1
|
Hager M, Simek IM, Promberger R, Ott J. The Role of Diagnostic Hysteroscopy in the Evaluation of Fallopian Tube Patency: a Short Review. Geburtshilfe Frauenheilkd 2019; 79:483-486. [PMID: 31148848 PMCID: PMC6529226 DOI: 10.1055/a-0826-1326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/31/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
The relevance of diagnostic hysteroscopy, especially when performed in an outpatient “office” setting, in the evaluation process of infertility has increased within the last few years. Notably, several articles on a possible role for diagnostic hysteroscopy in the assessment of Fallopian tube patency have been published recently. Three relevant articles were identified. Visualizing a “flow effect” or air bubbles dispersing through the ostia, sonographically assessed shifts in cul de sac volume, and selective Fallopian tubal cannulation are reportedly promising hysteroscopic techniques. In this review, an overview of hysteroscopy, details about diagnostic reliability, and considerations with regard to ease of use and difficulties are summarized. Based on these articles, hysteroscopic evaluation of tubal patency seems to be a promising, clinically relevant field for future clinical research.
Collapse
Affiliation(s)
- Marlene Hager
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Inga Malin Simek
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.,Department of Gynecology, Hanusch Krankenhaus, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
2
|
Pils S, Stepien N, Kurz C, Nouri K, Springer S, Hager M, Promberger R, Ott J. Does anti-Mullerian hormone predict the outcome of further pregnancies in idiopathic recurrent miscarriage? A retrospective cohort study. Arch Gynecol Obstet 2018; 299:259-265. [PMID: 30357497 PMCID: PMC6328709 DOI: 10.1007/s00404-018-4946-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/25/2018] [Accepted: 10/16/2018] [Indexed: 11/05/2022]
Abstract
Purpose To evaluate whether anti-Mullerian hormone, basal follicle-stimulating hormone, luteinizing hormone, estradiol, and female age would predict future outcomes in women with idiopathic recurrent miscarriage. Methods One hundred and sixteen women with idiopathic recurrent miscarriage were retrospectively included. Luteal support with or without a combined treatment regimen for idiopathic recurrent miscarriage was applied in a tertiary-care center in Vienna. Occurrence and outcome of further pregnancies were analyzed. Results Within a median follow-up duration of 42.3 months, 94 women (81.0%) achieved one or more pregnancies. Further miscarriages occurred in 47 patients in whom only a higher number of previous miscarriages was predictive (OR 3.568, 95% CI 1.457–8.738; p = 0.005). Fifty-seven women had a live birth > 23 + 0 gestational weeks. In a multivariate analysis, age (OR 0.920, 95% CI 0.859–0.986; p = 0.019) and the number of previous miscarriages (OR 0.403, 95% CI 0.193–0.841; p = 0.016), but not AMH (OR 1.191, 95% CI 0.972–1.461; p = 0.091) were significantly predictive. Conclusion AMH seems of either no or only minor relevance for the prediction of further miscarriages and live birth in women with idiopathic recurrent miscarriage.
Collapse
Affiliation(s)
- Sophie Pils
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Natalia Stepien
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Kurz
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kazem Nouri
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephanie Springer
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Hager
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Burgenland, Austria
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
3
|
Promberger R, Simek IM, Nouri K, Obermaier K, Kurz C, Ott J. Accuracy of Tubal Patency Assessment in Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study. J Minim Invasive Gynecol 2017; 25:794-799. [PMID: 29221993 DOI: 10.1016/j.jmig.2017.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 11/02/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopic routine evaluation is predictive of tube patency. DESIGN A retrospective cohort study (Canadian Task Force Classification II-2). SETTING Data from all patients who underwent surgery because of infertility at the study center between 2008 and 2016 were analyzed retrospectively. The main outcome parameter was fallopian tube patency as assessed by laparoscopic chromopertubation. The predictive parameters tested were the presence of hysteroscopic tube "flow," general patient characteristics, and intraoperative findings. PATIENTS Five hundred eleven infertile women who underwent combined hysteroscopy and laparoscopy were included. INTERVENTIONS All women underwent combined hysteroscopy and laparoscopy. Some had other interventions when necessary, but no additional interventions were taken because of this study. RESULTS In an analysis of 998 fallopian tubes, the hysteroscopic assessment of fallopian tube "flow" was highly accurate in predicting fallopian tube patency (p < .001), with a sensitivity of 86.4% (95% confidence interval [CI], 83.7-88.8) and a specificity of 77.6% (95% CI, 72.1-82.5). Risk factors for a false-negative hysteroscopy result were the presence of uterine myomas (odds ratio [OR] = 2.11; 95% CI, 1.10-4.05; p = .025), the presence of a hydrosalpinx on the analyzed side (OR = 2.50, 95% CI, 1.17-5.34; p = .019), and the presence of peritubal adhesions surrounding the analyzed tube (OR = 2.87; 95% CI, 1.21-6.76; p = .016). CONCLUSION A visualizable tube "flow" in hysteroscopy was accurate in the prediction of tubal patency, with a positive predictive value of about 91%. Knowledge about hysteroscopic fallopian tube "flow" can help to plan the future approach in an individual patient.
Collapse
Affiliation(s)
- Regina Promberger
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Burgenland, Austria
| | - Inga-Malin Simek
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Kazem Nouri
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Karin Obermaier
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Neurology, Krankenhaus Mistelbach, Lower Austria, Austria
| | - Christine Kurz
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
4
|
Ott J, Pecnik P, Promberger R, Pils S, Binder J, Chalubinski KM. Intra- versus retroplacental hematomas: a retrospective case-control study on pregnancy outcomes. BMC Pregnancy Childbirth 2017; 17:366. [PMID: 29073889 PMCID: PMC5658933 DOI: 10.1186/s12884-017-1539-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/18/2016] [Accepted: 10/06/2017] [Indexed: 09/03/2023] Open
Abstract
Background Intrauterine hematomas are a common pregnancy complication. The literature lacks studies about outcomes based on hematoma localization. Thus, we aimed to compare pregnancies complicated by an intraplacental hematoma to cases with a retroplacental hematoma and to a control group. Methods In a retrospective case-control study, 32 women with an intraplacental hematoma, 199 women with a retroplacental hematoma, and a control group consisting of 113 age-matched women with no signs of placental abnormalities were included. Main outcome measures were pregnancy complications. Results Second-trimester miscarriage was most common in the intraplacental hematoma group (9.4%), followed by women with a retroplacental hematoma (4.2%), and controls (0%; p = 0.007). The intraplacental hematoma group revealed the highest rates for placental insufficiency, intrauterine growth retardation, premature preterm rupture of membranes, preterm labor, preterm delivery <37 weeks, and early preterm delivery <34 weeks (p < 0.05), followed by the retroplacental hematoma group. When tested in multivariate models, intraplacental hematomas were independent predictors for placental insufficiency (ß = 4.19, p < 0.001) and intrauterine growth restriction (ß = 1.44, p = 0.035). Intrauterine fetal deaths occurred only in women with a retroplacental hematoma (p = 0.042). Conclusions Intra- and retroplacental hematomas have different risk profiles for the affected pregnancy and act as independent risk factors.
Collapse
Affiliation(s)
- Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria
| | - Philipp Pecnik
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria.,Second Department of Internal Medicine, Klinikum Wels-Grieskirchen, Wagnleithnerstraße 27, 4710, Grieskirchen, Upper Austria, Austria
| | - Regina Promberger
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria. .,Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Johannes-von-Gott Platz 1, 7000, Eisenstadt, Burgenland, Austria.
| | - Sophie Pils
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria
| | - Julia Binder
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria
| | - Kinga M Chalubinski
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria
| |
Collapse
|
5
|
Pils S, Stepien N, Kurz C, Nouri K, Promberger R, Ott J. Anti-Mullerian hormone is linked to the type of early pregnancy loss in idiopathic recurrent miscarriage: a retrospective cohort study. Reprod Biol Endocrinol 2017; 15:60. [PMID: 28768516 PMCID: PMC5541661 DOI: 10.1186/s12958-017-0278-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
We correlated Anti-Mullerian hormone (AMH) levels and other parameters for ovarian reserve to the gestational age at the time of pregnancy loss in women with idiopathic recurrent miscarriage. In a retrospective study, 79 patients had suffered a total of 266 miscarriages. When comparing women with an "unembryonic" to those with an "embryonic" most recent miscarriage, there was no difference in median age (36.3 years, IQR 31.6-40.1 versus 34.2 years, IQR 29.9-38.0; p = 0.303) but in median AMH levels (0.7, IQR 0.2-18, versus median 1.8, IQR 1.3-3.3, respectively, p = 0.044) and in the rate of patients with an AMH ≤ 1 ng/mL (23/37, 62.2%, versus 8/42, 19%; p < 0.001). Thus, AMH might add to the diagnostic process in recurrent miscarriage in the future.
Collapse
Affiliation(s)
- Sophie Pils
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Natalia Stepien
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christine Kurz
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kazem Nouri
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Regina Promberger
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Johannes von Gott-Platz 1, 7000 Eisenstadt, Austria
| | - Johannes Ott
- 0000 0000 9259 8492grid.22937.3dDepartment of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- 0000 0000 9259 8492grid.22937.3dClinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| |
Collapse
|
6
|
Promberger R, Walch K, Seemann R, Pils S, Ott J. A Retrospective Study on the Association between Thyroid Autoantibodies with β2-glycoprotein and Cardiolipin Antibodies in Recurrent Miscarriage. Iran J Allergy Asthma Immunol 2017; 16:72-76. [PMID: 28417627] [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] [Subscribe] [Scholar Register] [Accepted: 02/25/2017] [Indexed: 06/07/2023]
Abstract
Etiologic factors for recurrent miscarriage (RM) include autoimmune diseases, the most frequently antiphospholipid syndrome and thyroiditis. Some women who suffer from RM might also have an altered immune system. We aimed to evaluate possible associations between anti-thyroid and anti-phospholipid antibodies in women with RM. In a retrospective case series 1 on 156 women with RM, major outcome parameters were antibodies against cardiolipin, β2-glycoprotein I, thyreoperoxidase (TPO-Ab), and thyroglobulin (TG-Ab). Significant (p<0.05) positive correlations were found between TPO-Ab and TG-Ab (r=0.577), TPO-Ab and IgG anti-cardiolipin antibodies (r=0.284), TPO-Ab and IgG anti- β2-glycoprotein I antibodies (r=0.196), and TG-Ab and IgG anti-cardiolipin antibodies (r=0.193), as well as between all types of anti-phospholipid antibodies. Women with both increased TPO-Ab and TG-Ab levels revealed higher (p<0.001) IgG anti-cardiolipin and IgG anti-β2-glycoprotein I antibodies. Anti-thyroid antibodies were linked to anti-phospholipid antibodies and should be in the focus of future research on RM.
Collapse
Affiliation(s)
- Regina Promberger
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria
| | - Katharina Walch
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria
| | - Rudolf Seemann
- Deparetment of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Sophie Pils
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria
| |
Collapse
|
7
|
Pils S, Promberger R, Springer S, Joura E, Ott J. Decreased Ovarian Reserve Predicts Inexplicability of Recurrent Miscarriage? A Retrospective Analysis. PLoS One 2016; 11:e0161606. [PMID: 27627119 PMCID: PMC5023100 DOI: 10.1371/journal.pone.0161606] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 05/21/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate anti-Mullerian hormone, basal follicle stimulating hormone, luteinizing hormone, estradiol, and female age in women with recurrent miscarriage and to compare women with explained and idiopathic recurrent miscarriage. Design Retrospective cohort study. Setting University hospital, tertiary care center. Patients Women with recurrent miscarriage (78 explained, 66 idiopathic). Intervention(s) None. Main Outcome Measures(s) Anti-Mullerian hormone, basal follicle stimulating hormone, luteinizing hormone, estradiol, and age. Results Anti-Mullerian hormone and estradiol were significantly lower in women with idiopathic recurrent miscarriage (median 1.2 ng/ml, IQR 0.6–2.1, and median 36.5 pg/ml, IQR 25.8–47.3, respectively) than in women with explained recurrent miscarriage (median 2.0 ng/ml, IQR 1.1–2.7, and median 42.5 pg/ml, IQR 32.8–59.8, respectively; p<0.05). Optimized cut-off values for the prediction of idiopathic recurrent miscarriage were <39.5 pg/ml for estradiol (sensitivity: 63.3%, 95% CI: 50.9–75.1; specificity: 56.4%, 95% CI: 44.7–67.6) and <1.90 ng/ml for anti-Mullerian hormone (sensitivity: 72.7%, 95% CI: 60.4–83.0; specificity: 52.6%, 95% CI: 40.9–64.0). Conclusion Idiopathic recurrent miscarriage was associated with lower basal estradiol and anti-Mullerian hormone levels compared to explained recurrent miscarriage.
Collapse
Affiliation(s)
- Sophie Pils
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Burgenland, Austria
| | - Stephanie Springer
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Elmar Joura
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
8
|
Nouri K, Ott J, Lenart C, Walch K, Promberger R, Tempfer CB. Predictors of Paracentesis in Women with Severe Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study. Gynecol Obstet Invest 2016; 81:504-511. [PMID: 27399220 DOI: 10.1159/000443829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/08/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND To identify predictors of paracentesis in women with severe ovarian hyperstimulation syndrome (OHSS). METHODS In a retrospective cohort study, we assessed patient characteristics and outcome measures of women with severe OHSS Golan grade II/III from 1996 to 2010 using univariate and multivariate analyses with the number of paracenteses as the main outcome. RESULTS Three hundred ninety four women with OHSS Golan grade II (n = 40) and grade III (n = 354) were included in the study. Paracentesis was performed in 108/394 (27%) of these women. One paracentesis was performed in 63 (16%), 2 paracenteses in 26 (6%), and ≥3 paracenteses 19 (5%) women, respectively. No thrombotic or cerebrovascular morbidity occurred. The mortality of the cohort was 0/394 (0%). In a univariate analysis, late onset OHSS (p = 0.02), pregnancy (p < 0.001), human chorionic gonadotropin use (p = 0.02), ovarian diameter (p = 0.006), and elevated serum levels of alanine aminotransferase (p < 0.001), hematocrit (p < 0.001), leucocytes (p < 0.001), thrombocytes (p < 0.001), and uric acid (p < 0.001) were associated with paracentesis. In a multivariate logistic regression analysis, only alanine aminotransferase (OR 1.006; 95% CI 1.001-1.01) and hematocrit (OR 1.16; 95% CI 1.05-1.27) were independently associated with paracentesis. CONCLUSION Alanine aminotransferase and hematocrit at initial presentation are independent predictors of paracentesis.
Collapse
Affiliation(s)
- Kazem Nouri
- Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
9
|
Pils S, Eppel W, Promberger R, Winter MP, Seemann R, Ott J. The predictive value of sequential cervical length screening in singleton pregnancies after cerclage: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16:79. [PMID: 27085320 PMCID: PMC4833952 DOI: 10.1186/s12884-016-0866-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 05/08/2015] [Accepted: 04/07/2016] [Indexed: 11/11/2022] Open
Abstract
Background There are few valid predictors for preterm delivery after cerclage. Experience with a screening program that included four sequential cervical length measurements in singleton pregnancies after cerclage is reviewed. Methods In this retrospective cohort study, 88 singleton pregnancies after cerclage were included. Cervical length (CL) measurements were performed perioperatively and at weeks 16 + 0, 18 + 0, 20 + 0, and 22 + 0 by transvaginal ultrasound. Predictive factors for early preterm delivery included patient characteristics, obstetric history and CL measurements and were analyzed separately for women with ultrasound-indicated cerclage and those with history-indicated cerclage. Women with emergency cerclage were excluded. Results In women with delivery <35 weeks, CL declined from the 16 + 0 to the 22 + 0 weeks of gestation (p = 0.009). In univariate analysis, all CL measurements were predictive for delivery <35 weeks in women who underwent ultrasound-indicated cerclage and in women who received a history-indicated cerclage, whereas in multivariate analysis only CL three to six days after cerclage remained significant (odds ratio 0.85, 95 % CI 0.73–0.98). In women with ultrasound-indicated cerclage, optimized cut-off was ≤20 mm (specificity 83.8 %, sensitivity 84.2 %). Conclusions CL measured three to six days after cerclage placement provides the best information about the risk for delivery <35 weeks.
Collapse
Affiliation(s)
- Sophie Pils
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
10
|
Promberger R, Ott J, Chalubinski KM. Ten-Year Experience with the Conservative Management of Abnormally Invasive, Residual Trophoblastic Disease. A Retrospective Case Series. Gynecol Obstet Invest 2016; 81:375-80. [PMID: 26824748 DOI: 10.1159/000443395] [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: 08/19/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
Conservative management of abnormally invasive, residual trophoblastic disease (AIRTD) is underreported. We aimed at critically reviewing our experience with such conservative management. We conducted a retrospective cohort study that included 24 women. The median completed week of gestation at delivery (20/24, 83.3%)/2nd trimester miscarriage (4/24, 16.7%) was 35 (range 17-41). Two women initially chose a surgical treatment (dilatation and curettage), but AIRTD remained sonographically visible afterward. Five patients developed a fever >38.0°C for ≥2 days (5/24, 20.8%). Due to heavy vaginal bleeding, 2 patients then underwent dilatation, diagnostic hysteroscopy, and curettage (2/24, 8.3%). One of these women also had to undergo hysterectomy (1/24, 4.2%). The 23 patients without hysterectomy underwent regular sonographic follow-up examinations. Regression of AIRTD was found after a median of 74 days (range 36-323). In conclusion, our data suggest that a conservative, observational treatment is feasible in AIRTD, with low rates of secondary surgical interventions. The long time intervals until regression require perseverance by these patients.
Collapse
Affiliation(s)
- Regina Promberger
- Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria
| | | | | |
Collapse
|
11
|
Promberger R, Dubsky P, Mittlböck M, Ott J, Singer C, Seemann R, Exner R, Panhofer P, Steger G, Bergen E, Gnant M, Jakesz R, Bago-Horvath Z, Rudas M, Bartsch R. Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy. Clin Breast Cancer 2015. [DOI: 10.1016/j.clbc.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Ott J, Gritsch E, Pils S, Kratschmar S, Promberger R, Seemann R, Fürst S, Bancher-Todesca D, Hauser-Auzinger C. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced mifwives. BMC Pregnancy Childbirth 2015; 15:270. [PMID: 26493021 PMCID: PMC4619016 DOI: 10.1186/s12884-015-0703-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical staff's influence on patient outcomes has become a subject of interest. We evaluated experienced midwives and compared their performance concerning perineal lacerations (PL). METHODS In a retrospective cohort study, 1937 women with singleton pregnancies who had delivered spontaneously with a cephalic presentation by experienced midwives in the Medical University of Vienna from January 2009 to April 2014 were included. As predictive parameters, we included basic patient-, pregnancy- and delivery-related characteristics including the individual midwife who delivered the child. The incidence of PL was the main outcome measure. RESULTS Overall PL and severe PL were found in 508/1937 (26.2%) and 19/1937 women (1.0%), respectively. In a multivariate analysis for PL of any degree, maternal age (ß = 0.170 ± 0.080), gestational age at delivery (ß = 0.190 ± 0.320), and birth weight (ß = 0.002 ± 0.000) significantly increased the risk, whereas multiparity (ß = -0.379 ± 0.141) and mediolateral episiotomy (ß = -1.514 ± 0.284) decreased it (p < 0.05). In addition, the individual midwife who delivered the child was a significant influencing factor, with ß-values ranging from -0.028 to 0.899 compared to the reference midwife. For severe PL, the midwife was not of significant influence. CONCLUSIONS The individual midwife is an independent factor that influences the risk for overall PL, not for severe PL. Other risk factors include maternal age, gestational age at delivery, birth weight, parity and episiotomy.
Collapse
Affiliation(s)
- Johannes Ott
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Evelyn Gritsch
- Midwifery Services, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sophie Pils
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sophie Kratschmar
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Regina Promberger
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Department of Gynecology, St. John of God Hospital Vienna, Johannes von Gott Platz 1, 1020, Vienna, Austria.
| | - Rudolf Seemann
- Department of for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sabine Fürst
- Midwifery Services, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Dagmar Bancher-Todesca
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Christa Hauser-Auzinger
- Midwifery Services, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
13
|
Nouri K, Tempfer CB, Walch K, Promberger R, Dag S, Ott J. Predictive value of the time interval between embryo loading and transfer for IVF/ICSI success: a prospective cohort study. Reprod Biol Endocrinol 2015; 13:51. [PMID: 26022289 PMCID: PMC4455943 DOI: 10.1186/s12958-015-0048-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/21/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The influence of embryo loading time (ELT) and the time interval between embryo loading and embryo transfer (TIEL-ET) on the success of IVF/ICSI is unknown. METHODS In a prospective cohort study, we aimed to ascertain the influence of ELT and TIEL-ET on ongoing pregnancy rate (OPR) and life birth rate (LBR). Data from 603 consecutive embryo transfers between January 2008 and December 2013 were collected. A complete data set including the outcomes of interest OPR and LBR was available for 410 women. The primary outcome was IVF/ICSI success, defined as OPR and LBR. RESULTS We used univariate and multivariate logistic regression for analysis. In a multivariate analysis, age (odds ratio [OR] 0.94; 95% confidence interval [CI] 0.89-0.99), catheter type (OR 0.45; 95% CI 0.24-0.84), and uterine length (OR 1.03; 95% CI 1.01-1.06), but not ELT and TIELT-ET were independently associated with OPR. Regarding LBR, age (OR 0.93; 95% CI 0.88-0.98), catheter type (OR 0.41; 95% CI 0.22-0.79), and uterine length (OR 1.03; 95% CI 1.01-1.06), but not ELT and TIELT-ET were independent predictors. CONCLUSION We conclude that speed of embryo transfer is not critical for the success of IVF/ICSI. However, care should be taken to choose catheter types proven to be associated with a high success rate.
Collapse
Affiliation(s)
- Kazem Nouri
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Clemens B Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
- Marienhospital Herne, Hoelkeskampring 40, 44625, Herne, Germany.
| | - Katharina Walch
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Regina Promberger
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sema Dag
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
14
|
Promberger R, Ott J, Bures C, Freissmuth M, Seemann R, Hermann M. Perioperative kinetics of parathyroid hormone in unilateral, primary thyroid surgery. Endocrine 2015; 48:293-8. [PMID: 24858628 DOI: 10.1007/s12020-014-0300-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 05/09/2014] [Indexed: 02/01/2023]
Abstract
Dysfunction of the parathyroid glands is an important cause of complications after thyroid surgery. Intraoperative monitoring of the function of the parathyroid glands can be performed using parathyroid hormone (PTH) kinetics. Unilateral thyroid surgery is associated with a decreased risk for postoperative hypocalcemia (POH) and permanent hypoparathyroidism (PEH). We focused on unilateral thyroid surgery by monitoring the functionality of the parathyroid glands and comparing the perioperative PTH kinetics of patients with and without POH. In a prospective study, 143 patients scheduled for unilateral thyroid surgery underwent monitoring of perioperative changes in serum PTH and serum calcium levels, and of clinical symptoms of hypocalcemia. The rates of POH and PEH were 18.2 and 0%, respectively. In patients without POH, PTH significantly increased from the time of skin incision to the end of the operation and after the operation (20.1 pg/ml, IQR 15.5-26.8 vs. 21.4 pg/ml, IQR 16.4-29.5; p=0.005), which was not the case in patients who developed POH. In a multivariate analysis of predictive factors for POH, two parameters became significant, namely female gender (odds ratio 6.87, 95% confidence interval 0.92-51.01) and lower initial serum calcium levels (odds ratio 3.54*e(-8), 95% confidence interval 3.63*e(-12); 0.00). The rate of POH was unexpectedly high. Rather than intraoperative PTH declines, an unstable balance of factors that influence calcium metabolism likely is the major contributor to POH after unilateral thyroid surgery. There was no case of PEH after unilateral, primary thyroid surgery, which underlines the need for an individualized approach to the extent of resection.
Collapse
Affiliation(s)
- Regina Promberger
- Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
15
|
Nouri K, Huber D, Walch K, Promberger R, Buerkle B, Ott J, Tempfer CB. Fertility awareness among medical and non-medical students: a case-control study. Reprod Biol Endocrinol 2014; 12:94. [PMID: 25260495 PMCID: PMC4182859 DOI: 10.1186/1477-7827-12-94] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the understanding and perceptions of fertility issues among medical and non-medical University students. METHODS In a prospective case-control study, using a 43 item questionnaire with 5 sections and 43 questions regarding personal data (8 questions), lifestyle factors (9 questions), plans on having children (5 questions), age and fertility (5 questions), and lifestyle and fertility (16 questions), knowledge of fertility and influencing factors, desired age at commencement and completion of childbearing, among male and female medical and non-medical students in their first academic year at Vienna University, Vienna, Austria were evaluated. RESULTS 340 students were included. 262/340 (77%) participants planned to have children in the future. Medical students (n = 170) planned to have fewer and later children and had a higher awareness of the impact of age on fertility than non-medical students (n = 170; estimated knowledge probability 0.55 [medical students] vs. 0.47 [non-medical students]; F (1, 336) = 5.18 and p = .024 (η p = .015). Gender did not independently affect estimated knowledge probability (F (1, 336) = 1.50 and p = .221). More female and male medical students had a positive attitude towards Assisted Reproductive Technology in case of infertility than non-medical students (47 and 55% vs. 23 and 29%, respectively; p = <.001). Medical students had a healthier lifestyle than non-medical students. A healthy lifestyle and female gender were associated with higher fertility awareness. CONCLUSIONS Medical students have a higher awareness of fertility issues than non-medical students. Choice of academic study, gender, and personal life style are important factors affecting fertility awareness. These data may be helpful to address knowledge gaps among young non-medical Academics.
Collapse
Affiliation(s)
- Kazem Nouri
- />Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dagmar Huber
- />Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Katharina Walch
- />Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Regina Promberger
- />Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Bernd Buerkle
- />Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany
| | - Johannes Ott
- />Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Clemens B Tempfer
- />Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
16
|
Nouri K, Tempfer CB, Lenart C, Windischbauer L, Walch K, Promberger R, Ott J. Predictive factors for recovery time in patients suffering from severe OHSS. Reprod Biol Endocrinol 2014; 12:59. [PMID: 24996451 PMCID: PMC4096731 DOI: 10.1186/1477-7827-12-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate predictive factors for recovery time from severe ovarian hyperstimulation syndrome (OHSS). METHODS In a retrospective cohort study, 201 women who were hospitalized for severe OHSS were included. Patients with recurrent OHSS were excluded. All the patients received standardized treatment including intravenous hydration, plasma volume expansion, human albumin, furosemid, subcutaneous heparin, and paracentesis if necessary. The main outcome parameter was recovery time from OHSS. Recovery was defined if a morning hematocrit <40%, rebalance of electrolytes, and serum creatinine <1 mg/dL were reached during the standardized therapy and the patient had not suffered from abdominal pain and discomfort at least for one day without any OHSS-specific infusions or medications. RESULTS Pregnant patients (n=80, 39.8%) revealed a longer median duration until recovery than non-pregnant patients (n=121, 60.2%; 10 days, IQR 7-13, vs. 8 days, IQR 6-10, respectively; p=0.001). In a generalized linear model, presence of polycystic ovary syndrome before controlled ovarian hyperstimulation (beta=0.3342 +/- 0.1335, p=0.012) and use of hCG for ovulation induction (beta=0.222 +/- 0.1389, p=0.048) were associated with a longer recovery time in pregnant patients. In non-pregnant patients, none of the tested factors was associated with recovery time. CONCLUSIONS Pregnant patients with severe OHSS needed a significantly longer recovery time than non-pregnant patients. In pregnant patients, presence of polycystic ovary syndrome and ovulation induction with hCG were associated with longer recovery times.
Collapse
Affiliation(s)
- Kazem Nouri
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Clemens B Tempfer
- Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany
| | - Christian Lenart
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lisa Windischbauer
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
17
|
Ott J, Bartsch R, Dubsky P, Singer C, Promberger R. Postoperative Extension einer neoadjuvanten Chemotherapie bei Brustkrebspatientinnen – eine retrospektive Analyse. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374762] [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: 10/25/2022] Open
|
18
|
Ott J, Eppel W, Promberger R, Winter MP, Seemann R, Pils S. Der prädiktive Wert von sequentiellen Zervixlängenmessungen in Einlingsschwangerschaften nach Cerclage: Eine retrospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374782] [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: 10/25/2022] Open
|
19
|
Ott J, Walch K, Tempfer CBA, Promberger R, Kurz C, Nouri K. Die schwere Ovarialblutung nach transvaginaler Ovarialpunktion bei IVF: Retrospektive Fallserie und gepoolte Analyse zu Inzidenz, Verlauf und Managment. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374737] [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: 10/25/2022] Open
|
20
|
Promberger R, Hermann M, Pallikunnel SJ, Seemann R, Meusel M, Ott J. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis. Am J Surg 2014; 207:974-9. [DOI: 10.1016/j.amjsurg.2013.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/29/2013] [Accepted: 05/16/2013] [Indexed: 01/21/2023]
|
21
|
Födermayr M, Sebesta M, Rudas M, Berghoff AS, Bergen E, Promberger R, Preusser M, Dubsky PC, Gnant M, Steger GG, Weltermann A, Zielinski C, Zach O, Bartsch R. Association of TP53 codon 72 polymorphism with TP53 mutation in triple-negative breast cancer (TNBC) patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | | | - Regina Promberger
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Center Vienna, Vienna, Austria
| | | | | | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther G. Steger
- Department of Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Zielinski
- Medical University of Vienna, and Initiative “Leben mit Krebs, Vienna, Austria, Vienna, Austria
| | - Otto Zach
- Hospital Elisabethinen Linz, Linz, Austria
| | - Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
22
|
Jatzko B, Vytiska-Bistorfer E, Pawlik A, Promberger R, Mayerhofer K, Ott J. The impact of thyroid function on intrauterine insemination outcome--a retrospective analysis. Reprod Biol Endocrinol 2014; 12:28. [PMID: 24708845 PMCID: PMC3978130 DOI: 10.1186/1477-7827-12-28] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/31/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hashimoto's thyroiditis is the most common endocrinopathy in premenopausal women, and is associated with various gynecological problems, including recurrent miscarriage and unexplained infertility. A possible influence of Hashimoto's thyroiditis on the success of intrauterine insemination seems likely, but has not been evaluated as yet. Therefore, the aim of our study was to retrospectively analyze the impact on intrauterine insemination outcome of thyroid function and markers suggestive for Hashimoto's thyroiditis. METHODS Retrospective cohort study in a tertiary care center of 540 women who underwent Intrauterine Insemination. The clinical pregnancy rate was the main outcome parameters. The following possible influencing factors were tested: thyroid-stimulating hormone (TSH); thyroid autoantibodies; age; body mass index; type of sterility (primary/secondary); parity; male factor; presence of PCO syndrome; ovulation induction; ovarian stimulation; and current thyroid medication. RESULTS The overall clinical pregnancy rate was 6.9% (37/540). Age, thyroid hormone supplementation for thyroid-stimulating hormone (TSH) levels>2.5 micro-IU/ml, and ovulation induction with HCG were significantly predictive in the multivariate analysis (p<0.05) as influencing factors for the pregnancy rate after intrauterine insemination. CONCLUSIONS Women undergoing intrauterine insemination seem to benefit from a strict thyroid hormone supplementation regimen in order to achieve lower TSH levels.
Collapse
Affiliation(s)
- Birgit Jatzko
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Vytiska-Bistorfer
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexandra Pawlik
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Regina Promberger
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Klaus Mayerhofer
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
23
|
Bader Y, Helmy S, Promberger R, Marschalek J, Jirecek S, Jaksch P, Ott J. Hormonal contraception in female lung transplant recipients: a case series: Table 1. J Fam Plann Reprod Health Care 2014; 40:294-6. [DOI: 10.1136/jfprhc-2013-100783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Foedermayr M, Sebesta M, Rudas M, Berghoff AS, Promberger R, Preusser M, Dubsky P, Fitzal F, Gnant M, Steger GG, Weltermann A, Zielinski CC, Zach O, Bartsch R. Abstract P1-08-40: BRCA-1 promotor methylation and p53 mutation in triple-negative breast cancer patients refrectory to taxane-based neoadjuvant chemotherapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-40] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Triple-negative breast cancer (TNBC) without pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with high risk of disease recurrence. In ABCSG trials 14 and 24, concomitant epirubicin plus docetaxel (+/- capecitabine) was used as NAC regimen; patients (pts) without pCR routinely received another 4-8 cycles of adjuvant CMF.
Tumours harbouring BRCA-1 germline mutations are apparently less responsive to taxane-based chemotherapy, while sensitivity to DNA-damaging agents is retained. In sporadic TNBC, BRCA-1 promotor methylation is frequently observed; this may also result in an impaired activity of genetic repair mechanisms. Therefore, we investigated the effect of adjuvant CMF as salvage therapy in pts with or without BRCA-1 promotor methylation who did not achieve pCR to taxane-based (cyclophosphamide-free) NAC. Moreover, the predictive role of TP53 mutations was investigated in these tumours.
Methods
All pts with TNBC refractory to taxane-based NAC who received adjuvant CMF were included.
DNA was extracted from formalin-fixed paraffin-embedded tissue samples with the Qiagen DNA FFPE Tissue Kit® and purified. For determining BRCA1 promoter methylation status, DNA was bisulfite-treated; the TaqMan® assay was used in order to perform a quantitative methylation-specific PCR. DNA quantity was normalized using Actin-b.
For the investigation of TP53 mutations in exons 4-9, purified DNA was PCR amplified, sequenced by Sanger sequencing and results were analyzed with SeqScape® software version 2.7. Mutations were validated using the IARC p53 database.
Results
Twenty-four pts, median age 47 years, were available for this analysis. In 10/24 pts (41.7%), a BRCA-1 promotor methylation was detected; TP53 mutations were observed in 16/24 pts (66.7%). At a median follow-up of 27.5 months, 2/10 pts (20%) with BRCA-1 promotor metyhlation had a disease-free survival (DFS) event, as compared to 9/14 (64.3%) in the non-methylated group (p = 0.0472; Fisher's exact test). Kaplan Meier estimation of disease-free survival (DFS) in the non-methylated group was 16 months (95% CI 0.0-41.73) and was not reached in the methylated group (n.s.). TP53 mutation was neither associated with increased risk of disease recurrence nor with DFS. No correlation was observed between BRCA-1 promotor methylation and TP53 mutation; still, all methylated samples were exclusively affected be missense and nonsense mutations.
Conclusions
Adjuvant CMF is of limited activity in TNBC refractory to taxane-based NAC. Still, in breast cancer harbouring BRCA-1 promotor methylation, a significant decrease of DFS events was observed. TP53 mutation status on the other hand, was not associated with outcome; while no correlation was found between BRCA-1 promotor methylation and TP53 mutation status, we only observed missense and non-sense mutations in methylated samples.
In conclusion, tumours harbouring BRCA-1 promotor methylation are apparently sensitive to DNA damage caused by cyclophosphamide. Further clinical validation of this concept is warranted.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-40.
Collapse
Affiliation(s)
- M Foedermayr
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Sebesta
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Rudas
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - AS Berghoff
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Promberger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Preusser
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - F Fitzal
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - M Gnant
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - GG Steger
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - A Weltermann
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - CC Zielinski
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - O Zach
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| | - R Bartsch
- Academic Teaching Hospital Elisabethinen Linz, Linz, Austria; Medical University of Vienna, Vienna, Austria
| |
Collapse
|
25
|
Bartsch R, Födermayr M, Sebesta M, Rudas M, Berghoff AS, Promberger R, Preusser M, Dubsky PC, Fitzal F, Gnant M, Weltermann A, Zielinski C, Steger GG, Zach O. BRCA-1 promotor methylation as predictor of benefit from adjuvant CMF in triple-negative breast cancer not responsive to taxane-based neoadjuvant chemotherapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.148] [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: 11/20/2022] Open
Abstract
148 Background: Triple-negative breast cancer (TNBC) patients (pts) without pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) have an unfavourable prognosis. ABCSG trials 14 and 24 defined 6 cycles of epirubicin/docetaxel (+/- capecitabine) as active NAC regimen; pts without pCR commonly received another 4-8 cycles of adjuvant CMF. Different studies suggested that breast tumours harbouring BRCA-1 germline mutations were resistant to taxane-based therapy while sensitivity to DNA-damaging agents was retained. BRCA-1 mutations are rare in sporadic BC; BRCA-1 promotor methylation (PM), however, is frequently observed. We hypothesized that pts with TNBC harbouring BRCA1 PM would benefit from adjuvant CMF salvage therapy. Methods: For this analysis, we included all pts with TNBC refractory to taxane-based NAC who received adjuvant CMF. DNA was extracted from formalin-fixed paraffin-embedded tissue samples, purified and bisulfite-converted. The TaqMan assay was used in order to perform a quantitative methylation-specific PCR. Actin-b was used as reference gene to normalise the amount of provided DNA; bisulfite-converted, artificially methylated DNA was used as positive control. Results: Twenty-four pts, median age 47 years, were available for this analysis. In 9/24 pts (37.5%), BRCA-1 PM was detected. At a median follow-up of 27.5 months, 1/9 pts (11.1%) with BRCA-1 PM had a disease-free survival (DFS) event, as compared to 10/15 (66.6%) in the non-methylated group (p = 0.013; Fisher’s exact test). Kaplan Meier estimation of DFS in the non-methylated group was 24 months (95% CI 14.06-33.94) and was not reached in the methylated group (n.s.). Conclusions: In TNBC refractory to taxane-based NAC, adjuvant CMF is of limited efficacy. In tumours harbouring BRCA-1 PM, however, a significant decrease of DFS events was observed. Therefore, tumours harbouring defects in genetic repair mechanism might be exceptionally sensitive to drugs causing DNA-damage. Further clinical investigation of this concept is warranted.
Collapse
Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Anna Sophie Berghoff
- Department of Medicine I and Comprehensive Cancer Center CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Regina Promberger
- Department of Surgery, Medical University of Vienna and Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Center CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Zielinski
- Department of Medicine I and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Guenther G. Steger
- Department of Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Otto Zach
- Hospital Elisabethinen Linz, Linz, Austria
| |
Collapse
|
26
|
Promberger R, Lenglinger J, Riedl O, Seebacher G, Eilenberg W, Ott J, Riegler F, Gadenstätter M, Neumayer C. Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and pathophysiologic aspects - a retro-pro study. BMC Gastroenterol 2013; 13:132. [PMID: 23972125 PMCID: PMC3765380 DOI: 10.1186/1471-230x-13-132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022] Open
Abstract
Background Information about gastro-oesophageal reflux disease (GERD) in patients with Diabetes mellitus type 2 (T2D) is scarce, although the incidence of both disorders is increasing. We aimed to determine GERD symptoms and their underlying pathophysiologic characteristics in T2D patients. Methods This “retro-pro” study compared 65 T2D patients to a control group of 130 age- and sex-matched non-diabetics. GERD was confirmed by gastroscopy, manometry, pH-metry and barium swallow. Results In patients with T2D compared to controls, dysphagia (32.3% vs. 13.1%; p = 0.001) and globus sensation (27.7% vs. 13.8%; p = 0.021) were found more frequently, whereas heartburn (76.9% vs. 88.5%; p = 0.046) and regurgitation (47.7% vs. 72.3%; p = 0.001) were predominant in non-diabetics. Despite higher body mass indices (31.1 ± 5.2 vs. 27.7 ± 3.7 kg/m2; p < 0.001), hiatal hernia was less frequent in T2D patients compared to controls (60.0% vs. 90.8%, p < 0.001). Lower oesophageal sphincter (LES) pressure was higher in patients with T2D (median 10.0 vs. 7.2 mmHg, p = 0.016). DeMeester scores did not differ between the groups. Helicobacter pylori infections were more common in T2D patients (26.2% vs. 7.7%, p = 0.001). Barrett metaplasia (21.5% vs. 17.7%), as well as low- (10.8% vs. 3.8%) and high-grade dysplasia (1.5% vs. 0%) were predominant in T2D patients. Conclusions T2D patients exhibit different GERD symptoms, higher LES pressures and a decreased prevalence of hiatal hernia than non-diabetics, which may be related to worse oesophageal motility and, thus, a more functional rather than anatomical cause of GERD. Low-grade dysplasia was more than twice as high in T2D than in non-diabetics patients. Trial registration Ethics committee of the Medical University of Vienna, IRB number 720/2011.
Collapse
|
27
|
Ott J, Pecnik P, Promberger R, Pils S, Seemann R, Hermann M, Frigo P. Dehydroepiandrosterone in women with premature ovarian failure and Hashimoto's thyroiditis. Climacteric 2013; 17:92-6. [DOI: 10.3109/13697137.2013.800040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
28
|
Promberger R, Spitzer A, Ott J, Lenglinger J, Eilenberg W, Gadenstätter M, Neumayer C. Quality of life in type 2 diabetics with gastroesophageal reflux disease: a case control study. Eur Surg 2013. [DOI: 10.1007/s10353-013-0219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
29
|
Ott J, Pils S, Pecnik P, Promberger R, Hermann M, Frigo P. DHEA bei Frauen mit Prämaturer Ovarialinsuffizienz und Hashimoto-Thyreoiditis: Pathophysiologische und therapeutische Implikationen? Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347782] [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] Open
|
30
|
Abstract
Hashimoto's thyroiditis (HT) is one of the most common autoimmune endocrine disorders and often leads to hypothyroidism. It has been shown to substantially affect a patient's quality of life. Associated conditions and diseases were thought to be attributable to hypothyroidism. Yet, many patients still suffer from various symptoms even though all thyroid parameters are within the normal range. Independently of thyroid gland function, HT is associated with a wide range of organ-specific and non-organ-specific autoimmune disorders, as well as other diseases, including neuropsychological/psychiatric deficits, decreased left ventricular performance, disorders of the gut, fibromyalgia and reproductive health issues, among others. The underlying pathomechanisms remain unclear. Future treatment options might include thyroidectomy, selenium administration, prophylactic levothyroxine supplementation and dehydroepiandrosterone. However, further research is warranted to clarify the main pathophysiologic implications of thyroid autoimmunity and also to establish treatment options for euthyroid patients who suffer from HT-related symptoms and diseases.
Collapse
Affiliation(s)
- Regina Promberger
- a Department of Surgery, Kaiserin Elisabeth Spital, Huglgasse 1-3, 1150 Vienna, Austria
- b Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Michael Hermann
- a Department of Surgery, Kaiserin Elisabeth Spital, Huglgasse 1-3, 1150 Vienna, Austria
| | - Johannes Ott
- a Department of Surgery, Kaiserin Elisabeth Spital, Huglgasse 1-3, 1150 Vienna, Austria
- c Department of Gynecologic Endocrinology & Reproductive Medicine, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
31
|
Promberger R, Ott J, Kober F, Koppitsch C, Seemann R, Freissmuth M, Hermann M. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 2012; 99:373-9. [PMID: 22231603 DOI: 10.1002/bjs.7824] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Postoperative bleeding after thyroid surgery is a feared and life-threatening complication. The aim of the study was to identify risk factors for postoperative bleeding, with special emphasis on the impact of the individual surgeon and the time to diagnosis of the complication. METHODS Data on consecutive thyroid operations were collected prospectively in a database over 30 years and analysed retrospectively for potential risk factors for postoperative bleeding. RESULTS There were 30,142 operations and postoperative bleeding occurred in 519 patients (1·7 per cent). Risk factors identified were older age (odds ratio (OR) 1·03 per year), male sex (OR 1·64), extent of resection (OR up to 1·41), bilateral procedure (OR 1·99) and operation for recurrent disease (OR 1·54). The risk of complications among individual surgeons differed by up to sevenfold. Postoperative bleeding occurred in 336 (80·6 per cent) of 417 patients within the first 6 h after surgery. Postoperative bleeding was diagnosed after 24 h in ten patients (2·4 per cent), all of whom had bilateral procedures. Nine patients required urgent tracheostomy. Three patients died, giving a mortality rate of 0·01 per cent overall and 0·6 per cent among patients who had surgery for postoperative bleeding. CONCLUSION Observation for up to 24 h is recommended for the majority of patients undergoing bilateral thyroid surgery in an endemic goitre area. Same-day discharge is feasible in selected patients, especially after a unilateral procedure. Quality improvement by continuous outcome monitoring and retraining of individual surgeons is suggested.
Collapse
Affiliation(s)
- R Promberger
- Department of Surgery, Kaiserin Elisabeth Spital, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
32
|
Ott J, Aust S, Promberger R, Huber JC, Kaufmann U. Cross‐Sex Hormone Therapy Alters the Serum Lipid Profile: A Retrospective Cohort Study in 169 Transsexuals. J Sex Med 2011; 8:2361-9. [DOI: 10.1111/j.1743-6109.2011.02311.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Ott J, Meusel M, Schultheis A, Promberger R, Pallikunnel SJ, Neuhold N, Hermann M. The incidence of lymphocytic thyroid infiltration and Hashimoto's thyroiditis increased in patients operated for benign goiter over a 31-year period. Virchows Arch 2011; 459:277-81. [PMID: 21786141 DOI: 10.1007/s00428-011-1130-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 10/18/2022]
Abstract
The incidence of Hashimoto's thyroiditis (HT) seems to have increased over the last several decades. Since there is a lack of recent studies in the literature that evaluate this phenomenon on a histological basis, we aimed to assess the incidence of lymphocytic thyroid infiltration (LTI) in our large surgical patient collective over a 31-year period. In our study, a total of 1,050 patients who had undergone uni- or bilateral thyroid surgery for benign goiter were included (150 patients in each group, during 1979 to 2009). The stored histological sections of the removed thyroid specimens were re-analyzed, including routine grading of LTI severity on a scale of 0-4, according to Williams and Doniach. Positive correlations were seen for the incidences of LTI grading (0-4) (r = 0.077, p = 0.013) and HT (r = 0.044, p = 0.078) over the years. Furthermore, when comparing the years 1979-1989 and 1994-2009, i.e., before and after the second iodine prophylaxis had been introduced in Austria, a higher incidence of HT was found for the later years (2 out of 450, 0.4%, vs. 6 out of 600, 1.0%, respectively; p < 0.0001). In conclusion, the data demonstrate that the incidence of LTI and HT has increased substantially over the last 31 years.
Collapse
Affiliation(s)
- Johannes Ott
- Department of Surgery, Kaiserin Elisabeth Spital, Huglgasse 1-3, 1150, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Permanent hypoparathyroidism has become the most common and the most severe complication after thyroid surgery. In our experience, some patients suffer from permanent hypocalcemia and related symptoms despite normal parathyroid hormone (PTH) values after thyroid surgery. The aim of this work was to present a series of such patients with long-term hypocalcemia and normal PTH values to evaluate to what extent parathyroid function was impaired by thyroidectomy, and determine whether irregularities of bone and calcium metabolism were associated with this phenomenon. METHODS We present a series of eight patients with normal PTH and subnormal calcium levels at follow-up 2 months after thyroid surgery. Outcome parameters were intra- and postoperative PTH and calcium kinetics, and the following markers of calcium and bone metabolism at long-term follow-up: serum calcium, total serum albumin, ionized calcium, magnesium, PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, urinary calcium, urinary creatinine, osteocalcin, c-terminal telopeptide of type I collagen, and alkaline phosphatase. RESULTS All patients had normal calcium and PTH levels at the start of the operation. The intraoperative decline in PTH was >90%; the trough (3.3% of preoperative value) was reached 3 hours after surgery. Patients underwent complete determination of bone metabolism parameters during long-term follow-up 13.8 ± 2.4 months after surgery. Hypocalcemia was found in all eight patients, as well as PTH levels within the normal range. In three patients (3/8 = 37.5%), none of the other parameters was altered. In the remaining five patients, only isolated abnormalities in bone and calcium metabolism parameters were found (i.e., alterations in urinary calcium, thyrotropin, 25-hydroxyvitamin D, osteocalcin, and c-terminal telopeptide of type I collagen). CONCLUSIONS An intraoperative injury to the parathyroid glands or their vascularization is the likely contributing factor to the development of permanent hypocalcemia with normal PTH values after thyroid surgery. The remaining parathyroid tissue is subject to a maximum stimulus by hypocalcemia and, therefore, is able to maintain PTH values in the normal range. These are still too low to re-establish normal serum calcium levels. In these patients, the term "hypoparathyroidism" might be replaced with "parathyroid insufficiency."
Collapse
|
35
|
Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, Hermann M. Hashimoto's thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid 2011; 21:161-7. [PMID: 21186954 DOI: 10.1089/thy.2010.0191] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is a common disease, and is the most prevalent cause of hypothyroidism. Symptoms and diseases associated with HT are considered to be caused by hypothyroidism. We hypothesized that higher antithyroperoxidase (anti-TPO) antibody levels would be associated with an increased symptom load and a decreased quality of life in a female euthyroid patient collective. METHODS In a prospective cohort study 426 consecutive euthyroid female patients undergoing thyroid surgery for benign thyroid disease were included. Main outcome measures were preoperative anti-TPO levels, a symptom questionnaire and the SF-36 questionnaire, and lymphocytic infiltration of the thyroid tissue as evaluated by histology. RESULTS Histology revealed HT in 28/426 (6.6%) subjects. To maximize the sum of the predictive values, a cut-off point for anti-TPO of 121.0 IU/mL was calculated (sensitivity 93.3% [95% confidence interval: 77.9%-99.0%]; specificity 94.7% [95% confidence interval: 92.0%-96.7%]) to predict the presence of histological signs of HT. The mean number of reported symptoms was significantly higher in patients with anti-TPO levels >121.0 IU/mL than in the other group (6.7 ± 2.5 vs. 4.1 ± 2.8; p < 0.001). There were no differences in preoperative thyroid-stimulating hormone levels (1.7 ± 1.3 vs. 1.5 ± 1.4 μU/mL, respectively; p = 0.155). Chronic fatigue, dry hair, chronic irritability, chronic nervousness, a history of breast cancer and early miscarriage, and lower quality-of-life levels were significantly associated with anti-TPO levels exceeding the cut-off point (p < 0.05). CONCLUSIONS Women with HT suffer from a high symptom load. Hypothyroidism is only a contributing factor to the development of associated conditions.
Collapse
Affiliation(s)
- Johannes Ott
- Department of Surgery, Kaiserin Elisabeth Spital, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
36
|
Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M, Hermann M. Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid 2010; 20:1371-5. [PMID: 20954822 DOI: 10.1089/thy.2010.0157] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroidectomy continues to pose the risk of typical complications, including postoperative hypocalcemia and permanent hypoparathyroidism. The strategic decision on how to preserve parathyroid hormone (PTH) secretion relies on assessing the viability of the parathyroid glands (PGs). The aim of this study was to assess parathyroid discoloration as an indicator for loss of parathyroid function. METHODS The prospective study included 29 patients (24 women, 5 men; age 53.2 ± 13.0 years) who underwent near-total or total thyroidectomy. An intra- and postoperative PTH and calcium monitoring was performed. The intraoperative situs of the PGs was documented by a study protocol. The patients were grouped in three categories: group A, 12 patients with four visualized and normally colored PGs; group B, 13 patients with four visualized and three or four discolored PGs; group C, 4 patients who had undergone autotransplantation of two PGs. RESULTS Compared to group A, groups B and C showed sharper intraoperative PTH declines. PTH values recovered more quickly in group B than in group C. However, no significant differences in PTH kinetics were found in the general linear model for repeated measures (p = 0.132). However, a significantly higher incidence of protracted hypocalcemia-related symptoms for more than 14 postoperative days was found for group C (50.0%) than for groups A (0%) and B (0%; p = 0.011). None of the patients developed permanent hypoparathyroidism. CONCLUSIONS The function of discolored PGs is only transiently impaired and recovers within a short time after surgery. Our observations do not support autotransplantation as a generally applicable first-line intervention for discolored PGs in the absence of other criteria for autotransplantation.
Collapse
Affiliation(s)
- Regina Promberger
- Department of Surgery, Kaiserin Elisabeth Spital der Stadt Wien, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Because a significant number of mucoceles are caused by mucinous cystadenocarcinoma, the authors stress that a general surgeon be consulted in cases of right lower quadrant “dumbbell shaped” abdominal cysts. Objective: To present the case of a postmenopausal woman, who was suspected of having an ovarian cyst. Instead, a cystadenoma of the appendix was discovered during laparoscopy. Methods: A 64-year-old postmenopausal nulliparous woman was admitted to our hospital because of a cystic lesion, which had been detected in the course of a routine gynecological examination. The patient underwent vaginal ultrasound, magnetic resonance tomography, and laparoscopy. Results: During vaginal ultrasound, a dumbbell-shaped anechogenic cystic structure 70 × 32 × 22 mm in diameter was found in the region of the right adnexa. Magnetic resonance tomography revealed no additional information. During diagnostic laparoscopy, the cystic lesion was found to be a distended appendix. A laparoscopic appendectomy was performed. Subsequent histological analysis revealed a villous mucinous cystadenoma of the appendix with low-grade intraepithelial neoplasia. Conclusion: Gynecologists should routinely consider this disease in the differential diagnosis of right lower dumbbell abdominal cysts. Eleven percent to 20% of mucoceles are caused by mucinous cystadenocarcinomas, which carry the risk of peritoneal tumor implantation caused by rupture or laparoscopic resection. Therefore, it should be mandatory that a general surgeon be involved in the laparoscopic procedure and the conversion to laparotomy for resection of the structure.
Collapse
Affiliation(s)
- K Nouri
- Department of Gynaecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
38
|
Mayerhofer K, Ott J, Nouri K, Stoegbauer L, Fischer EM, Lipovac M, Promberger R, Huber JC. Laparoscopic ovarian tissue harvesting for cryopreservation: an effective and safe procedure for fertility preservation. Eur J Obstet Gynecol Reprod Biol 2010; 152:68-72. [DOI: 10.1016/j.ejogrb.2010.05.034] [Citation(s) in RCA: 27] [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: 11/19/2009] [Revised: 04/22/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
|
39
|
Ott J, Promberger R, Pallikunnel SJ, Meusel M, Tea M, Hermann M. Der Einfluss der Thyreoiditis Hashimoto auf die Lebensqualität. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1254981] [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] Open
|
40
|
Promberger R, Ott J, Mikola B, Freissmuth M, Hermann M. Lunar phase does not influence the incidence of postoperative haemorrhage after thyroid surgery: an analysis of 26,852 operations. Eur Surg 2010. [DOI: 10.1007/s10353-010-0523-4] [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] [Indexed: 11/30/2022]
|
41
|
Nouri K, Ott J, Demmel M, Promberger R, Huber JC, Mayerhofer K. Bipolar vessel sealing increases operative safety in laparoscopic-assisted vaginal hysterectomy. Arch Gynecol Obstet 2009; 283:91-5. [DOI: 10.1007/s00404-009-1333-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
|
42
|
Ott J, Nouri K, Stögbauer L, Fischer EM, Lipovac M, Promberger R, Huber JC, Mayerhofer K. Ovarian tissue cryopreservation for non-malignant indications. Arch Gynecol Obstet 2009; 281:735-9. [DOI: 10.1007/s00404-009-1224-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 09/08/2009] [Indexed: 11/29/2022]
|
43
|
Zaafrani S, Ott J, Kober F, Promberger R, Neuhold N, Hermann M. Hashimoto Thyreoiditis: Vorhersagewert der antiTPO-Antikörper und Relevanz in der Frauenheilkunde. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225253] [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
|
44
|
Hermann M, Ott J, Promberger R, Kober F, Karik M, Freissmuth M. Kinetics of serum parathyroid hormone during and after thyroid surgery. Br J Surg 2008; 95:1480-7. [DOI: 10.1002/bjs.6410] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Hypocalcaemia after thyroidectomy is thought to result from surgical damage to the parathyroid glands. This study analysed postoperative outcomes related to perioperative parathyroid hormone (PTH) levels.
Methods
Some 402 consecutive patients undergoing thyroid surgery were studied prospectively to monitor perioperative changes in serum PTH and Ca2+ levels, and clinical symptoms of hypocalcaemia.
Results
Transient symptomatic hypocalcaemia and persistent hypoparathyroidism occurred in 61 (15 per cent) and six (1·5 per cent) of 402 patients respectively. The intraoperative decline in PTH was 20·2 per cent; the trough (63·8 per cent of preoperative value) was reached 3 h after surgery. Before surgery, PTH levels were correlated inversely with serum Ca2+ concentration. The correlation remained positive from 3 h after surgery until postoperative day 14. Thus, PTH secretion was reduced, but remained sufficient to prevent symptomatic hypocalcaemia in most patients. A low serum PTH level was predictive of persistent hypoparathyroidism (sensitivity and negative predictive value 100 per cent, but poor specificity of 54·1 per cent).
Conclusion
Thyroid surgery impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.
Collapse
Affiliation(s)
- M Hermann
- Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Vienna, Austria
| | - J Ott
- Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Vienna, Austria
| | - R Promberger
- Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Vienna, Austria
| | - F Kober
- Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Vienna, Austria
| | - M Karik
- Department of Surgery, Kaiserin-Elisabeth-Spital, Medical University of Vienna, Vienna, Austria
| | - M Freissmuth
- Institute of Pharmacology, Centre for Biomolecular Medicine and Pharmacology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
45
|
Promberger R, Gadenstätter M, Ciovica R, Schwab G, Neumayer C. Gastroesophageal reflux disease in diabetic patients: a systematic review. Eur Surg 2007. [DOI: 10.1007/s10353-007-0366-9] [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] [Indexed: 12/24/2022]
|