinoma of the corpus uteri at stages I and II, and that in stages III and IV the necessity for these investigations should be considered for each patient on an individual basis.

Human endometrium and early pregnancy decidua harbor a considerable and diverse population of antigen-presenting cells (APC). Changes in the number and distribution of macrophages and dendritic cells (DC) could point to a possible role of these immunocompetent cells in implantation and success of early pregnancy.Uterine tissue was obtained from 22 women undergoing hysterectomy for bleeding disorders or dysmenorrhea and from 11 women undergoing legal abortion. Tissue was investigated with antibodies against CD14, CD68, CD83, DC-SIGN, Ki-67, and human leukocyte antigen (HLA)-DR using single and double immunohistochemical staining techniques.The number of CD14(+) cells was stable during all phases of the menstrual cycle and early pregnancy. In comparison to nonpregnant endometrium, DC-SIGN(+) cells showed a higher proliferation rate and were found associated in clusters with CD56(+) natural killer (NK) cells in early pregnancy. In the late secretory phase of the menstrual cycle, numbers of CD83(+) (P.01) cells were significantly higher than in other endometrial phases and early pregnancy. HLA-DR(+) expression was significantly increased in early pregnancy but remained unchanged throughout the menstrual cycle.The presence of DC-SIGN(+) cells during the menstrual cycle and their proliferation in early pregnancy suggests an important role of these cells with regard to the balance between defense against pathogens and tolerance of the fetal allograft. Whether the increase of CD83(+) mature DC and CD68(+) macrophages in the late secretory phase is caused by hormonal stimuli and/or is due to changes of the cytokine/chemokine micromilieu remains to be investigated.

Zielsetzung: Diese Studie untersucht die Regulation von Proteinkinase C (PKC) durch Ostrogen in Brustkrebszellen. Material und Methoden/Ergebnisse: Ostrogen-Rezeptor (ER)-positive (+) MCF-7 und ER-negative (-)-HCC38-Zellen wurden mit 17s-Estradiol (E2) oder E2-BSA (nicht membrangangig) behandelt. E2 und E2-BSA erhoht PKC-α in beiden Zelltypen uber die Phosphatidylinositol abhangige Phospholipase C und das korrespondierende G-Protein, aber nicht uber Phospholipase A2 oder Arachidonsaure. In MCF-7 Zellen haben E2 und E2-BSA vergleichbare Effekte. Die maximale PKC-Stimulation wurde jeweils nach 90 Minuten erreicht. In HCC38-Zellen waren PKC-Werte nach 9 Minuten am hochsten. Tamoxifen blockiert die Ostrogen-abhangige PKC-Aktivitat in MCF-7-Zellen und reduziert sie in HCC38-Zellen. ER- Antagonist ICI 182780, ER-Agonist Diethylstilbestrol und Antikorper fur ERα und ERβ hatten keine Effekte. Tamoxifen verandert den E2 abhangigen Anstieg in MCF-7-Zellen nicht, wohingegen ICI 182780 die DNA-Synthese in der Kontrolle und in E2-behandelten Kulturen reduziert. Die PKC-Aktivitat war positiv korreliert mit der Tumorgrose in 133 Brustkrebstumoren und war in ER(-)-Tumoren groser als in ER(+)-Tumoren. Wie klinische Untersuchungen gezeigt haben, reduziert eine Tamoxifenbehandlung die Rezidivrate. Zusatzlich konnte gezeigt werden, dass Rezidivtumoren durchschnittlich hohere PKC-Aktivitaten aufweisen. Schlussfolgerung: Die Ergebnisse zeigen zum einen, dass Ostrogen die PKC-Aktivitat uber die Membran unabhangig von ERα oder ERβ erhoht und zum anderen, dass Tamoxifen uber die Reduzierung der PKC-Aktivitat uber einen nicht Erα- und Erβ-abhangigen Mechanismus arbeitet.

Diagnosis, therapy and biological behaviour of the Buschke-Lowenstein tumour of the vulva are described. Surgical treatment is accompanied by an antiviral therapy with interferon. Viral genesis of HPV 6 and/or HPV 11 is probably the cause of this intermediate tumour a type between condyloma and invasive squamous cell carcinoma.

Clinical and histological data of 168 patients with squamous cell carcinoma of the vulva were analyzed with respect to survival. 151 patients underwent surgery, 12 patients were treated with primary radiation and in 5 patients no treatment was performed. Follow-up lasted from at least 2 up to 22 years’ posttreatment. In univariate analysis, the following factors were highly significant: presurgery lymph node status, tumor infiltration beyond the vulva, tumor grading, histological inguinal lymph node status, pre- and postsurgery tumor stage, depth of invasion and tumor diameter. In the multivariate analysis (Cox regression), the most powerful factors were shown to be histological inguinal lymph node status, tumor diameter and tumor grading. The multivariate logistic regression analysis worked out as main prognostic factors for metastases of inguinal lymph nodes: presurgery inguinal lymph node status, tumor size, depth of invasion and tumor grading. Based on these results, tumor biology seems to be the decisive factor concerning recurrence and survival. Therefore, we suggest a more conservative treatment of vulvar carcinoma. Patients with confined carcinoma to the vulva, with a tumor diameter up to 3 cm and without clinical suspected lymph nodes, should be treated by wide excision/partial vulvectomy with ipsilateral lymphadenectomy.

814 questionnaires of conized and conized-hysterectomized women were evaluated according to menstruation disorders, sexual behaviour, course of pregnancy, medical check-up, carcinophobia, mentality to the operation, pains caused by the operation, and changes of womanliness. 32 percent of the conized women (less than or equal to 45 years old) gave menstruation disorders, mostly hypermenorrhea and dysmenorrhea. Course of pregnancy was not influenced by the conization. Over 80 percent of the women (less than or equal to 45 and greater than 45 years old) said their sexual life were not changed by the conization, in difference to the conized-hysterectomized women: 56 percent (greater than 45 years old) and 69 percent (less than or equal to 45 years old). Half all women were more anxious to get cervical cancer after the conization. The conized women were significantly more to a medical check-up compare to conized-hysterectomized ones. Over 80 percent would like to repeat the conization before removing the uterus. Conized-hysterectomized women felt significantly more less according to womanliness compare to conized ones. 51 percent (less than or equal to 45 years old) and only 35 percent (greater than 45 years old) said no side effects after hysterectomy. Mostly the women complained of pains of the bladder, menses-like mastodynia, and labile circulatory system. There was no significant difference according the answers about abdominal or vaginal hysterectomy with or without adnexectomy.

Worldwide, the incidence of nonruptured tubal pregnancy has increased, and so has the feasibility of conservative management of this condition. Following conservative surgery the rate of intrauterine pregnancy is significantly higher than after salpingectomy. The rate of ectopic pregnancy has not (or hardly) increased. For a surgeon skilled in this technique, the laparoscopic approach has advantages because it avoids laparotomy. For the time being, medical treatment of ectopic pregnancy with methotrexate, prostaglandins, and antiprogesterone should be confined to clinical studies. For nonviable, nonruptured tubal pregnancy with decreasing HCG titers expectant management seems possible; following conservative treatment, monitoring of HCG until it becomes undetectable is mandatory.

This report describes the results of a feasibility study of detection endometrial carcinoma in a population of 256 women, age 45 and above (221 patients with abnormal bleeding, 35 asymptomatic women). All of the asymptomatic women had a negative endometrial cytology. The microscopic examination of the curettings of patients with abnormal bleeding was correlated to the endometrial cytology. 13 adenocarcinomas, 2 sarcomas, but only 3 of 8 adenomatous hyperplasias, 2 of 4 circumscribed adenocarcinomas and none of 2 high differentiated adenoakanthomas were predicted by the cytological examination. The endouterine cell sampling is only effective in exophytic or broad endophytic growing adenocarcinomas. For precancerous conditions or early cancerous changes is the endouterine cell sampling not quite accurate. The routine use of endometrial cytology from the uterine cavity area is apparently not justified for early detection of endometrial carcinomas.

Little is known about the comparative safety of the isthmocorporal versus the low transverse uterine incision for Caesarean delivery of the very low birthweight infant. To address this question, the fetal outcome of 59 deliveries by isthmocorporal incision and 76 by low transverse incision were analysed. The incidences of a 5-min-Apgar score of 6 or lower and UA-pH were not significantly different. No correlation was evident between early intraventricular hemorrhage and type of incision. The number of neonatal deaths weighing less than 1000 g associated with vertical incision (27%) was lower than that associated with the low transverse incision (47%). Nevertheless the difference was not statistically significant. The decision for the type of incision should be made intraoperatively by an experienced surgeon. This factor is probably more important than the choice of a particular incision.

The histopathological examination of several sections of tubal ectopic pregnancies shows that the growth of the trophoblast usually takes place in an extraluminal subperitoneal site and dilation of the tube is caused by coagulated blood and not by the trophoblast. For conservative surgery of the tube it is necessary to keep in mind the histopathological findings of tubal pregnancies.

945 human sera from children, fertile and infertile females, pregnant women and fertile and infertile males were tested for antibodies to porcine zona pellucida by immunofluorescence and the pronase-induced zona-lysis inhibition test. Positive sera were found in each of the groups examined, with a higher percentage of anti-zona activity in infertile, pregnant and menopausal women. There was no correlation between anti-sperm antibody titer and the incidence of anti-zona activity in either female or male human sera, nor did the occurrence of anti-zona activity correlate with a particular blood group type.

The histopathological examination of several sections of tubal ectopic pregnancies shows that the growth of the trophoblast mostly takes place in an extraluminal site subperitoneally and that the dilated tube is caused by coagulated blood and not by the trophoblast.