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Kuenkel E, Jaeger A, Bohlmann I, Bergauer F, Kuehler-Obbarius C, Prieske K, Maass-Poppenhusen K, Schmalfeldt B, Woelber L. The use of colposcopy for triage in HPV-positive women aged 65 years and older. Arch Gynecol Obstet 2024; 309:1561-1567. [PMID: 38081959 PMCID: PMC10894107 DOI: 10.1007/s00404-023-07281-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Persistent high-risk HPV infection is associated with an elevated risk for prevalent CIN II + despite normal cytology (NILM). Our study aims to evaluate the clinical relevance of a persistent high-risk HPV infection without cytologic changes in women aged ≥ 65 and to determine the role of colposcopy for triage in these cases. METHODS 211 patients aged ≥ 65 with persistent HPV infection and normal cytology (NILM) who presented for colposcopy at five certified centers between January 2021 and April 2022 were included in the study. Colposcopic findings, HPV subtypes, when available, histology and p16/Ki67 staining were assessed as well as individual risk factors such as smoking and previous HPV-related surgery. RESULTS 87.7% (185/211) of the included women had a type 3 transformation zone. In 83.4% (176/211), a biopsy was taken [thereof 163 endocervical curettages (ECC)]. In 35/211 women (16.6%), sampling was not possible during colposcopy due to an inaccessible cervix, pain during examination or obliteration of the cervical canal. Out of these, 6 women received a diagnostic excision. CIN II + was detected in 10.6% of all histologies (excisional or biopsy) (20/182). 50% of the women with a CIN II + where HPV 16 positive. Taking only the women diagnosed with CIN III or AIS into account, (n = 12) 75% were HPV 16 positive. Interestingly, 80% of the women with CIN II + had an abnormal cytology when repeatedly taken during colposcopy, vice versa an endocervical lesion was diagnosed in 53% of women with abnormal repeat cytology (27/51). CONCLUSION The prevalence of CIN II + in women is ≥ 65 with persistent hr HPV infection but NILM cytology is similar to that in younger women. However, more than 85% of the women have a type 3 transformation zone. Colposcopy is, therefore, not helpful to diagnose the women who need treatment in this age group.
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Affiliation(s)
- E Kuenkel
- Dysplasia Unit Women's Practice Heussweg, Frauenarztpraxis und Dysplasie-Einheit Heussweg, Heussweg 37, 20255, Hamburg, Germany.
| | - A Jaeger
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
| | - I Bohlmann
- Dysplasia Munich, Nymphenburger Str. 77, 80636, Munich, Germany
| | - F Bergauer
- Dysplasia Munich, Nymphenburger Str. 77, 80636, Munich, Germany
| | - C Kuehler-Obbarius
- Dysplasia Unit Women's Practice Heussweg, Frauenarztpraxis und Dysplasie-Einheit Heussweg, Heussweg 37, 20255, Hamburg, Germany
- Cytologylaboratory Dr. Med. Kühler-Obbarius, Fangdieckstr. 75a, 22547, Hamburg, Germany
| | - K Prieske
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
| | - K Maass-Poppenhusen
- Department of Gynecology, University Hospital Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Germany
| | - B Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - L Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Dysplasia Unit at Jerusalem Hospital, Moorkamp 2-6, 20357, Hamburg, Germany
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Kolben TM, Etzel LT, Bergauer F, Hagemann I, Hillemanns P, Repper M, Kaufmann AM, Sotlar K, Kolben T, Helms HJ, Gallwas J, Mahner S, Dannecker C. A randomized trial comparing limited-excision conisation to Large Loop Excision of the Transformation Zone (LLETZ) in cervical dysplasia patients. J Gynecol Oncol 2019; 30:e42. [PMID: 30887760 PMCID: PMC6424847 DOI: 10.3802/jgo.2019.30.e42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/14/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To show noninferiority of a limited-excision (resection of the dysplastic lesion only) vs. classical Large Loop Excision of the Transformation Zone (LLETZ). Methods In this prospective, randomized, multicenter trial, women with human papillomavirus (HPV) positive cervical intraepithelial neoplasia grade 3 were randomized into two groups (1:1). Primary outcome was the rate of negative HPV tests after 6 months, secondary outcomes included cone size, complete resection rates as well as cytological and histological results after 6 and 12 months. A sample size of 1,000 was calculated to show noninferiority of the limited-excision compared to the LLETZ group using a noninferiority margin of 5%. Enrollment was stopped after 100 patients due to slow accrual. Results Patients in the limited-excision group did not show a lower number of negative HPV tests (78% [LLETZ]−80% [limited-excision]=−2%; 90% confidence interval=−15%, 12%). The limited-excision resulted in a substantially lower cone size (LLETZ: 1.97 mL vs. limited-excision: 1.02 mL; p<0.001) but higher numbers of involved margins (LLETZ: 8% vs. limited-excision: 20%). Although postoperative cytological results slightly differed, histological results were similar in both groups. One limited-excision patient received immediate re-conisation, whereas one patient in each group was scheduled for re-conisation after 6 months. Conclusion The limited-excision could represent a promising option to reduce the surgical extent of conisations while maintaining oncological safety. The trial was not sufficiently powered to reach statistical significance due to early termination. Nevertheless, the study provides important insights in the feasibility of a limited-excision and could serve as a pilot study for future trials. Trial Registration German Clinical Trials Register Identifier: DRKS00006169
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Affiliation(s)
- Theresa Maria Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany.
| | - Lea T Etzel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Florian Bergauer
- Amedes MVZ for Gynecology and Pathology Munich GmbH, Munich, Germany
| | | | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | - Monika Repper
- Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany
| | - Andreas M Kaufmann
- Department for Gynecology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Hans Joachim Helms
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Julia Gallwas
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Dannecker
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
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Eggersmann TK, Sharaf K, Baumeister P, Thaler C, Dannecker CJ, Jeschke U, Mahner S, Weyerstahl K, Weyerstahl T, Bergauer F, Gallwas JKS. Prevalence of oral HPV infection in cervical HPV positive women and their sexual partners. Arch Gynecol Obstet 2019; 299:1659-1665. [PMID: 30953186 DOI: 10.1007/s00404-019-05135-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Human papillomavirus (HPV) infection represents the primary cause of anogenital premalignant and malignant disease. Regarding the high prevalence of cervical HPV infection and the increasing incidence of HPV associated oropharyngeal cancer in recent years, a significant viral transmission from the cervical to the oral site, possibly depending on the sexual behavior must be considered. The present study aims to determine the prevalence of oral HPV infection in cervical HPV positive and negative women and their sexual partners. METHODS Cervical HPV positive and negative women and their sexual partners took part in the study. Cervical smears, oral smears and mouthwashes were taken from women attending gynecological outpatient clinics in two different institutions. Further, oral smears as well as mouthwashes of their sexual partners were obtained whenever possible. HPV genotyping was performed using the Cobas® polymerase chain reaction and nucleic acid hybridization assay for the detection of 14 high-risk HPV types. In addition, all participants were invited to complete a personal questionnaire. RESULTS 144 HPV positive and 77 HPV negative women and altogether 157 sexual partners took part in the study. Age, sexual behaviour, medication, smoking and alcohol consumption were distributed equally in both groups. Cervical HPV positive women had a significantly higher number of sexual partners. One woman with a HPV positive cervical smear and one partner of a woman with a HPV positive cervical smear showed an oral HPV infection. No oral HPV infections were detected in the HPV negative control group. The overall incidence of oral HPV infection was 0.5%, the incidence of oral HPV infection in women with a positive cervical smear was 0.7%. CONCLUSION The data demonstrate that the overall risk of an oral HPV infection is low. HPV transmission to the oropharynx by autoinoculation or oral-genital contact constitute a rare and unlikely event.
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Affiliation(s)
- T K Eggersmann
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - K Sharaf
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - P Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - C Thaler
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - C J Dannecker
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - U Jeschke
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - K Weyerstahl
- Faculty of Medicine/Dentistry, Danube Private University, Krems, Austria
| | - T Weyerstahl
- Amedes Medizinisches Versorgungszentrum, Munich, Germany
| | - F Bergauer
- Amedes Medizinisches Versorgungszentrum, Munich, Germany
| | - J K S Gallwas
- Department of Obstetrics and Gynecology and Breast Center, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- Department of Obstetrics and Gynecology, University of Munich, Maistr. 11, 80337, Munich, Germany.
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Bergauer F, Geisler T, Santos M, Afheldt B, Eßer M, Remorini-Niedermayer D, Weyerstahl T. Konservative Therapie der CIN 3 durch lokale Imiquimod-Applikation im Bereich der cervikalen Transformationszone. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671227] [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: 10/28/2022] Open
Affiliation(s)
- F Bergauer
- MVZ für Gynäkologie und Pathologie München, Zertifizierte Gynäkologische Dysplasie-Einheit, München, Deutschland
| | - T Geisler
- amedes MVZ für Pathologie und Laboratoriumsmedizin, Pathologie, Göttingen, Deutschland
| | - M Santos
- MVZ für Gynäkologie und Pathologie München, Zertifizierte Gynäkologische Dysplasie-Einheit, München, Deutschland
| | - B Afheldt
- MVZ für Gynäkologie und Pathologie München, Zertifizierte Gynäkologische Dysplasie-Einheit, München, Deutschland
| | - M Eßer
- MVZ für Gynäkologie und Pathologie München, Zertifizierte Gynäkologische Dysplasie-Einheit, München, Deutschland
| | - D Remorini-Niedermayer
- amedes MVZ für Gynäkologie und Pathologie München, Zentrum für Gynäkologische Zytologie und Dysplasie, München, Deutschland
| | - T Weyerstahl
- amedes MVZ für Gynäkologie und Pathologie München, Zentrum für Gynäkologische Zytologie und Dysplasie, München, Deutschland
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Eggersmann T, Thaler C, Dannecker C, Mahner S, Weyerstahl K, Weyerstahl T, Bergauer F, Gallwas J. Prevalence of oral HPV infection in cervical HPV positive women. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671068] [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: 10/28/2022] Open
Affiliation(s)
- T Eggersmann
- Ludwig Maximilians Universität, Klinik für Frauenheilkunde und Geburtshilfe, München, Deutschland
| | - C Thaler
- Ludwig Maximilians Universität, Klinik für Frauenheilkunde und Geburtshilfe, München, Deutschland
| | - C Dannecker
- Ludwig Maximilians Universität, Klinik für Frauenheilkunde und Geburtshilfe, München, Deutschland
| | - S Mahner
- Ludwig Maximilians Universität, Klinik für Frauenheilkunde und Geburtshilfe, München, Deutschland
| | - K Weyerstahl
- Danube Private University, Fakultät Medizin/Zahnmedizin, Krems, Österreich
| | - T Weyerstahl
- Amedes Medizinisches Versorgungszentrum, München, Deutschland
| | - F Bergauer
- Amedes Medizinisches Versorgungszentrum, München, Deutschland
| | - J Gallwas
- Ludwig Maximilians Universität, Klinik für Frauenheilkunde und Geburtshilfe, München, Deutschland
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Kost BP, Hofmann J, Stoellnberger S, Bergauer F, Blankenstein T, Alba-Alejandre I, Stein A, Stuckart C, Weizsäcker K, Mylonas I, Mahner S, Gingelmaier A. Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations. Oncol Lett 2017; 13:2495-2501. [PMID: 28454426 DOI: 10.3892/ol.2017.5714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/19/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)- and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages.
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Affiliation(s)
- Bernd P Kost
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Jörg Hofmann
- Institute of Medical Virology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Susanne Stoellnberger
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Florian Bergauer
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Thomas Blankenstein
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Irene Alba-Alejandre
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Angela Stein
- Institute of Medical Virology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Claudia Stuckart
- STAT-UP Statistical Consulting and Services, D-80802 Munich, Germany
| | - Katharina Weizsäcker
- Department of Obstetrics and Gynecology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Ioannis Mylonas
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Andrea Gingelmaier
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
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Kolben TM, Bergauer F, Moeckel J, Böttcher B, Thaler C, Crispin A, Kolben T, Dannecker C, Mahner S, Gallwas J. Does a short interval between two pap smears significantly affect the result of the second smear? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593054] [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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Kolben TM, Etzel LT, Noskowicz M, Hillemanns P, Bergauer F, Hagemann I, Kolben T, Gallwas J, Mahner S, Dannecker C. Vergleich zweier operativer Vorgehensweisen im Rahmen der Therapie der CIN III: Klassische LLETZ versus isolierte Resektion der kolposkopisch sichtbaren Läsion – ECO-ROCS Study. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593281] [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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Knabl J, Kainer F, Geiger P, Bergauer F, Riedel C, Friese K, Kirn V. Cervical conisation and the risk of preterm delivery: a retrospective matched pair analysis of a German cohort. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566554] [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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Trummer F, Wiest I, Kirn V, Bergauer F, Kost B, Dian D, Jeschke U. Die Expression des TA-MUC1 in normalem Cervixepithel, Dysplasien und im Cervixkarzinom. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555073] [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: 10/23/2022] Open
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Kirn V, Geiger P, Riedel C, Bergauer F, Friese K, Kainer F, Knabl J. Cervical conisation and the risk of preterm delivery: a retrospective matched pair analysis of a German cohort. Arch Gynecol Obstet 2014; 291:599-603. [PMID: 25234516 DOI: 10.1007/s00404-014-3463-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 03/26/2014] [Accepted: 09/09/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Since the routine screening program for cervical dysplasia by Pap smear was established in the early 1970s, the rate of cervical cancer has continually dropped. Even if a high percentage of cervical dysplasia shows spontaneous restitution, the only effective therapy for persisting cervical dysplasia is local ablation or excision which might be associated with an increased risk of preterm delivery in subsequent pregnancies. However, data from German patients are missing, so the aim of this study was to evaluate the risk of preterm delivery and associated risks in a cohort of patients who had undergone cervical conisation previous to their pregnancies. METHODS A total of 144 patients with conisation and subsequent pregnancy were identified. They were compared regarding week of delivery and preterm birth, fetal birth weight, fetal outcome and birth procedure (spontaneous delivery, vacuum extraction, primary and secondary cesarean section) with their matched partners. RESULTS 135 patients with singleton pregnancies and their matched partners were evaluated in the final analysis. The mean age was 33.5 years. Comparing the case and control group we reached significant different results for week of delivery, but not preterm birth defined as birth prior to 37 weeks of gestation. CONCLUSIONS Within this German cohort cervical conisation did not increase the risk for preterm birth, cesarean section or poor fetal outcome. We therefore conclude that cervical conisation is an appropriate method to treat women with cervical dysplasia also at childbearing age when prevention of cervical cancer is needed.
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Affiliation(s)
- Verena Kirn
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany,
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12
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Kirn V, Thangarajah F, Richters L, Afheldt B, Bergauer F, Engel K, Schmidt-Petruschkat S, Theune M, Patzke J, Einzmann T, Mallmann P. Der „auffällige“ Pap-Abstrich: Belastung und Informationsbedürfnisse betroffener Frauen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388311] [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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13
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Engelstaedter V, Fluegel B, Kunze S, Mayr D, Friese K, Jeschke U, Bergauer F. Expression of the carbohydrate tumour marker Sialyl Lewis A, Sialyl Lewis X, Lewis Y and Thomsen-Friedenreich antigen in normal squamous epithelium of the uterine cervix, cervical dysplasia and cervical cancer. Histol Histopathol 2012; 27:507-14. [PMID: 22374728 DOI: 10.14670/hh-27.507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The carbohydrate molecules Sialyl Lewis X (SLeX), Sialyl Lewis A (SLeA), Lewis Y (LeY) and Thomsen-Friedenreich antigen (TF) are known to mediate the adhesion between tumor cells and endothelium. They are used as serum markers in diagnosis and treatment in a broad spectrum of human carcinomas, but their expression profile and role in the development of cervical cancer remains unclear. The aim of this study was to investigate the expression of SLeX, SLeA, LeY and TF in normal cervical squamous epithelium, cervical dysplasia and cervical cancer. Slides of paraffin-embedded tissue were fixed and incubated with monoclonal antibodies against SLeX, SLeA, LeY and TF. Immunohistochemical staining was evaluated by using a semi-quantitative score (IRS Score). We found a significant difference of SLeA expression in invasive cervical cancer compared to normal epithelium (p=0.006) and all grades of dysplasia (p=0.002). The expression of SLeX in normal epithelium was less intense than in carcinoma in situ (p=0.036). Staining for LeY showed the weakest results of the investigated markers. Significant differences were found when normal epithelium was compared to CIN I (p=0.011), to CIN II (p=0.013) and to invasive cervical cancer (p=0.005). For TF, significant differences were found in normal epithelium compared to CIN I (p=0.011), CIN II (p=0.013) and compared to invasive cervical cancer (p=0.005). This is the first study on the expression of SLeA, SLeX, LeY and TF in normal cervical endothelium, cervical dysplasia, carcinoma in situ and invasive cervical cancer. Further studies and higher numbers are desirable.
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Affiliation(s)
- V Engelstaedter
- Department of Obstetrics and Gynecology, Campus Innenstadt, Munich, Germany.
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14
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Engelstaedter V, Fluegel B, Kunze S, Bergauer F, Mayr D, Jeschke U, Friese K. Die Expression von Sialyl Lewis A, Sialyl Lewis X, Lewis Y und Thomsen-Friedenreich Antigen in zervikalen Dysplasien und invasiven Zervixkarzinomen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278577] [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: 10/18/2022] Open
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Blankenstein T, Jückstock J, Shabani N, Kunze S, Brüning A, Bergauer F, Mylonas I. Immunolabelling of the inhibin/activin-βC subunit in normal and malignant human uterine cervical tissue and cervical cancer cell lines. Oncol Rep 2011; 25:147-152. [PMID: 21109970] [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: 05/30/2023] Open
Abstract
Inhibins are dimeric glycoproteins, composed of an α-subunit and one of two possible β-subunits (βA or βB), with substantial roles in human reproduction and in endocrine-responsive tumours. Recently a novel β subunit named βC was described, although it is still unclear if normal or cancerous cervical epithelial cells as well as cervical cancer cell lines can synthesise the inhibin-βC subunit. Four normal cervical tissue samples together with specimens of well-differentiated squamous cervical cancer and adenocarcinoma of the cervix were immunohistochemically analyzed. Additionally, two cervical carcinoma cell lines (HeLa and CaSKi) were analyzed by immunofluorescence for the expression of this novel subunit. We demonstrated for the first time an immunolabelling of the inhibin-βC subunit in normal and malignant cervical tissue, as well as cervical cancer cells. Although the physiological role is still unclear in cervical tissue, the inhibin-βC subunit might play important roles in carcinogenesis. Moreover, the synthesis of this subunit in cervical carcinoma cell lines of squamous and epithelial origins allows the use of these cell lines in elucidating its functions in cervical pathogenesis.
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Affiliation(s)
- Thomas Blankenstein
- First Department of Obstetrics and Gynaecology, Ludwig-Maximilians-University Munich, Germany
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Jückstock J, Brüning A, Blankenstein T, Kunze S, Shabani N, Bergauer F, Mylonas I. Immunolabeling of the Inhibin-βA and -βB Subunit in Normal and Malignant Human Cervical Tissue and Cervical Cancer Cell Lines. Int J Gynecol Cancer 2010; 20:1117-24. [DOI: 10.1111/igc.0b013e3181ef10aa] [Citation(s) in RCA: 4] [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: 11/29/2022] Open
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Gingelmaier A, Weissenbacher T, Kost B, Kaestner R, Sovric M, Mylonas I, Friese K, Bergauer F. Anal cytology as a screening tool for early detection of anal dysplasia in HIV-infected women. Anticancer Res 2010; 30:1719-1723. [PMID: 20592367] [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: 05/29/2023]
Abstract
BACKGROUND AND AIM HIV-infected patients show a high rate of anal dysplasia and anal carcinoma but there is no gold standard for early detection. Therefore, the objectives of this prospective study were: a) evaluation of an anal screening using anal/perianal cytology; b) in case of a positive result to investigate its relation to immune status, clinical symptoms of HIV infection and antiretroviral therapy. PATIENTS AND METHODS In every HIV-infected woman visiting our gynaecological outpatient clinic, an anal and perianal swab for anal cytology was taken. One experienced cytologist examined all specimens. Relevant details of the HIV-related history such as CDC classification, CD4 count, viral load, actual antiretroviral therapy etc. were documented. RESULTS Altogether, 104 HIV-infected women were enrolled on this study. The results of 13 (13.5%) anal cytologies were classified as suspicious for low-grade or high-grade anal dysplasia and 6 of these were confirmed in an anal biopsy. A total of 9 out of 13 also had a cervical dysplasia and 12 were positive for high-risk HPV at the cervix. Ten of these women had already experienced clinical symptoms of their HIV infection and 8 showed a nadir of the CD4 count below 200 cells/microl. All but one took a highly active antiretroviral therapy. CONCLUSION In this pilot study, anal screening using anal cytology showed 13.5% suspected anal dysplasia in HIV-infected women. All performed biopsies revealed the presence of a high-grade anal lesion. The majority of these women already had an advanced disease and/or immune defect related to their HIV infection. In summary, we found anal cytology to be a useful tool to early detect anal dysplasia of high-risk patients such as HIV-infected women. How far this screening method contributes to the prevention of anal cancer has to be evaluated in further investigations.
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Affiliation(s)
- Andrea Gingelmaier
- Department of Obstetrics and Gynecology, Downtown Campus, Ludwig Maximilians University, Munich, Germany.
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Bergauer F, Brüning A, Shabani N, Blankenstein T, Jückstock J, Dian D, Mylonas I. Inhibin/activin-betaE subunit in normal and malignant human cervical tissue and cervical cancer cell lines. J Mol Histol 2009; 40:353-9. [PMID: 20033758 DOI: 10.1007/s10735-009-9246-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 12/07/2009] [Indexed: 01/08/2023]
Abstract
Inhibins are dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (betaA or betaB), with substantial roles in human reproduction and in endocrine-responsive tumours. Recently a novel beta subunit named betaE was described, although it is still unclear if normal or cancerous cervical epithelial cells as well as cervical cancer cell lines can synthesise the novel inhibin-betaE subunit. About 4 normal cervical tissue samples together with 10 specimens of well-differentiated squamous cervical cancer and adenocarcinoma of the cervix were immunohistochemical analyzed. Additionally, two cervical carcinoma cell lines (HeLa and CaSki) were analyzed by immunofluorescence and RT-PCR for the expression of this novel subunit. We demonstrated for the first time an immunolabelling of the inhibin-betaE subunit in normal and malignant cervical tissue, as well as cervical cancer cells. Although the physiological role is still quite unclear in cervical tissue, inhibin-betaE might play important roles in carcinogenesis. Moreover, the synthesis of this subunit in cervical carcinoma cell lines of squamous and glandular epithelial origins also allows the use of these cell lines in elucidating its functions in cervical cancer pathogenesis. However, since the expression of the inhibin-betaE is minimal in HeLa cells as assessed by immunofluorescence and RT-PCR, the CaSki cell line might be a better model for further functional experiments regarding cervical cancer pathogenesis.
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Affiliation(s)
- Florian Bergauer
- 1st Department of Obstetrics and Gynaecology, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337 Munich, Germany
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Gingelmaier A, Weissenbacher T, Kästner R, Kost B, Friese K, Bergauer F. Anales Dysplasiescreening bei einem Hochrisikokollektiv. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225178] [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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Bergauer F, Spitzauer G, Rost A, Gingelmaier A, Frank A, Niedermeier A. Exfoliativzytologie zur Detektion analer Epitheldysplasien (AIN: Anale intraepitheliale Neoplasie); eine Möglichkeit zur Früherkennung analer Präkanzerosen und zur Abschätzung des Analkarzinomrisikos. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225170] [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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Struthmann L, Günthner-Biller M, Bergauer F, Friese K, Mylonas I. Complete hydatidiform mole in a perimenopausal woman with a subsequent severe thyriotoxicosis. Arch Gynecol Obstet 2008; 279:411-3. [PMID: 18642009 DOI: 10.1007/s00404-008-0734-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Gestational trophoblastic disease is one form of abnormal pregnancy, with a median maternal age of 27-28 years. One complication of trophoblastic disease is the development of a secondary hyperthyroidism, which resolves rapidly after evacuation of the hydatidiform mole. CASE REPORT We report a case of a 53-year-old woman presenting with a complete hydatidiform mole and who developed a severe thyrotoxicosis after suction evacuation of the hydatidiform mole. CONCLUSION A severe thyriotoxicosis can occur even after surgical evacuation of the mole. Therefore, evaluation of the thyroid function prior to operation, especially with a high quantitative hCG, should be performed to avoid severe complications.
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Affiliation(s)
- Lena Struthmann
- First Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistrasse 11, 80337 Munich, Germany
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Gingelmaier A, Grubert T, Kaestner R, Mylonas I, Weissenbacher T, Bergauer F, Barthell L, Friese K. High recurrence rate of cervical dysplasia and persistence of HPV infection in HIV-1-infected women. Anticancer Res 2007; 27:1795-8. [PMID: 17649775] [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: 05/16/2023]
Abstract
AIM A) evaluation of the recurrence of cervical dysplasia after surgical treatment and of the rate of HPV persistence of HIV-infected women and b) the influence of antiretroviral therapy on the recurrence. PATIENTS AND METHODS In a retrospective analysis, the follow-up data of HIV-positive women visiting our outpatient clinic regarding results of cervical cytology, cervical HPV detection, cervical biopsy, patient history of dysplasia and antiretroviral therapy were assessed. A total of 388 HIV-positive women had a mean follow-up of 2.7 years and a median of 2.5 outpatient visits. RESULTS Out of the 344 patients (57.3%) tested for HPV, 197 showed at least one positive HPV result. Of the same group, 136 women had four or more HPV tests which showed that 84 of them (61.8%) had a persistent HPV-infection. Overall, 157/388 had cervical dysplasia and 70 needed surgery. Forty-one of the 70 patients (58.6%) received more than one surgical treatment because of a recurrence, all of this group had persistent HPV. DISCUSSION The recurrence of cervical dysplasia in HIV-positive women after surgical treatment was found to be very high as was the associated long-term persistence of HPV-infection. HPV persistence represented an excellent marker for relapsing cervical dysplasia.
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Affiliation(s)
- Andrea Gingelmaier
- First Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany.
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Frank A, Bergauer F, Gingelmaier A, Günther-Kühne E, Schroeder K, Spitzauer C. Exfoliativzytologie perianal/anal bei Patientinnen mit HIV Infektion oder genitaler Dysplasie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983492] [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: 10/21/2022] Open
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Abstract
Pregnancy, leading to new life, on one hand, and life threatening malignancies an the other hand, are per se diametric subjects. Symptoms of malignancies are ignored more frequently during pregnancy by patients and physicians, often resulting in delayed diagnosis. Diagnosis and treatment of gynaecological malignancies, however, are increasingly important for four reasons: the peak incidence of several malignancies occurs during the reproductive age; late pregnancies present more often in an age group with increased risk for cancer, intensified care for pregnant women leads to more thorough diagnosis, and, curative treatment of malignancies gives women the potential chance for becoming pregnant. For these reasons, special features of the diagnosis and treatment of gynaecological malignancies will regularly part of routine patient care. This review article covers certain practice related features of gynaecological malignancies.
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Affiliation(s)
- W Janni
- I. Frauenklinik Innenstadt, Klinikum der Ludwig-Maximilians-Universtität München.
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Jundt K, Kiening M, Fischer P, Bergauer F, Rauch E, Janni W, Peschers U, Dimpfl T. Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct? Neurourol Urodyn 2005; 24:44-50. [PMID: 15573382 DOI: 10.1002/nau.20080] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/07/2022]
Abstract
AIMS To compare the histomorphology of pelvic floor specimens of 94 female cadavers, ten male cadavers, and 24 female symptomatic patients who underwent pelvic floor surgery, and to evaluate the association of age, parity, and sex to myogenic and/or neurogenic changes to the levator ani muscle (LAM). METHODS The pelvic floor was biopsied at the pubococcygeus, the iliococcygeus and the coccygeus muscle. After staining, signs for myogenic/neurogenic changes to the muscle were evaluated (fibrosis, variation in fiber diameter, centralization of nuclei, small angulated fibers, and type grouping). To identify the intact neuromuscular junction stainings with NCAM (neuronal cell adhesion molecule) and acetylcholinesterase (ACE) were used. RESULTS A significant influence of age and parity on the histomorphological criteria of myogenic cell-damage was shown in this study. Although these criteria were found even in young nulliparous women, there was a significant increase in older or parous women with at least one vaginal delivery. We failed to demonstrate significant changes between the nulliparous LAM, the male LAM, and the LAM from women with prolapse and incontinence. None of the specimen showed any obvious evidence of neuropathy. CONCLUSIONS We have evaluated histological criteria adapted from the examination of limb muscles in the LAM of nulliparous young women. "Myogenic changes" seem to be a normal finding in the LAM. The increase of these changes with aging and parity points to mechanical stress to the LAM as the most plausible causative factor. We propose that further studies using histomorphological techniques of the pelvic floor muscle in nulliparous and parous women should clarify the potential role of our histological findings.
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Affiliation(s)
- Katharina Jundt
- Department of Obstetrics and Gynecology, Maistrasse, Ludwig-Maximilians-Universitaet, Munich, Germany.
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Eisenmann P, Kästner R, Bergauer F, Mayer A, Kainer F, Friese K. Sanfte Wendung bei BEL. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923083] [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: 10/18/2022]
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Röhrle RR, Schießl B, Bergauer F, Kästner R, Kainer F. Schwangerschaftsverlauf nach Notfallzerklage im 2.Trimenon. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818152] [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]
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Röhrle RR, Bergauer F, Kästner R, Arenz S, Kainer F. Mütterliche und kindliche Morbidität nach Notsectio. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818207] [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]
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Janni W, Bergauer F, Kürzl R, Woernle F, Kupka M, Lippmann K, Schindlbeck C, Bechtold I, Friese K. Medizinische Leistungsdokumentation bei der Entbindung unter DRG-Kriterien - aller Anfang ist schwer. Geburtshilfe Frauenheilkd 2003. [DOI: 10.1055/s-2003-42743] [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: 10/27/2022] Open
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Janni W, Rjosk D, Strobl B, Bergauer F, Linka F, Dimpfl T, Schindlbeck C, Rack B, Kaestner R, Sommer H. [Chemotherapy-associated myelosuppression in gynecological oncology]. Gynakol Geburtshilfliche Rundsch 2002; 41:166-73. [PMID: 11904473 DOI: 10.1159/000049471] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE A clinically important myelosuppression due to adjuvant chemotherapy is seen more frequently as dosage is intensified and new drugs are used. The assessment of the cytopenia expected is frequently hampered by a lack of directly comparable data. The aim of this study was to compare - in our own patient population - the chemotherapy-associated myelosuppression of four chemotherapeutic regimens used in gynecological oncology. METHODS 79 patients with primary breast cancer and 26 patients with epithelial ovarian carcinoma underwent cytostatic treatment, and the associated myelosuppression was evaluated by the determination of cytopenia and the need for supportive therapy. The chemotherapy regimens investigated were CMF (cyclophosphamide 600 mg/m(2), methotrexate 40 mg/m(2), 5-fluorouracil 600 mg/m(2), 6xq3w), EC/CMF (epirubicin 90 mg/m(2), cyclophosphamide 600 mg/m(2), 4xq3w, followed by CMF, 3xq3w), DE (docetaxel 75 mg/m(2), epirubicin 90 mg/m(2), 6xq3w) and CC (cyclophosphamide 600 mg/m(2), carboplatin AUC 6, 6xq3w). RESULTS The EC/CMF and DE regimens were used significantly more frequently for more advanced tumor stages, but there were no differences concerning tumor-dependent prechemotherapeutic myelosuppression. Hemopoiesis was most impaired in the CC group with a mean drop of serum hemoglobin of 1.5 g/dl to the end of the cytostatic treatment; correspondingly, most transfusions of concentrated erythrocytes were needed in this group. The strongest suppression of leukopoiesis was found in the DE group, with a mean drop in leukocyte counts of 6.2 x 10(3)/microliter per cycle; in this group, a mean of 7.6 ready-made syringes with 263 microgram Lenogastrim was used to stimulate leukopoiesis. The severest drop in the mean thrombocyte count, i.e. 171.7 x 10(3)/microliter, was found in the CC group. CONCLUSIONS The CC regimen impairs thrombo- and erythropoiesis most, whereas the DE regimen causes marked leukopenia. The regimen with the smallest myelosuppression was CMF. No severe cytopenia-associated complications were detected in any of the cases investigated.
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Affiliation(s)
- W Janni
- 1. Frauenklinik, Klinikum der Ludwig-Maximilians-Universität, München, Deutschland.
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Strobl B, Janni W, Rjosk D, Bergauer F, Kriegel S, Rack B, Sommer H, Dimpfl T. Erfolge und Komplikationen der brusterhaltenden Mammakarzinomtherapie - Ergebnisse einer Langzeitbeobachtung. Geburtshilfe Frauenheilkd 2002. [DOI: 10.1055/s-2002-22111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Janni W, Shabani N, Dimpfl T, Starflinger I, Rjosk D, Peschers U, Bergauer F, Lampe B, Genz T. Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow up. J Cancer Res Clin Oncol 2001; 127:455-62. [PMID: 11469684 DOI: 10.1007/s004320100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 10/27/2022]
Abstract
BACKGROUND Local recurrence remains a major concern after primary treatment of breast cancer and has a major impact on subsequent survival. While most studies report a poorer survival rate in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial whether different risk profiles at the time of primary diagnosis may account for this difference. METHOD Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Matching criteria included the primary surgical treatment, tumor size, nodal status, and age. The significance of various prognostic parameters at the time of primary diagnosis and at the time of recurrence were evaluated, by univariate and multivariate analyses, with respect to survival after recurrence. The median follow-up was 8.4 years. RESULTS Risk factors at the time of presentation, such as tumor size and lymph node status, were comparable between both groups. Local recurrence occurred on an average 9 months earlier in patients after mastectomy (P = 0.08). Univariate analysis showed that lymph node status (P = 0.0001) and disease-free interval from primary treatment to local recurrence (P = 0.0002) were the most significant single prognostic factors for subsequent survival after local recurrence. The primary surgical treatment modality was shown to be of marginal statistical influence (only P = 0.05). CONCLUSION Local recurrence after mastectomy seems to be associated with worse survival than after breast-conserving therapy. Early onset of chest-wall recurrence, moreover, represents the highest independent risk for cancer-associated death.
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Affiliation(s)
- W Janni
- Department of Gynecology and Obstetrics, Klinikum Innenstadt, Ludwig-Maximilians-Universität Muenchen, Germany.
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Janni W, Rjosk D, Dimpfl TH, Haertl K, Strobl B, Hepp F, Hanke A, Bergauer F, Sommer H. Quality of life influenced by primary surgical treatment for stage I-III breast cancer-long-term follow-up of a matched-pair analysis. Ann Surg Oncol 2001; 8:542-8. [PMID: 11456055 DOI: 10.1007/s10434-001-0542-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 11/12/2022]
Abstract
BACKGROUND Breast-conserving therapy has been demonstrated to be just as safe and a less disruptive experience compared with mastectomy for surgically manageable breast cancer. There is, however, no agreement in the literature about the impact of these procedures on several important aspects of quality of life (QOL). The purpose of the present study is to compare the long-term impact of these two surgical approaches on QOL in patients with identical tumor stages and to suggest possible shortcomings of the standard QOL questionnaires. METHOD Between August 1999 and May 2000, QOL questionnaires were answered by 152 pair-matched patients at the I. Frauenklinik, Ludwig-Maximilians University Munich, as part of routine follow-up examinations. The pairs of patients, each consisting of one patient after mastectomy and one after breast conservation, were selected according to the highest degree of equivalence in tumor stage. All patients had been initially treated for stage I-III breast cancer without evidence of distant metastases. The QOL was evaluated by using the QLQ-C30 questionnaire version 2.0 of the EORTC Study Group on Quality of Life. We formulated seven additional questions about the patients' satisfaction with the primary surgical treatment modality as viewed from their current perspective. The QOL questionnaires were answered after a median interval of 46 months following primary treatment. RESULTS Tumor stage, prognostic factors, and adjuvant systemic treatment were well balanced between the two groups. No differences between the two groups were observed in terms of all QOL items measured by the QLQ-C30. Our additional questions, however, revealed that patients in the mastectomy group were less satisfied with the cosmetic result of their primary operation (P < .0001), were more likely to feel basic changes in their appearance (P < .0001), and were more likely to be emotionally stressed by these facts (P < .0001). From their perspective at the time of completing the questionnaires, 11 patients in the mastectomy group (15%) would decide differently about the surgical treatment modality, compared with only 3 patients (4%) in the breast conservation group (P = .025). CONCLUSION While the primary surgical treatment modality seems to have no long-term impact on general QOL, certain body-image-related problems may be caused by mastectomy. Standard measuring instruments for QOL may fail to detect differences in satisfaction and adaptation with the primary surgical treatment modality.
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Affiliation(s)
- W Janni
- Department of Gynecology and Obstetrics, Women's Clinic at Ludwig-Maximilians-University, Munich, Germany.
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Janni W, Dimpfl T, Rjosk D, Strobl B, Bergauer F, Sommer H, Lampe B, Genz T. Prognose des Lokalrezidives beim nodalnegativen Mammakarzinom in Abhängigkeit von der Primäroperation - Langzeitergebnisse einer Matched-Pair-Analyse*. Geburtshilfe Frauenheilkd 2001. [DOI: 10.1055/s-2001-11161] [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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Janni W, Bergauer F, Rjosk D, Lohscheidt K, Hagena FW. [Prospective randomized study comparing the effectiveness and tolerance of various low-molecular-weight heparins in high risk patients]. Zentralbl Chir 2001; 126:32-8. [PMID: 11227291 DOI: 10.1055/s-2001-11725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/17/2022]
Abstract
INTRODUCTION In several studies, low-molecular-weight-heparins (LMWH) have been shown to be as effective in the prevention of deep vein thrombosis (DVT) as unfractionated heparin. However, different LMWHs vary significantly in their pharmacokinetic profile and bioavailability pattern. It remains unknown, whether these pharmacological differences result in a clinically divergent behavior. METHODS Safety and antithrombotic efficacy of three LMWHs, certoparin (18 mg), dalteparin (30 mg) and enoxaparin (24 mg), were compared in a prospective, randomized controlled trial involving 188 patients undergoing knee or hip replacement or spinal surgery. Efficacy was assessed by changes in venous flow patterns between pre- and postoperative Doppler sonography. The clinical endpoint for the assessment of safety were intra- and postoperative bleeding, changes in activated partial thromboplastin time (APTT) and thrombin clotting time (TCT), local hematoma and local infections. RESULTS Two verified DVTs (1.1%) were observed in the study, leading to no statistical difference in the antithrombotic efficacy of the used LMWHs. In 21 patients (11.2%) local hematoma or local infections complicated the postoperative course. Of these 21 patients, 13 belonged to the certoparin group, compared to 4 patients each in the other groups (p < 0.01). An allergic reaction occurred in only one case treated with dalteparin. No differences between the groups were observed in terms of intra- and postoperative bleeding, APTT, TCT and blood count. CONCLUSION The results of this study suggest, that all three LMWHs are equally efficacious in the prophylaxis of DVT in high risk patients after orthopedic surgery. Larger randomized controlled trials are necessary to confirm this conclusion and to evaluate the clinical relevance of the observed differences in postoperative complications.
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Affiliation(s)
- W Janni
- Frauenklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, München.
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Janni W, Dimpfl T, Starflinger L, Rjosk D, Bergauer F, Sigg W, Sommer H, Genz T. Matched pair analysis of survival after local recurrence in breast cancer patients after mastectomy vs. breast conservation: A long-term follow-up. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82782-4] [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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Hirsch A, Weirauch G, Steimer B, Bihler K, Peschers U, Bergauer F, Leib B, Dimpfl T. Treatment of female urinary incontinence with EMG-controlled biofeedback home training. Int Urogynecol J 1999; 10:7-10. [PMID: 10207760 DOI: 10.1007/pl00004015] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
The aim of the study was to evaluate the efficacy of pelvic floor training with EMG-controlled home biofeedback in the treatment of stress and mixed incontinence in women. Subjects were recruited from the urodynamic outpatient clinic and performed pelvic muscle training with an EMG-controlled biofeedback device for 20 minutes daily for 6 months. The number of pads used per day, the number of incontinence and urgency episodes, voiding frequency, maximum urethral closure pressure, functional urethral length and pressure/transmission ratio during stress were assessed before and after treatment. Thirty-three patients (13 with stress and 20 with mixed incontinence) completed the study. There was a significant decrease in the number of pads used per day, the number of incontinence and urgency episodes, and the voiding frequency. Twenty-eight patients (85%) reported that they were cured or improved. Urodynamic parameters did not change significantly. It was concluded that home pelvic floor training with EMG-controlled biofeedback is efficient in 85% of patients in alleviating the symptoms of genuine stress and mixed incontinence without causing side effects.
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Affiliation(s)
- A Hirsch
- Ludwig-Maximilians-Universitaet, Muenchen, Germany
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Sommer H, Bergauer F, Bernasconi H, Buchfelder A. Reanimation bei Anaphylaxie auf Paclitaxel. Geburtshilfe Frauenheilkd 1998. [DOI: 10.1055/s-2007-1022144] [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: 10/21/2022] Open
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Brucker C, Löser C, Bergauer F, Hinrichsen MJ. Einsatz monoklonaler Antikörper gegen SAA-1 in der Diagnostik des sterilen Paares. Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02265969] [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: 11/30/2022]
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