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Geißler C, Knoerlein J, Bohlmann MK, Brandt A, Guluzade D, Gerber M, Watermann D, Weiz O, König G, Markfeld F, Klar M, Juhasz-Böss I, Kunze M. [Correction: Evaluation of Psychological Distress in Obstetric Patients during the Visit Ban in Hospitals in the SARS-CoV-2 Pandemic: A Prospective, Multicentre, Controlled Study]. Z Geburtshilfe Neonatol 2024; 228:e1. [PMID: 37984361 DOI: 10.1055/a-2206-7340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Carmen Geißler
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Julian Knoerlein
- Anästhesiologische Klinik, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Michael K Bohlmann
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Andreas Brandt
- Frauenheilkunde und Geburtshilfe, Ortenau Klinikum, Offenburg, Germany
| | - Durdana Guluzade
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Monika Gerber
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Dirk Watermann
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Olga Weiz
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Gudrun König
- Geburtshilfe, Eichsfeld Klinikum, Eichsfeld, Germany
| | - Filiz Markfeld
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Maximilian Klar
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Ingolf Juhasz-Böss
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinik Freiburg, Freiburg, Germany
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Geißler C, Knoerlein J, Bohlmann MK, Brandt A, Guluzade D, Gerber M, Watermann D, Weiz O, König G, Markfeld F, Klar M, Juhasz-Böss I, Kunze M. [Evaluation of Psychological Distress in Obstetric Patients during the Visit Ban in Hospitals in the SARS-CoV-2 Pandemic: A Prospective, Multicentre, Controlled Study]. Z Geburtshilfe Neonatol 2024; 228:80-87. [PMID: 37931900 DOI: 10.1055/a-2180-7507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Risk factors for postpartum depression include a lack of social support and perceived social isolation. We would like to determine whether the isolation of inpatients on the maternity wards during Covid-19 leads to increased psychological stress. METHODS This is a multicentre, controlled study of obstetric patients who gave birth during an inpatient stay. Patients were included during the visitation ban (study group) and after the visitation ban (control group). Psychological stress was evaluated with the Edinburgh Postnatal Depression Scale (EPDS) during the inpatient stay and six to eight weeks postpartum. RESULTS A total of 194 women were included, 107 in the study group and 87 in the control group. The overall result of the first EPDS shows a higher score in the study group compared to the control group (7.0 vs. 4.9 points). Primipara show a higher score in the first EPDS compared to multipara (7.28 vs. 4.82). Caesarean section, regardless of isolation, shows a higher score in the first EPDS than vaginal birth (8.42 vs. 5.11). Comparison of vaginal birth shows a higher score only in the study group (5.97 vs. 4.07). CONCLUSION In the context of Covid-19, women giving birth and new mothers, especially primipara, are exposed to increased psychological stress in the clinics. Caesarean section leads to increased psychological stress.
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Affiliation(s)
- Carmen Geißler
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Julian Knoerlein
- Anästhesiologische Klinik, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Michael K Bohlmann
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Andreas Brandt
- Frauenheilkunde und Geburtshilfe, Ortenau Klinikum, Offenburg, Germany
| | - Durdana Guluzade
- Frauenheilkunde und Geburtshilfe , St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Monika Gerber
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Dirk Watermann
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Olga Weiz
- Frauenheilkunde und Geburtshilfe, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
| | - Gudrun König
- Geburtshilfe, Eichsfeld Klinikum, Eichsfeld, Germany
| | - Filiz Markfeld
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Maximilian Klar
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Ingolf Juhasz-Böss
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Freiburg, Medizinische Universitätsklinik, Freiburg im Breisgau, Germany
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinik Freiburg, Freiburg, Germany
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Hachenberg J, Guenther J, Steinkasserer L, Brodowski L, Dueppers AL, Delius M, Chiaie LD, Lobmaier S, Sourouni M, Richter MF, Manz J, Parchmann O, Schmidt S, Winkler J, Werring P, Kraft K, Kunze M, Manz M, Eichler C, Schaefer V, Berghaeuser M, Schlembach D, Seeger S, Schäfer-Graf U, Kyvernitakis I, Bohlmann MK, Ramsauer B, Morfeld CA, Ruediger M, Pecks U, von Kaisenberg C. Evolution of Fetal Growth in Symptomatic Sars-Cov-2 Pregnancies. Z Geburtshilfe Neonatol 2024; 228:57-64. [PMID: 38330960 DOI: 10.1055/a-2224-2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
INTRODUCTION SARS-CoV-2 is a viral disease with potentially devastating effects. Observational studies of pregnant women infected with SARS-CoV-2 report an increased risk for FGR. This study utilizes data from a prospective SARS-CoV-2 registry in pregnancy, investigating the progression of fetuses to fetal growth restriction (FGR) at birth following maternal SARS-CoV-2 and evaluating the hypothesis of whether the percentage of SGA at birth is increased after maternal SARS-CoV-2 taking into account the time interval between infection and birth. MATERIALS & METHODS CRONOS is a prospective German registry enrolling pregnant women with confirmed SARS-CoV-2 infection during their pregnancy. SARS-CoV-2 symptoms, pregnancy- and delivery-specific information were recorded. The data evaluated in this study range from March 2020 until August 2021. Women with SARS-CoV-2 were divided into three groups according to the time of infection/symptoms to delivery: Group I<2 weeks, Group II 2-4 weeks, and Group III>4 weeks. FGR was defined as estimated and/or birth weight<10% ile, appropriate for gestational age (AGA) was within 10 and 90%ile, and large for gestational age (LGA) was defined as fetal or neonatal weight>90%ile. RESULTS Data for a total of 2,650 SARS-CoV-2-positive pregnant women were available. The analysis was restricted to symptomatic cases that delivered after 24+0 weeks of gestation. Excluding those cases with missing values for estimated fetal weight at time of infection and/or birth weight centile, 900 datasets remained for analyses. Group I consisted of 551 women, Group II of 112 women, and Group III of 237 women. The percentage of changes from AGA to FGR did not differ between groups. However, there was a significantly higher rate of large for gestational age (LGA) newborns at the time of birth compared to the time of SARS-CoV-2 infection in Group III (p=0.0024), respectively. CONCLUSION FGR rates did not differ between symptomatic COVID infections occurring within 2 weeks and>4 weeks before birth. On the contrary, it presented a significant increase in LGA pregnancies in Group III. However, in this study population, an increase in the percentage of LGA may be attributed to pandemic measures and a reduction in daily activity.
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Affiliation(s)
- Jens Hachenberg
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Julia Guenther
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Lena Steinkasserer
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Lars Brodowski
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Maria Delius
- Obstetrics and Gynecology, LMU, München, Germany
| | - Loredana Delle Chiaie
- Department of Gynecology and Obstetrics, City of Stuttgart Hospitals, Stuttgart, Germany
| | - Silvia Lobmaier
- Frauenheilkunde und Geburtshilfe, Klinikum rechts der Isar der Technischen Universitat München, München, Germany
| | - Marina Sourouni
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | | | - Jula Manz
- Department of Gynecology and Obstetrics, Darmstadt Hospital, Darmstadt, Germany
| | - Olaf Parchmann
- Department of Gynecology and Obstetrics, HELIOS Klinik Sangerhausen, Sangerhausen, Germany
| | - Saskia Schmidt
- Department of Gynecology and Obstetrics, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Jennifer Winkler
- Department of Gynecology and Obstetrics, Dresden University Hospital, Dresden, Germany
| | - Pia Werring
- Department of Gynecology and Obstetrics, Christophorus-Kliniken GmbH Betriebsstätte Sankt-Vincenz-Hospital Coesfeld, Coesfeld, Germany
| | - Katrina Kraft
- Department of Gynecology and Obstetrics, München Klinik Harlaching, München, Germany
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinik Freiburg, Freiburg, Germany
| | - Maike Manz
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Darmstadt, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, St Franziskus-Hospital Münster GmbH, Münster, Germany
| | - Viola Schaefer
- Department of Gynecology and Obstetrics, University Hospital Marburg Department of Gynaecology and Obstetrics, Marburg, Germany
| | - Martin Berghaeuser
- Department of Gynecology and Obstetrics, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | | | - Sven Seeger
- KH St. Elisabeth und St. Barbara Halle, Klinik für Frauenheilkunde und Geburtshilfe, Perinatalzentrum, Halle/Saale, Germany
| | - Ute Schäfer-Graf
- Klinik für Geburtshilfe, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Ioannis Kyvernitakis
- Dept. of Obstetrics and Gynecology, Philipps-University of Marburg, Marburg, Germany
| | - Michael K Bohlmann
- Frauenheilkunde und Geburtshilfe, St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Babette Ramsauer
- Department of Gynecology and Obstetrics, Vivantes Klinikum Neukölln, Berlin, Germany
| | | | - Mario Ruediger
- Department of Neonatology, Dresden University Hospital, Dresden, Germany
| | - Ulrich Pecks
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
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Zöllkau J, Heimann Y, Hagenbeck C, Pecks U, Abou-Dakn M, Schlösser R, Schohe A, Dressler-Steinbach I, Manz M, Banz-Jansen C, Reuschel E, Iannaccone A, Bohlmann MK, Kraft K, Fill Malfertheiner S, Wimberger P, Kolben T, Bartmann C, Longardt AC. Breastfeeding Behavior Within the Covid-19 Related Obstetric and Neonatal Outcome Study (CRONOS). J Hum Lact 2023; 39:625-635. [PMID: 37712573 DOI: 10.1177/08903344231190623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic and its influence on peripartum processes worldwide led to issues in breastfeeding support. RESEARCH AIM The aim of this study was to describe breastfeeding behavior and peripartum in-hospital management during the pandemic in Germany and Austria. METHODS This study was a descriptive study using a combination of secondary longitudinal data and a cross-sectional online survey. Registry data from the prospective multicenter COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS) cohort study (longitudinal, medical records of 1,815 parent-neonate pairs with confirmed SARS-CoV-2 infection during pregnancy) and a cross-sectional online survey of CRONOS hospitals' physicians (N = 67) were used for a descriptive comparison of feeding outcomes and postpartum management. RESULTS In 93.7% (n = 1700) of the cases in which information on the neonate's diet was provided, feeding was with the mother's own milk. Among neonates not receiving their mother's own milk, 24.3% (n = 26) reported SARS-CoV-2 infection as the reason. Peripartum maternal SARS-CoV-2 infection, severe maternal COVID-19 including the need for intensive care unit (ICU) treatment or invasive ventilation, preterm birth, mandatory delivery due to COVID-19, and neonatal ICU admission were associated with lower rates of breastfeeding. Rooming-in positively influenced breastfeeding without affecting neonatal SARS-CoV-2 frequency (4.2% vs. 5.6%). CRONOS hospitals reported that feeding an infant their mother's own milk continued to be supported during the pandemic. In cases of severe COVID-19, four of five hospitals encouraged breastfeeding. CONCLUSION Maintaining rooming-in and breastfeeding support services in the CRONOS hospitals during the pandemic resulted in high breastfeeding rates.
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Affiliation(s)
- Janine Zöllkau
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Michael Abou-Dakn
- Department of Obstetrics and Gynecology, St. Joseph-Hospital, Berlin, Germany
| | - Rolf Schlösser
- Hospital for Children and Adolescents, University Hospital of Frankfurt, Frankfurt, Germany
| | - Anna Schohe
- Department of Obstetrics and Gynecology, St. Joseph-Hospital, Berlin, Germany
| | | | - Maike Manz
- Department of Obstetrics and Gynecology, Darmstadt City Hospital, Darmstadt, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, Protestant Hospital of Bethel Foundation, Bielefeld, Germany
| | - Edith Reuschel
- University Department of Obstetrics and Gynecology, The Hospital St. Hedwig of The Order of St. John, University of Regensburg, Regensburg, Germany
| | | | - Michael K Bohlmann
- Department of Obstetrics and Gynecology, St. Elisabeth' Hospital, Loerrach, Germany
| | - Katrina Kraft
- Department of Obstetrics and Gynecology, Munich Municipal Hospital, Harlaching, Munich, Germany
| | - Sara Fill Malfertheiner
- University Department of Obstetrics and Gynecology, The Hospital St. Hedwig of The Order of St. John, University of Regensburg, Regensburg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden, Dresden, Germany
| | - Thomas Kolben
- Department for Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Catharina Bartmann
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Ann - Carolin Longardt
- Clinic for Pediatrics and Adolescent Medicine I / Neonatology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
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Abstract
Although admission to an intensive care unit during pregnancy is rare, pregnant women may become critically ill due to either obstetric or non-obstetric illness. Whilst critical illness due to obstetric reasons during the peripartum period (e.g. peripartum haemorrhage, HELLP-syndrome) is more common, it is also important to know how to care for critically ill pregnant women with non-obstetric illness (e.g. infection, cardiovascular diseases, neurological diseases, trauma). Physiological changes during pregnancy may affect critical care treatment, variation in standard and target values for blood pressure management or artificial ventilation. Pregnancy specific reference values in interpretation of blood chemistry are important issues to consider. The use of different drugs is inevitable in critical care, knowing which drugs are safe to use during the different stages of pregnancy is essential. Caring for mother and unborn child in the ICU is a challenge, open communication, ethical considerations and interdisciplinary as well as multiprofessional collaborations should be key points when caring for critically ill pregnant patients.
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Hofheinz R, Lorenzen S, Bohlmann MK. HER-2-Positive Tumors: A Continuously Evolving Field in Cancer Research. Cancers (Basel) 2023; 15:3333. [PMID: 37444443 DOI: 10.3390/cancers15133333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Almost 25 years ago, trastuzumab, a monoclonal antibody targeting the human epidermal growth factor receptor 2 (HER2), was licensed for the treatment of patients with metastatic HER2-positive breast cancer in the United States of America (USA) [...].
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Affiliation(s)
- Ralf Hofheinz
- Mannheim Cancer Center, University Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Sylvie Lorenzen
- Klinik und Poliklinik für Innere Medizin III, Technische Universität München, 81675 München, Germany
| | - Michael K Bohlmann
- Zentrum für Geburtshilfe und Gynäkologie, St. Elisabethen Krankenhaus Lörrach, 79539 Lörrach, Germany
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Brüggmann D, Quinkert-Schmolke K, Jaque JM, Quarcoo D, Bohlmann MK, Klingelhöfer D, Groneberg DA. Global cervical cancer research: A scientometric density equalizing mapping and socioeconomic analysis. PLoS One 2022; 17:e0261503. [PMID: 34990465 PMCID: PMC8735629 DOI: 10.1371/journal.pone.0261503] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2021] [Indexed: 01/05/2023] Open
Abstract
Cervical cancer has caused substantial morbidity and mortality for millions of women over the past decades. While enormous progress has been made in diagnosis, prevention and therapy, the disease is still fatal for many women—especially in low-income countries. Since no detailed studies are available on the worldwide research landscape, we here investigated the global scientific output related to this cancer type by an established protocol. The “New Quality and Quantity Indices in Science” platform assessed all relevant cervical cancer research published in the Web of Science since 1900. A detailed analysis was conducted including country-specific research productivity, indicators for scientific quality, and relation of research activity to socioeconomic and epidemiologic figures. Visualization of data was generated by the use of density equalizing map projections. Our approach identified 22,185 articles specifically related to cervical cancer. From a global viewpoint, the United States of America was the dominating country in absolute numbers, being followed by China and Japan. By contrast, the European countries Sweden, Austria, and Norway were positioned first when the research activity was related to the population number. When the scientific productivity was related to annual cervical cancer cases, Scandinavian countries (Finland #1, Sweden #4, Norway #5, Denmark #7), the Alpine countries Austria (#2) and Switzerland (#6), and the Netherlands (#3) were leading the field. Density equalizing mapping visualized that large parts of Africa and South America were almost invisible regarding the global participation in cervical cancer research. Our data documented that worldwide cervical cancer research activity is continuously increasing but is imbalanced from a global viewpoint. Also, the study indicated that global and public health aspects should be strengthened in cervical carcinoma research in order to empower more countries to take part in international research activities.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology and Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
- * E-mail:
| | - Kathrin Quinkert-Schmolke
- Department of Obstetrics and Gynecology and Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - Jenny M. Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - David Quarcoo
- Department of Obstetrics and Gynecology and Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - Michael K. Bohlmann
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Loerrach, Germany
| | - Doris Klingelhöfer
- Department of Obstetrics and Gynecology and Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - David A. Groneberg
- Department of Obstetrics and Gynecology and Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
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Rogenhofer N, Bohlmann MK. Gerinnungsabklärung und Therapie bei habituellen Aborten und wiederholtem Implantationsversagen. Gynäkologische Endokrinologie 2019. [DOI: 10.1007/s10304-019-0261-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Goertz L, Schneider SW, Desch A, Mayer FT, Koett J, Nowak K, Karampinis I, Bohlmann MK, Umansky V, Bauer AT. Heparins that block VEGF-A-mediated von Willebrand factor fiber generation are potent inhibitors of hematogenous but not lymphatic metastasis. Oncotarget 2018; 7:68527-68545. [PMID: 27602496 PMCID: PMC5356571 DOI: 10.18632/oncotarget.11832] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 08/21/2016] [Indexed: 12/31/2022] Open
Abstract
Von Willebrand factor (VWF) serves as a nidus for platelet aggregation and thrombosis. We hypothesize that VWF fibers contribute to the development of venous thromboembolism (VTE) and to metastasis formation. Here, we show that vascular and lymphatic endothelial cells (ECs) express VWF in vitro and release VWF fibers after activation by tumor cell supernatants. In contrast, an ex vivo analysis of primary mouse tumors revealed the presence of VWF fibers in the blood microvasculature but not in lymphatic vessels. Unlike the anticoagulant Fondaparinux, an inhibitor of thrombin generation, the low-molecular-weight heparin (LMWH) Tinzaparin inhibited VWF fiber formation and vessel occlusion in tumor vessels by blocking thrombin-induced EC activation and vascular endothelial growth factor-A (VEGF-A)-mediated VWF release. Intradermal tumor cell inoculation in VWF- and ADAMTS13-deficient mice did not alter lymph node metastases compared with wild type animals. Interestingly, multiple tumor-free distal organs exhibited hallmarks of malignancy-related VTE, including luminal VWF fibers, platelet-rich thrombi and vessel occlusions. Furthermore, ADAMTS13 deficiency, characterized by prolonged intraluminal VWF network lifetimes, resulted in a severely increased number of metastatic foci in an experimental model of hematogenous lung seeding. Treatment with Tinzaparin inhibited tumor-induced release of VWF multimers, impeded platelet aggregation and decreased lung metastasis. Thus, our data strongly suggest a critical role of luminal VWF fibers in determining the occurrence of thrombosis and cancer metastasis. Moreover, the findings highlight LMWHs as therapeutic strategy to treat thrombotic complications while executing anti-metastatic activities.
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Affiliation(s)
- Lukas Goertz
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Desch
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Thomas Mayer
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julian Koett
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynaecology, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany
| | - Viktor Umansky
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Alexander Thomas Bauer
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Graspeuntner S, Bohlmann MK, Gillmann K, Speer R, Kuenzel S, Mark H, Hoellen F, Lettau R, Griesinger G, König IR, Baines JF, Rupp J. Microbiota-based analysis reveals specific bacterial traits and a novel strategy for the diagnosis of infectious infertility. PLoS One 2018; 13:e0191047. [PMID: 29315330 PMCID: PMC5760088 DOI: 10.1371/journal.pone.0191047] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/27/2017] [Indexed: 11/19/2022] Open
Abstract
Tubal factor infertility (TFI) accounts for more than 30% of the cases of female infertility and mostly resides from an inflammatory process triggered by an infection. Clinical appearances largely differ, and very often infections are not recognized or remain completely asymptomatic over time. Here, we characterized the microbial pattern in females diagnosed with infectious infertility (ININF) in comparison to females with non-infectious infertility (nININF), female sex workers (FSW) and healthy controls (fertile). Females diagnosed with infectious infertility differed significantly in the seroprevalence of IgG antibodies against the C. trachomatis proteins MOMP, OMP2, CPAF and HSP60 when compared to fertile females. Microbiota analysis using 16S amplicon sequencing of cervical swabs revealed significant differences between ININF and fertile controls in the relative read count of Gardnerella (10.08% vs. 5.43%). Alpha diversity varies among groups, which are characterized by community state types including Lactobacillus-dominated communities in fertile females, an increase in diversity in all the other groups and Gardnerella-dominated communities occurring more often in ININF. While all single parameters did not allow predicting infections as the cause of infertility, including C. trachomatis IgG/IgA status together with 16S rRNA gene analysis of the ten most frequent taxa a total of 93.8% of the females were correctly classified. Further studies are needed to unravel the impact of the cervical microbiota in the pathogenesis of infectious infertility and its potential for identifying females at risk earlier in life.
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Affiliation(s)
- Simon Graspeuntner
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - Michael K. Bohlmann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
- Department of Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Baden-Wuertemberg, Germany
| | - Kathrin Gillmann
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - Runa Speer
- Berlin Department of Public Health, Center for Sexual Health, Berlin, Berlin, Germany
| | - Sven Kuenzel
- Max Planck Institute for Evolutionary Biology, Ploen, Schleswig-Holstein, Germany
| | - Heike Mark
- Berlin Department of Public Health, Center for Sexual Health, Berlin, Berlin, Germany
| | - Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Reinhard Lettau
- Outpatient Medical Care for Gynecology, Luebeck, Schleswig-Holstein, Germany
| | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany
| | - Inke R. König
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Schleswig-Holstein, Germany
| | - John F. Baines
- Max Planck Institute for Evolutionary Biology, Ploen, Schleswig-Holstein, Germany
- Institute for Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Schleswig-Holstein, Germany
- * E-mail:
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Sadik CD, Pas HH, Bohlmann MK, Mousavi S, Benoit S, Sárdy M, Terra JB, Lima AL, Hammers CM, van Beek N, Bangert C, Zillikens D, Schmidt E. Value of BIOCHIP Technology in the Serological Diagnosis of Pemphigoid Gestationis. Acta Derm Venereol 2017; 97:128-130. [PMID: 27174635 DOI: 10.2340/00015555-2460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, DE-23538 Lübeck, Germany.
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Hoellen F, Rody A, Banz-Jansen C, Weichert J, Beckmann A, Bohlmann MK. Management of very early-onset fetal growth restriction: Results from 92 consecutive cases. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Große-Steffen T, Lippert C, Smakic A, Sütterlin M, Bohlmann MK. Primär ossär metastasiertes adenoid-zystisches Karzinom der Bartholin-Drüse – Ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hoellen F, Beckmann A, Banz-Jansen C, Weichert J, Rody A, Bohlmann MK. Management of Very Early-onset Fetal Growth Restriction: Results from 92 Consecutive Cases. In Vivo 2016; 30:123-131. [PMID: 26912823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To evaluate management of early-onset intrauterine growth restriction (IUGR) and to define outcome according to obstetric setting. PATIENTS AND METHODS During an 11-year period (2000-2011), data of patients presenting with IUGR and preterm delivery of less than 30 weeks of gestation at a tertiary perinatal center were retrospectively reviewed. RESULTS A total of 92 pregnancies were investigated. Delivery was indicated for fetal reasons in 38 out of 92 patients. Sixteen children of our cohort died within one year post partum, out of which eight had suffered from severe early-onset IUGR causing iatrogenic preterm delivery. Concerning the fetal outcome, gestational age at delivery and antenatal exposure to corticosteroids were found to be crucial. CONCLUSION In some cases, respiratory distress syndrome prophylaxis and a "wait and see" approach to management in favor of a prolongation of the pregnancy might be favorable. Randomized prospective trials in early-onset IUGR with threatened preterm deliveries are needed in order to define guidelines for an individually tailored management of early-onset preterm infants.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Annika Beckmann
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Constanze Banz-Jansen
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jan Weichert
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital Mannheim, Mannheim, Germany
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Toth B, Würfel W, Bohlmann MK, Gillessen-Kaesbach G, Nawroth F, Rogenhofer N, Tempfer C, Wischmann T, von Wolff M. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG (S1-Level, AWMF Registry No. 015/050, December 2013). Geburtshilfe Frauenheilkd 2015; 75:1117-1129. [PMID: 26997666 DOI: 10.1055/s-0035-1558299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Official guideline coordinated and published by the German Society of Gynecology and Obstetrics (DGGG). Aim of the guideline was to standardize the diagnosis and treatment of patients with recurrent miscarriage (RM). Recommendations were proposed, based on the current national and international literature and the experience of the involved physicians. Consistent definitions, objective assessments and standardized therapy were applied. Methods: Members of the different involved societies developed a consensus in an informal process based on the current literature. The consensus was subsequently approved by the heads of the scientific societies. Recommendations: Recommendations for the diagnosis and treatment of patients with RM were compiled which took the importance of established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders into consideration.
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Affiliation(s)
- B Toth
- Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsfrauenklinik Heidelberg, Heidelberg
| | - W Würfel
- Kinderwunsch Centrum München-Pasing, München
| | - M K Bohlmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Mannheim, Mannheim
| | | | - F Nawroth
- Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, Hamburg
| | - N Rogenhofer
- Hormon und Kinderwunschzentrum der Ludwig-Maximilians-Universität München, München
| | - C Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Herne
| | - T Wischmann
- Institut für Medizinische Psychologie im Zentrum für Psychosoziale Medizin des Universitätsklinikums Heidelberg, Heidelberg
| | - M von Wolff
- Inselspital, Universitätsfrauenklinik, Abteilung Gynäkologische Endokrinologie und Reproduktionsmedizin, Bern, Switzerland
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Bohlig M, Weichert J, Härtel C, Hoellen F, Banz-Jansen C, Bohlmann MK. Peripartale Hysterektomie – Ursachen, Geburtsverlauf, Outcome und Analyse der Fälle des Zeitraums 2000 – 2014 einer deutschen Universitätsklinik. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bohlmann MK, Hornemann A, Sänger N, Hackethal A, von Horn K, Wilkens P, Hoellen F. Medikamentöse Myomtherapie. Gynäkologische Endokrinologie 2015. [DOI: 10.1007/s10304-015-0021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schleussner E, Kamin G, Seliger G, Rogenhofer N, Ebner S, Toth B, Schenk M, Henes M, Bohlmann MK, Fischer T, Brosteanu O, Bauersachs R, Petroff D. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme. Ann Intern Med 2015; 162:601-9. [PMID: 25938990 DOI: 10.7326/m14-2062] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A daily injection of low-molecular-weight heparin (LMWH) is often prescribed to women with unexplained recurrent pregnancy loss (RPL), although evidence suggesting a benefit is questionable. OBJECTIVE To determine whether LMWH increases ongoing pregnancy and live-birth rates in women with unexplained RPL. DESIGN Controlled, multicenter trial with randomization using minimization conducted from 2006 to 2013. (ClinicalTrials.gov: NCT00400387). SETTING 14 university hospitals and perinatal care centers in Germany and Austria. PATIENTS 449 women with at least 2 consecutive early miscarriages or 1 late miscarriage were included during 5 to 8 weeks' gestation after a viable pregnancy was confirmed by ultrasonography. INTERVENTION Women in the control group received multivitamin pills, and the intervention group received vitamins and 5000 IU of dalteparin-sodium for up to 24 weeks' gestation. MEASUREMENTS Primary outcome was ongoing pregnancy at 24 weeks' gestation. Secondary outcomes included the live-birth rate and late pregnancy complications. RESULTS At 24 weeks' gestation, 191 of 220 pregnancies (86.8%) and 188 of 214 pregnancies (87.9%) were intact in the intervention and control groups, respectively (absolute difference, -1.1 percentage points [95% CI, -7.4 to 5.3 percentage points]). The live-birth rates were 86.0% (185 of 215 women) and 86.7% (183 of 211 women) in the intervention and control groups, respectively (absolute difference, -0.7 percentage point [CI, -7.3 to 5.9 percentage points]). There were 3 intrauterine fetal deaths (1 woman had used LMWH); 9 cases of preeclampsia or the hemolysis, elevated liver enzyme level, and low platelet count (HELLP) syndrome (3 women had used LMWH); and 11 cases of intrauterine growth restriction or placental insufficiency (5 women had used LMWH). LIMITATION Placebo injections were not used, and neither trial staff nor patients were blinded. CONCLUSION Daily LMWH injections do not increase ongoing pregnancy or live-birth rates in women with unexplained RPL. Given the burden of the injections, they are not recommended for preventing miscarriage. PRIMARY FUNDING SOURCE Pfizer Pharma.
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Affiliation(s)
- Ekkehard Schleussner
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Gabriele Kamin
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Gregor Seliger
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Nina Rogenhofer
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Susanne Ebner
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Bettina Toth
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Michael Schenk
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Melanie Henes
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Michael K. Bohlmann
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Fischer
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Oana Brosteanu
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - Rupert Bauersachs
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
| | - David Petroff
- From Friedrich Schiller University Hospital, Jena, Germany; University Hospital Carl Gustav Carus, Dresden, Germany; St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany; Ludwig Maximilians University, Munich, Germany; Centre for Human Genetics, Regensburg, Germany; Ruprecht-Karls University of Heidelberg, Heidelberg, Germany; University of Tübingen, Tübingen, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; Leipzig University, Leipzig, Germany
- Klinikum Darmstadt, Darmstadt, Germany; Center for Thrombosis and Hemostasis, Mainz, Germany; Das Kinderwunsch Institut, Dobl, Austria; and Paracelsus Medical University, Salzburg, Austria
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Luedders DW, Steinhoff J, Thill M, Rody A, Bohlmann MK. Lack of difference in acute nephrotoxicity of intravenous bisphosphonates zoledronic acid and ibandronate in women with breast cancer and bone metastases. Anticancer Res 2015; 35:1797-1802. [PMID: 25750345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND More than 50% of patients with advanced breast cancer develop bone metastases that may lead to multiple complications such as pathological fractures, bone pain or hypercalcaemia. The standard treatment, besides endocrine, targeted-therapy or chemotherapy, is the use of bisphosphonates. However, one of their main adverse side-effects is bisphosphonate-induced nephrotoxicity. The mechanism by which the latter occurs is not well-understood, although emerging evidence suggests that the effect of bisphosphonates on the kidney may differ between agents. PATIENTS AND METHODS The aim of this evaluation was to compare the renal toxicity of 6 mg ibandronate i.v. versus 4 mg zoledronic acid i.v. over a period of six months in women with breast cancer and bone metastases. A prospective randomized trial was carried out to examine specific kidney and other parameters (α1- and β2-microglobulin, albumin, α2-macroglobulin, IgG and C-reactive protein (CRP) generated from spontaneous urine samples from 17 patients of each group. RESULTS We were unable to find any significant difference between the two treatment groups with regard to renal toxicity. All patients, independently of the applied bisphosphonate, experienced only temporary renal dysfunction without any evidence of irreversible damage in terms of acute nephrotoxicity during the study period. α1-Microglobulin, a marker for proximal tubular damage, in particular, was not differently elevated in either group. CONCLUSION Both applied bisphosphonates were found to be well-tolerated and safe with regard to renal toxicity during a six-month treatment period in patients with otherwise healthy kidneys having advanced breast cancer and bone metastases.
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Affiliation(s)
- Dörte W Luedders
- Department of Obstetrics and Gynaecology, University Hospital Oldenburg, Oldenburg, Germany Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Jürgen Steinhoff
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Marc Thill
- Department of Gynaecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt (Main), Germany
| | - Achim Rody
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
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Bohlmann MK, Hoerster JC, Bundschuh D, Boemicke P, Luedders DW, Köster F. Growth-modulatory effects of heparin and VEGF165 on the choriocarcinoma cell-line JEG-3 and its expression of heparanase. Anticancer Res 2014; 34:7071-7076. [PMID: 25503134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Expression of heparanase (HPSE) in tumor cells is strongly associated with invasion, metastasis and angiogenesis. It also plays a key role during pregnancy, in processes of implantation as well as placentation. Vascular endothelial growth factor (VEGF) and heparin are known to alter HPSE expression, with heparin given prophylactically to women with a history of placenta-mediated complications in subsequent pregnancies. MATERIALS AND METHODS We examined the growth-modulatory effects of different concentrations of heparin and VEGF on the choriocarcinoma cell-line JEG-3 and the expression of heparanase under VEGF and heparin by proliferation assays, PCR, and western blot. RESULTS Proliferation of JEG-3 cells was induced by heparin in a dose-dependent manner, whereas highly concentrated VEGF led to a decreased cell proliferation. Both agents did not influence the HPSE-expression. CONCLUSION The presumed pregnancy-protecting effects of heparin may partially be due to an increase of trophoblast proliferation and not via regulation of HPSE expression.
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Affiliation(s)
- Michael K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jana-Christin Hoerster
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Diana Bundschuh
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philipp Boemicke
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Doerte W Luedders
- Department of Obstetrics and Gynaecology, University Hospital Oldenburg, Oldenburg, Germany
| | - Frank Köster
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Hoellen F, Hornemann A, Haertel C, Reh A, Rody A, Schneider S, Tuschy B, Bohlmann MK. Does maternal underweight prior to conception influence pregnancy risks and outcome? In Vivo 2014; 28:1165-1170. [PMID: 25398817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Data analyzing risks during pregnancy and neonatal outcome in Caucasian women with pre-conceptional underweight are scarce. PATIENTS AND METHODS We conducted a retrospective cohort study in Northern Germany comparing pregnancy risks and neonatal outcomes in nulliparous women with either pre-conceptional underweight or normal weight. RESULTS The data of 3,854 nulliparous women with either underweight (n = 243; BMI ≤ 18.5 kg/m(2)) or normal weight (n = 3611; BMI 18.5-24.9 kg/m(2)) were screened. The risks for preterm birth (23.3 vs. 18.6%; p = 0.004) and neonatal underweight were significantly higher in women with underweight prior to conception (p < 0.0001). The risk for secondary caesarean sections was significantly lower in underweight patients. CONCLUSION To our knowledge, the present retrospective cohort study constitutes the largest sub-group analysis on delivery and maternal and neonatal outcome in pre-conceptionally underweight mothers. There are significantly more preterm deliveries in underweight mothers, while maternal outcome and birth-associated trauma (lacerations, caesarean section) is not disadvantageously influenced by maternal underweight. Further investigations are required in order to specify nutritional deficits in underweight pregnant women and to optimize medication in cases where nutritional balance cannot be achieved in order to improve the neonatal status at birth.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Haertel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Annette Reh
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Schneider
- Institute of Public Health, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Reh-Buresch A, Hornemann A, Tröger B, Tuschy B, Bohlmann MK. Geburtsverlauf und kindliches Outcome bei prägravide untergewichtigen Frauen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bohlmann MK, Hoellen F, Hunold P, David M. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome. Geburtshilfe Frauenheilkd 2014; 74:139-145. [PMID: 24741124 DOI: 10.1055/s-0033-1360311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/11/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022] Open
Abstract
Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.
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Affiliation(s)
- M K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - F Hoellen
- Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - P Hunold
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck
| | - M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin
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Hoellen F, Rody A, Ros A, Bruns A, Cirkel C, Bohlmann MK. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature. MINIM INVASIV THER 2013; 23:184-7. [PMID: 24329014 DOI: 10.3109/13645706.2013.870577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.
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Affiliation(s)
- Friederike Hoellen
- Department of Gynecology and Ostetrics, University Hospital Schleswig Holstein , Campus Luebeck, Luebeck , Germany
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Ruhnke H, Eckey T, Bohlmann MK, Beldoch MP, Neumann A, Agic A, Hägele J, Diedrich K, Barkhausen J, Hunold P. MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice. ROFO-FORTSCHR RONTG 2013; 185:983-991. [PMID: 24490234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate a novel feedback-regulated volumetric sonication method in MRguided HIFU treatment of symptomatic uterine fibroids. MATERIALS AND METHODS 27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 TMR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). RESULTS In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 – 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 – 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 – 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded. CONCLUSION Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter
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Ruhnke H, Eckey T, Bohlmann MK, Beldoch MP, Neumann A, Agic A, Hägele J, Diedrich K, Barkhausen J, Hunold P. MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice. ROFO-FORTSCHR RONTG 2013; 184:983-91. [PMID: 23884908 DOI: 10.1055/s-0033-1335289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate a novel feedback-regulated volumetric sonication method in MR-guided HIFU treatment of symptomatic uterine fibroids. MATERIALS AND METHODS 27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 T MR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). RESULTS In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 - 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 - 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 - 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded. CONCLUSION Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter and a less diversifying temperature. KEY POINTS ▶ MR-guided HIFU ablation of symptomatic uterine fibroids is a valuable treatment option. ▶ By non-invasive HIFU fibroid volumes can be reduced and symptoms improved. ▶ The novel feedback-regulated treatment cells offer advantages over standard treatment cells.
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Affiliation(s)
- H Ruhnke
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck/Germany
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Baumann K, Beuter-Winkler P, Hackethal A, Strowitzki T, Toth B, Bohlmann MK. Maternal Factor V Leiden and Prothrombin Mutations Do Not Seem to Contribute to the Occurrence of Two or More Than Two Consecutive Miscarriages in Caucasian patients. Am J Reprod Immunol 2013; 70:518-21. [DOI: 10.1111/aji.12144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/03/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kristin Baumann
- Department of Obstetrics and Gynaecology; University Hospital of Schleswig-Holstein; Campus Luebeck; Luebeck Germany
| | - Petra Beuter-Winkler
- Department of Gynaecological Endocrinology and Fertility Disorders; Ruprecht-Karls-University Heidelberg; Heidelberg Germany
| | - Andreas Hackethal
- Department of Obstetrics and Gynecology; Justus-Liebig-University Giessen; Giessen Germany
| | - Thomas Strowitzki
- Department of Gynaecological Endocrinology and Fertility Disorders; Ruprecht-Karls-University Heidelberg; Heidelberg Germany
| | - Bettina Toth
- Department of Gynaecological Endocrinology and Fertility Disorders; Ruprecht-Karls-University Heidelberg; Heidelberg Germany
| | - Michael K. Bohlmann
- Department of Obstetrics and Gynaecology; University Hospital of Schleswig-Holstein; Campus Luebeck; Luebeck Germany
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Hoellen F, Bohlmann MK, Brade J, Rody A, Diedrich K, Husstedt WD, Hornemann A. Influence of acetic acid on a pap smear of dysplastic lesion. Anticancer Res 2013; 33:1125-1130. [PMID: 23482790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Cervical cancer prevention is performed by taking Pap smears. The correct execution of the smear is crucial as an inadequate smear might result in underdiagnosis. The second means of cervical cancer prevention is visual inspection of the cervix uteri with acetic acid, while often both methods are combined. We investigated whether the application of acetic acid compromises the Pap smear. PATIENTS AND METHODS A total of 100 patients with dysplasia were prospectively included; Pap smears were obtained before and after the application of acetic acid. RESULTS We observed an alteration of the result of the Pap smear after acetic acid application in 41%. However, these alterations did not result in a dysplastic case being classed as a normal smear or vice versa. CONCLUSION The application of acetic acid to the transformation zone of the cervix uteri may enhance changes of the Pap smear in dysplasia, however, the changes affect subgroups of dysplasia and thus do not change therapeutic management.
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Affiliation(s)
- Friederike Hoellen
- Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany.
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Tröger B, Müller T, Faust K, Bendiks M, Bohlmann MK, Thonnissen S, Herting E, Göpel W, Härtel C. Intrauterine growth restriction and the innate immune system in preterm infants of ≤32 weeks gestation. Neonatology 2013; 103:199-204. [PMID: 23295537 DOI: 10.1159/000343260] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intrauterine growth restriction (IUGR) is a well-known cause of adverse neonatal outcomes. As it may have an impact on innate immune responses, we aimed to investigate several parameters of the innate immune response in preterm infants of ≤32 weeks gestation who were small for gestational age (SGA). METHODS We compared clinical data of SGA (n = 20) and appropriate for gestational age (AGA; n = 124) newborns with a gestational age of ≤32 weeks. We investigated full blood counts at birth and on days 3 and 7 of life and cytokine immune responses in a human whole cord blood assay. RESULTS SGA preterm infants had a higher risk of the combined outcome mortality or bronchopulmonary dysplasia. Numbers of white blood cells and neutrophils were diminished in SGA infants at birth and on day 3. At birth, platelet counts were also diminished while the number of nucleated red blood cells tended to be elevated in SGA infants. After stimulation of whole blood cell cultures with lipopolysaccharides, the concentrations of interleukin-6 and interleukin-10 were significantly lower in SGA preterm infants compared to AGA infants. CONCLUSIONS SGA infants differ remarkably from AGA infants in full blood counts and in their ability to mount an immune response. Whether the quantitative deficiency in innate immunity plays a role for adverse outcomes needs to be investigated in larger future trials.
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Affiliation(s)
- Birte Tröger
- Department of Paediatrics, University of Lübeck, Lübeck, Germany
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Karsten J, Bohlmann MK, Sedemund-Adib B, Wnent J, Paarmann H, Iblher P, Meier T, Heinze H. Electrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure. Int J Obstet Anesth 2012; 22:67-71. [PMID: 23122281 DOI: 10.1016/j.ijoa.2012.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 08/16/2012] [Accepted: 09/01/2012] [Indexed: 11/27/2022]
Abstract
Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.
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Affiliation(s)
- J Karsten
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
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Abstract
Genital tract infections with Chlamydia trachomatis (C. trachomatis) are the most frequent transmitted sexually disease in women worldwide. Inefficient clearance or persistence of the pathogens may lead to ascending infections of the upper genital tract and are supposed to cause chronic inflammatory damage to infected tissues 1,2. As a consequence, severe clinical sequelae like pelvic inflammatory disease (PID), tubal occlusion and infertility may occur 3,4. Most of the research with C. trachomatis has been conducted in epithelial cell lines (e.g. HEp-2 cells and HeLa-229) or in mice. However, as with cell- culture based models, they do neither reflect the physiology of native tissue nor the pathophysiology of C. trachomatis genital tract infections in vivo5. Further limitations are given by the fact that central signaling cascades (e.g. IFN-γ mediated JAK/STAT signaling pathway) that control intracellular chlamydial growth fundamentally differ between mice and humans 6,7. We and others therefore established a whole organ fallopian tube model to investigate direct interactions between C. trachomatis and human fallopian tube cells ex vivo8,9. For this purpose, human fallopian tubes from women undergoing hysterectomy were collected and infected with C. trachomatis serovar D. Within 24 h post infection, specimen where analyzed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to detect Chlamydia trachomatis mediated epithelial damage as well as C. trachomatis inclusion formation in the fallopian tissue.
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Affiliation(s)
- Stefan Jerchel
- Institute of Medical Microbiology and Hygiene, University of Lübeck
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Kamin G, Bohlmann MK, Seeger S, Rogenhofer N, Toth B, Schleußner E. Niedermolekulares Heparin zur Prävention habitueller Aborte - Vorstellung der multizentrischen EThIG2-Studie und Diskussion der aktuellen Datenlage. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
In recent years galectin-3 has gained attention as a signalling molecule, mainly in inflammatory diseases. Data on galectin-3 expression in neonates, however, are limited, and expression of this lectin in cord blood has not yet been reported. The aim of this study was to determine galectin-3 levels in cord blood of term and preterm neonates as well as galectin-3 levels in cord blood of term neonates after stimulation with the prevalent pathogen Streptococcus agalactiae. Cord blood samples were incubated for 24 h and galectin-3 levels were assessed by enzyme-linked immunosorbent assay. There is a positive correlation between gestational age and galectin-3 levels in cord blood. Expression of galectin-3 is significantly higher in cord blood of small-for-gestational-age infants compared to appropriate-for-gestational-age infants. Stimulation with an invasive but not with a colonizing strain of S. agalactiae induced expression of galectin-3. Galectin-3 is expressed constitutively in cord blood of neonates and seems to play a role in the innate immunity of this population.
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Affiliation(s)
- M Demmert
- Department of Paediatrics, University of Lübeck, Lübeck, Germany
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Bohlmann MK, Goettsching H, Jatzko B, Härtel C, Diedrich K, Husslein P. Schwangerschaftsoutcome nach einer länger als 48h durchgeführten Tokolyse–ein retrospektiver Vergleich zwischen Fenoterol und Atosiban. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Hoerster JC, Koester F, Luedders DW, Boemicke P, Bundschuh D, Bohlmann MK. Einfluss von Heparin auf die Proliferation humaner Chorioncarcinom-Zellen sowie deren Expression der Endoglykosidase Heparanase. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Hoellen F, Reibke R, Hornemann K, Thill M, Luedders DW, Kelling K, Hornemann A, Bohlmann MK. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet 2011; 285:195-205. [PMID: 21858441 DOI: 10.1007/s00404-011-2058-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE 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. METHODS This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy. RESULTS In part I, we report on diagnosis and therapy of gynecological tumors. CONCLUSION 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.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Luedders DW, Bundschuh D, Hornemann A, Hoerster JC, Boemicke P, Köster F, Bohlmann MK. Erratum to: Heparanase expression in term placentas of diabetic patients and healthy controls. Arch Gynecol Obstet 2011. [DOI: 10.1007/s00404-010-1729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bohlmann MK. Regulation der Expression des Enzyms ‘Heparanase’ in Placenta und gynäkologischen Tumorzellen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Luedders DW, Bohlmann MK, Germer U, Axt-Fliedner R, Gembruch U, Weichert J. Fetal micrognathia: objective assessment and associated anomalies on prenatal sonogram. Prenat Diagn 2011; 31:146-51. [PMID: 21268032 DOI: 10.1002/pd.2661] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 09/30/2010] [Accepted: 10/03/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the accuracy and characteristics of prenatally detected fetal micrognathia. METHODS A retrospective analysis of all pregnancies with the suspicion of fetal micrognathia was performed. The affected fetuses were reassessed by estimation of the inferior facial angle (IFA) and the frontal nasomental angle on stored gray scale images to objectively establish the diagnosis. RESULTS Of the 28.935 ultrasounds (USs) reviewed, 58 cases were eligible and 4 were excluded because of inconclusive data. The mean values for IFA and frontal nasomental angle were 44.8° and 123.3°, respectively. In 33 cases, the pregnancy was terminated. Four fetuses died sub partu or immediately after birth, five were stillborn. Invasive testing in 40/54 cases revealed aneuploidies in 35%. Associated anomalies comprised musculoskeletal disorders (43%) and non-skeletal anomalies (15%). Less than one fifth (9/54) were alive beyond postnatal period. Four fetuses had an isolated micrognathia, one of which was found to have a cleft palate postnatally. CONCLUSION The diagnosis of micrognathia has a crucial impact on both prenatal and postnatal outcomes of affected individuals due to its association with additional abnormalities. A detailed sonographic survey using objective criteria for defining micrognathia is mandatory. Once the diagnosis is confirmed, an intensive interdisciplinary counseling of the parents is needed.
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Affiliation(s)
- Doerte W Luedders
- Department of Gynecology and Obstetrics, Division of Prenatal Medicine, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Baumann K, Beuter-Winkler P, Hackethal A, Strowitzki T, Bohlmann MK. Prevalence of hereditary thrombophilic disorders in Caucasian women with two and with more first trimester miscarriages. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weichert J, Kahl FO, Schröer A, Bohlmann MK, Diedrich K, Hartge DR. [Congenital gastroschisis--prenatal diagnosis and perinatal management]. Z Geburtshilfe Neonatol 2010; 214:135-44. [PMID: 20806148 DOI: 10.1055/s-0030-1255101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The birth prevalence of gastroschisis is increasing world-wide. This situation applies particularly to young, slim women who smoke. At a first glance this is a paradox in light of the ever-increasing age of pregnant women among whom there are fewer and fewer smokers. In numerous studies it has been clearly demonstrated that not only (nutritional) teratogenic substances and environmental factors but also epidemiological causes can be held responsible for this phenomenon. Nowadays gastroschisis is detected prenatally in up to 90% of all foetuses. Advantages of a prenatal diagnosis include the identification of associated disorders and the determination of a high-risk constellation (IUGR, intraabdominal bowel dilatation or vanishing gut). This is essential for an adequate interdisciplinary counseling for the afflicted parents together with obstetricians, paediatric surgeons and neonatalogists. The efficacy of serial amnioexchanges with regard to a better neonatal outcome has as yet not been unambiguously clarified. The possibilities for surgical procedures on the foetus are limited and can at present only be considered as experimental attempts in animal models. From an obstetrical perspective the in utero transport and elective Caesarean section before completion of the 36 (th) week of gestation in a tertiary centre with appropriate facilities (paediatric surgery, neonatalogy) seem to be the course recommended by most authors in spite of inconclusive data. The survival rates for babies with gastroschisis after operative treatment (primary defect closure, silotechnique) are considerably high (>90%).
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Affiliation(s)
- J Weichert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
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Luedders DW, Bundschuh D, Hornemann A, Hoerster JC, Boemicke P, Köster F, Bohlmann MK. Heparanase expression in term placentas of diabetic patients and healthy controls. Arch Gynecol Obstet 2010; 284:287-92. [DOI: 10.1007/s00404-010-1636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 08/02/2010] [Indexed: 12/16/2022]
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Bohlmann MK, von Wolff M, Luedders DW, Beuter-Winkler P, Diedrich K, Hornemann A, Strowitzki T. Hysteroscopic findings in women with two and with more than two first-trimester miscarriages are not significantly different. Reprod Biomed Online 2010; 21:230-6. [DOI: 10.1016/j.rbmo.2010.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 02/01/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
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Luedders DW, Bohlmann MK, Hornemann A, Dittmer C, Diedrich K, Thill M. Successful application of vacuum-assisted closure therapy for treatment of mastitis-associated chronic breast wounds. Arch Gynecol Obstet 2010; 283:1357-62. [DOI: 10.1007/s00404-010-1594-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
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Kavallaris A, Kalogiannidis I, Chalvatzas N, Hornemann A, Bohlmann MK, Diedrich K. Standardized technique of laparoscopic pelvic and para-aortic lymphadenectomy in gynecologic cancer optimizes the perioperative outcomes. Arch Gynecol Obstet 2010; 283:1373-80. [PMID: 20607263 DOI: 10.1007/s00404-010-1580-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 06/21/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The main objective of this study is to illustrate the effectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy. MATERIALS AND METHODS A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique. RESULTS The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time ± standard deviation for pelvic LNE for each side was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary. DISCUSSION Laparoscopic lymphadenectomy performed by a learning team with standardized technique is effective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
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Affiliation(s)
- Andreas Kavallaris
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Kavallaris A, Mytas S, Chalvatzas N, Nikolettos N, Diedrich K, Bohlmann MK, Hornemann A. Seven years' experience in laparoscopic dissection of intact ovarian dermoid cysts. Acta Obstet Gynecol Scand 2010; 89:390-2. [DOI: 10.3109/00016340903322768] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bohlmann MK, Diedrich K. [Risk prevention and therapeutic aspects of multiple pregnancies]. Z Geburtshilfe Neonatol 2010; 213:220. [PMID: 20099208 DOI: 10.1055/s-0029-1242800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luedders DW, Hornemann A, Fritzsching B, Thill M, Beyer DA, Diedrich K, Bohlmann MK. [Prevention of complications in twin gestations and pregnancies after assisted reproduction]. Z Geburtshilfe Neonatol 2010; 213:228-33. [PMID: 20099210 DOI: 10.1055/s-0029-1241846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Twin pregnancies and gestations after assisted reproductive therapy (ART) are of special obstetric significance with regard to their associated risks. However, little is known about preventive approaches specifically evaluated for these constellations. METHODS A selective literature search was conducted to examine possible preventive approaches for complications such as hypertensive disorders, anaemia, gestational diabetes, prematurity, and others, seen significantly more often in twin gestations and pregnancies after ART. RESULTS For both constellations, preventive approaches are not specifically evaluated for the majority of complications. For some preventive methods a possible detrimental effect cannot even be ruled out. CONCLUSIONS The knowledge about specific preventive approaches against complications in twin pregnancies and gestations after ART is scarce. More prospective trials are urgently needed to assess the risks and benefits of prophylactic approaches for these risk constellations.
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Affiliation(s)
- D W Luedders
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany.
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Nitzschke M, Raddatz J, Bohlmann MK, Stute P, Strowitzki T, von Wolff M. GnRH analogs do not protect ovaries from chemotherapy-induced ultrastructural injury in Hodgkin’s lymphoma patients. Arch Gynecol Obstet 2009; 282:83-8. [DOI: 10.1007/s00404-009-1308-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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