1
|
Paternostro C, Joura EA, Ranftl C, Langthaler EM, Pils S. In-sano-Rate nach ectozervikalem Konus in Abhängigkeit der
Transformationszone und des HPV Stammes. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746163] [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: 10/18/2022] Open
Affiliation(s)
- C Paternostro
- Universitätsklinik für Frauenheilkunde, Medizinischen
Universität Wien
| | - E A Joura
- Universitätsklinik für Frauenheilkunde, Medizinischen
Universität Wien
| | - C Ranftl
- Universitätsklinik für Frauenheilkunde, Medizinischen
Universität Wien
| | - E M Langthaler
- Klinisches Institut für Pathologie, Medizinischen
Universität Wien
| | - S Pils
- Universitätsklinik für Frauenheilkunde, Medizinischen
Universität Wien
| |
Collapse
|
2
|
Moreira ED, Giuliano AR, de Hoon J, Iversen OE, Joura EA, Restrepo J, Van Damme P, Vandermeulen C, Ellison MC, Krick A, Shields C, Heiles B, Luxembourg A. Safety profile of the 9-valent human papillomavirus vaccine: assessment in prior quadrivalent HPV vaccine recipients and in men 16 to 26 years of age. Hum Vaccin Immunother 2017; 14:396-403. [PMID: 29211620 PMCID: PMC5806635 DOI: 10.1080/21645515.2017.1403700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9–26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16–26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.
Collapse
Affiliation(s)
- E D Moreira
- a Centro de Pesquisa Clínica, Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health , Salvador , Bahia , Brazil
| | - A R Giuliano
- b Department of Cancer Epidemiology , Center for Infection Research (CIRC), Moffitt Cancer Center , Tampa , Florida , USA
| | - J de Hoon
- c Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - O-E Iversen
- d Department of Clinical Science , University of Bergen/Womens Clinic, Haukeland University Hospital , Bergen , Norway
| | - E A Joura
- e Department of Gynecology , Comprehensive Cancer Center, Medical University of Vienna , Vienna , Austria
| | - J Restrepo
- f Fundación Centro de Investigación Clínica CIC , Medellín , Colombia
| | - P Van Damme
- g University of Antwerp, Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination , Antwerp , Belgium
| | - C Vandermeulen
- h Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - M C Ellison
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Krick
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - C Shields
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - B Heiles
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Luxembourg
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| |
Collapse
|
3
|
Joura EA, Pils S. Vaccines against human papillomavirus infections: protection against cancer, genital warts or both? Clin Microbiol Infect 2017; 22 Suppl 5:S125-S127. [PMID: 28034371 DOI: 10.1016/j.cmi.2016.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022]
Abstract
Since 2006, three vaccines against infections and disease caused by human papillomavirus (HPV) became available in Europe-in 2006 a quadrivalent HPV 6/11/16/18 vaccine, in 2007 a bivalent HPV 16/18 vaccine and in 2015 a nonavalent HPV 6/11/16/18/31/33/45/52/58 vaccine. HPV 16 and 18 are the most oncogenic HPV strains, causing about 70% of cervical and other HPV-related cancers, HPV 6 and 11 cause 85% of all genital warts. The additional types of the polyvalent vaccine account for about 20% of invasive cervical cancer and >35% of pre-cancer. The potential differences between these vaccines caused some debate. All three vaccines give a robust and long-lasting protection against the strains in the various vaccines. The promise of cross-protection against other types (i.e. HPV 31/33/45) and hence a broader cancer protection was not fulfilled because these observations were confounded by the vaccine efficacy against the vaccine types. Furthermore, cross-protection was not consistent over various studies, not durable and not consistently seen in the real world experience. The protection against disease caused by oncogenic HPV strains was not compromised by the protection against low-risk types causing genital warts. The most effective cancer protection to date can be expected by the nonavalent vaccine, data indicate a 97% efficacy against cervical and vulvovaginal pre-cancer caused by these nine HPV types.
Collapse
Affiliation(s)
- E A Joura
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Centre, Medical University of Vienna, Austria.
| | - S Pils
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Centre, Medical University of Vienna, Austria
| |
Collapse
|
4
|
Pils S, Joura EA. From the monovalent to the nine-valent HPV vaccine. Clin Microbiol Infect 2015; 21:827-33. [PMID: 25980355 DOI: 10.1016/j.cmi.2015.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 03/01/2015] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022]
Abstract
An investigational monovalent human papillomavirus (HPV) 16 virus-like particle vaccine has been shown to prevent persistent infection and cervical disease related to HPV 16 and was proof of concept (2002). Designed to prevent the bulk of invasive cervical cancer, quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccines have been available since 2006 and 2007, respectively. They are highly effective in preventing HPV 16/18-related cervical precancer; the quadrivalent version also prevents genital warts related to HPV 6/11. It has been shown that the precursors of vulvar, vaginal and anal cancer related to the vaccine types are effectively prevented. This led to a paradigm shift from a female-only cervical cancer vaccine to a vaccine for the prevention of HPV-related disease and cancer for both sexes. Vaccination before the start of sexual activity is most effective, and consequently most programs target 9- to 12-year-olds. Additionally, recent studies have proven the noninferior immunoresponse of a two-dose schedule in these age cohorts. Gender-neutral vaccination has become more common; it improves coverage and also provides protection to all males. Recently a nine-valent HPV vaccine (HPV 6/11/16/18/31/33/45/52/58) was licensed; it provides high and consistent protection against infections and diseases related to these types, with ∼90% of cervical and other HPV-related cancers and precancers potentially being avoided. Coverage is key. Efforts must be made to provide HPV vaccination in low-resource countries that lack screening programs. In countries with cervical cancer screening, HPV vaccination will greatly affect screening algorithms.
Collapse
Affiliation(s)
- S Pils
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E A Joura
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
5
|
Joura EA, Sings HL, Haupt RM. Authors' reply to Fiala. Assoc Med J 2012. [DOI: 10.1136/bmj.e3198] [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: 11/04/2022]
|
6
|
Six L, Leodolter S, Sings HL, Barr E, Haupt R, Joura EA. Prävalenz von HPV 6, 11, 16 und 18-Infektionen bei Frauen zwischen dem 16. und 24. Lebensjahr in Österreich. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1239022] [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
|
7
|
Six L, Leodolter S, Sings H, Joura EA. Die Prävalenz einer Infektion mit Humanen Papilloma Viren (HPV) 6, 11, 16, 18 bei jungen Frauen in Österreich – Österreichische Daten einer Phase III Studie zur Testung eines quadrivalenten Impfstoffes. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1078331] [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
|
8
|
Hohlagschwandtner M, Chalubinski K, Nather A, Husslein P, Joura EA. Continuous vs interrupted sutures for single-layer closure of uterine incision at cesarean section. Arch Gynecol Obstet 2003; 268:26-8. [PMID: 12673471 DOI: 10.1007/s00404-002-0308-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2001] [Accepted: 01/07/2002] [Indexed: 11/26/2022]
Abstract
In a non-randomized cohort study, we compared continuous with interrupted sutures for the closure of the lower uterine segment at cesarean section. Eighty-two women, who underwent cesarean section at the Department of Obstetrics at the University Hospital of Vienna between January and May 2000, were included in the study. Thirty-eight patients had single-layer closure of the lower uterine segment and 43 patients had closure with interrupted sutures. There were significant differences in total operating-time (32 min vs 40 min, P=0.001) and in the pre- and postoperative maternal hemoglobin (DeltaHb 0.6 g/dl vs 1.1 g/dl, P<0.01), but there was no significant difference in sonographically diagnosed hematomas (32% vs 21%, P=0.27). No woman had fever, the median hospitalization time was 6 days, and there were no re-admissions. In both groups, the median need for analgesics was 150 mg diclofenac ( P=0.22). Continuous single-layer closure of the lower uterine segment at cesarean section saves operating time, reduces blood loss, and introduces less foreign material into the wound.
Collapse
Affiliation(s)
- M Hohlagschwandtner
- University Hospital of Vienna, Department of Obstetrics and Gynecology, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | | | | | | | | |
Collapse
|
9
|
Janschek EC, Hohlagschwandtner M, Nather A, Schindl M, Joura EA. A study of non-closure of the peritoneum at vaginal hysterectomy. Arch Gynecol Obstet 2003; 267:213-6. [PMID: 12592421 DOI: 10.1007/s00404-002-0330-7] [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] [Received: 01/28/2002] [Accepted: 02/27/2002] [Indexed: 10/25/2022]
Abstract
The aim of this case-controlled study was to determine whether non-closure of the peritoneum is detrimental in vaginal hysterectomy. 233 patients who underwent total vaginal hysterectomy (TVH) or laparoscopically assisted vaginal hysterectomy (LAVH) at the University of Vienna/Austria were analyzed. Cohorts of patients were formed according to their peritonealization status (open, n=117, vs closed peritoneum, n=116) and further stratified according to the type of surgical procedure: simple TVH ( n=115), TVH with concurrent vaginal repair and/or urinary incontinence surgery ( n=91) and LAVH ( n=27). No significant differences could be observed in analyzed surgical outcome (operation time, blood loss and analgesia). Complications (fever, infection, hemorrhage or revision) were similar whether the peritoneum was closed or not. After simple TVH, resumption of bowel function took place earlier in patients with open peritoneum than in those where it had been sutured (1.9 vs 2.4 days, P=0.001). No readmission for prolapse of the vaginal vault was recorded. Non-closure of the peritoneum at vaginal hysterectomy appears to be safe. Omission of peritoneal closure reduces the potential risk of injury and has a beneficial effect on bowel function.
Collapse
Affiliation(s)
- E C Janschek
- Department of Gynecology and Obstetrics, General Hospital of Vienna, Vienna, Austria
| | | | | | | | | |
Collapse
|
10
|
Girardi F, Pickel H, Joura EA, Breitenecker G, Gitsch G, Graf AH, Neunteufel W. [Guidelines for diagnosis and therapy of intraepithelial neoplasia and early invasive carcinoma of the female lower genital system (cervix uteri, vagina, vulva) established by the AGK (Colposcopy Work Group in the OGGG [Austrian Society of Gynecology and Obstetrics])]. Gynakol Geburtshilfliche Rundsch 2002; 41:197-200. [PMID: 11904476 DOI: 10.1159/000049475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F Girardi
- Abteilung für Gynäkologie und Geburtshilfe, A. ö. KH Baden, Osterreich
| | | | | | | | | | | | | |
Collapse
|
11
|
Hohlagschwandtner M, Chalubinski K, Nather A, Husslein P, Joura EA. Sectio caesarea ohne Blasenpräparation: Eine sonographische Nachuntersuchung. Geburtshilfe Frauenheilkd 2002. [DOI: 10.1055/s-2002-22116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
12
|
|
13
|
Abstract
OBJECTIVE To evaluate the effects of not forming a bladder flap at lower-segment cesarean delivery. METHODS A total of 102 women who underwent cesarean delivery were prospectively randomized to one of two groups. In the study group (n = 53), a cesarean was performed without formation of a bladder flap. In the control group (n = 49), cesarean was performed with formation of a bladder flap before the uterine incision. RESULTS There were differences of median skin incision-delivery interval (5 versus 7 minutes, P <.001), median total operating time (35 versus 40 minutes, P =.004), and median blood loss (Delta hemoglobin 0.5 versus 1 g/dL, P =.009) in favor of the study group. Postoperative microhematuria was reduced in the study group (21% versus 47%, P <.01). The median need for analgesics was reduced in the study group (75.0 mg diclofenac versus 150.0 mg, P <.001), and there was a lower percentage of patients receiving analgesics 2 or more days after cesarean in the study group (26.4% versus 55.1%, P =.006). There was no difference in bowel function. CONCLUSION Omission of the bladder flap provides short-term advantages such as reduction of operating time and incision-delivery interval, reduced blood loss, and need for analgesics. Long-term effects remain to be evaluated.
Collapse
Affiliation(s)
- M Hohlagschwandtner
- Department of Obstetrics and Gynecology, University of Vienna (AKH), Vienna, Austria.
| | | | | | | |
Collapse
|
14
|
Gregor H, Sam CE, Reinthaller A, Joura EA. Port site metastases after laparoscopic lymph node staging of cervical carcinoma. J Am Assoc Gynecol Laparosc 2001; 8:591-3. [PMID: 11677343 DOI: 10.1016/s1074-3804(05)60627-5] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The literature revealed only six cases of cervical carcinoma metastatic to a port site after laparoscopic lymphadenectomy. A woman with a poorly differentiated squamous cell carcinoma of the cervix had port site metastases after laparoscopic lymph node staging. The frequency of this event might be higher than expected. Therefore, surgeons should reduce mechanical irritation of port sites and spillage of tumor cells.
Collapse
Affiliation(s)
- H Gregor
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | | | | | | |
Collapse
|
15
|
Bodner-Adler B, Bodner K, Joura EA, Husslein P, Wagenbichler P, Kaider A, Mayerhofer K. Einfluss der unterschiedlichen Geburtspositionen auf mütterliche Geburtsverletzungen und kindliche Parameter während spontaner vaginaler Geburt. Geburtshilfe Frauenheilkd 2001. [DOI: 10.1055/s-2001-18368] [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: 10/17/2022] Open
|
16
|
Birner P, Bachtiary B, Dreier B, Schindl M, Joura EA, Breitenecker G, Oberhuber G. Signal-amplified colorimetric in situ hybridization for assessment of human papillomavirus infection in cervical lesions. Mod Pathol 2001; 14:702-9. [PMID: 11455003 DOI: 10.1038/modpathol.3880375] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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: 11/09/2022]
Abstract
Detection and typing of human papillomavirus (HPV) infection may have a major impact in cervical-screening and follow-up. In this study various commercially available techniques for the detection of HPV were evaluated. HPV-status was determined in 86 samples of cervical cancer by PCR and direct sequencing, catalyzed signal amplified colorimetric DNA in situ hybridization (CSAC- ISH) (GenPoint system, DAKO), immunohistochemistry (IHC) and in 12 selected cases also by conventional, non-amplified ISH. Twenty-one samples of cervical intraepithelial neoplasias grade III (CIN III) were investigated by CSAC-ISH, conventional ISH and by IHC, in corresponding PAP smears HPV-detection and typing was performed by CSAC-ISH and Hybrid Capture test II (HC). In additional 20 PAP smears HPV typing was performed using HC and a novel immunocytochemical system for HPV detection and-typing. CSAC-ISH showed good correlation with PCR analysis in cervical cancers: In 87% of PCR positive cases, HPV infection was also detected by CSAC- ISH (66/76). HPV 16 was detected in 75% of PCR-positive cases (44/59), HPV 18 in 71% of PCR positive cases (5/7). CSAC-ISH detected HPV 31 in only 29% of PCR positive cases (2/7), and HPV 33 in 64% of PCR-positive cases (23/36). Nevertheless, CSAC-ISH- false negative cases for HPV 31 or 33 were nearly always combined infections with other HPV types, which were detectable by CSAC-ISH in most cases. CSAC-ISH revealed HPV infection in 20 of 21 HC-positive cervical smears, while in corresponding biopsies (CIN III) CSAC-ISH detected 100% of HPV infections. Conventional, non-amplified ISH showed significantly lower sensitivity compared with CSAC-ISH, and immunocyto- and -histochemistry were of very low sensitivity for detection of HPV. CSAC-ISH is an easy-to-handle method for detection and typing of cervical HPV infection, and shows sufficient sensitivity for clinical practice.
Collapse
Affiliation(s)
- P Birner
- Institute of Clinical Pathology, Department of Gynecopathology and Cytology, University of Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
17
|
Nather A, Zeisler H, Sam CE, Husslein P, Joura EA. [Non-closure of peritoneum at cesarean section. Results from repeat cesarean sections]. Wien Klin Wochenschr 2001; 113:451-3. [PMID: 11467092] [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: 02/20/2023]
Abstract
OBJECTIVES A number of publications advocate the short-term advantages of peritoneal nonclosure at cesarean section. However, currently there are no hard data available about long-term results and the repeat cesareans. MATERIAL AND METHODS The study group of this retrospective analysis consisted of 30 women who underwent a repeat cesarean delivery, after a previous cesarean without closure of the visceral and parietal peritoneum. The control group (n = 31) had undergone peritoneal closure at the primary operation. All cesareans were performed at the same institution between 04/01/1997 and 12/31/1998 (first operation), and 01/01/1999 and 06/30/2000 (repeat operation). RESULTS The mean operation time was 38.9 (+/- 11.6) minutes in the study group and 44.2 (+/- 13.6) minutes in controls (p = 0.05). The mean incision-delivery time was 6.7 (+/- 3.2) minutes in the study group and 9.1 (+/- 3.9) minutes in controls (p < 0.01). No difference in intraoperative blood loss was observed between the two groups. In each cohort one case with significant intraabdominal adhesions was observed. CONCLUSION Our results indicate that nonclosure of the peritoneum at primary cesarean section does not promote intraabdominal adhesions. This appears to be beneficial for the repeat cesareans.
Collapse
Affiliation(s)
- A Nather
- Universitätsklinik für Frauenheilkunde Wien, Allgemeines Krankenhaus (AKH), Wien, Osterreich
| | | | | | | | | |
Collapse
|
18
|
Lösch A, Joura EA, Stani J, Breitenecker G, Lahodny J. Leiomyosarcoma of the vulva. A case report. J Reprod Med 2001; 46:609-12. [PMID: 11441690] [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: 02/20/2023]
Abstract
BACKGROUND Leiomyosarcoma of the vulva is a rare mesenchymal tumor. Biologic features of a low grade tumor were investigated by an immunohistochemical workup. CASE A 38-year-old woman presented with a slowly growing vulvar mass. Surgical treatment was performed, and a low grade leiomyosarcoma of the vulva was diagnosed. Immunohistochemical reactions were performed with monoclonal antibodies against desmin, vimentin, smooth muscle actin, cytokeratin, S-100 protein, estrogen, progesterone and androgen receptor, p53 protein, Ki-67 antigen, leukocyte common antigen and polyclonal antibodies to factor VIII-related antigen. Expression of estrogen, progesterone and androgen receptor was present in addition to a moderate number of Ki-67-positive cells and absence of p53 protein overexpression and lymphatic cell infiltration besides adequate microvessel density for smooth muscle tumors. Since the immunohistochemical markers indicated a less aggressive tumor, any further adjuvant therapy was rejected. The patient was without recurrence 24 months later. CONCLUSION The immunohistologic profile proved the low histologic grade of vulvar leiomyosarcoma. The findings helped to estimate prognosis and plan therapy.
Collapse
Affiliation(s)
- A Lösch
- Department of Gynecology and Obstetrics, St. Pölten Hospital, St. Pölten, Austria
| | | | | | | | | |
Collapse
|
19
|
|
20
|
Mayerhofer K, Bodner K, Bodner-Adler B, Schindl M, Kaider A, Hefler L, Zeillinger R, Leodolter S, Joura EA, Kainz C. Interleukin-8 serum level shift in patients with ovarian carcinoma undergoing paclitaxel-containing chemotherapy. Cancer 2001; 91:388-93. [PMID: 11180086] [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: 02/18/2023]
Abstract
BACKGROUND Paclitaxel has been described to induce interleukin-8 (IL-8) transcription and secretion in human ovarian carcinoma cells. The objective of this study was to investigate possible clinical implications of the effect of paclitaxel on IL-8 serum levels in patients suffering from ovarian carcinoma. METHODS Thirty-one patients with ovarian carcinoma who were treated with combination chemotherapy consisting of paclitaxel and carboplatin entered the study. IL-8 serum levels and CA 125 serum levels were detected three times for each patient directly before chemotherapy, after three cycles of chemotherapy, and after six cycles of chemotherapy. In addition, serum samples from 59 healthy, age-matched women were obtained. A quantitative human IL-8 immunoassay was used to determine the IL-8 serum levels. RESULTS Seventy-eight percent of patients responded to chemotherapy, with 61% achieving a complete response and 16% achieving a partial response. The median IL-8 serum level before chemotherapy was 75 pg/mL (range, 2.7-903.3 pg/mL), the level during chemotherapy was 23.75 pg/mL (range, 0.5-248.2 pg/mL), and the level after chemotherapy was 17.65 pg/mL (range, 0.6-377.0 pg/mL). The median IL-8 serum level in controls was 15.6 pg/mL (range, 1.4-106.3 pg/mL). The authors found a statistically significant decrease in both IL-8 serum levels (P < 0.05 and P < 0.05) and CA 125 serum levels (P < 0.05 and P < 0.05) from the first to the second measurement and from the first to the third measurement, respectively. They found no correlation between the shifts of IL-8 serum levels and CA 125 serum levels during chemotherapy. CONCLUSIONS The authors found a significant decrease in IL-8 serum levels in patients undergoing a paclitaxel-containing chemotherapy regimen, indicating that IL-8 possibly acts as a useful monitoring marker in patients with ovarian carcinoma.
Collapse
Affiliation(s)
- K Mayerhofer
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Zeisler H, Rabl M, Joura EA, Husslein P. Prenatal Acupuncture and Serum Prostaglandin E2 Levels During the First Stage of Labor. Geburtshilfe Frauenheilkd 2000. [DOI: 10.1055/s-2000-9544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
22
|
Abstract
OBJECTIVE Extrauterine leiomyomas are rare events. These tumors may be easily misdiagnosed as ovarian tumors at the clinical investigation. We present the first case of an otherwise healthy postmenopausal woman, hysterectomized 20 years ago, who developed a preperitoneal lipoleimoyoma in the 30-year-old scar of a Pfannenstiel incision. The patient received continuous hormone replacement therapy (HRT) for 5 years with 1.25 mg conjugated estrogen and 5 mg medrogeston per day. METHODS In sections of the tumor, immunohistochemical reactions with antibodies against actin, desmin, vimentin, estrogen and progesterone receptors and factor VIII related antigen was performed. RESULTS Histologic findings revealed cellular fascicles of spindle-shaped smooth muscle cells in a whorled arrangement. Mitotic figures were absent. Central degenerative changes and focal edema were observed. Between muscle fascicles, a significant amount of fat cells (20% of tumor volume) was visible. Leiomyocytes showed immunohistochemicaly positive reactions with actin, desmin, vimentin, and steroid hormone receptors. Based on these findings, the tumor was diagnosed as lipoleiomyoma. CONCLUSIONS Origin of the tumor of smooth muscle cells of vessels located in the abdominal wall and development under influence of oral steroids seems most probable. HRT appears to promote the development of extrauterine leiomyomas in postmenopausal women.
Collapse
Affiliation(s)
- M Schindl
- Department of Gynecology and Obstetrics, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | | | | | | | | |
Collapse
|
23
|
Sam CE, Rabl M, Joura EA. [Aneurysm of the splenic artery: rupture in pregnancy]. Wien Klin Wochenschr 2000; 112:896-8. [PMID: 11244617] [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: 02/19/2023]
Abstract
The rupture of a splenic artery aneurysm during pregnancy is a rare event. Two thirds of all ruptures happen during the third trimester. We report a case of a patient at 39 weeks of gestation suffering from abdominal pain and fetal distress. At cesarean delivery an aneurysm of the splenic artery was found to be the reason for the hematoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. The patient and her infant survived without further damage. Increased blood flow and changes in the vascular wall put pregnant women at risk for rupture of an aneurysm. In case of acute abdominal pain accompanied by progressive hypotension in a pregnant patient, a rupture of the splenic artery has to be considered. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately.
Collapse
Affiliation(s)
- C E Sam
- Universitätsklinik für Frauenheilkunde Wien, Allgemeines Krankenhaus (AKH), Wien, Osterreich.
| | | | | |
Collapse
|
24
|
Kucera E, Helbich TH, Klem I, Schurz B, Sliutz G, Leodolter S, Joura EA. Systemic methotrexate treatment of interstitial pregnancy--magnetic resonance imaging (MRI) as a valuable tool for monitoring treatment. Wien Klin Wochenschr 2000; 112:772-5. [PMID: 11042907] [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: 02/18/2023]
Abstract
OBJECTIVE Interstitial pregnancy occurs in 2-4% of ectopic pregnancies and is defined as implantation of the trophoblast in the interstitial part of the tuba uterina. Therefore the term intramural pregnancy can also be found in the literature. In 20% of the cases that progress beyond 12 weeks of amenorrhea a potentially life-threatening rupture of the uterus occurs, leading to a maternal mortality rate of 2.5%. According to the literature until a few years ago diagnosis was mainly made intraoperatively, and resulted in cornual resection or hysterectomy per laparotomy. Better methods of diagnosis and treatment of interstitial pregnancy can help to decrease morbidity and mortality associated with this condition. PATIENTS We describe two cases of interstitial pregnancies that were eventually diagnosed and also monitored by magnetic resonance imaging (MRI) after systemic methotrexate treatment. Both patients were uniparous and experienced their second spontaneous pregnancy. METHODS Treatment consisted of four doses (50 mg/m2 body surface area) of systemic intramuscular methotrexate alternating with four doses (6 mg) of intramuscular folic acid. When beta-hCG levels were undetectable, MRI results were compared with pre-therapeutic MRI findings. RESULTS In patients A and B, beta-hCG levels were undetectable 64 and 88 days after initiation of methotrexate treatment, while magnetic resonance imaging revealed nearly equally persisting interstitial pregnancies. They initially presented as hyperintense lesions with hypointense zones and changed into a hypointense lesion with a central hyperintense area for patient A, and a completely hyperintense lesion for patient B at the time of negative beta-hCG levels in follow-up MRI. CONCLUSION Systemic methotrexate treatment with an intramuscular regimen is effective in the treatment of interstitial pregnancy. MRI has the ability of correct tissue differentiation and objective three-dimensional measuring of interstitial pregnancy. We therefore propose this imaging modality as a valuable tool for monitoring systemic methotrexate treatment of interstitial pregnancy that should be used additionally to beta-hCG clearance curves.
Collapse
Affiliation(s)
- E Kucera
- Department of Gynecology and Obstetrics, University of Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
25
|
Joura EA, Lösch A, Haider-Angeler MG, Breitenecker G, Leodolter S. Trends in vulvar neoplasia. Increasing incidence of vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva in young women. J Reprod Med 2000; 45:613-5. [PMID: 10986677] [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: 02/17/2023]
Abstract
OBJECTIVE To determine trends in the epidemiology of vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma (SCC) of the vulva in a Central European sample during the last decade. STUDY DESIGN A total of 366 women with VIN 2 and 3 (n = 128) or vulvar SCC (n = 238) presented within two four-year periods separated by one decade (1985-1988 and 1994-1997). We performed a retrospective analysis of the clinicopathologic records of the cohorts. RESULTS The number of women with high grade VIN (n = 29 vs. 99) tripled during the last decade, while the incidence of vulvar SCC remained stable. In women < or = 50 years old, the incidence of high grade VIN increased by 392% (n = 12 vs. 59) and of invasive vulvar cancer by 157% (n = 7 vs. 18). In the earlier cohort there were 7/126 (5%) women with invasive vulvar SCC under the age of 50 and, in the latter cohort, 18/112 (16%, P < .01). CONCLUSION Over the past decade a striking increase occurred in the incidence of VIN and an increase in invasive vulvar SCC in young women.
Collapse
Affiliation(s)
- E A Joura
- Department of Gynecology and Obstetrics, University of Vienna, Austria.
| | | | | | | | | |
Collapse
|
26
|
Kucera E, Helbich T, Sliutz G, Joura EA. The modern management of interstitial or intramural pregnancy--is MRI and "alloyed" diagnostic gold standard or the real thing? Fertil Steril 2000; 73:1063-4. [PMID: 10866510 DOI: 10.1016/s0015-0282(99)00613-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Zeisler H, Sator MO, Joura EA. Serum levels of progesterone in patients with preeclampsia. Wien Klin Wochenschr 2000; 112:362-4. [PMID: 10849942] [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: 02/16/2023]
Abstract
In a matched pair-study study we investigated the hitherto controversially discussed serum levels of progesterone in 40 women with severe preeclampsia (PE) and 40 normotensive controls. Serum levels were determined by applying a sandwich enzyme-linked immunosorbent assay (ELISA). Median serum levels of progesterone in preeclamptic women and in controls were not statistically significant (P = 0.73). Our study indicates that the absence of altered serum levels of progesterone may not reflect the potential role of this hormone in preeclampsia.
Collapse
Affiliation(s)
- H Zeisler
- Department of Obstetrics and Gynecology, University Hospital of Vienna, General Hospital Vienna, Austria.
| | | | | |
Collapse
|
28
|
Joura EA, Husslein P. Cesarean delivery: bladder flap and use of diathermy. J Reprod Med 2000; 45:363-4. [PMID: 10804499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
|
29
|
Mayerhofer K, Bodner K, Aktas C, Schindl M, Kaider A, Leodolter S, Joura EA, Kainz C. Knowledge of tumor markers and the psychological consequences of tumor marker sampling in patients with gynecologic cancers. Anticancer Res 2000; 20:1281-4. [PMID: 10810435] [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: 02/16/2023]
Abstract
BACKGROUND The aim of this study was to investigate the extent of knowledge about serum tumor markers in patients suffering from gynecologic cancer. MATERIALS AND METHODS 360 women with a median age of 60 years (range: 26-88 years) visiting the oncological outpatient clinic of the Department of Gynecology and Obstetrics of the University of Vienna, between February and July 1998, were asked to complete a self-report questionnaire. RESULTS The majority of patients (85.2%) believed it was important to know about tumor markers and felt safe when they knew the recent level of the tumor marker (71.6%). On the other hand, many patients felt they were insufficiently informed (43%). 88.9% of the patients did not know the recent serum level of the tumor marker. The patients who had been informed by a physician were significantly better informed about tumor markers than women relying on other sources such as nurses, relatives or other patients (p < 0.001). Patients with an age of more than 65 years significantly less frequently knew the meaning of tumor markers (p < 0.001). Fewer women suffering from ovarian cancer were uninformed about tumor markers as compared to women suffering from other malignancies (p < 0.001). CONCLUSION We conclude that the majority of patients in oncological follow-up are interested in tumor markers and want to be informed about these substances. Periodical serum tumor marker sampling is regarded as a safety measure by patients, but information about tumor markers should be improved.
Collapse
Affiliation(s)
- K Mayerhofer
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Rabl M, Gregor H, Sam C, Joura EA. Sectio caesarea: offenes Peritoneum und subfasziales Hämatom - Rectus Sheath Hematoma After Cesarean Section With Nonclosure of the Peritoneum: A Case Report -. Geburtshilfe Frauenheilkd 2000. [DOI: 10.1055/s-2000-9530] [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
|
31
|
|
32
|
Schulz-Lobmeyr I, Zeisler H, Pateisky N, Husslein P, Joura EA. Die Kristeller-Technik: Eine prospektive Untersuchung. Geburtshilfe Frauenheilkd 1999. [DOI: 10.1055/s-1999-5984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
33
|
Jones RW, Joura EA. Analyzing prior clinical events at presentation in 102 women with vulvar carcinoma. Evidence of diagnostic delays. J Reprod Med 1999; 44:766-8. [PMID: 10509298] [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: 02/14/2023]
Abstract
OBJECTIVE To evaluate the clinical events preceding the diagnosis of squamous cell carcinoma of the vulva. STUDY DESIGN One hundred two women presenting with squamous cell carcinoma of the vulva to a gynecologic oncology unit between 1989 and 1996 were prospectively evaluated by a single investigator. History, clinical findings, previous physician contact, investigations and treatment were analyzed. RESULTS Vulvar symptoms were present for more than six months in 88% and for more than five years in 28% of women. Eighty-five percent of patients had clinical evidence of abnormal skin adjacent to the cancer. Thirty-one percent of women had three or more medical consultations for vulvar symptoms prior to the diagnosis of cancer. Twenty-five percent of women had had a previous diagnostic vulvar biopsy, and 27% gave a history of having applied topical estrogen or corticosteroid to the vulva. Patients with a history of a preceding biopsy were more likely to present with stage 1 disease. CONCLUSION Avoidable factors appear to be present in many women who present with vulvar cancer. A more active approach to the diagnosis and management of precursor lesions may often prevent the development of vulvar cancer.
Collapse
Affiliation(s)
- R W Jones
- Department of Gynaecologic Oncology, National Women's Hospital, Auckland, New Zealand
| | | |
Collapse
|
34
|
Sator MO, Wieser F, Gruber DM, Joura EA, Huber JC. Trends in the prescription of psychotropic drugs and hormone substitutes in Austria. Wien Klin Wochenschr 1999; 111:402-5. [PMID: 10413833] [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: 02/13/2023]
Abstract
INTRODUCTION Psychological instability as a result of changing hormone levels are commonly observed during menopause. We examined the question whether the prescription of psychotropic drugs is related to age or gender and whether the increase in the prescription rate of hormone substitutes has an impact on this phenomenon. METHODS Age and gender-specific prescription rates of psychotropic drugs and hormone substitutes were examined in a retrospective study using data of the European Pharmaceutical Market Research Association of Austria. The relevant Austrian figures were established on the basis of representative samples. RESULTS There are no gender-specific differences in terms of prescription frequency up to the age of 45 years. After the age of 45, there is a significant increase in the prescription of psychotropic drugs for women. When comparing the years 1991 and 1996, we find a reduction in the number of prescriptions of psychotropic drugs and an increase in the prescription rate of hormone replacement drugs. DISCUSSION An increase in the prescription rate of hormone substitutes may contribute to the psychological stabilisation of menopausal women and thereby reduce the need for psychotropic drugs.
Collapse
Affiliation(s)
- M O Sator
- Division of Gynecological Endocrinology & Reproductive Medicine, University of Vienna, Austria.
| | | | | | | | | |
Collapse
|
35
|
Sator MO, Joura EA, Gruber DM, Obruca A, Zeisler H, Egarter C, Huber JC. Non-invasive detection of alterations of the carotid artery in pregnant women with high-frequency ultrasound. Ultrasound Obstet Gynecol 1999; 13:260-262. [PMID: 10341404 DOI: 10.1046/j.1469-0705.1999.13040260.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare the thickness of the layers of the carotid artery wall in pregnant and fertile non-pregnant women. DESIGN Prospective cross-sectional study. SUBJECTS Fifty-one pregnant women at a mean gestational age of 38.9 weeks and 64 fertile non-pregnant women were examined at a University hospital. METHODS The three layers (adventitia, media, intima) of the superficial wall of the left common carotid artery were identified and measured with high-resolution ultrasound (22.5 MHz). RESULTS Pregnant women had a thinner intima layer (0.25 +/- 0.07/0.29 +/- 0.08 mm) and a thicker media layer (0.31 +/- 0.08/0.27 +/- 0.09 mm) compared with controls. A statistically significantly higher intima/media ratio was calculated for the pregnant women (1.14 +/- 0.03), compared with the non-pregnant women (0.88 +/- 0.04). CONCLUSION There are differences in the thickness of the histological layers of the carotid artery wall in pregnant compared with non-pregnant women. This is likely to be due to the effect of different estradiol levels in these two groups.
Collapse
Affiliation(s)
- M O Sator
- Division of Gynecological Endocrinology and Reproductive Medicine, University of Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
36
|
Kohlberger PD, Joura EA, Bancher D, Gitsch G, Breitenecker G, Kieback DG. Evidence of androgen receptor expression in lichen sclerosus: an immunohistochemical study. J Soc Gynecol Investig 1998; 5:331-3. [PMID: 9824815 DOI: 10.1016/s1071-5576(98)00033-1] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE While topical androgen administration is widely used in the treatment of lichen sclerosus of the vulva, localization and level of expression of androgen receptor (AR) have not been described previously. METHODS Thirty-nine paraffin-embedded punch biopsies of patients with lichen sclerosus of the vulva were examined. Androgen receptor, estrogen receptor (ER), and progesterone receptor (PR) expression in lichen sclerosus and in normal vulvar skin were investigated by immunohistochemistry. RESULTS Five tissue specimens (12.8%) of lichen sclerosus showed nuclear staining with anti-AR in the parabasal cell layers of the epidermis. Median age of patients with positive nuclear staining for AR versus women without AR expression was 71 (range, 63-78) and 66.5 (range, 38-91) years, respectively. Estrogen receptor expression was present in only one patient. Nuclear staining reaction for PR expression was absent in all cases. Four of the five AR-positive women reported no complaints and therefore received no topical testosterone therapy. CONCLUSION Our results suggest a lack of complaints in AR-positive lichen sclerosus patients. Our findings could justify a larger study comparing symptoms of patients with and without AR expression.
Collapse
Affiliation(s)
- P D Kohlberger
- Department of Obstetrics and Gynecology, Freiburg University Medical Center, Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Sator MO, Joura EA, Gruber DM, Wieser F, Jirecek S, Tschugguel W, Huber JC. The effect of hormone replacement therapy on carotid arteries: measurement with a high frequency ultrasound system. Maturitas 1998; 30:63-8. [PMID: 9819785 DOI: 10.1016/s0378-5122(98)00036-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effect of hormone replacement therapy (HRT) on carotid arteries in postmenopausal women with a high frequency ultrasound system. METHODS In a clinical cross-sectional study carotid artery layers were measured in 82 postmenopausal women receiving a sequential regimen of HRT (oestradiol valerate 2 mg and dydrogesterone 10 mg) and in 70 postmenopausal women without HRT. Measurements of the left carotid artery layers (externa, media, intima) were taken with a single mechanically activated 22.5-MHz transducer with an effective band width of 8 MHz. RESULTS A statistically significant increase in thickness of the media layer of the carotid artery was observed in the HRT group (0.34 +/- 0.06 mm) as compared to the untreated group (0.27 +/- 0.03 mm). The media/intima ratio of the treated group was statistically significantly higher than that of the untreated group (P < 0.05). The mean strength of the carotid wall was 0.70 +/- 0.17 mm in the 70 postmenopausal women without HRT and 0.76 +/- 0.24 mm in the 82 patients undergoing HRT. CONCLUSION HRT has a morphological effect on the carotid arteries in postmenopausal women. These findings support a cardioprotective effect, especially in terms of prevention of atherosclerosis. This effect can be measured non-invasively by high frequency ultrasound.
Collapse
Affiliation(s)
- M O Sator
- Department of Obstetrics and Gynecology, University Hospital of Vienna, Medical School, Austria
| | | | | | | | | | | | | |
Collapse
|
38
|
Joura EA, Zeisler H, Lösch A, Sator MO, Müllauer-Ertl S. Differentiating vulvar intraepithelial neoplasia from nonneoplastic epithelial disorders. The toluidine blue test. J Reprod Med 1998; 43:671-4. [PMID: 9749417] [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: 02/08/2023]
Abstract
OBJECTIVE To determine the effectiveness of the toluidine blue test in the differentiation of vulvar intraepithelial neoplasia (VIN) and nonneoplastic epithelial disorders (NNEDs). STUDY DESIGN This retrospective clinical study included all women with VIN (n = 24) and NNED (n = 72) referred to a vulvar clinic at a university hospital during a two-year period. Vulvoscopy, staining of vulvar epithelium with 1% toluidine blue and punch biopsy were performed. RESULTS Vulvar epithelium demonstrated toluidine blue staining in 100% of the patients with VIN 3, in 83% of women with VIN 1-2, in 50% of the women with squamous cell hyperplasia and in 10% of the women with lichen sclerosus. The differences in staining between the groups were statistically significant (P < .001). The sensitivity of toluidine blue staining for the detection of VIN was 92%; the negative predictive value 96% in teh investigated cohort. The specificity for strong staining was 88%. CONCLUSION The toluidine blue test is an inexpensive and reliable method of separating VIN from hyperplastic NNED areas and choosing a biopsy site on the vulva.
Collapse
Affiliation(s)
- E A Joura
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Allgemeines Krankenhaus, Vienna, Austria
| | | | | | | | | |
Collapse
|
39
|
Lösch A, Tempfer C, Kohlberger P, Joura EA, Denk M, Zajic B, Breitenecker G, Kainz C. Prognostic value of cathepsin D expression and association with histomorphological subtypes in breast cancer. Br J Cancer 1998; 78:205-9. [PMID: 9683294 PMCID: PMC2062888 DOI: 10.1038/bjc.1998.465] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study investigated the prognostic value of immunohistochemically detected cathepsin D expression in 103 invasive ductal carcinomas of the breast at stages pT1 and 2. We also assessed the association between cathepsin D expression and histomorphological tumour subtypes (invasive ductal carcinoma with extensive intraductal component, multifocal tumour). Cathepsin D expression was examined at two cut-off levels (positive and highly positive) and separately identified within the epithelial and stromal component of all tumours. Positive and highly positive epithelial expression was detected in 32 (31.1%) and 20 (19.4%) patients respectively. Stromal expression was found in 35 (34%) and 19 (18.4%) cases respectively. Epithelial cathepsin D expression was associated with stage and nuclear grade, but not with lymph node or oestrogen receptor status. Positive and highly positive epithelial cathepsin D expression showed significant prognostic value for overall survival (P = 0.003 and 0.01) and recurrence-free interval (P = 0.04 and 0.02). Cathepsin D expression in stromal cells was not associated with either several established prognostic factors or survival. Multivariate analysis revealed that cathepsin D expression failed to be an independent predictor of patients' outcome. Cathepsin D expression shows no significant association with histomorphological subtypes of breast cancer. Our study supports the prognostic impact of immunohistochemically detected cathepsin D expression in the epithelial component of breast cancer.
Collapse
Affiliation(s)
- A Lösch
- Gynaecopathological Unit, Institute of Pathology, University of Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Gruber DM, Sator MO, Kirchengast S, Joura EA, Huber JC. Effect of percutaneous androgen replacement therapy on body composition and body weight in postmenopausal women. Maturitas 1998; 29:253-9. [PMID: 9699197 DOI: 10.1016/s0378-5122(98)00031-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was carried out to assess the effect of topical androgen replacement therapy on body weight, body composition and fat distribution in postmenopausal women. METHODS 39 healthy postmenopausal women (51.4 +/- 2.24 years), with increasing body weight, were prospectively studied for 6 months. Body composition (fat mass, kg, %) was measured by means of dual-energy X-ray absorptiometry (DXA). Hormonal and lipid parameters were also measured. Subjects were divided into two groups. An androgen gel (group A) or placebo gel (group P) was topically administered to the abdominal and gluteo-femoral regions. DXA was performed before commencement of topical treatment and after 6 months. RESULTS A highly significant total body weight reduction was found in group A (68.0 +/- 13.1 to 65.4 +/- 11.8 kg). Abdominal fat (37.3 +/- 11.2 to 35.1 +/- 9.7%), gluteo-femoral fat (46.3 +/- 6.6 to 45.4 +/- 7.7%), total body fat (38.2 +/- 7.9 to 36.1 +/- 8.6%) and BMI (24.8 +/- 4.3 to 23.7 +/- 3.8) were also found to have decreased significantly in this group. No significant reduction in body weight (kg) and body fat (%) could be measured in the placebo group. No influence on lipid parameters was found although total testosterone increased significantly in group A (0.29 +/- 0.24 to 0.72 +/- 0.17 ng/ml). CONCLUSIONS Topically applied androgen is capable of reducing abdominal fat accumulations as well as total body weight in postmenopausal women with unexplained weight gain. In contrast to systemic androgen application, topical administration has no effect on the lipid profile. Gluteal fat, however, is less effectively influenced by androgens.
Collapse
Affiliation(s)
- D M Gruber
- Department of Gynecological Endocrinology and Reproductive Medicine, University of Vienna, Wien, Austria.
| | | | | | | | | |
Collapse
|
41
|
Sator MO, Akramian J, Joura EA, Nessmann A, Wedrich A, Gruber D, Metka M, Huber JC. Reduction of intraocular pressure in a glaucoma patient undergoing hormone replacement therapy. Maturitas 1998; 29:93-5. [PMID: 9643522 DOI: 10.1016/s0378-5122(97)00091-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [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: 02/07/2023]
Abstract
OBJECTIVES To show the reducing effect of estrogens and progestins on the elevated intraocular pressure (IOP) in the case of a 56-year-old woman showing typical climacteric complaints, who was admitted to the menopause outpatient unit. She also suffered from a primary open-angle glaucoma treated with betaophtiole eye drops with intraocular pressures of 16-20 mmHg under this local therapy. METHODS IOP patterns were monitored by means of standardised daily pressure profiles four times a day before as well as 4 and 12 weeks after the beginning of hormone replacement therapy (HRT). The local glaucoma therapy remained unchanged. RESULTS During HRT, IOP levels were reduced from 16-20 mmHg before therapy to 12-15 mmHg at week 4 and to 13-15 mmHg at week 12 after the beginning of HRT. CONCLUSION The finding of a close chronological relationship between the onset of menopause and the development of a glaucoma is a potentially new indication for HRT.
Collapse
Affiliation(s)
- M O Sator
- Department of Obstetrics and Gynecology, General Hospital, University of Vienna, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Interleukin-1 (IL-1) is a multifunctional cytokine playing a central role in the immune response and displaying direct cytotoxic activity in vitro. Serum IL-1 alpha and beta levels were measured by enzyme linked immunosorbent assay (ELISA) in 75 ovarian cancer patients, 30 patients with benign ovarian cysts and 50 healthy controls. Both serum IL-1 alpha and IL-1 beta levels were more often elevated in ovarian cancer patients compared with healthy controls (chi-square test, P < 0.001 and P < 0.001, respectively). Mean serum IL-1 alpha and beta levels decreased significantly after surgical intervention (paired t-test, P = 0.0001 and P = 0.0002, respectively). No correlation with histopathological parameters and overall and disease-free survival was found. These preliminary results indicate that serum levels of IL-1 alpha and beta represent a host defence reaction rather than an autonomous tumour cell production.
Collapse
Affiliation(s)
- H Zeisler
- Department of Gynaecology and Obstetrics, University of Vienna Medical School, General Hospital Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
43
|
Zeisler H, Mayerhofer K, Joura EA, Bancher-Todesca D, Kainz C, Breitenecker G, Reinthaller A. Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature. Gynecol Oncol 1998; 69:78-83. [PMID: 9571003 DOI: 10.1006/gyno.1998.4962] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [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: 11/22/2022]
Abstract
Embryonal rhabdomyosarcoma (RMS) of the female genital tract usually occurs during childhood in the vagina. In rare cases, RMS can originate in the uterine cervix, with a peak incidence in the second decade. A combined modality approach to treating RMS using multidrug chemotherapy, radiotherapy, and surgery has markedly improved survival. Early stage embryonal RMS of the cervix has been found to have an excellent prognosis. The present case and literature review indicate that extensive surgery does not improve survival in patients with stage I disease.
Collapse
Affiliation(s)
- H Zeisler
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Austria
| | | | | | | | | | | | | |
Collapse
|
44
|
Gruber DM, Sator MO, Joura EA, Kokoschka EM, Heinze G, Huber JC. Topical cyproterone acetate treatment in women with acne: a placebo-controlled trial. Arch Dermatol 1998; 134:459-63. [PMID: 9554298 DOI: 10.1001/archderm.134.4.459] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the clinical and hormonal response of topically applied cyproterone acetate, oral cyproterone acetate, and placebo lotion in women with acne. DESIGN Placebo-controlled, randomized study. SETTING Patients were recruited from the Institute of Endocrine Cosmetics, Vienna, Austria. PATIENTS Forty women with acne. INTERVENTIONS Treatment with oral medication consisting of 0.035 mg of ethinyl estradiol and 2 mg of cyproterone acetate (n=12), 20 mg of topical cyproterone acetate lotion (n=12), and placebo lotion (n=16) was offered. Patients were assessed monthly for 3 months. MAIN OUTCOME MEASURES Clinical grading according to acne severity and lesion counts as well as determinations of serum cyproterone acetate concentrations. RESULTS After 3 months of therapy with topical cyproterone acetate, the decrease of mean facial acne grade from 1.57 to 0.67 was significantly better (P<.05) compared with placebo (which showed a change from 1.57 to 1.25), but not compared with oral medication (1.56 to 0.75) (P>.05). Lesion counts also decreased from 35.9 to 9.1 in the topical cyproterone acetate group compared with oral medication (45.4 to 15.5) (P>.05) and placebo (38.2 to 23.1) (P<.05). After topical cyproterone acetate treatment, serum cyproterone acetate concentrations were 10 times lower than those found after oral cyproterone acetate intake. CONCLUSIONS The therapeutic effect of topically applied cyproterone acetate for acne treatment was clearly demonstrated. Topically applied sexual steroids in combination with liposomes are as effective as oral antiandrogen medication in acne treatment, while reducing the risk of adverse effects and avoiding high serum cyproterone acetate concentrations.
Collapse
Affiliation(s)
- D M Gruber
- Division of Gynecological Endocrinology and Reproductive Medicine, General Hospital, University of Vienna, Wien, Austria.
| | | | | | | | | | | |
Collapse
|
45
|
Joura EA, Zeisler H, Sator MO. [Epidemiology and clinical value of true umbilical cord knots]. Wien Klin Wochenschr 1998; 110:232-5. [PMID: 9586149] [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: 02/07/2023]
Abstract
OBJECTIVE To evaluate the epidemiology of true knots of the umbilical cord and their impact on pregnancy outcome. MATERIALS AND METHODS 22531 singleton deliveries were included in this retrospective study (1976-1994). Newborns with malformations were excluded. The database of the 2nd Department of Obstetrics and Gynaecology, Vienna University Hospital was analyzed. RESULTS The incidence of true knots was 1.27% (n = 286). Multiparous women are more likely to give birth to a child with a true knot of the umbilical cord than primiparae (1.52% vs. 1.01%, P < 0.001). Male fetuses are more frequently affected than females (1.49% vs. 1.04%, P = 0.01). Duration of pregnancy, fetal weight, presentation and mode of delivery are not significantly influenced by umbilical knots. Fetal acidosis (pH < 7.10) was more common in the cohort with true knots as compared with the controls (8.33% vs. 4.03%, P < 0.01). Apgar score and transfer rate to a neonatal unit were not influenced. Still-births were more common in the cohort with umbilical knots (1.7% vs. 0.6%, P < 0.05); there was no neonatal death in the cohort with true knots, however. CONCLUSION A fetus with a true knot of the umbilical cord is at risk for fetal death. During labour umbilical knots have no adverse effect on pregnancy outcome.
Collapse
Affiliation(s)
- E A Joura
- Universitätsklinik für Frauenheilkunde Wien, Allgemeines Krankenhaus, Osterreich
| | | | | |
Collapse
|
46
|
Sator MO, Joura EA, Golaszewski T, Gruber D, Frigo P, Metka M, Hommer A, Huber JC. Treatment of menopausal keratoconjunctivitis sicca with topical oestradiol. Br J Obstet Gynaecol 1998; 105:100-2. [PMID: 9442170 DOI: 10.1111/j.1471-0528.1998.tb09358.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effect of 17 beta-oestradiol ophthalmic drops in comparison with a traditional tear substitute in postmenopausal women with keratoconjunctivitis sicca. DESIGN Randomised prospective trial. SETTING Menopause clinic. PARTICIPANTS Eighty-four postmenopausal women suffering from keratoconjunctivitis sicca and necessitating a hormone replacement therapy (HRT) for general climacteric symptoms. METHODS The women were randomised into two groups and were given 17 beta-oestradiol eye drops (n = 42, group 1) or a tear substitute (n = 42, group 2). Both groups received a systemic HRT. MAIN OUTCOME MEASURES A Schirmer's test was performed immediately before the beginning of therapy and after four months. In addition, eye symptoms were assessed using a visual analogue scale. RESULTS A comparison of visual analogue scores at four months in the women who received 17 beta-oestradiol eye drops versus those who received a tear substitute demonstrated a statistically significant difference in all observed ocular symptoms (P < 0.0001). The Schirmer's test revealed a significant difference of results before and after treatment in the oestradiol group (P < 0.0001) while in group 2 no significant difference was found. CONCLUSIONS Our study demonstrates that topical oestrogen is successful in treating keratoconjunctivitis sicca while it seems that the blood-eye barrier prevents systemic oestrogens from acting on the conjunctivae.
Collapse
Affiliation(s)
- M O Sator
- Department of Obstetrics and Gynaecology, University of Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Joura EA, Sator MO, Geusau A, Zeisler H, Söregi G, Huber JC. [The clinical value of 3 alpha-androstanediol-glucuronide in hirsute women]. Wien Klin Wochenschr 1997; 109:919-21. [PMID: 9487606] [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: 02/06/2023]
Abstract
Aim of this prospective diagnostic study was to determine the serum 3 alpha-androstanediol-glucuronide (AdiolG) level in hirsute women in order to assess the androgenic activity in peripheral tissue and to differentiate between hirsutism of peripheral origin and that of adrenal or ovarian origin. Diagnostic advantages might have been expected in patients with idiopathic hirsutism, in whom increased 5 alpha-reductase activity may be reflected by this parameter. Apart from serum AdiolG, we determined the established parameters testosterone, androstendione and dehydroepiandosterone sulfate in 63 hirsute premenopausal women and in 51 non-hirsute controls. AdiolG (P < 0.05), as well as the 3 established parameters (P < 0.001) were elevated in the hirsute women as compared with the controls; however, the subgroup of women with idiopathic hirsutism (n = 32) showed no elevation of serum AdiolG. Analysis of the combined hirsute and control groups showed that the correlation of AdiolG to the hirsutism score (r = 0.42) was markedly weaker than that of testosterone to the latter (r = 0.62). Moreover, no correlation was found between the body-mass index and AdiolG. Our data show that serum AdiolG is obviously not a specific marker for peripheral 5 alpha-reductase activity, but appears to reflect the adrenal and ovarian androgen precursors. Thus, determination of serum AdiolG is of no diagnostic benefit in the clinical assessment of hirsute women.
Collapse
Affiliation(s)
- E A Joura
- Universitätsklinik für Frauenheilkunde, Allgemeines Krankenhaus Wien, Osterreich
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVES To evaluate the effect of hormone replacement therapy (HRT) on intraocular pressure (IOP) in menopausal women. METHODS The IOP of 25 white menopausal women without an abnormal ophthalmologic history was measured before and during HRT regimen. IOP fluctations were recorded before and 1, 4, and 12 weeks after the beginning of HRT. These measurements were obtained according to a standardized time schedule (08:00, 12:00, 16:00, and 19:00 h). RESULTS The mean IOP in the left eye decreased from 16.2 +/- 2.4 mmHg before therapy to 14.0 +/- 2.1 mmHg after 12 weeks of therapy (P < 0.001). In the right eye, whose IOP was at 15.3 +/- 2.3 mmHg before therapy there was a decrease to 14.0 +/- 1.9 mmHg after 12 weeks of therapy (P < 0.001). CONCLUSION Hormone replacement therapy has a positive effect on IOP in menopausal women.
Collapse
Affiliation(s)
- M O Sator
- Department of Obstetrics and Gynecology, General Hospital, University of Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
49
|
Zeisler H, Joura EA, Bancher-Todesca D, Hanzal E, Gitsch G. Prophylactic cerclage in pregnancy. Effect in women with a history of conization. J Reprod Med 1997; 42:390-2. [PMID: 9252928] [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: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effect of prophylactic cerclage on the course of pregnancy in women with prior conization. STUDY DESIGN In a retrospective, observational study, the outcome of pregnancies in 69 women with (n = 30) and without (n = 39) cerclage who previously underwent conization was evaluated regarding hospitalization due to threatened preterm labor and delivery before 37 weeks of gestation. RESULTS The occurrence of preterm delivery was 23.3% in the cerclage group and 20.5% in the control group (P = .78). Women with prophylactic cerclage were hospitalized significantly more often due to threatened premature labor: with cerclage, 66.7%; without cerclage, 33.3% (P = .006). CONCLUSION Prophylactic cerclage should be used more sparingly in women with a history of conization because it does not prevent premature delivery and tends to induce preterm uterine contractions.
Collapse
Affiliation(s)
- H Zeisler
- Department of Gynecology and Obstetrics, University of Vienna, Vienna General Hospital, Austria
| | | | | | | | | |
Collapse
|
50
|
Zeisler H, Joura EA, Moeschl P, Maier U, Koelbl H. Preoperative evaluation of tumor extension in patients with recurrent cervical cancer. Acta Obstet Gynecol Scand 1997; 76:474-7. [PMID: 9197452 DOI: 10.3109/00016349709047831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pelvic exenteration is an option in the treatment of locally recurrent cervical cancer. Various preoperative diagnostic procedures in the estimation of tumor invasion of the bladder and rectum or lymphonodal involvement were evaluated. DESIGN The sensitivity and specificity of cystoscopy, intravenous pyelography, irrigoscopy, rectoscopy, and computed tomography were evaluated by comparing the preoperative findings with the histological result as the 'golden standards'. RESULTS In the assessment of bladder invasion the sensitivity of cystoscopy, intravenous pyelography and computed tomography was 22.2%, 55.6% and 55.6%, respectively. The overall sensitivity of the three diagnostic procedures was 77.8%. In the assessment of invasion of the rectum irrigoscopy, rectoscopy and CT revealed a sensitivity of 33.3%, respectively. Only 50% of all cases with tumor infiltration of the rectum showed positive results when all three diagnostic procedures were combined. The sensitivity and specificity of computed tomography in the diagnosis of lymphonodal involvement were 75% and 83.3%, respectively. CONCLUSION We think that there is an obvious necessity for all diagnostic procedures for patient selection prior to pelvic exenteration. However, all these investigations are not conclusive but complement each other. Prior to pelvic exenteration, critical interpretation of all preoperative diagnostic procedures is mandatory, otherwise surgery results in an unintended palliative procedure.
Collapse
Affiliation(s)
- H Zeisler
- Department of Gynecology and Obstetrics, University of Vienna Medical School, Austria
| | | | | | | | | |
Collapse
|