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Wicker C, Roux CJ, Goujon L, de Feraudy Y, Hully M, Brassier A, Bérat CM, Chemaly N, Wiedemann A, Damaj L, Abi-Warde MT, Dobbelaere D, Roubertie A, Cano A, Arion A, Kaminska A, Da Costa S, Bruneel A, Vuillaumier-Barrot S, Boddaert N, Pascreau T, Borgel D, Kossorotoff M, Harroche A, de Lonlay P. Association between acute complications in PMM2-CDG patients and haemostasis anomalies: Data from a multicentric study and suggestions for acute management. Mol Genet Metab 2023; 140:107674. [PMID: 37542768 DOI: 10.1016/j.ymgme.2023.107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Patients with PMM2-CDG develop acute events (stroke-like episodes (SLEs), thromboses, haemorrhages, seizures, migraines) associated with both clotting factors (factor XI) and coagulation inhibitors (antithrombin, protein C and protein S) deficiencies. The aim of the study was to correlate acute events to haemostasis and propose practical guidelines. METHODS In this multicentric retrospective study, we evaluated clinical, radiological, haemostasis and electroencephalography data for PMM2-CDG patients hospitalized for acute events. Cerebral events were classified as thrombosis, haemorrhage, SLE, or "stroke mimic" (SM: normal brain imaging or evoking a migraine). RESULTS Thirteen patients had a total of 31 acute episodes: 27 cerebral events with 7 SLEs, 4 venous thromboses, 4 haemorrhages (3 associated with thrombosis), 15 SMs at a mean age of 7.7 years; 4 non-cerebral thromboses, one of which included bleeding. A trigger was frequently involved (infection, head trauma). Although sometimes normal at baseline state, factor XI, antithrombin and protein C levels decreased during these episodes. No correlation between haemostasis anomalies and type of acute event was found. DISCUSSION Acute events in PMM2-CDG are not negligible and are associated with haemostasis anomalies. An emergency protocol is proposed for their prevention and treatment (https://www.filiere-g2m.fr/urgences). For cerebral events, brain Magnetic Resonance Imaging with perfusion weight imaging and diffusion sequences, electroencephalogram and haemostasis protein levels guide the treatment: anticoagulation, antithrombin or fresh frozen plasma supplementation, antiepileptic therapy. Preventing bleeding and thrombosis is required in cases of surgery, prolonged immobilization, hormone replacement therapy. CONCLUSION Acute events in PMM2-CDG are associated with abnormal haemostasis, requiring practical guidance.
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Affiliation(s)
- Camille Wicker
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France; Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Charles-Joris Roux
- Université Paris Cité, Paris, France; Service de Radiologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Louise Goujon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Yvan de Feraudy
- Service de Neurologie Pédiatrique, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Marie Hully
- Service de Neurologie Pédiatrique, Médecine physique et réadaptation de l'enfant, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Anais Brassier
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Claire-Marine Bérat
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Nicole Chemaly
- Service de Neurologie Pédiatrique, Médecine physique et réadaptation de l'enfant, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Arnaud Wiedemann
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Nancy, Nancy, France
| | - Lena Damaj
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Rennes, Renne, France
| | - Marie-Thérèse Abi-Warde
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Strasbourg, Strasbourg, France; Service de Neurologie Pédiatrique, Hôpital Universitaire de Strasbourg, Strasbourg, France
| | - Dries Dobbelaere
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire Jeanne de Flandre de Lille, MetabERN, Lille, France
| | - Agathe Roubertie
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Aline Cano
- Centre de Référence des Maladies Héréditaires du Métabolisme, service de Neurologie pédiatrique, Hôpital Universitaire d'enfants La Timone de Marseille, MetabERN, Marseille, France
| | - Alina Arion
- Centre de Compétence des Maladies Héréditaires du Métabolisme, Hôpital Universitaire de Caen, Caen, France
| | - Anna Kaminska
- Service d'Exploration Fonctionnelle, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France
| | - Sabrina Da Costa
- Centre de Référence d'Endocrinologie des Maladies Rares, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Arnaud Bruneel
- Département de Biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
| | - Sandrine Vuillaumier-Barrot
- Département de Biochimie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
| | - Nathalie Boddaert
- Université Paris Cité, Paris, France; Service de Radiologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - Tiffany Pascreau
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Delphine Borgel
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Manoelle Kossorotoff
- Centre national de référence de l'AVC de l'enfant, Service de Neurologie Pédiatrique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Inserm U1266, Paris, France
| | - Annie Harroche
- Centre de Référence Maladies Hémorragiques constitutionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, Paris, France
| | - P de Lonlay
- Centre de Référence des Maladies Héréditaires du Métabolisme, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker-Enfants-Malades, Institut Imagine, G2M, MetabERN, Paris, France; Université Paris Cité, Paris, France; INSERM, Institut Necker-Enfants Malades, France.
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Millischer AE, Santulli P, Da Costa S, Bordonne C, Cazaubon E, Marcellin L, Chapron C. Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril 2023; 119:626-633. [PMID: 36592649 DOI: 10.1016/j.fertnstert.2022.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/21/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence on magnetic resonance imaging (MRI) of ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE) in adolescents presenting with severe dysmenorrhea. DESIGN Prospective study. SETTING Clinic. PATIENT(S) A total of 345 adolescents aged 12-20 years referred to the radiologic MRI department unit between September 2019 and June 2020. INTERVENTION(S) Multiplanar pelvic MRI with cine MRI was performed. Data on the medical history with systematic questioning were collected for each patient before the scan. MAIN OUTCOME MEASURE(S) Data on the endometriosis phenotypes (OMA and/or DIE), distribution of anatomical lesions, and adenomyosis were evaluated and recorded using a dedicated MRI spreadsheet. Myometrial contractions were systematically reported for each case. The data were correlated with the characteristics of the patients and severity of painful symptoms evaluated using a visual analog scale. RESULT(S) The prevalence rates of endometriosis and adenomyosis were 39.3% (121 patients) and 11.4% (35 patients), respectively. Among the adolescents with endometriosis, 25 (20.7%) presented with OMA, and 107 (88.4%) presented with DIE. The odds ratios (confidence intervals) for each pairwise comparison between the age distributions were 2.3 (1.4-3.8) for 15-18 vs. <15 years of age and 3.3 (1.2-8.5) for 18-20 vs. <15 years of age, highlighting a predominance of cases after 18 years of age. Uterine contractions were visualized in 34.4% of cases, with no particular association with endometriosis. No clinical risk factor was identified as being particularly associated with endometriosis. Notably, the visual analog scale score was the same for cases with and without endometriosis. CONCLUSION(S) Severe endometriosis phenotypes (OMA and/or DIE) can be observed in adolescents with intense dysmenorrhea, with a linear increase in prevalence over time resulting in a clear predominance after 18 years of age. Endometriosis in adolescents is a challenging clinical problem with a long delay in diagnosis. Imaging can help reduce this delay in young patients with suggestive symptoms. CLINICAL TRIAL REGISTRATION NUMBER NCT05153512.
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Affiliation(s)
- Anne-Elodie Millischer
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Radiology Department (Prof. Boddaert), Centre Hospitalier Universitaire (CHU) Necker, Paris, France.
| | - Pietro Santulli
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Sabrina Da Costa
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Pediatric Gynecology Department (Prof. Polak), Centre Hospitalier Universitaire (CHU) Necker, Paris, France
| | - Corinne Bordonne
- Imagerie Médicale Paris Centre (IMPC) Bachaumont-IFEEN - Ramsay Santé, Centre de Radiologie, Paris, France; Department of Radiology (Prof. Dion), Centre Hospitalier Universitaire (CHU) Hôtel Dieu, Paris, France
| | - Elise Cazaubon
- IQVIA statistic Real World Solutions, Biometric, Paris, France
| | - Louis Marcellin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
| | - Charles Chapron
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Paris, France; Faculté de Médecine Paris Centre, Université de Paris, Faculté de Santé, Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Prof. Chapron), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France; Department of "Development, Reproduction and Cancer," Institut Cochin, INSERM U1016, Paris, France
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3
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Heddar A, Ogur C, Da Costa S, Braham I, Billaud-Rist L, Findikli N, Beneteau C, Reynaud R, Mahmoud K, Legrand S, Marchand M, Cedrin-Durnerin I, Cantalloube A, Peigne M, Bretault M, Dagher-Hayeck B, Perol S, Droumaguet C, Cavkaytar S, Nicolas-Bonne C, Elloumi H, Khrouf M, Rougier-LeMasle C, Fradin M, Le Boette E, Luigi P, Guerrot AM, Ginglinger E, Zampa A, Fauconnier A, Auger N, Paris F, Brischoux-Boucher E, Cabrol C, Brun A, Guyon L, Berard M, Riviere A, Gruchy N, Odent S, Gilbert-Dussardier B, Isidor B, Piard J, Lambert L, Hamamah S, Guedj AM, Brac de la Perriere A, Fernandez H, Raffin-Sanson ML, Polak M, Letur H, Epelboin S, Plu-Bureau G, Wołczyński S, Hieronimus S, Aittomaki K, Catteau-Jonard S, Misrahi M. Genetic landscape of a large cohort of Primary Ovarian Insufficiency: New genes and pathways and implications for personalized medicine. EBioMedicine 2022; 84:104246. [PMID: 36099812 PMCID: PMC9475279 DOI: 10.1016/j.ebiom.2022.104246] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Primary Ovarian Insufficiency (POI), a public health problem, affects 1-3.7% of women under 40 yielding infertility and a shorter lifespan. Most causes are unknown. Recently, genetic causes were identified, mostly in single families. We studied an unprecedented large cohort of POI to unravel its molecular pathophysiology. Methods 375 patients with 70 families were studied using targeted (88 genes) or whole exome sequencing with pathogenic/likely-pathogenic variant selection. Mitomycin-induced chromosome breakages were studied in patients’ lymphocytes if necessary. Findings A high-yield of 29.3% supports a clinical genetic diagnosis of POI. In addition, we found strong evidence of pathogenicity for nine genes not previously related to a Mendelian phenotype or POI: ELAVL2, NLRP11, CENPE, SPATA33, CCDC150, CCDC185, including DNA repair genes: C17orf53(HROB), HELQ, SWI5 yielding high chromosomal fragility. We confirmed the causal role of BRCA2, FANCM, BNC1, ERCC6, MSH4, BMPR1A, BMPR1B, BMPR2, ESR2, CAV1, SPIDR, RCBTB1 and ATG7 previously reported in isolated patients/families. In 8.5% of cases, POI is the only symptom of a multi-organ genetic disease. New pathways were identified: NF-kB, post-translational regulation, and mitophagy (mitochondrial autophagy), providing future therapeutic targets. Three new genes have been shown to affect the age of natural menopause supporting a genetic link. Interpretation We have developed high-performance genetic diagnostic of POI, dissecting the molecular pathogenesis of POI and enabling personalized medicine to i) prevent/cure comorbidities for tumour/cancer susceptibility genes that could affect life-expectancy (37.4% of cases), or for genetically-revealed syndromic POI (8.5% of cases), ii) predict residual ovarian reserve (60.5% of cases). Genetic diagnosis could help to identify patients who may benefit from the promising in vitro activation-IVA technique in the near future, greatly improving its success in treating infertility. Funding Université Paris Saclay, Agence Nationale de Biomédecine.
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Affiliation(s)
- Abdelkader Heddar
- Université Paris Saclay, Faculté de Médecine. Unité de Génétique Moléculaire des Maladies Métaboliques et de la Reproduction, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, AP-HP, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; UMR-S 1193, INSERM, Université Paris Saclay, Faculté de Médecine, Hôpital Paul Brousse, Villejuif, France
| | - Cagri Ogur
- Igenomix Turkey, İstanbul, Turkey; Institute of Science, Department of Bioengineering Yildiz Technical University, İstanbul, Turkey
| | - Sabrina Da Costa
- Service d'Endocrinologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, CNR pathologies gynécologiques rares, 75015, Paris, France
| | - Inès Braham
- Service d'Endocrinologie et de Médicine de la Reproduction, Hôpital Universitaire de Nice, 06200, Nice, France
| | - Line Billaud-Rist
- Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin/Port-Royal, 75005, Paris, France
| | - Necati Findikli
- Bahçeci Umut IVF Centre, Altunizade, İstanbul, Turkey; Faculty of Engineering and Architecture, Department of Biomedical Engineering, Beykent University, İstanbul, Turkey
| | - Claire Beneteau
- Service de Génétique Médicale, Centre Hospitalier Universitaire Nantes, 44000, Nantes, France
| | - Rachel Reynaud
- Aix Marseille Université, Assistance-Publique des Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire Hôpital de la Timone Enfants, 13385, Marseille Cedex 05, France
| | - Khaled Mahmoud
- Centre FERTILLIA de Médecine de la Reproduction- Clinique la ROSE, Tunis, Tunisie
| | - Stéphanie Legrand
- Centre de Fertilité - Clinique de l'Atlantique La Rochelle, 17000, La Rochelle, France
| | - Maud Marchand
- Service d'Endocrinologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, CNR pathologies gynécologiques rares, 75015, Paris, France
| | - Isabelle Cedrin-Durnerin
- Service de Médecine de la Reproduction et Préservation de la Fertilité, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, 93143 Bondy, France
| | - Adèle Cantalloube
- Service de Gynécologie et d'Obstétrique, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, AP-HP. Faculté de Médecine Pierre et Marie Curie. Université de la Sorbonne, Paris, France
| | - Maeliss Peigne
- Service de Médecine de la Reproduction et Préservation de la Fertilité, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, 93143 Bondy, France
| | - Marion Bretault
- Service d'Endocrinologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne Billancourt, France
| | - Benedicte Dagher-Hayeck
- Service de Médecine de la Reproduction et Préservation de la Fertilité, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, 93143 Bondy, France
| | - Sandrine Perol
- Unité de gynécologie médicale, APHP, Hôpital Port-Royal Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Celine Droumaguet
- Service de Médecine Interne, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Sabri Cavkaytar
- Bahçeci Umut IVF Centre, Altunizade, İstanbul, Turkey; Üsküdar University, Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Carole Nicolas-Bonne
- Service de Gynécologie et d'Obstétrique, Centre Hospitalier Alpes Léman, 74130, Contamine-Sur-Arve, France
| | - Hanen Elloumi
- Centre FERTILLIA de Médecine de la Reproduction- Clinique la ROSE, Tunis, Tunisie
| | - Mohamed Khrouf
- Centre FERTILLIA de Médecine de la Reproduction- Clinique la ROSE, Tunis, Tunisie
| | - Charlotte Rougier-LeMasle
- Service d'Endocrinologie et de Médicine de la Reproduction, Hôpital Universitaire de Nice, 06200, Nice, France
| | - Melanie Fradin
- Service de Génétique Clinique, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, Univ Rennes, CNRS IGDR UMR 6290, Centre de référence Anomalies du développement CLAD-Ouest, ERN ITHACA, 35203, Rennes, France; Service de Génétique Médicale, Centre Hospitalier de Saint Brieuc, 22000, Saint-Brieuc, France
| | - Elsa Le Boette
- Service de Génétique Médicale, Centre Hospitalier de Saint Brieuc, 22000, Saint-Brieuc, France
| | - Perrine Luigi
- Service d'Endocrinologie-Diabétologie, Centre Hospitalier Antibes Juan Les Pins, 06600, Antibes, France
| | - Anne-Marie Guerrot
- Normandie Univ, UNIROUEN, Inserm U1245, CHU Rouen, Department of Genetics and reference center for developmental disorders, FHU G4 Génomique, F-76000 Rouen, France
| | | | - Amandine Zampa
- Service de Génétique, Centre Hospitalier de Mulhouse, 68100, Mulhouse, France
| | - Anais Fauconnier
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre Hospitalier Universitaire de Saint-Etienne, 42270, Saint-Priest-en-Jarez, France
| | - Nathalie Auger
- Service de génétique des tumeurs. Institut Gustave Roussy, 94805, Villejuif, France
| | - Françoise Paris
- Département de Pédiatrie, Unité d'Endocrinologie-Gynécologie Pédiatrique, Hôpital A.-de-Villeneuve, Centre Hospitalier Universitaire Montpellier et Université Montpellier, 34090, Montpellier, France; Constitutif Sud, Centre de Référence Maladies Rares du Développement Génital, Hôpital Lapeyronie, Centre Hospitalier Universitaire Montpellier, Université de Montpellier, 34090 Montpellier, France; INSERM 1203, Développement Embryonnaire Fertilité Environnement, Université de Montpellier, 34090, Montpellier, France
| | - Elise Brischoux-Boucher
- Centre de Génétique Humaine, Université de Franche-Comté, Centre Hospitalier Universitaire de Besançon, 25000, Besançon, France
| | - Christelle Cabrol
- Centre de Génétique Humaine, Université de Franche-Comté, Centre Hospitalier Universitaire de Besançon, 25000, Besançon, France
| | - Aurore Brun
- Service de Génétique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, 86021, Poitiers, France
| | - Laura Guyon
- Service de Génétique Médicale, Centre Hospitalier Universitaire Nantes, 44000, Nantes, France
| | - Melanie Berard
- Service de Génétique Clinique, Centre Hospitalier Régional Universitaire de Nancy, F-54000, Nancy, France
| | - Axelle Riviere
- Service de Génétique Clinique, Centre Hospitalier Régional Universitaire de Nancy, F-54000, Nancy, France
| | - Nicolas Gruchy
- Normandy University, UNICAEN, Caen University Hospital, Department of Genetics, EA 7450 BioTARGen, FHU G4 Genomics, Caen, France
| | - Sylvie Odent
- Service de Génétique Clinique, Centre Hospitalier Universitaire de Rennes, Hôpital Sud, Univ Rennes, CNRS IGDR UMR 6290, Centre de référence Anomalies du développement CLAD-Ouest, ERN ITHACA, 35203, Rennes, France
| | - Brigitte Gilbert-Dussardier
- Service de Génétique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, 86021, Poitiers, France
| | - Bertrand Isidor
- Service de Génétique Médicale, Centre Hospitalier Universitaire Nantes, 44000, Nantes, France
| | - Juliette Piard
- Centre de Génétique Humaine, Université de Franche-Comté, Centre Hospitalier Universitaire de Besançon, 25000, Besançon, France
| | - Laetitia Lambert
- Service de Génétique Clinique, Centre Hospitalier Régional Universitaire de Nancy, F-54000, Nancy, France
| | - Samir Hamamah
- INSERM 1203, Développement Embryonnaire Fertilité Environnement, Université de Montpellier, 34090, Montpellier, France; Centre Hospitalier Universitaire de Montpellier, Département de Biologie de la Reproduction, Biologie de la Reproduction/DPI et CECOS, Université de Montpellier, Montpellier, France
| | - Anne Marie Guedj
- Service d'Endocrinologie et de Maladies Métaboliques, Centre Hospitalier Universitaire Nîmes, Université de Montpellier, 30029, Nîmes, France
| | - Aude Brac de la Perriere
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares du Développement Génital, Groupement Hospitalier Est, Hôpital Louis Pradel, 69002, Lyon, France
| | - Hervé Fernandez
- Service de Gynecologie et d'Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Faculté de médicine, Université Paris-Saclay, 94270 Le Kremlin Bicêtre, France; UVSQ, Inserm, CESP, Université Paris-Saclay, 94807 Villejuif, France
| | - Marie-Laure Raffin-Sanson
- Service d'Endocrinologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne Billancourt, France
| | - Michel Polak
- Service d'Endocrinologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, CNR pathologies gynécologiques rares, 75015, Paris, France
| | - Hélène Letur
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Foch, 40 rue Worth 92 150 Suresnes, France; Service de Médecine de la Reproduction et Préservation de la Fertilité, Polyclinique de Navarre, 8, boulevard Hauterive, 64000 Pau, France
| | - Sylvie Epelboin
- Service de Gynécologie et d'Obstétrique, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, AP-HP. Faculté de Médecine Pierre et Marie Curie. Université de la Sorbonne, Paris, France
| | - Genevieve Plu-Bureau
- Unité de gynécologie médicale, APHP, Hôpital Port-Royal Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Sławomir Wołczyński
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - Sylvie Hieronimus
- Service d'Endocrinologie et de Médicine de la Reproduction, Hôpital Universitaire de Nice, 06200, Nice, France
| | - Kristiina Aittomaki
- Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sophie Catteau-Jonard
- Service de gynécologie médicale, orthogénie et sexologie, Centre Hospitalier Universitaire de Lille, Université de Lille, 59000 Lille, France
| | - Micheline Misrahi
- Université Paris Saclay, Faculté de Médecine. Unité de Génétique Moléculaire des Maladies Métaboliques et de la Reproduction, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, AP-HP, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; UMR-S 1193, INSERM, Université Paris Saclay, Faculté de Médecine, Hôpital Paul Brousse, Villejuif, France.
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4
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Fiot E, Alauze B, Donadille B, Samara-Boustani D, Houang M, De Filippo G, Bachelot A, Delcour C, Beyler C, Bois E, Bourrat E, Bui Quoc E, Bourcigaux N, Chaussain C, Cohen A, Cohen-Solal M, Da Costa S, Dossier C, Ederhy S, Elmaleh M, Iserin L, Lengliné H, Poujol-Robert A, Roulot D, Viala J, Albarel F, Bismuth E, Bernard V, Bouvattier C, Brac A, Bretones P, Chabbert-Buffet N, Chanson P, Coutant R, de Warren M, Demaret B, Duranteau L, Eustache F, Gautheret L, Gelwane G, Gourbesville C, Grynberg M, Gueniche K, Jorgensen C, Kerlan V, Lebrun C, Lefevre C, Lorenzini F, Manouvrier S, Pienkowski C, Reynaud R, Reznik Y, Siffroi JP, Tabet AC, Tauber M, Vautier V, Tauveron I, Wambre S, Zenaty D, Netchine I, Polak M, Touraine P, Carel JC, Christin-Maitre S, Léger J. Turner syndrome: French National Diagnosis and Care Protocol (NDCP; National Diagnosis and Care Protocol). Orphanet J Rare Dis 2022; 17:261. [PMID: 35821070 PMCID: PMC9277788 DOI: 10.1186/s13023-022-02423-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Turner syndrome (TS; ORPHA 881) is a rare condition in which all or part of one X chromosome is absent from some or all cells. It affects approximately one in every 1/2500 liveborn girls. The most frequently observed karyotypes are 45,X (40–50%) and the 45,X/46,XX mosaic karyotype (15–25%). Karyotypes with an X isochromosome (45,X/46,isoXq or 45,X/46,isoXp), a Y chromosome, X ring chromosome or deletions of the X chromosome are less frequent. The objective of the French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins) is to provide health professionals with information about the optimal management and care for patients, based on a critical literature review and multidisciplinary expert consensus. The PNDS, written by members of the French National Reference Center for Rare Growth and Developmental Endocrine disorders, is available from the French Health Authority website. Turner Syndrome is associated with several phenotypic conditions and a higher risk of comorbidity. The most frequently reported features are growth retardation with short adult stature and gonadal dysgenesis. TS may be associated with various congenital (heart and kidney) or acquired diseases (autoimmune thyroid disease, celiac disease, hearing loss, overweight/obesity, glucose intolerance/type 2 diabetes, dyslipidemia, cardiovascular complications and liver dysfunction). Most of the clinical traits of TS are due to the haploinsufficiency of various genes on the X chromosome, particularly those in the pseudoautosomal regions (PAR 1 and PAR 2), which normally escape the physiological process of X inactivation, although other regions may also be implicated. The management of patients with TS requires collaboration between several healthcare providers. The attending physician, in collaboration with the national care network, will ensure that the patient receives optimal care through regular follow-up and screening. The various elements of this PNDS are designed to provide such support.
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Affiliation(s)
- Elodie Fiot
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Bertille Alauze
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Bruno Donadille
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Dinane Samara-Boustani
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Muriel Houang
- Explorations Fonctionnelles Endocriniennes, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Armand-Trousseau Hospital, 75012, Paris, France
| | - Gianpaolo De Filippo
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Anne Bachelot
- Endocrinology and Reproductive Medicine Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié Salpétrière University Hospital, 75013, Paris, France
| | - Clemence Delcour
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Constance Beyler
- Cardiopaediatric Unit, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emilie Bois
- Pediatric Otorhinolaryngology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emmanuelle Bourrat
- Dermatology Unit, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Emmanuel Bui Quoc
- Ophthalmology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Nathalie Bourcigaux
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Catherine Chaussain
- Odontology Department, Assistance Publique-Hôpitaux de Paris, University Hospitals Charles Foix, PNVS, and Henri Mondor, 94000, Créteil, France
| | - Ariel Cohen
- Department of Cardiology, GRC n°27, GRECO, AP-HP, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Martine Cohen-Solal
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Lariboisière Hospital, 75010, Paris, France
| | - Sabrina Da Costa
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Claire Dossier
- Department of Paediatric Nephrology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Stephane Ederhy
- Department of Cardiology, GRC n°27, GRECO, AP-HP, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Monique Elmaleh
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit, Cardiology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Georges Pompidou University Hospital, 75015, Paris, France
| | - Hélène Lengliné
- Department of Pediatric Gastroenterology and Nutrition, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Armelle Poujol-Robert
- Hepatology Department, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Dominique Roulot
- Hepatology Department, Assistance Publique-Hopitaux de Paris, Université Sorbonne Paris Nord, Avicenne Hospital, 93009, Bobigny, France
| | - Jerome Viala
- Department of Pediatric Gastroenterology and Nutrition, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Frederique Albarel
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille. Hospital La Conception, 13005, Marseille, France
| | - Elise Bismuth
- Department of Pediatric Endocrinology and Diabetology, Competence Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Valérie Bernard
- CHU Pellegrin, Department of Gynecological Surgery, Medical Gynecology and Reproductive Medicine, Centre Aliénor d'aquitaine, Bordeaux University Hospitals, 33000, Bordeaux, France
| | - Claire Bouvattier
- Paediatric Endocrinology Department, Reference Center for Rare Genital Development Disorders, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Aude Brac
- Department of Endocrinology Pediatric and Adult, Reference Center for Rare Genital Development Disorders, Lyon Hospices Civils, Est Hospital Group, 69677, Bron, France
| | - Patricia Bretones
- Department of Endocrinology Pediatric and Adult, Reference Center for Rare Genital Development Disorders, Lyon Hospices Civils, Est Hospital Group, 69677, Bron, France
| | - Nathalie Chabbert-Buffet
- Gynecology-Obstetrics and Reproductive Medicine Department, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, 75020, Paris, France
| | - Philippe Chanson
- Department of Endocrinology and Reproductive Diseases, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Regis Coutant
- Department of Pediatric Endocrinology and Diabetology and Reference Center for Rare Diseases of Thyroid and Hormone Receptivity, Angers University Hospital, 49100, Angers, France
| | - Marguerite de Warren
- AGAT, French Turner Syndrome Association (AGAT; Association Des Groupes Amitié Turner), 75011, Paris, France
| | - Béatrice Demaret
- Grandir Association (French Growth Disorders Association), 92600, Asnières-sur-Seine, France
| | - Lise Duranteau
- Adolescent and Young Adult Gynecology Unit, Reference Center for Rare Genital Development Disorders, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre University Hospital, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Florence Eustache
- Reproductive Biology Department, Assistance Publique-Hôpitaux de Paris, Jean Verdier University Hospital, 93140, Bondy, France
| | - Lydie Gautheret
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Georges Gelwane
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Claire Gourbesville
- Department of Endocrinology and Metabolic Diseases, Caen University Hospital, 14000, Caen, France
| | - Mickaël Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Assistance Publique-Hôpitaux de Paris, Antoine Béclère University Hospital, 92140, Clamart, France
| | - Karinne Gueniche
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Carina Jorgensen
- Endocrinology and Metabolism Department, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Veronique Kerlan
- Endocrinology and Metabolism Department, Brest University Hospital Centre, 29200, Brest, France
| | - Charlotte Lebrun
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Christine Lefevre
- Pediatric Endocrinology, Lille University Jeanne de Flandre Hospital, 59000, Lille, France
| | - Françoise Lorenzini
- Department of Endocrinology, Toulouse University Paule Viguier Hospital, 31300, Toulouse, France
| | - Sylvie Manouvrier
- Clinical Genetics Department, DEV GEN Genital Development Reference Center, Lille University Jeanne de Flandre Hospital, 59000, Lille, France
| | - Catherine Pienkowski
- Genetics and Medical Gynecology Department, Reference Center for Rare Gynecological Pathologies, Toulouse University Hospitals - Hôpital Des Enfants, Pediatrics - Endocrinology, 31059, Toulouse, France
| | - Rachel Reynaud
- Department of Multidisciplinary Pediatrics, Reference Center for Pituitary Rare Diseases Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Timone Enfants, 13005, Marseille, France
| | - Yves Reznik
- Department of Endocrinology and Metabolic Diseases, Caen University Hospital, 14000, Caen, France
| | - Jean-Pierre Siffroi
- Genetics and Embryology Department, Sorbonne Université; INSERM UMRS-933, Assistance Publique-Hôpitaux de Paris, Hôpital d'Enfants Armand-Trousseau, Paris, France
| | - Anne-Claude Tabet
- Genetics Department, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 75019, Paris, France
| | - Maithé Tauber
- Genetics and Medical Gynecology Department, Toulouse University Hospital - Hôpital Des Enfants, Pediatrics - Endocrinology, 31059, Toulouse, France
| | - Vanessa Vautier
- Pediatric Diabetology Department, Bordeaux University Hospitals, 33000, Bordeaux, France
| | - Igor Tauveron
- Clermont-Ferrand University Hospital, Endocrinology Department, Clermont Auvergne University, 63000, Clermont-Ferrand, France
| | - Sebastien Wambre
- French Turner Syndrome Association (Turner Et Vous Association), 59155, Faches-Thumesnil, France
| | - Delphine Zenaty
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Irène Netchine
- Explorations Fonctionnelles Endocriniennes, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Armand-Trousseau Hospital, 75012, Paris, France
| | - Michel Polak
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Université de Paris, Necker Enfants Malades University Hospital, 75015, Paris, France
| | - Philippe Touraine
- Endocrinology and Reproductive Medicine Department, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Pitié Salpétrière University Hospital, 75013, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France
| | - Sophie Christin-Maitre
- Department of Reproductive Endocrinology, Reference Center for Rare Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Saint Antoine Hospital, 75012, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology-Diabetology Department, Reference Center for Rare Growth and Development Endocrine Diseases, INSERM NeuroDiderot, Assistance Publique-Hôpitaux de Paris, Université de Paris, Robert Debré University Hospital, 48 Bd Sérurier, 75019, Paris, France.
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Wasserloos A, Thomassen MCLGD, Costa SD, Zenclussen A, Tchaikovski V, Hackeng TM, Stickeler E, Tchaikovski SN. Effect of blood loss during caesarean section on coagulation parameters. Thromb Res 2021; 202:84-89. [PMID: 33784534 DOI: 10.1016/j.thromres.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Venous thrombosis is the leading cause of pregnancy-related maternal morbidity and mortality. The thrombosis risk is increased by caesarean section and blood loss, though underlying mechanisms of these prothrombotic changes remain unknown. MATERIALS AND METHODS This prospective study recruited 50 pregnant women at term undergoing elective caesarean section at University Hospital Magdeburg, Germany. Blood loss during surgery was correlated with the changes in total protein S, full length TFPI (TFPIfl), prothrombin, the endogenous thrombin potential (ETP) and resistance to activated protein C (APCsr) determined via calibrated automated thrombography. RESULTS Mean blood loss was 506 ml (95%CI: 456 to 557 ml). Total protein S was 0.63 (95%CI: 0.60 to 0.67) U/ml preoperatively, decreased by 14.8% after caesarean section and almost normalised five days later. TFPIfl was 0.47 (95%CI: 0.41 to 0.53) U/ml before, remained unchanged immediately after and increased by 11.5% five days after surgery. Prothormbin was 1.10 (95%CI: 1.03 to 1.16) U/ml preoperatively, reduced by 10.4% immediately after and increased again five days after caesarean section, exceeding the preoperative values by 4.4% (-0.7 to 9.6). The ETP decreased by 3.9%, whereas the APCsr increased by 37.0% immediately after caesarean section. The changes in total protein S, prothrombin, thrombin generation and APC resistance showed a trend to be more pronounced in the subgroups with higher blood loss. DISCUSSION Moderate blood loss during caesarean section hardly reduces thrombin generation but aggravates pregnancy-induced APC resistance and combined deficiency of TFPI and protein S, which can account for the increased thrombosis risk in early puerperium.
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Affiliation(s)
- A Wasserloos
- University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany
| | - M C L G D Thomassen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands
| | - S D Costa
- Women's Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - A Zenclussen
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - V Tchaikovski
- Academic Teaching Hospital of RWTH Aachen University, Rhein-Maas Clinic, Germany
| | - T M Hackeng
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands
| | - E Stickeler
- University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany
| | - S N Tchaikovski
- University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany.
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Harroche A, Meunier S, Falaise C, Da Costa S, Oudot C. [Heavy menstrual bleeding in teenage girls and women with inherited bleeding disorders]. Rev Prat 2019; 69:417-422. [PMID: 31626499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Menometrorrhagia is a frequent bleeding symptom in young women, and may be related to an inherited bleeding disorder. If there is no gynecological etiology, hemostasis tests are required. The early medical management of these teenage girls is important, especially when a bleeding disorder is known. The bleeding risk of the first periods may then be anticipated. Afterwards, the objective of the treatment is to keep the bleeding symptoms under control: anti-fibrinolytic treatment, specific replacement therapy for bleeding disorder and hormonal treatment. This management requires a multidisciplinary medical team, mainly hematologist and gynecologist, all along the genital lifespan, from the first periods to the desire for pregnancy.
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Affiliation(s)
- Annie Harroche
- Hôpital Necker- Enfants malades, CRC maladies hémorragiques constitutionnelles, Paris, France
| | - Sandrine Meunier
- Hospices civils de Lyon, hôpital Louis-Pradel, CNR hémophilie, Bron, France
| | - Céline Falaise
- APHM, Centre de référence des pathologies plaquettaires -CRPP-, Marseille, France
| | - Sabrina Da Costa
- Hôpital Necker- Enfants malades, CNR pathologies gynécologiques rares, service d'endocrinologie pédiatrique, Paris, France
| | - Caroline Oudot
- CHU de Limoges, CRC maladies hémorragiques constitutionnelles, Limoges, France
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Oettel A, Costa SD, Wollschlaeger K. Fallbericht: monochoriale Geminigravidität mit TRAP-Sequenz. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Oettel
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg, Deutschland
| | - SD Costa
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg, Deutschland
| | - K Wollschlaeger
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg, Deutschland
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Fettke F, Costa SD. Die Koexistenz von Schwangerschaft und Krebs – ein Fallbericht. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Fettke
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg, Deutschland
| | - SD Costa
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Magdeburg, Deutschland
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Muendane A, Seliger G, Chaoui K, Hiller R, Lautenschläger C, Costa SD, Tchirikov M. Reduktion der Doppelnarben-Rate und Optimierung der Narbenarchitektur durch ultraschallgestützte chirurgische Intervention im Rahmen der Re-Sectio caesarea. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Muendane
- Universitätsklinik für Geburtshilfe und Pränatalmedizin Halle (Saale)
| | - G Seliger
- Universitätsklinik für Geburtshilfe und Pränatalmedizin Halle (Saale)
| | - K Chaoui
- Universitätsklinik für Geburtshilfe und Pränatalmedizin Halle (Saale)
| | - R Hiller
- Institut für Pathologie des Universitätsklinikums Halle (Saale)
| | - C Lautenschläger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik der Martin-Luther Universität Halle-Wittenberg
| | - SD Costa
- Universitätsfrauenklinik Magdeburg
| | - M Tchirikov
- Universitätsklinik für Geburtshilfe und Pränatalmedizin Halle (Saale)
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Fettke F, Brüeckner J, Eggemann H, Costa SD. Das Chorionkarzinom nach einer Terminschwangerschaft. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645900] [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: 10/27/2022] Open
Affiliation(s)
- F Fettke
- Universitätsfrauenklinik, Otto-von-Guericke Universität Magdeburg
| | - J Brüeckner
- Universitätsfrauenklinik, Otto-von-Guericke Universität Magdeburg
| | - H Eggemann
- Universitätsfrauenklinik, Otto-von-Guericke Universität Magdeburg
| | - SD Costa
- Universitätsfrauenklinik, Otto-von-Guericke Universität Magdeburg
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Oettel A, Baake L, Costa SD, Gerloff C. Die Wertigkeit der sonografischen Gewichtsschätzung am Entbindungstermin an der Universitätsfrauenklinik Magdeburg. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645916] [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: 10/27/2022] Open
Affiliation(s)
- A Oettel
- Universitätsfrauenklinik Magdeburg
| | - L Baake
- Universitätsfrauenklinik Magdeburg
| | - SD Costa
- Universitätsfrauenklinik Magdeburg
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Tchaikovski S, Thomassen MCLG, Hackeng T, Costa SD, Stickeler E. Effekte von Blutverlusten auf das Gerinnungssystem in der Geburtshilfe. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1606173] [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)
- S Tchaikovski
- Universitätsfrauenklinik Magdeburg, Otto von Guericke Universität Magdeburg
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
| | - MCLG Thomassen
- Dept. of Biochemistry, CARIM, Maastricht University, Maastricht, The Netherlands
| | - T Hackeng
- Dept. of Biochemistry, CARIM, Maastricht University, Maastricht, The Netherlands
| | - SD Costa
- Universitätsfrauenklinik Magdeburg, Otto von Guericke Universität Magdeburg
| | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen
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Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Abstract P5-16-03: Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The GeparSepto (NCT01583426) study showed that nab-paclitaxel (nP) increases the pathological complete response (ypT0 ypN0) rate when it replaces paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for pts with early breast cancer (BC) (Untch Lancet Oncol 2016). After a safety analysis showed a higher rate of dose reductions, treatment discontinuations as well as peripheral sensory neuropathy (PSN) with nP 150 mg/m2 w (nP150) compared to P 80mg/m2 w, dose of nP was reduced to 125 mg/m2 w (nP125). The risk-benefit ratio of nP125 was improved over nP150 (von Minckwitz SABCS 2015). We reported follow-up (FU) data on PSN occurrence and resolution.
Methods: Pts with untreated BC received P 80mg/m2 w or nP 150/125mg/m2 w followed by four cycles of E 90 mg/m2 plus C 600 mg/m2 q3w, with trastuzumab 6 mg/kg (loading (LD) dose 8 mg/kg) and pertuzumab 420 mg (LD 840 mg) q3w if HER2+. After the end of the study the protocol was amended in order to collect long-term data on PSN outcome as well as on treatment modalities. PSN will be reported according treatment and dose received on day 1.
Results: Overall 601 pts received P80; 220 pts nP150 and 385 pts nP125 on day 1. PSN grade 2-4 was observed in 18.8% (n=113/601) of pts treated with P80 and in 41.8% (n=92/220) vs 39.2% (n=151/385) with nP150 and nP125 respectively (p=0.547). Grade 3-4 PSN was reported for 2.7% (n=16/601) of pts in the P80 group and 14.5% (n=32/220) vs 8.1% (n=31/385) in the nP150 vs nP125 group respectively (p=0.018). In 31.8% (36/113), 35.9% (33/92) and 27.2% (41/151), PSN was not resolved at the end of the treatment (EOT); PSN grade 3-4 was not resolved in 37.5% (6/16), 56.3% (18/32) and 58.1% (18/31). After a median FU of 110 weeks after EOT, data on PSN status for pts with unresolved PSN grade 2-4 were available from 30, 22 and 32 pts; 26 pts did not provide update information (n=7 died, n=5 data not yet available, n=14 status unknown). For 63.3% (n=19), 40.9% (n=9) and 56.2% (n=18) of pts, PSN grade 2-4 was resolved to grade 1. Time to resolve (TTR) of PSN grade 2-4 was significantly different between nP150 and nP125 (p<0.001); no significant difference was seen between P and nP (p=0.405) [Tab.1]. After a median FU of 103 weeks after EOT, data on PSN status of pts with unresolved PSN grade 3-4 were available for 6, 14 and 14 pts. For 66.6% (n=4), 42.8% (n=6) and 50.0% (n=7) of pts PSN grade 3-4 was resolved to grade 1. TTR of PSN grade 3-4 was not significantly different neither for nP150 vs nP125 (p=0.103) nor for P vs nP (p=0.120) ) [Tab.1].
Conclusions: nP125 is associated with a lower occurrence of PSN compared to nP150 but higher PSN than P80. If PSN occurred nP125 is associated with a more rapid resolution compared to nP150. Nearly 10.7% had no resolution of PSN so far. Further FU and markers for selecting pts at risk are needed.
The trial is supported by Celgene.
Table 1. Median time to resolution (mTTR) of PSN to grade 1comparison groupsmTTR n (weeks); [95% CI]P vs nPPnP150nP125grade 2-47 [6-9]8 [6-10]grade 3-49 [4-15]17 [5-123]nP150 vs nP125 grade 2-4 13 [9-15]6 [4-9]grade 3-4 56 [11-170]17 [10-nr]abbreviations: nP, nab-paclitaxel; P, paclitaxel; nr, not reached
Citation Format: Furlanetto J, von Minckwitz G, Jackisch C, Schneeweiss A, Aktas B, Denkert C, Wiebringhaus H, Kuemmel S, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Untch M, Loibl S. Peripheral sensory neuropathy occurrence and resolution: Results from the neoadjuvant randomized GeparSepto study (GBG 69) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-03.
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Affiliation(s)
- J Furlanetto
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Jackisch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Aktas
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Denkert
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - H Wiebringhaus
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Warm
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Paepke
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Just
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J Hackmann
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Clemens
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - SD Costa
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - B Gerber
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - V Nekljudova
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - M Untch
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
| | - S Loibl
- German Breast Group, Neu-Isenburg; Sana Klinikum Offenbach; Universitätsklinikum Heidelberg; Universitätsklinikum Essen; Charite Berlin; St. Barbara Kliniken Heessen Hamm; Kliniken Essen-Mitte, Essen; Kliniken der Stadt Köln GmbH, Köln; Frauenklinik und Poliklinik der Technischen Universität München; Onkologische Schwerpunktpraxis Bielefeld; Klinikum zum Roten Kreuz, München; Marien Hospital Witten; Mutterhaus der Borromäerinnen Trier; Universitätsklinikum Magdeburg; Universitätsklinikum Rostock; Helios Kliniken, Berlin-Buch
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Luley L, Lessel W, Costa SD, Zenclussen AC. Gesteigerte Hämoxygenase-1-Expression in zervikalen Dysplasien und dem Zervixkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593023] [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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Kempa C, Berek I, Kropf S, Costa SD. Analyse des Einflusses familienpolitischer Maßnahmen auf die Geburtenentwicklung am Beispiel des Elterngeldes in Magdeburg und internationaler Vergleich mit Lyon/Frankreich. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593049] [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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Seliger G, Chaoui K, Kunze C, Costa SD, Tchirikov M. Multimodal-ultraschallgestützte Detektion biophysikalischer Eigenschaften des unteren Uterinsegmentes (Narbenregion) bei Z.n. Sectio caesarea. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592939] [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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Kuhnt V, Thomassen MC, Hackeng T, Stickeler E, Costa SD, Tchaikovski S. Der Einfluss von Blutverlust bei einer Sectio caesarea auf das Gerinnungssystem. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593250] [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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Seliger G, Muendane A, Chaoui K, Costa SD, Tchirikov M. Optimierung der Uterotomie-Wundheilung durch Intervention bei der Re-Sectio – eine prospektive, kontrollierte, klinische Fall-Kontroll-Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592893] [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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Müller K, Redlich A, Böttger R, Costa SD. Extrapulmonaler Lungensequester mit Hydrops fetalis und Todesfolge – Grenzen der pränatalen Ultraschalldiagnostik. Ein Fallbericht. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592870] [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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Grumpelt AM, Eggemann H, Costa SD. Vergleich der älteren metastasierten Mammakarzinompatientin mit der jüngeren hinsichtlich Tumorcharakteristika und Therapie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592992] [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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Muendane A, Seliger G, Chaoui K, Costa SD, Tchirikov M. Optimierung der Uterotomie-Wundheilung durch Intervention im Rahmen der Re-Sectio caesarea – eine prospektive, kontrollierte, klinische Fall-Kontroll-Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ignatov A, Eggemann H, Costa SD. Überlebensvorteil einer Lymphonodektomie bei Endometriumkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Cochereau D, Da Costa S, Le Maignan C, Gauthier H, Cochereau J, Espié M, Giacchetti S, Teixeira L. [Intrathecal methotrexate in breast cancer meningeal carcinomatosis - Experience with a new administration schedule]. Bull Cancer 2016; 103:444-54. [PMID: 26987841 DOI: 10.1016/j.bulcan.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/01/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 12/30/2022]
Abstract
Methotrexate represents the standard intrathecal treatment of breast cancer meningeal carcinomatosis. However, its optimal schedule remains undefined. The aim of the present study was to evaluate results obtained with the methotrexate schedule used in Saint-Louis hospital (Paris). Patients followed in Saint-Louis hospital for breast cancer and who received intrathecal methotrexate were included in this retrospective monocentric study. Intrathecal treatment received contained methotrexate 12 mg/day (days: 1-5) and then 15 mg/week until progression or toxicity. Between 2003 and 2015, 41 patients were included. Primitive tumours were RH+/HER2-, HER2+ and triple-negative in respectively 66%, 14%, 5% and 15% of patients, 22% of them had meningeal carcinomatosis as metastatic disease initial manifestation. Objective response rate was 54%, median overall survival was 4.0 mois [CI 95%: 3-7.3] and 1-year survival rate was 15.2% (11.4%, 50% et 0% in RH+/HER2-, HER2+ and triple-negative subgroups; HR=0.45 [0.21-0.97] between HER2+ and RH+/HER2-). In univariate analysis, prognostic factors were brain involvement (p=0.049), initial cerebrospinal fluid protein level (p=0.0002) and concomitant systemic treatment received (p=0.049). This intrathecal methotrexate schedule demonstrates a similar median overall survival as the one obtained with a dose-dense schedule and an improved quality of life. Nevertheless, as the objective response and 1-year survival rates are slightly inferior, a dose-dense schedule remains still preferred in HER2+ patients or in those harboring a mainly meningeal progression.
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Affiliation(s)
- Delphine Cochereau
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Sabrina Da Costa
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Christine Le Maignan
- AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Hélène Gauthier
- AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Jérôme Cochereau
- CHRU, hôpital Gui-de-Chauliac, service de neurochirurgie, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - Marc Espié
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, UFR de médecine, 75890 Paris cedex 18, France
| | - Sylvie Giacchetti
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Luis Teixeira
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France; AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, UFR de médecine, 75890 Paris cedex 18, France
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von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. Abstract P1-14-11: nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We previously reported that nab-paclitaxel (nP) increases the pathological complete response (pCR, ypT0 ypN0) rate when it replaces solvent-based paclitaxel (P) as part of a sequential taxane followed by epirubicin/cyclophosphamide (EC) neoadjuvant chemotherapy for patients with early breast cancer (Untch et al. SABCS 2014). Here, we report efficacy and safety of patients being treated either with 150 mg/m2 nab-paclitaxel (nP150) before an amendment or with 125 mg/m2 nab-paclitaxel (nP125) thereafter in comparison to solvent-formulated paclitaxel at 80 mg/m2 (P80).
Methods: In the GeparSepto study (NCT01583426), 1207 patients were randomized to either nP150 or P80 q1w for 12 weeks followed by 4 cycles of conventionally dosed EC (E: 90mg/m2; C: 600 mg/m2) q3w. The primary objective of the study was to compare the pCR rate (pCR, ypT0 ypN0). Patients with untreated, histologically confirmed uni- or bilateral, cT2- cT4d carcinoma, and no clinically relevant cardiovascular and other co-morbidities were included. Patients with HER2+ tumors received trastuzumab (loading dose 8mg/kg; 6 mg/kg) plus pertuzumab (loading dose 840 mg; 420 mg) q3w concomitantly to all chemotherapy cycles. After a safety analysis showed a higher rate of dose reductions and treatment discontinuations with nP150 compared to P80, weekly dose of nP was reduced to 125 mg/m2.
Results: nP was given for the majority of cycles at a dose of 150 mg/m2 to 179 patients and at a dose of 125 mg/m2 to 426 patients. Treatment characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for HER2 status (HER2-positive: nP150 22%, nP125 37% and P80 33%) and Ki67 (<20%: nP150 60%, nP125 73% and P80 69%). Taxane treatment was discontinued in 16% (nP150), 11% (nP125) and 6% (P80) of patients, respectively. Median dose per cycle (based on relative total dose intensity (RTDI)) was 129 mg/m2 with nP150, 119 mg/m2 with nP125 and 78 mg/m2 with P80, respectively. Peripheral sensory neuropathy (PNP) grade 3/4 (NCI-CTCAE v4.0) was observed in 15% with nP150, 8% with nP125 and 3% with P80, respectively. pCR was 32% with nP150, 41% with nP125 and 29% with P80 in all patients and 46% with nP150, 49% with nP125 and 26% with P80 in 277 patients with triple-negative breast cancer, respectively.
Conclusions: Risk-benefit ratio of nP125 was improved over nP150 with better drug adherence and RTDI, lower frequency of PNP but a higher pCR rate. It should therefore be considered as the preferred schedule when nP is used as neoadjuvant treatment for primary breast cancer.
The trial was financially supported by Celgene and Roche.
Citation Format: von Minckwitz G, Untch M, Jakisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Weibringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer J-U, Clemens M, Costa SD, Gerber B, Nekljudova V, Loibl S. nab-paclitaxel at a dose of 125 mg/m2 weekly is more efficacious but less toxic than at 150 mg/m2. Results from the neoadjuvant randomized GeparSepto study (GBG 69). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-11.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Jakisch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Conrad
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Aktas
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - H Weibringhaus
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hilfrich
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Warm
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Just
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J Hackmann
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - M Clemens
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - SD Costa
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Helios Klinikum Berlin-Buch, Berlin, Germany; Sana Klinikum Offenbach, Offenbach, Germany; University Hospital Heidelberg, Heidelberg, Germany; Elisabeth Krankenhaus, Kassel, Germany; University Hospital Essen, Essen, Germany; Charité-University of Berlin, Berlin, Germany; Universitätsklinikum Schleswig-Holstein, Kiel, Germany; St. Barbara Kliniken Heesen, Heesen, Germany; Kliniken Essen Mitte, Essen, Germany; Eilenriede Klinik Hannover, Hannover, Germany; Kliniken der Stadt Köln, Köln, Germany; Universitäts-Frauenklinik Rechts der Isar, München, München, Germany; Onkologie Praxis Bielefeld, Bielefeld, Germany; Rotkreuzklinikum München, München, Germany; Marienhospital Witten, Witten, Germany; Mutterhaus Trier, Trier, Germany; University Hospital Magdeburg, Magdeburg, Germany; University Hospital Rostock, Rostock, Germany
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Seliger G, Chaoui K, Kunze C, Jenderka KV, Costa SD, Tchirikov M. Beurteilung der Stabilität von Uterusnarbengewebe bei Z.n. Sectio caesarea (SC) mittels quantitativer Sonografie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0035-1570060] [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] Open
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Chaoui K, Seliger G, Kunze C, Jenderka KV, Costa SD, Tchirikov M. Beurteilung der Stabilität von Uterusnarbengewebe bei Z.n. Sectio caesarea mittels quantitativer Sonografie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566511] [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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Thäle V, Pacholke J, Costa SD, Haase R, Tchirikov M. Methylprednisolon zur Schwangerschaftsprolongation beim HELLP-Syndrom – eine retrospektive Fall-Kontroll-Studie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566657] [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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Malfertheiner M, Malfertheiner P, Costa SD, Pfeifer M, Ernst W, Seelbach-Göbel B, Fill Malfertheiner S. Extraesophageal symptoms of gastroesophageal reflux disease during pregnancy. Z Gastroenterol 2015; 53:1080-3. [PMID: 26367023 DOI: 10.1055/s-0034-1399453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Typical symptoms of gastroesophageal reflux disease (GERD) are known to be frequent in pregnancy. The aim of this study was to gain a first estimation of the occurrence of extraesophageal symptoms in this context. METHODS A prospective longitudinal study was performed on 166 pregnant women and in a control group of 285 women. The diagnosis of GERD was based on the Montreal classification using the reflux disease questionnaire (RDQ). Extraesophageal symptoms were recorded with a self-administered questionnaire. Typical GERD symptoms and extraesophageal GERD symptoms were recorded in each trimester of pregnancy. RESULTS The prevalence of GERD during pregnancy was 16.9% in the first, 25.3% in the second and 51.2% in the third trimester. The prevalence of GERD in the control group was 6.3%. Asthma was reported by 3.5% of controls and by 6% of pregnant women during pregnancy. Chest pain occurred in 6% of the controls and in 1.8%, 2.4% and 2.4% during the trimesters of pregnancy, chronic cough was reported by 1.1% of controls and 1.2% of pregnant women. With the diagnosis of GERD the odds ratios and 95% confidence intervals for asthma, chronic cough and chest pain in the third trimester of pregnancy were as follows: 1.56 (0.58-4.22) for asthma, 0.91 (0.08-10.28) for chronic cough and 2.04 (0.49-8.46) for chest pain. CONCLUSION GERD is very frequent during pregnancy with progressive incidence during the course of pregnancy. Extraesophageal symptoms of GERD have an unexpected low prevalence during pregnancy.
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Affiliation(s)
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Germany
| | - S D Costa
- Gynäkologie und Geburtshilfe, Universitätsklinikum Magdeburg, Germany
| | - M Pfeifer
- Pneumologie, Barmherzige Brüder, Regensburg, Germany
| | - W Ernst
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
| | - B Seelbach-Göbel
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
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Findeklee S, Costa SD. Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy. Geburtshilfe Frauenheilkd 2015; 75:839-843. [PMID: 26366004 DOI: 10.1055/s-0035-1557763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/17/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022] Open
Abstract
Placentation disorders are the result of impaired embedding of the placenta in the endometrium. The prevalence of these disorders is estimated to be around 0.3 %. A history of previous prior uterine surgery (especially cesarean section and curettage) is the most common risk factor. Impaired placentation is differentiated into deep placental attachment; marginal, partial and total placenta previa; and placenta accreta, increta and percreta. Treatment depends on the severity of presentation and ranges from expectant management to emergency hysterectomy. In most cases, preterm termination of pregnancy is necessary. We report here on the case of a 39-year-old woman with placenta accreta and total placenta previa who underwent hysterectomy in the 19th week of pregnancy.
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Affiliation(s)
- S Findeklee
- Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - S D Costa
- Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
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Seliger G, Chaoui K, Kunze C, Costa SD, Tchirikov M. Multimodale Beurteilung der Stabilität von Uterusnarbengewebe bei Z.n. Sectio caesarea – Young's modulus in-vivo und in-vitro – quantitative Sonografie und Zugdehnungsversuch. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1551643] [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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Eggemann H, Ehricke J, Ignatov T, Fettke F, Semczuk A, Costa SD, Ignatov A. Platelet Count After Chemotherapy is a Predictor for Outcome for Ovarian Cancer Patients. Cancer Invest 2015; 33:193-6. [PMID: 25831456 DOI: 10.3109/07357907.2015.1020384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated platelet count occasionally is associated with gynecologic malignancies. We investigated the level of platelet count in 450 patients with gynecologic tumors. Ovarian cancer patients have increased platelet count associated with the course of treatment and disease progression. In multivariate analysis, the decrease of platelet count less than 25% after chemotherapy was an unfavorable prognostic factor for PFS (HR, 1.948; 95% CI, 1.083-3.505; p = 0.026) and overall survival (HR, 2.093; 95% CI, 1.022-4.287; p = 0.043). An insufficient decrease of the platelet count increased the risk of recurrence. Thus platelet count could be used for monitoring the disease progression and to predict treatment response.
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Affiliation(s)
- H Eggemann
- 1Department of Obstetrics and Gynecology, Otto-von-Guericke University , Magdeburg , Germany
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Findeklee S, Costa SD, Tchaikovski SN. [Thrombophilia and HELLP syndrome in pregnancy - case report and overview of the literature]. Z Geburtshilfe Neonatol 2015; 219:45-51. [PMID: 25734477 DOI: 10.1055/s-0034-1385856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thrombophilia is a prothrombotic state that can be caused by genetic disorders, such as the factor-V-Leiden or prothrombin mutation, as well as by acquired changes like oestrogen-induced APC resistance and the antiphospholipid syndrome. Pregnancy induces multiple procoagulant changes in the haemostatic system, increasing the risk of venous thromboembolism in women with a thrombophilia even further. Additionally, thrombophilias are suggested to be associated with a number of pregnancy complications such as recurrent miscarriage, stillbirth, preeclampsia and HELLP syndrome. Increased local activation of coagulation may directly influence trophoblast expansion and invasion, causing thereby an impaired trophoblast development and insufficient widening of spiral arteries in the first trimenon, which results in placenta-mediated pregnancy complications like preeclampsia or HELLP syndrome. Besides, macro- and microthrombosis in the vessels of placental stemm villi and spiral arteries may lead to multiple infarctions with release of necrotic trophoblast fragments and inflammatory cytokines playing an important role in the pathogenesis of recurrent pregnancy loss and stillbirth. For women with a known thrombophilia it is recommended to carry out either only postpartal or combined ante- and postpartal thrombosis prophylaxis with low-molecular weight heparins (LMWH) depending on the individual risk stratification. The effectiveness of the LMWH administration for prevention of thrombophilia-induced pregnancy complications and improvement of the pregnancy outcome is currently a matter of debate. Furthermore, an additional application of acetyIsalicylic acid (ASA) should be considered in the management of women with the antiphospholipid antibody syndrome. In the current article we present the case of a 28-year-old woman with the heterozygous prothrombin mutation, HELLP syndrome, a late miscarriage and a stillbirth in the anamnesis, who delivered 3 healthy babies under antenatal LMWH prophylaxis combined with intensive interdisciplinary prenatal care.
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Affiliation(s)
- S Findeklee
- Gynecology und Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - S D Costa
- Gynecology und Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - S N Tchaikovski
- Gynecology und Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
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Malfertheiner SF, Eckart A, Ernst W, Costa SD, Malfertheiner P, Seelbach-Göbel B. Gesundheitsbezogene Lebensqualität von schwangeren Patientinnen mit gastroösophagealer Refluxkrankheit. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388242] [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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Fettke F, Schumacher A, Costa SD, Zenclussen AC. Humanes Choriongonadotropin induziert IL-10-produzierende regulatorische B-Zellen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1387966] [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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Seiz L, Ignatov T, Modl S, Weißenborn C, Zenclussen A, Costa SD, Ortmann O, Ignatov A. GPER-1 acts as a tumor suppressor in ovarian cancer. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388395] [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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Ignatov A, Ignatov T, Costa SD, Eggemann H. Ultrasound-guided breast-conserving surgery is superior to the palpation-guided surgery for palpable breast cancer. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388386] [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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Grumpelt AM, Eggemann H, Costa SD. Vergleich der älteren Mammakarzinompatientin mit der jüngeren hinsichtlich adjuvanter Therapie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388381] [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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38
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Luley L, Schumacher A, Mulla MJ, Franke D, Abrahams VM, Costa SD, Zenclussen AC. Therapie mit niedermolekularem Heparin beeinflusst Immunantwort bei Schwangeren mit angeborener Thrombophilie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388030] [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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Schippan J, Eggemann H, Altmann U, Röhl FW, Costa SD. Endokrine Therapie des metastasierten Mammakarzinoms des Mannes – eine retrospektive Analyse von 80 Patienten im Vergleich mit 541 Frauen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388356] [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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Schwarzenau-Szydlowski C, Gerloff C, Wiemann D, Costa SD. Schwangerschaftsverlauf und postnatales Outcome nach Valsartaneinnahme bis zur 22. SSW – eine Kasuistik. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388205] [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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Weißenborn C, Ignatov T, Costa SD, Zenclussen AC, Ignatov A. GPER is inactivated by promoter methylation and potentially functions as a tumor suppressor in breast cancer. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388378] [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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42
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Eggemann H, Heuer H, Schwarzenau-Szydlowski C, Amse T, Röhl FW, Costa SD. Laparoskopisch assistierte vaginale Hysterektomie versus vaginale Hysterektomie – eine prospektive, randomisierte, Doppel-blind-Studie bei Patientinnen mit der Indikation zur vaginalen Hysterektomie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388319] [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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Ignatov A, Ignatov T, Costa SD, Eggemann H. Accuracy of ultrasound-guided breast-conserving surgery in the determination of adequate surgical margins. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388452] [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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von Minckwitz G, Rezai M, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Blohmer JU, Costa SD, Jackisch C, Paepke S, Schneeweiss A, Kümmel S, Denkert C, Mehta K, Loibl S, Untch M. Survival after adding capecitabine and trastuzumab to neoadjuvant anthracycline-taxane-based chemotherapy for primary breast cancer (GBG 40--GeparQuattro). Ann Oncol 2013; 25:81-9. [PMID: 24273046 DOI: 10.1093/annonc/mdt410] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The GeparQuattro study showed that adding capecitabine or prolonging the duration of anthracycline-taxane-based neoadjuvant chemotherapy from 24 to 36 weeks did not increase pathological complete response (pCR) rates. Trastuzumab-treated patients with HER2-positive disease showed a higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone. We here present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1495) with cT ≥ 3 tumors, or negative hormone-receptor status, or positive hormone-receptor and clinically node-positive disease received four times epirubicin/cyclophosphamide and were thereafter randomly assigned to four times docetaxel (Taxotere), or four times docetaxel/capecitabine over 24 weeks, or four times docetaxel followed by capecitabine over 36 weeks. Patients with HER2-positive tumors received 1 year of trastuzumab, starting with the first chemotherapy cycle. Follow-up was available for a median of 5.4 years. RESULTS Outcome was not improved for patients receiving capecitabine (HR 0.92; P = 0.463 for DFS and HR 93; P = 0.618 for OS) as well as for patients receiving 36 weeks of chemotherapy (HR 0.97; P = 0.818 for DFS and HR 0.97; P = 0.825 for OS). Trastuzumab-treated patients with HER2-positive disease showed similar DFS (P = 0.305) but a significantly better adjusted OS (P = 0.040) when compared with patients with HER2-negative disease treated with chemotherapy alone. Recorded long-term cardiac toxicity was low. CONCLUSIONS Long-term results, similar to the results of pCR, do not support the use of capecitabine in the neoadjuvant setting in addition to an anthracycline-taxane-based chemotherapy. However, the results support previous data showing a benefit of trastuzumab as predicted by higher pCR rates.
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Eggemann H, Ignatov T, Beni A, Costa SD, Ortmann O, Ignatov A. Intraoperative Ultrasound in the Treatment of Breast Cancer. Geburtshilfe Frauenheilkd 2013; 73:1028-1034. [PMID: 24771892 DOI: 10.1055/s-0033-1350828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/17/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022] Open
Abstract
Purpose: The aim of this study was to investigate the value of intraoperative ultrasound in breast-conserving operations and to compare it with standard procedures. Methods: For this purpose 307 women with palpable breast cancers and 116 patients with non-palpable breast cancers were compared retrospectively. In the group with palpable breast cancers 177 patients were treated by US-guided operations and 130 patients underwent palpation-guided breast-conserving operations. As primary outcomes, the resection margins and the rate of re-operations were evaluated. Results: With regard to disease-free resection margins, intraoperative ultrasound was significantly superior to palpation alone. In the group of patients in whom the tumours were extirpated with the help of palpation, R1 resections were observed almost twice as often (16.9 %) as in the US-guided group (8.5 %). In the group with non-palpable breast cancers, intraoperative ultrasound was employed in 61 patients. As a control, 43 cases were evaluated in whom the breast-conserving operation was performed after wire marking. In this group US-guided tumour removal proved to be superior to that after wire marking for tumours that did not exhibit any intraductal components. Otherwise the redo resection rate was reduced by use of ultrasound. Furthermore, the surgeon was able by means of intraoperative ultrasound to identify "problematic" margins and to excise them in the same sitting. Conclusions: The US-guided, breast-conserving operations led to a lower rate of R1 resections and redo operations in comparison to operations with palpation alone or those after wire marking.
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Affiliation(s)
| | | | - A Beni
- Unifrauenklinik, Magdeburg
| | | | - O Ortmann
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Uni Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - A Ignatov
- Unifrauenklinik, Magdeburg ; Lehrstuhl für Frauenheilkunde und Geburtshilfe der Uni Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
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Ignatov T, Poehlmann A, Ignatov A, Schinlauer A, Costa SD, Roessner A, Kalinski T, Bischoff J. BRCA1 promoter methylation is a marker of better response to anthracycline-based therapy in sporadic TNBC. Breast Cancer Res Treat 2013; 141:205-12. [PMID: 24026861 DOI: 10.1007/s10549-013-2693-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
The aim of the current study was to investigate the role of BRCA1 gene aberrations in sporadic triple-negative breast cancer (TNBC) and its impact on anthracycline-based therapy. BRCA1 promoter methylation was analyzed in 70 TNBC and compared with the clinical and pathologic characteristics. As a control group, we used 70 patients with non-TNBC. BRCA1 promoter methylation was observed in 65.2 % of patients and was similar in both groups. BRCA1 promoter methylation was associated with decreased intensity of BRCA1 protein expression (P = 0.002) and significant increase of median disease-free survival (DFS) of TNBC patients receiving adjuvant anthracycline-based chemotherapy (P = 0.001). Multivariate analysis revealed that BRCA1 promoter methylation remains a favorable factor in regard to DFS (HR 0.224; 95 % CI 0.092-0.546, P = 0.001) in TNBC after adjustment for other prognostic factors. In contrast, in non-TNBC, BRCA1 promoter methylation was not associated with any clinical and pathologic parameters. BRCA1 promoter methylation is a common mechanism of BRCA1 gene aberration in sporadic breast cancer and is predictive for better response to anthracycline-based therapies.
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Affiliation(s)
- T Ignatov
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany,
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von Minckwitz G, Kaufmann M, Kümmel S, Fasching PA, Eiermann W, Blohmer JU, Costa SD, Hilfrich J, Jackisch C, Gerber B, Barinoff J, Huober J, Hanusch C, Konecny G, Fett W, Stickeler E, Harbeck N, Mehta K, Loibl S, Untch M. PD07-05: Local Recurrence Risk in 6377 Patients with Early Breast Cancer Receiving Neoadjuvant Anthracycline-Taxane +/− Trastuzumab Containing Chemotherapy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd07-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Locoregional recurrence (LRR; defined according to Hudis C, JCO 2007) risk after neoadjuvant systemic treatment is considered as a possible hazard of this treatment approach. However, few data exist on the incidence and risk factors for LRR after anthracycline-taxane+/−trastuzumab (AT+/−H) containing neoadjuvant treatment. We analyzed individual data of 7 prospective neoadjuvant trials conducted by the German Breast Group and the AGO Breast Group.
Patients (Pts) and methods: 6377 Pts with operable or locally advanced, non-metastatic breast cancer were analyzed (for details see von Minckwitz G et al, BCRT 2010). Postsurgical radiotherapy was indicated after breast conservation for all patients and after mastectomy for patients with cT3/4 or cN+ disease. Endocrine treatment was given to ER− and/or PgR-positive patients. 485 LRR were observed during a median follow up of 46.2 (0-127) months.
Results: LRR was similar for patients treated by tumorectomy (7.2% of N=1123), segmentectomy (6.8% of N=1121), quadrantectomy (7% of 557), or breast conservation (BCT) (not otherwise specified) (7.7% of N=819), but higher in patients treated by mastectomy (ME) (12.1% of N=1670) (p<0.001). Rate of breast conservation decreased by increasing initial tumor size (cT1(N=198): 77.7%, cT2(N=3675): 78.1%, cT3(N=795): 49.4%, cT4a-c(N=348): 35.9%, cT4d(N=235):19.1%). LRR in patients treated by BCT or ME were 9.1% vs 9.1% for cT1 (p=0.9); 6.9% vs. 9.8% for cT2 (p=0.001); 9.7% vs 14.2% for cT3 (p=0.04); 3.2% vs. 11.7% for cT4a-c (p=0.004; and 22.2% vs 18.9% for cT4d (p=0.4). LRR increased with surgical yT-stage from 4.7% for ypT0 (N=990), 11.8% for ypTis (N=340), 9.1% for ypT1 (N=1555), 8.2% for ypT2 (N=926), 13.8% for ypT3 (N=232), 20% ypT4a-c (N=80), to 31.2% for ypT4d (N=16) (p<0.001). Comparable results were obtained for cN and ypN stages. Patients with a pathological complete response (pCR = ypT0 ypN0) showed a lower LRR of 3.7% compared to patients not achieving a pCR (3.7% vs 9.9% (HR 0.36 p<0.001). Patients with a pCR showed low LRR in all intrinsic subtypes except Luminal B/HER2+ -like tumors (Luminal A-like tumors (N=105; 3.8%), Luminal B/HER2− -like (N=40; 0%), Luminal B/Her2+ -like (N=124; 8.1%), HER2+(non-luminal)-like (N=158; 1.9%), triple-negative (N=276; 2.5%) (p=0.016). Patients without a pCR showed an excessive LRR for HER2+(non-luminal) and triple-negative tumors (Luminal A-like tumors (N=1498; 5.1%), Luminal B/HER2− -like (N=304; 11.9%), Luminal B/HER2+ -like (N=602; 8.5%), HER2+(non-luminal)-like (N=367; 18%) and triple-negative (N=276; 17.8%) (p<0.001). cT, cN, ypN, intrinsic subtype, but not ypT stage and type of surgery were independent predictors of LRR for patients without pCR in a Cox regression model. None of these factors except Luminal B/HER2+ (p=0.012) were significant in patients with pCR.
Conclusions: LRR in this large pooled analysis after AT+/−H containing neoadjuvant treatment appears to be low, especially in all patients with a pCR except Luminal B/HER2+ disease. In patients without a pCR low cT, cN, ypN and Luminal tumor type predict a low LRR. Other stages and subtypes without pCR should be carefully followed up irrespective of type of surgery.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD07-05.
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Affiliation(s)
- G von Minckwitz
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - M Kaufmann
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - S Kümmel
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - PA Fasching
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - W Eiermann
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - JU Blohmer
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - SD Costa
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - J Hilfrich
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - C Jackisch
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - B Gerber
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - J Barinoff
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - J Huober
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - C Hanusch
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - G Konecny
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - W Fett
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - E Stickeler
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - N Harbeck
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - K Mehta
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - S Loibl
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
| | - M Untch
- 1German Breast Group, Neu-Isenburg; Universitäts-Frauenklinik, Frankfurt; Universitäts-Frauenklinik, Essen; University Hospital Erlangen, Erlangen; Klinikum zum Roten Kreuz, München; St. Gertrauden Krankenhaus, Berlin; UniversitätsFrauenklinik, Magdeburg; Henrietten-Stiftung, Hannover; Städtische Kliniken, Offenbach; Universitäts-Frauenklinik, Rostock; Horst Schmidt Klinik Wiesbaden; Universitäts-Frauenklinik, Tübingen; University of California, Los Angeles; Hämato-Onkologische Praxis, Wuppertal; Universitäts-Frauenklinik, Freiburg; UniversitätsFrauenklinik, Köln; Helios-Klinikum Berlin-Buch, Berlin
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Ignatov A, Ignatov T, Kalinski T, Costa SD. G-Protein-gekoppelter Estrogenrezeptor GPR30 und Tamoxifenresistenz beim Mammakarzinom. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Tchaikovski SN, Thomassen MCLGD, Costa SD, Brandkvist C, Bremme K, Rosing J. Changes in haemostatic parameters induced by drospirenone-containing oral contraceptives. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Eggemann H, Ignatov A, Stabenow R, Minkwitz GV, Röhl FW, Hildebrandt G, Hass P, Costa SD. Postmastectomy radiotherapy in male breast cancer –20 Years follow-up data. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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