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Thangarajah F, Soff J, Lenz C, Jeschke J, Kössendrup J, Papior D, Hagenbeck C, Kirn V, Scholten N. Care needs and self-induced measures of women with postpartum pelvic floor disorder- Results of a social media-based survey of 2930 women. Arch Gynecol Obstet 2024; 309:1467-1473. [PMID: 38353721 PMCID: PMC10894144 DOI: 10.1007/s00404-024-07369-6] [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: 10/01/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Pelvic floor disorders (PFD) occur in about 40% of women after delivery. Less is known about the intervention and care needs of women with postpartum PFD. The aim of this analysis was to analyze care needs and self-initiated measures to strengthen the pelvic floor in postpartum women in relation to incontinence and sexual dysfunction. Furthermore, influencing factors for self-initiated measures were evaluated. PATIENTS AND METHODS An anonymous online survey (via LimeSurvey) was conducted between September and October 2022 and distributed via social media (Instagram and Facebook). The survey explicitly addressed mothers with and without pelvic floor disorders up to 5 years postpartum (inclusion criteria). Validated instruments were employed to assess incontinence (ICIQ-SF) and sexual functioning (PISQ-IR: Condition Impact). The questions on the use of services and preventive measures, as well as on the interaction with a gynecologist, were based on self-developed items. RESULTS In total, 49.4% of the participants of the survey showed symptoms of urinary incontinence (UI). Furthermore, only 40.3% (n = 241) of women were actively asked by their gynecologists for the occurrence of UI or PFD among those who suffered from PFD. Overall, 79.3% of the participants of the survey with UI underwent measures to deal with the complaints. The ICIQ-SF Score was significantly associated with all self-induced measures. High School diplomas and academic degrees were associated with the use of love balls (p < 0.05). CONCLUSION The results of the study show the unmet needs of postpartum women. PFD should be addressed more frequently in the outpatient setting. Furthermore, more systematic information about the treatment of PFD could help to address unmet information needs and improve interventions.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany.
| | - Johannes Soff
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - Caroline Lenz
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Janice Jeschke
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Jan Kössendrup
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - David Papior
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Verena Kirn
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
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Kirn V, Bors S, Fridrich C, Schumacher C, Thangarajah F. Staging for Breast Cancer: A Comparison Between Old and New Approaches. Cancer Diagn Progn 2023; 3:673-677. [PMID: 37927808 PMCID: PMC10619575 DOI: 10.21873/cdp.10271] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
Background/Aim Staging for breast cancer in advanced stages or prior to neoadjuvant chemotherapy is recommended to be performed with CT scan of the chest and abdomen and a bone scan. This recommendation is valid since 2012, when conventional staging with chest x-ray and ultrasound of the abdomen was replaced by the more sensitive CT scan. However, it remains unclear if this approach improves patient outcome and prognosis. Patients and Methods We identified patients who were treated for breast cancer at the breast center of the St. Elisabeth Hospital, Cologne, in 2012 and 2014. Clinical information such as age at diagnosis, stage, tumor biology, grading, and the applied method for staging was abstracted from the patient chart. We also looked for local or distant recurrence and data of survival. Results A total of 1,122 patients were identified. Of those, 104 patients developed local or distant recurrence and 54 died. Conventional staging with chest x-ray, abdominal ultrasound and a bone scan was more often in 2012 (482 cases) than in 2014 (135), but CT-staging was more often in 2014 (180 vs. 29 cases). In general, less patients were staged in 2014 than in 2012. There were no significant survival differences between the two groups. Conclusion Staging habits changed in 2012 compared to 2014 according to the changes in guidelines. This change did not affect disease-free survival.
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Affiliation(s)
- Verena Kirn
- Medical Faculty of the University of Cologne, Cologne, Germany
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Sarah Bors
- Medical Faculty of the University of Cologne, Cologne, Germany
| | - Claudius Fridrich
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Claudia Schumacher
- Breast Center St. Elisabeth Hospital/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
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Jannes M, König A, Kolben M, Fridrich C, Kirn V. Staging for Breast Cancer: A Nationwide Survey about Adherence to Guidelines in German Breast Centers. Breast Care (Basel) 2022; 17:316-320. [DOI: 10.1159/000521967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction:
The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications for when, whom and how to stage breast cancer patients. Ideally, this should be done via CAT scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey.
Methods:
Between July and September 2020 we sent out a survey via email to all certified and non certified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging and the applied method. In case we did not get back any reply we sent out a reminder.
Results:
A total of 220 certified breast centers/28 non-certified breast center/48 Departments of Gynecology and Obstetrics who care for breast cancer patients took part in our survey. A general pre-therapeutic staging was performed in 16,4%/39,3%/66,7% of all institutions and a general post-operative staging was performed in 4,1%/0%/6,3% of each institutional type, respectively.
In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23,3% primarily use chest x-ray, ultrasound of the abdomen (27,7%) or MRI. As a potential reason for using x-ray and ultrasound the presence of a „low-risk“ breast cancer was mentioned.
Summary:
Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability for primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.
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Vogel C, Malter W, Morgenstern B, Ludwig S, Vehreschild JJ, Hamacher S, Mallmann P, Kirn V, Thangarajah F. The Role of Previous Therapies and Sites of Metastasis as Influencing Factors on Discordance of ER, PR and HER2 Status Between Primary and Metastasized Breast Cancer. Anticancer Res 2019; 39:2647-2659. [PMID: 31092464 DOI: 10.21873/anticanres.13389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/30/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the present study was to analyze metastasized breast cancer (BC) patients with regard to the discordance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). We especially aimed to analyze the association between the change of tumor biology and previous treatment or metastatic sites. PATIENTS AND METHODS Patients with metastasized BC who were treated at the Department of Gynecology/Breast Center of the University Hospital of Cologne were analyzed. RESULTS Loss of HER2 occurred more frequently in lymph node metastases that were not in the axillary region (p=0.026). Letrozole showed a significant correlation with loss of ER and/or PR (p=0.041). Improved overall survival and post-metastasis survival were noticed with a gain of HER2 (p=0.044 and p=0.009, respectively) and concordant positive ER and PR status (p=0.002 and p=0.001, respectively). CONCLUSION The discordance of receptors and the dependence of BC on therapies as well as metastatic sites stresses the necessity of early sample taking to offer patients suitable therapy options.
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Affiliation(s)
- Constanze Vogel
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Jörg Janne Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner-site Bonn-Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Department of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Verena Kirn
- Department of Senology, Heilig Geist Krankenhaus, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
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Malter W, Hellmich M, Badian M, Kirn V, Mallmann P, Krämer S. Factors Predictive of Sentinel Lymph Node Involvement in Primary Breast Cancer. Anticancer Res 2018; 38:3657-3662. [PMID: 29848724 DOI: 10.21873/anticanres.12642] [Citation(s) in RCA: 12] [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: 03/13/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for axillary staging in patients with early-stage breast cancer. The need for therapeutic ALND is the subject of ongoing debate especially after the publication of the ACOSOG Z0011 trial. In a retrospective trial with univariate and multivariate analyses, factors predictive of sentinel lymph node involvement should be analyzed in order to define tumor characteristics of breast cancer patients, where SLNB should not be spared to receive important indicators for adjuvant treatment decisions (e.g. thoracic wall irradiation after mastectomy with or without reconstruction). PATIENTS AND METHODS Between 2006 and 2010, 1,360 patients with primary breast cancer underwent SLNB with/without ALND with evaluation of tumor localization, multicentricity and multifocality, histological subtype, tumor size, grading, lymphovascular invasion (LVI), and estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status. These characteristics were retrospectively analyzed in univariate and multivariate logistic regression models to define significant predictive factors for sentinel lymph node involvement. The multivariate analysis demonstrated that tumor size and LVI (p<0.001) were independent predictive factors for metastatic sentinel lymph node involvement in patients with early-stage breast cancer. CONCLUSION Because of the increased risk for metastatic involvement of axillary sentinel nodes in cases with larger breast cancer or diagnosis of LVI, patients with these breast cancer characteristics should not be spared from SLNB in a clinically node-negative situation in order to avoid false-negative results with a high potential for wrong indication of primary breast reconstruction or wrong non-indication of necessary post-mastectomy radiation therapy. The prognostic impact of avoidance of axillary staging with SLNB is analyzed in the ongoing prospective INSEMA trial.
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Affiliation(s)
- Wolfram Malter
- Breast Center, University Medical Center of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University Medical Center of Cologne, Cologne, Germany
| | - Mayhar Badian
- Western German Breast-Center, DOC Holding GmbH, Düsseldorf, Germany
| | - Verena Kirn
- Breast Center, University Medical Center of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Gynaecology and Obstetrics, University Medical Center of Cologne, Cologne, Germany
| | - Stefan Krämer
- Department of Gynaecology and Obstetrics, Helios Hospital Krefeld, Krefeld, Germany
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Karsten MM, Enders S, Knabl J, Kirn V, Düwell P, Rack B, Blohmer JU, Mayr D, Dian D. Biologic meshes and synthetic meshes in cancer patients: a double-edged sword: differences in production of IL-6 and IL-12 caused by acellular dermal matrices in human immune cells. Arch Gynecol Obstet 2018; 297:1265-1270. [PMID: 29417284 DOI: 10.1007/s00404-018-4710-z] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE In 2005, Breuing et al. first described the use of acellular dermal matrices (ADMs) in breast cancer patients. ADMs are assumed to be safe to use in an oncologic setting, but data from controlled studies are still needed. Here, we investigate the effects of ADMs on the production of interleukin (IL)-6 and IL-12, key regulators of immune suppression and activation. METHODS Strattice (ST), CollaMend (CM), and Biodesign (BD) biologic meshes and TiLoop, a synthetic mesh (TL), were used in this study. We isolated myeloid dendritic cells (MDCs), untouched plasmacytoid dendritic cells (pDCs), naïve B cells, and CD8+ T cells and co-cultured these cells with either the biologic meshes or TL. As positive controls, we used CpG ODN 2216 or lipopolysaccharide (LPS). The cytokine concentrations of IL-12p70 and IL-6 were determined after 7 days using sandwich ELISA sets. RESULTS There were highly significant differences between the ADMs and TL in terms of their ability to stimulate immunologic responses. IL-6 expression was significantly increased in B cells (p = 0.0006131) and T cells (p = 0.00418) when comparing TL and ADMs. We also identified significant differences in IL-12 production by B cells (p = 0.0166) and T cells (p = 0.003636) when comparing TL and ADMs. CONCLUSIONS Despite the assumed lack of an immunological response to ADMs, in our experimental study, human immune cells reacted with significantly different cytokine profiles. These findings may have implications for the potential activation or suppression of effector cells in cancer patients and could explain some of the post clinical post surgical signs of ADMS like skin rush and seroma.
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Affiliation(s)
- Maria Margarete Karsten
- Klinik für Gynäkologie und Brustzentrum, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sabine Enders
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Knabl
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Verena Kirn
- Klinik und Poliklinik für Frauenheilkunde, Universität Köln, Cologne, Germany
| | - Peter Düwell
- Abteilung für klinische Pharmakologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Brigitte Rack
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Doris Mayr
- Abteilung für Pathologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Darius Dian
- Klinik für Frauenheilkunde, Ludwig-Maximilians-Universität München, Munich, Germany
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Todorow V, Rahmeh M, Hofmann S, Kirn V, Mahner S, Jeschke U, von Schönfeldt V. Promotor analysis of ESR1 in endometrial cancer cell lines, endometrial and endometriotic tissue. Arch Gynecol Obstet 2017; 296:269-276. [PMID: 28578502 DOI: 10.1007/s00404-017-4405-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/21/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE The nuclear hormone receptor estrogen receptor α (ERα) is pivotal for numerous processes in the cell. As a transcription factor, it regulates eukaryotic gene expression and affects cellular proliferation and differentiation in target tissues. Moreover, ERα is known for its influence on various gynecological diseases and carcinogenesis. Since its expression is often altered in diseased tissues and this alteration was found to be caused by hypermethylation of the ESR1 promotor region in cancer, including breast and colorectal cancer, the aim of this study is to elucidate if the expression of ERα is also regulated epigenetically in endometriosis and endometrial cancer. METHODS Using real-time methylation-specific PCR (rt-MSP), we examined endometrial and endometriotic tissues as well as five endometrial cancer cell lines and compared the methylation status with the actual expression of ERα. RESULTS The results of our study indicate that, though its expression is altered in endometrial and endometriotic tissue, ERα is not regulated by methylation of the promotor region in endometriosis. In contrast, three of the five endometrial cancer cell lines are methylated in the promotor region of ESR1. CONCLUSIONS Thus, further investigation of the connection between ERα and endometrial cancer will be the next step.
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Affiliation(s)
- Vanessa Todorow
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany
| | - Martina Rahmeh
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany
| | - Simone Hofmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany
| | - Verena Kirn
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Köln, Cologne, Germany
| | - Sven Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany
| | - Udo Jeschke
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany.
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-University, Maistrasse 11, 80377, Munich, Germany.
| | - Viktoria von Schönfeldt
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, Munich, Germany
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Thangarajah F, Enninga I, Malter W, Hamacher S, Markiefka B, Richters L, Krämer S, Mallmann P, Kirn V. A Retrospective Analysis of Ki-67 Index and its Prognostic Significance in Over 800 Primary Breast Cancer Cases. Anticancer Res 2017; 37:1957-1964. [PMID: 28373466 DOI: 10.21873/anticanres.11536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/17/2017] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The Ki-67 index is chiefly important for distinguishing between luminal A and luminal B human epidermal growth factor receptor 2 (HER2neu)-negative breast cancer subtypes. However, its ability to predict response to chemotherapy is uncertain. PATIENTS AND METHODS Patients treated for primary breast cancer at the University Hospital of Cologne were identified. Immunohistochemistry for Ki-67 detection was performed according to standard protocols. Kaplan-Meier survival curves were calculated and compared using the log-rank test. RESULTS Patients with low Ki-67 index had a significantly better disease-free-survival (DFS) than patients with high Ki-67 index (hazard ratio=2.85; 95% confidence interval=1.45-5.59; p=0.002). A significant influence on DFS was demonstrated (hazard ratio(HR)=1.02; confidence interval(CI)=1.00-1.04; p=0.048) within the subgroup of hormone receptor-positive and HER2neu-negative patients, but not within the subgroup of those with luminal B/HER2neu-negative tumors (DFS: p=0.801; overall-survival: p=0.379). CONCLUSION The Ki-67 index has a prognostic impact on DFS in patients with hormone receptor-positive and HER2neu-negative tumors. The strict cut-off value was not suitable for distinguishing between high- and low-risk patients and their response to adjuvant chemotherapy.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Insa Enninga
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Wolfram Malter
- Breast Center, University Hospital of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Birgid Markiefka
- Department of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Lisa Richters
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Stefan Krämer
- Breast Center, Helios Clinic Krefeld, Krefeld, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Verena Kirn
- Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany.,Breast Center, University Hospital of Cologne, Cologne, Germany
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Thangarajah F, Malter W, Hamacher S, Schmidt M, Krämer S, Mallmann P, Kirn V. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67. Breast 2016; 30:87-91. [DOI: 10.1016/j.breast.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
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Strake L, Eischeid H, Koitzsch U, Mallmann P, Büttner R, Fries J, Odenthal M, Kirn V. ESR1-Promotor-Methylierung und ER-Rezeptorexpression beim metastasierenden Mammakarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592814] [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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Baur C, Thangarajah F, Mallmann P, Kirn V. Notfallmäßige Vorstellung im Kreißsaal – klare Diagnose oder maternale Sorge? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593200] [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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Thangarajah F, Scheufen P, Kirn V, Mallmann P. Induction of Labour in Late and Postterm Pregnancies and its Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd 2016; 76:793-798. [PMID: 27582577 DOI: 10.1055/s-0042-107672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION This study aimed to determine the effects of induction of labour in late-term pregnancies on the mode of delivery, maternal and neonatal outcome. METHODS We retrospectively analyzed deliveries between 2000 and 2014 at the University Hospital of Cologne. Women with a pregnancy aged between 41 + 0 to 42 + 6 weeks were included. Those who underwent induction of labour were compared with women who were expectantly managed. Maternal and neonatal outcomes were evaluated. RESULTS 856 patients were included into the study. The rate of cesarean deliveries was significantly higher for the induction of labour group (33.8 vs. 21.1 %, p < 0.001). Aside from the more frequent occurrence of perineal lacerations (induction of labour group vs. expectantly managed group = 38.1 % compared with 26.4 %, p = 0.002) and all types of lacerations (induction of labour group vs. expectantly managed group = 61.5% vs. 52.2 %, p = 0.021) in women with vaginal delivery, there were no significant differences in maternal outcome. Besides, no differences regarding neonatal outcome were observed. CONCLUSIONS Our study suggests that induction of labour in late and postterm pregnancies is associated with a significantly higher cesarean section rate. Other maternal and fetal parameters were not influenced by induction of labour.
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Affiliation(s)
- F Thangarajah
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - P Scheufen
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - V Kirn
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
| | - P Mallmann
- University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
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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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Kirn V, Malter W, Hamacher S, Schmidt M, Markiefka B, Krämer S, Mallmann P. Prädiktoren für den Befall des Sentinel-Lymphknotens bei der operativen Therapie des Mammakarzinoms in der adjuvanten Situation: Radioaktivität und Ki67. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1560015] [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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Thangarajah F, Scheufen P, Kirn V, Mallmann P. Der Einfluss der Geburtseinleitung auf maternale und neonatale Komplikationen bei Patientinnen mit Terminüberschreitung. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1559995] [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, Enninga I, Thangarajah F, Clement L, Richters L, Malter W, Markiefka B, Krämer S, Mallmann P. Der Proliferationsmarker Ki-67 und seine prognostische Bedeutung: Retrospektive Analyse von Mammakarzinom-Patientinnen an der Unifrauenklinik Köln. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1560011] [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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Malter W, Kirn V, Fridrich C, Paul L, Krämer S, Mallmann P. Verbesserung des Durchblutungsmonitorings durch Indocyaningrün (ICG) bei onkoplastischen und ästhetischen Mammaoperationen. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1559999] [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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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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Knabl J, Hiden U, Hüttenbrenner R, Riedel C, Hutter S, Kirn V, Günthner-Biller M, Desoye G, Kainer F, Jeschke U. GDM Alters Expression of Placental Estrogen Receptor α in a Cell Type and Gender-Specific Manner. Reprod Sci 2015; 22:1488-95. [PMID: 25947892 DOI: 10.1177/1933719115585147] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The nuclear receptor estrogen receptor α (ERα) is one of the key players in energy balance, insulin resistance, and trophoblast differentiation. We tested the hypothesis that gestational diabetes mellitus (GDM) alters expression of placental ERα in a cell type-specific manner and that this regulation may involve epigenetic changes. STUDY DESIGN Expression of ERα was analyzed by immunohistochemistry using the semiquantitative immunoreactive score in 80 placentas (40 GDM/40 controls). Quantitative real-time polymerase chain reaction (PCR) measured ERα messenger RNA (mRNA) in decidual tissue. Methylation-specific PCR was performed to analyze cytosine-phosphatidyl-guanine-island methylation of the ERα promoter. RESULTS Expression of ERα protein is upregulated (P = .011) in GDM in extravillous trophoblasts but not in syncytiotrophoblast. Gestational diabetes mellitus downregulated ERα in decidual vessels only in pregnancies with male but not female fetuses. Furthermore, mRNA of the ERα encoding gene estrogen receptor gene 1 (ESR1) was increased (+1.77 fold) in GDM decidua when compared to controls (P = .024). In parallel, the promoter of ESR1 was methylated only in decidua of healthy control individuals but not in GDM. CONCLUSION Gestational diabetes mellitus affects expression of placental ERα in a cell type-dependent way, on epigenetic level. These data link GDM with epigenetic deregulations of ERα expression and open new insights into the intrauterine programming hypothesis of GDM.
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Affiliation(s)
- Julia Knabl
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Klinik Hallerwiese, Department of Obstetrics, Nuremberg, Germany
| | - Ursula Hiden
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | - Rebecca Hüttenbrenner
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany
| | - Christina Riedel
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Institut für Soziale Pädiatrie und Jugendmedizin, Ludwig-Maximilians-Universität München, Munich, Gemany
| | - Stefan Hutter
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany
| | - Verena Kirn
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Margit Günthner-Biller
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | - Franz Kainer
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany Klinik Hallerwiese, Department of Obstetrics, Nuremberg, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, Ludwig Maximilians Universität München, Campus Innenstadt, Munich, Germany
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Malter W, Kirn V, Richters L, Fridrich C, Markiefka B, Bongartz R, Semrau R, Mallmann P, Kraemer S. Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences. Int J Breast Cancer 2014; 2014:637898. [PMID: 25587453 PMCID: PMC4281395 DOI: 10.1155/2014/637898] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 11/12/2014] [Accepted: 11/27/2014] [Indexed: 11/22/2022] Open
Abstract
Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than "tumor not touching ink" leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT) can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy) in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer.
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Affiliation(s)
- Wolfram Malter
- Breast Center, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Verena Kirn
- Breast Center, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Lisa Richters
- Breast Center, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Claudius Fridrich
- Breast Center, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Birgid Markiefka
- Department of Pathology, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Rudolf Bongartz
- Department of Radiotherapy, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Robert Semrau
- Department of Radiotherapy, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynaecology, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
| | - Stefan Kraemer
- Breast Center, University Hospital of Cologne, Kerpenerstrasse 34, 50931 Cologne, Germany
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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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Kirn V, Malter W, Hamacher S, Schmidt M, Markiefka B, Richters L, Fridrich C, Mallmann P, Krämer S. Prädiktoren für den Befall des Sentinel-LK bei der operativen Therapie des Mammakarzinoms: Radioaktivität und Ki67. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388428] [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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23
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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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24
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Malter W, Kirn V, Semrau R, Bongartz R, Markiefka B, Mallmann P, Krämer S. Update of single institution experiences with intraoperative radiotherapy (IORT) in targeted oncoplastic breast surgery. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388456] [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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25
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Krämer S, Malter W, Fridrich C, Kirn V, Richters L, Mallmann P. Targeted oncoplastic breast surgery (TOBS) – classification of breast-conserving techniques. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388429] [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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26
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Knabl J, Hüttenbrenner R, Hutter S, Kirn V, Riedel C, Hofmann S, Kuhn C, Kainer F, Friese K, Jeschke U. Ist die Hochregulation der placentaren Estrogenrezeptoren α im Gestationsdiabetes Folge einer epigenetischen Regulation? Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388060] [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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27
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Kirn V, Shi R, Heublein S, Knabl J, Guenthner-Biller M, Andergassen U, Fridrich C, Malter W, Harder J, Friese K, Mayr D, Jeschke U. Estrogen receptor promoter methylation predicts survival in low-grade ovarian carcinoma patients. J Cancer Res Clin Oncol 2014; 140:1681-7. [DOI: 10.1007/s00432-014-1729-9] [Citation(s) in RCA: 8] [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] [Received: 03/31/2014] [Accepted: 05/30/2014] [Indexed: 11/29/2022]
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Kirn V, Zaharieva I, Heublein S, Thangarajah F, Friese K, Mayr D, Jeschke U. ESR1 promoter methylation in squamous cell cervical cancer. Anticancer Res 2014; 34:723-727. [PMID: 24511005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM Estrogen receptor-alpha is usually expressed in normal cervical tissue, but its presence is decreased or absent in invasive cervical cancer indicating that its expression is lost during development of invasive cervical cancer. The aim of the present study was to investigate ESR1 promoter methylation in cervical cancer and correlate methylation status with clinico-pathological parameters. MATERIALS AND METHODS Fifty patients treated for cervical cancer were included in the study. Isolation and bisulfite treatment of genomic DNA from cervical cancer tissue was performed by commercially-available kits. Methylated ESR1 promoter sequences were detected by quantitative real-time methylation-specific PCR. RESULTS Methylation status did not present differences regarding age at-diagnosis, FIGO stage, grade, BMI and overall survival for all patients, but within the subgroup of non-keratinizing squamous cell cancer methylation status correlated with grading (p=0.047). CONCLUSION Methylation of the ESR1 promoter does not seem to be of any prognostic relevance, but is associated with higher tumor grading of cervical cancer patients.
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Affiliation(s)
- Verena Kirn
- University of Cologne, Department of Obstetrics and Gynecology, Kerpener Str. 34, 50931 Cologne, Germany.
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Tonolini M, Solbiati L, Ierace T, Kirn V, Croce F. Extrahepatic recurrence and second malignancies after treatment of hepatocellular carcinoma: spectrum of imaging findings. Radiol Med 2002; 103:196-205. [PMID: 11976616] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE To describe diagnostic imaging features (with a focus on CT findings) of extrahepatic relapses of treated hepatocellular carcinoma and to propose a post-treatment follow-up protocol. MATERIAL AND METHODS During a six-year span, 226 patients (aged 32-88 years) with chronic hepatitis/cirrhosis were diagnosed as having hepatocellular carcinoma confined to the liver and treated percutaneously with radiofrequency (RF) ablation. A total of 313 treatment sessions were performed. Post-therapeutic follow-up is based upon clinical evaluation, laboratory and imaging (with CT holding the key role) studies. RESULTS Mean duration of follow-up was 17 months. After successful treatment, actuarial probability of neoplastic relapse is 30.7% after 1 year and 58.5% after 2 years. Eighty-eight patients had recurrence of hepatocellular carcinoma after a variable time interval (mean 7.3 months). Extrahepatic neoplastic relapse was observed in 14 patients, half of these without active hepatic disease. Distribution of extrahepatic sites of recurrence was as follows: abdominal lymph nodes (6 cases), bone (3), peritoneum (2), adrenal (2), lung (1). Five patients (2.2%) had a second primary neoplasm. CONCLUSIONS Extrahepatic hepatocellular carcinoma is uncommon and occurs in advanced stages, but may represent a pattern of post-treatment relapse. The distinctive hypervascularity of this tumour histology may be observed in adenopathies and adrenal metastases. Second primary neoplasms should be considered in the differential diagnosis of lesions observed during follow-up.
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Affiliation(s)
- M Tonolini
- Servizio di Radiologia, Ospedale di Circolo, Busto Arsizio (Varese), Italy.
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Ghidini A, Salafia CM, Kirn V, Doria V, Spong CY. Biophysical profile in predicting acute ascending infection in preterm rupture of membranes before 32 weeks. Obstet Gynecol 2000; 96:201-6. [PMID: 10908763 DOI: 10.1016/s0029-7844(00)00908-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the performance of the biophysical profile (BPP) and its components within 24 hours of delivery in predicting histopathologic evidence of severe acute placental inflammation in women with premature rupture of membranes (PROM) before 32 weeks' gestation. METHODS We examined placentas from a series of consecutive, nonanomalous, live-born, singleton infants delivered before 32 weeks' gestation after PROM. In 166 cases, biophysical profiles (BPP) were done within 24 hours of birth. Histologic evidence of acute inflammation was assessed in the maternal (amnion) and fetal (chorionic and umbilical cord vessels) compartments, and scored on a severity scale of 0-4 by a single pathologist masked to clinical data. The presence and severity of acute inflammation was related to BPP results and its individual components. RESULTS The overall prevalence of severe acute inflammation, ie, a score of 3 or 4, was 59% (98 of 166). In 30 (18%) cases it was present in the amnion, in 49 (30%) cases in chorionic or umbilical cord vessels, and in 19 (11%) cases in maternal and fetal compartments. There was no association between abnormal BPP score and presence or absence of severe acute placental inflammation (48% versus 46%, P =.7). Our study had a 90% power to detect a 0.26 difference between them. When rates of abnormal BPP scores were compared in cases with different degrees of acute inflammation in the maternal, fetal, or both compartments, no association was found. When the individual components of the BPP were analyzed in relation to site and severity of acute inflammation, no association was detected. CONCLUSION We did not find evidence of a dose-response relationship between acute placental inflammation and BPP score or its individual components in cases of PROM with infants delivered before 32 weeks. Mediators other than infection might affect BPP in preterm PROM.
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Affiliation(s)
- A Ghidini
- Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, DC 20007, USA.
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Ghidini A, Doria V, Kirn V, Korker V. Successful outcome after antibiotic treatment of postamniocentesis membrane rupture and chorioamnionitis in multiple pregnancy. Am J Perinatol 2000; 16:403-6. [PMID: 10772199 DOI: 10.1055/s-1999-6819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Postamniocentesis chorioamnionitis is usually managed with induction of labor to prevent maternal sepsis and related morbidity and mortality. We report a case of chorioamnionitis in a triplet pregnancy after midtrimester genetic amniocentesis, in which multiple antibiotic treatment (ampicillin 2 g i.v. loading dose followed by 1 g i.v. every 6 hr; clindamycin 900 mg i.v. every 8 hr; gentamicin 120 mg i.v. loading dose followed by 100 mg i.v. every 8 hrs; and erythromycin 500 mg i.v. every 6 hr) for 7 days and delivery of the presumably infected triplet A successfully reversed the clinical symptomatology, allowing prolongation of pregnancy until 26 weeks and survival of the remaining fetuses. At age 2 years, both infants are doing well and are meeting their developmental milestones. The viable outcome of this management strategy suggests that antibiotic treatment and expectancy may be an option in selected cases of postamniocentesis chorioamnionitis in multiple pregnancies.
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Affiliation(s)
- A Ghidini
- Perinatal Diagnostic Center, Inova Alexandria Hospital, Virginia 22304, USA
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