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von Kaisenberg CS, Wilting J, Dörk T, Nicolaides KH, Meinhold-Heerlein I, Hillemanns P, Brand-Saberi B. Lymphatic capillary hypoplasia in the skin of fetuses with increased nuchal translucency and Turner's syndrome: comparison with trisomies and controls. Mol Hum Reprod 2010; 16:778-89. [PMID: 20457798 DOI: 10.1093/molehr/gaq035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fetuses with Turner's syndrome or trisomies 21, 18 and 13 show excess of skin, which can be visualized by ultrasonography as increased nuchal translucency at 11-13(+6) weeks' gestation. The objective of this study was to gain insight in the development and distribution of blood vessels, lymphatic capillaries of the cutis and lymphatic collectors of the cutis and subcutis and to study developmental changes with increasing gestation. Immunofluorescence of cryosections with 10 specific antibodies was used to investigate the nuchal skin of three fetuses with Turner syndrome's and to differentiate lymphatics, lymph capillaries (FLT4, PTN 63, LYVE1, PROX1), blood vessels (KDR, CD 31, PDPN), blood clotting activity (von Willebrand factor), basement membranes and big vessels (Laminin, Collagen Type IV). The findings were compared with those in seven fetuses with trisomy 21 and two fetuses each with trisomies 18 or 13, respectively, as well as six normal controls. Immunoreactive receptors for vascular endothelial growth factors (FLT4) were decreased in lymphatic capillaries of the skin of Turner fetuses. Accordingly, LYVE1 was scarce and PROX1 staining was less intense in the dermis of Turner fetuses. Lymphatic collectors were, however, evenly stained. In normal fetuses and in those with trisomies, lymphatic capillaries were evenly distributed. We conclude that lymphatic capillary hypoplasia might be responsible for nuchal cystic hygroma in Turner syndrome. The biological basis for increased nuchal translucency in trisomies may however be different.
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Schippert C, Bloechle M, Marr S, Caliebe A, Siebert R, Hillemanns P, von Kaisenberg CS. Preimplantation genetic diagnosis (polar body biopsy) and trisomy 21. Hum Reprod 2010; 25:1081-2. [DOI: 10.1093/humrep/dep462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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128
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Gallwas J, Ditsch N, Hillemanns P, Friese K, Thaler C, Dannecker C. The significance of HPV in the follow-up period after treatment for CIN. EUR J GYNAECOL ONCOL 2010; 31:27-30. [PMID: 20349777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE OF INVESTIGATION High-risk anogenital human papillomavirus (HPV) infections are causally related to cervical cancer. Successful treatment of cervical intraepithelial neoplasia (CIN) results in complete eradication of HPV in most cases. There is an increasing interest regarding the role of HPV testing in the follow-up period after treatment for CIN. PATIENTS AND METHODS This retrospective study includes 107 women who underwent conization for histologically verified CIN. All of them had HPV testing pre- and postoperatively. HPV testing was carried out using a hybrid capture assay (HC2). The mean follow-up period was 21.4 months (range 2-76 months). The data were analyzed with respect to success of conization, HPV persistence/recurrence and CIN recurrence. Sensitivity, specificity and negative predictive value (NPV) of HPV testing were assessed and compared to the cytological results. RESULTS Preoperatively, 97 of 107 women were HPV positive. Ninety-seven conizations showed negative resection margins with 86 women becoming HPV negative. In the following months, nine of these HPV negative women became HPV positive again. Out of ten conizations with positive resection margins, six women became HPV negative. Recurrent CIN 2/3 lesions were observed in 11 women, nine of whom had persistent positive HPV testing throughout the entire study period. Regarding CIN recurrence HPV testing showed a sensitivity of 93%, a specificity of 85% and a NPV of 99%. CONCLUSIONS The sensitivity of HPV testing concerning persistent or recurrent CIN as well as the NPV are high. The present data suggest that HPV testing should be integrated in a follow-up algorithm after treatment for CIN by conization.
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Versen-Höynck FV, Hillemanns P, Rajakumar A, Roberts JM, Powers RW. Die plazentare Adenosinrezeptor Expression ist höher bei Frauen mit Präeklampsie. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1239030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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130
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Gross MM, Fischer V, Behrends M, Hillemanns P. Europäischer Masterstudiengang für Hebammen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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131
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Pathirana D, Hillemanns P, Petry KU, Becker N, Brockmeyer N, Erdmann R, Gissmann L, Grundhewer H, Ikenberg H, Kaufmann A, Klußmann J, Kopp I, Pfister H, Rzany B, Schneede P, Schneider A, Smola S, Winter-Koch N, Wutzler P, Gross G. Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia. Vaccine 2009; 27:4551-9. [DOI: 10.1016/j.vaccine.2009.03.086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/19/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
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Kuemper C, Burges A, Hillemanns P, Mueller-Egloff S, Lenhard M, Ditsch N, Strauss A. Supraclavicular lymph node metastases of unknown origin: HPV-typing identifies the primary tumour. Eur J Cancer Care (Engl) 2009; 18:606-11. [PMID: 19549285 DOI: 10.1111/j.1365-2354.2008.00937.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cancers of unknown primary origin (CUP) account for 0.5-10% of all malignancies. CUP patients with metastases have a median survival of approximately 6 months, despite therapy. Identification of the primary tumour site may offer the opportunity of a specific and more efficient treatment. The case of a 45-year-old woman with supraclavicular lymph node metastases of a squamous cell CUP is reported. A staging laparoscopy with multiple biopsies and a loop diathermy excision of the cervix were performed. Human papillomavirus (HPV)-testing in the tissues revealed the tumour cells as metastases of an occult cervical cancer. Primary platin-based chemotherapy combined with paclitaxel leads to a complete apparative remission. Twelve months later, staging positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose in combination with computed tomography identified an isolated left renal lymph node metastasis. The patient received targeted radiation therapy, combined with cisplatin. To date, 19 months after diagnosis, she is doing well without any evidence of disease. The presented case report addresses the difficulties involving the identification of CUP. HPV-DNA is found in over 95% of cervical cancers. As the presented case illustrates, testing for this virus DNA in human tissues can be a useful diagnostic tool in patients with CUP where cervical cancer is the possible primary tumour.
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Schling S, Hillemanns P, Groß MM. Zur Historie des Mutterpasses und seines Aktualisierungsbedarfs. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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134
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Hörmansdörfer C, Schmidt P, Golatta M, Vaske B, Hillemanns P, Scharf A. Impact of the maternal age on first trimester screening for chromosomal aberrations of the fetus – Analysis of 15,228 datasets. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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135
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Soergel P, Staboulidou I, Claus V, Schippert C, Hillemanns P. Beeinflusst die Stellung des Mondes die Geburt? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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136
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Soergel P, Staboulidou I, Zempel W, Grüssner S, Kaisenberg CV, Hillemanns P. Treffsicherheit der fetometrischen Gewichtsschätzung in der klinischen Routine. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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137
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Hörmansdörfer C, Schmidt P, Hillemanns P, Golatta M, Scharf A. Does the exclusion of maternal background risk in calculation software PRC, PIA and JOY improve First Trimester Screening (FTS)? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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138
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Radtke K, Köhler L, Fischer V, Hillemanns P, Groß MM. Vom EU-Projekt zur Verwirklichung des Europäischen Masterstudiengangs für Hebammenwissenschaft. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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139
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Petersen A, Drobnič, PhD S, Hillemanns P, Groß MM. Der Interventionskaskade auf der Spur – Wie lange dauern die Intervalle zwischen Geburtsbeginn, intrapartalen Interventionen und der Geburt? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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140
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Schling S, Hillemanns P, Gross MM. [History of the German antenatal record ("mutterpass") and its need for updating]. Z Geburtshilfe Neonatol 2009; 213:42-8. [PMID: 19319792 DOI: 10.1055/s-0029-1202786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The German antenatal record, the "Mutterpass", is the most important document in German antenatal care. Following its introduction in 1968, subsequent editions were adapted to take account of successive revisions of the German maternity guidelines ("Mutterschaftsrichtlinien"). Before 1995, however, no details giving evidence for or explaining the reasons for the modifications to the maternity guidelines were included. While the maternity guidelines have been regularly updated, particularly with regard to serological findings and ultrasound examinations, the risk catalogue included in the "Mutterpass" has not, but has remained unchanged since 1986. Just one risk factor out of the 52 items listed suffices to define a pregnant woman as being at high risk during childbirth. DISCUSSION AND CONCLUSION The history of the risk catalogue shows that its revision is essential to meet current health science requirements. Likewise, arguments for an evidence-based revision of the items of the risk catalogue are to be found in current literature.
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Lautmann K, Staboulidou I, Wüstemann M, Günter H, Scharf A, Hillemanns P. Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2009; 30:71-73. [PMID: 17926256 DOI: 10.1055/s-2007-963214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproduction technique (ART) gestations increased. Due to the serious consequences, delayed diagnosis should be prevented in order to salvage the viable intrauterine fetus and avoid maternal morbidity and mortality. This case report demonstrates that the pitfalls of the diagnosis of heterotopic pregnancy make early diagnosis difficult and the prevention of heterotopic pregnancies by single embryo transfer should be continuously discussed. The role of high resolution ultrasound scans and the importance of close monitoring of early pregnancies following ART are emphasized because early diagnosis of heterotopic pregnancy results in a similar perinatal outcome as singleton pregnancies.
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Staboulidou I, Wüstemann M, Vaske B, Scharf A, Hillemanns P, Schmidt P. Interobserver variability of the measurement of fetal nasal bone length between 11+0 and 13+6 gestation weeks among experienced and inexperienced sonographers. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2009; 30:42-46. [PMID: 18773384 DOI: 10.1055/s-2008-1027402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Examination of fetal nasal bone (NB) by ultrasound between 11 + 0 and 13 + 6 gestation weeks has been proposed as an additional tool in the detection of trisomy 21 and therefore its application and implementation are used in a broad range. The study aimed at evaluating the interobserver feasibility of the measurement of fetal nasal bone length in comparison with experienced and inexperienced sonographers. MATERIALS AND METHODS The study population was comprised of women who chose to have first trimester screening (FTS) at the Fetal Medicine Unit of the University Medical School of Hannover. Two experienced (> 400 FTS examinations, sonographer 1 and 2) and one inexperienced sonographer (95 FTS examinations, sonographer 3) were asked to measure the nasal bone length consecutively and independently of each other. Statistical analysis was performed for any differences and variations in the results. RESULTS The fetal profile was examined in 220 cases. The median nasal bone length by sonographer one was 2.4 cm, sonographer two 2.4 cm and sonographer three 2 cm. The differences between the results of sonographer 1 and 3 as well 2 and 3 were statistically significant. There were no significant variations between the results of sonographer 1 and 2. There was also no significant difference in the results concerning nuchal translucency and crown-rump length among the three examiners. CONCLUSION The uncertainty and the difficulties of an inexperienced examiner with the presenting of the nasal bone, as shown by published data sets as well as by the variability of the measurement results of this study, with all the consequences in the risk calculation and counseling show that this tool should only be implemented by experienced and quality-controlled sonographers with a minimum amount of examinations. Because of its major impact in risk calculation and the importance of the nasal bone as a sonographic marker, documentation of the sonographer's skills is mandatory for the use of the nasal bones as an additional sonographic marker in first trimester screening.
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Hörmansdörfer C, Scharf A, Golatta M, Vaske B, Corral A, Hillemanns P, Schmidt P. Comparison of Prenatal Risk Calculation (PRC) with PIA Fetal Database software in first-trimester screening for fetal aneuploidy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:147-151. [PMID: 19009535 DOI: 10.1002/uog.6250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES In February 2007 new software, Prenatal Risk Calculation (PRC), for calculating the risk of fetal aneuploidy was introduced in Germany. Our aim was to investigate its test performance and compare it with that of the PIA Fetal Database (PIA) software developed and used by The Fetal Medicine Foundation. METHODS Between 31 August 1999 and 30 June 2004 at the Women's Hospital of the Medical University of Hanover in Germany, 3120 singleton pregnancies underwent combined first-trimester screening at 11 + 0 to 13 + 6 weeks of gestation. Calculation of risk for fetal aneuploidy was computed prospectively using the PIA software. In a subsequent retrospective analysis, we recalculated risks for the 2653 of these datasets with known fetal outcome using the PRC software and compared the results. RESULTS Of the 2653 datasets analyzed, 17 were cases of aneuploidy. At a cut-off of 1 : 230, for the detection of fetal aneuploidy, the respective sensitivity, false-positive rate and positive predictive value were 70.6%, 4.1% and 9.9% for PRC and 76.5%, 2.9% and 14.6% for PIA. At a cut-off of 1 : 300, the equivalent values were 70.6%, 5.6% and 7.5% for PRC and 76.5%, 4.0% and 11.0% for PIA. The differences in test performance between the two types of software were highly significant (P < 0.0001). DISCUSSION The test performance of PRC was inferior to that of PIA, the sensitivity for detection of fetal aneuploidy being lower and the false-positive rate higher. Had PRC been employed prospectively in our study, 40% more women examined would have been offered unnecessarily an invasive procedure for fetal karyotyping.
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Schwarz T, Garcia-Sicilia J, Carmona A, Malkin J, Tran M, Peters K, Hillemanns P, Thomas F, Descamps D. Co-Administration of GSK's AS04 Adjuvanted Cervical Cancer Vaccine with Combined dTpa-IPV Vaccine in Girls Aged 10–18 Years. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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145
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Ayerle G, Hecker H, Frömke C, Hillemanns P, Groß M. Zusammenhänge zwischen Anwesenheit der Hebamme, Interventionen und dem Outcome der Geburt. Z Geburtshilfe Neonatol 2008; 212:176-82. [DOI: 10.1055/s-2008-1076979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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146
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Hampl M, Hantschmann P, Michels W, Hillemanns P. Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol 2008; 111:282-8. [PMID: 18804850 DOI: 10.1016/j.ygyno.2008.08.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 08/07/2008] [Accepted: 08/11/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of the sentinel node procedure in patients with vulvar cancer, a multicenter study was launched in Germany in 2003 involving 7 oncology centers. PATIENTS AND METHODS Between 2003 and 2006, 127 women with primary T1-T3 vulvar cancer were entered in the study and treated with sentinel node removal after application of (99m)Technetium labeled nanocolloid and/or blue dye. Subsequently, in all women a complete inguinofemoral lymphadenectomy and the adequate vulvar operation were performed. Sentinel lymph nodes were examined by routine pathologic examination (H&E), followed by step-sectioning and immunhistochemistry if negative. RESULTS The sentinel node procedure was successful in 125 out of 127 cases, in 2 cases no sentinel nodes were detected. 21 patients received unilateral lymphadenectomy, 103 women were operated on both groins. In 39 women out of 127, positive lymph nodes in one or both groins were identified (30.7%). In 36 women, the sentinel nodes were also positive (sensitivity 92.3%). We had three cases with a false negative sentinel node (false negative rate: 7.7%), all of these women presenting with tumors in midline position. One tumor was a T1 tumor (10 mm), 2 tumors being classified as T2 (40 and 56 mm, respectively). In one additional case (18 mm T1 tumor, midline position), the sentinel was positive in the right groin, but false negative on the left side. CONCLUSIONS This study shows that identification of SLN in squamous cell cancer of the vulva is feasible, however not highly accurate depending on tumor localization and size. The false negative rate seems to be acceptable if the procedure is restricted to stage 1 tumors with clinically negative lymph node status. Tumors situated in or close to the midline seem to be less suitable for this procedure. Implementation of SLNB into clinical practice should be performed with care and only by experienced teams as to avoid preventable groin relapses.
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Schmidt P, Dormeier J, Hörmansdörfer C, Golatta M, Scharf A, Hillemanns P. Vorstellung einer neuen Methodik zur Visualisierung typischer Befundkonstellationen für euploide und aneuploide Feten – Common Bubbles im AFS–3D-Verfahren. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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148
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Hollwitz B, Rinnau F, Soergel P, Petry KU, Hillemanns P. HPV-assoziierte anogenitale Erkrankungen bei HIV-Infizierten im Zeitalter der HPV-Impfung – Implikationen für Prävention, Diagnose und Therapie eines multilokulären Problems. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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149
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Schippert C, Garcia-Rocha GJ, Hillemanns P. Die rekonstruktive, funktionswiederherstellende Mikrochirurgie ist bei tubarer Sterilität nach wie vor eine Alternative zur IVF! – Ergebnisse von 553 mikrochirurgischen Operationen an der MHH. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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150
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Hollwitz B, Günter HH, Oehler K, Glaubitz M, Hillemanns P. Äußere Wendung–effektiv und sicher – zum individualisierten Management von Lageanomalien unverzichtbar. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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