Diagnostic approach and therapeutic management in early-stage endometrial cancer.

OBJECTIVE: The effectiveness of pelvic and para-aortic lymphadenectomy in the morbidity of patients affected by early-stage endometrial carcinoma (EC) is the subject of this study. STUDY DESIGN: Ninety-two cases with endometrial cancer that underwent para-aortic and pelvic lymphadenectomy, from June 1995 to June 2006, were studied and compared with 30 cases of patients with endometrial cancer without lymphadenectomy. RESULTS: According to the results, systematic pelvic and para-aortic lymphadenectomies improved disease-free and overall survival rates among the patients with endometrial cancer. The mean number of removed para-aortic lymph nodes was 19.01 +/- 5.88, whereas the mean number of removed iliac lymph nodes was 32.94 +/- 6.69. Forty-two and 31 metastatic iliac and para-aortic nodes were found, respectively. No surgery-related deaths and major intraoperative injuries occurred. The frequency and the type of postoperative complications were not affected by the performance of lymphadenectomy. The morbidity rate was 6.2%, similar to the group without lymphadenectomy (5.79%). No recurrence occurred in the group with lymphadenectomy, while in the other group the recurrence rate was 23.3%. CONCLUSIONS: Lymph nodes metastases can be observed in early stages of EC. Pelvic and para-aortic lymphadenectomies seems to provide profound information about the Stage of the disease and the patient's survival, identifying which patients are suitable for supplementary treatment, without significant clinical increase of morbidity.

A retrospective analysis of twenty-eight borderline ovarian tumours in adolescent girls.

The aim of this retrospective study was to evaluate the clinical reproductive outcome and the rate of recurrence of low malignant ovarian tumors in adolescent girls after conservative surgical treatment by laparoscopy or laparotomy. We report 28 cases of borderline ovarian tumors (BOTs), that were surgically treated from 1990 to 2006 at the Obstetrical and Gynecological Department of Democritus University in Greece and the Aschaffenburg Teaching Hospital in Germany. All patient information was obtained by reviewing hospital records. BOT lesions in teenagers were associated with variable non-specific presenting symptoms. Ultrasonographic investigations can be helpful in the early diagnosis of BOTs in teenage girls. Most of the patients were diagnosed at an early stage. Available data of our study indicate that in these patients, fertility, pregnancy outcome and survival remain excellent.

Uterine sarcoma: a report of 57 cases over a 16-year period analysis.

Uterine sarcomas comprese approximately 4-9% of all uterine malignant tumors with a poor prognosis. We report 57 cases of sarcoma originating in the uterus treated from 1990 to 2006 at the Department of Obstetrics and Gynecology of Democritus University of Thrace, Greece and the Department of Obstetrics and Gynecology of Aschaffenburg Hospital, Germany. The median age of occurrence was 49 years with the commonest symptom being abnormal uterine bleeding. Forty-nine patients underwent a total hysterectomy and bilateral salpingo-oophorectomy whereas 17 cases underwent radical lymphadenectomy. During the last followup (December 2006), six patients were alive and well with no evidence of disease, 23 patients had died of undercurrent disease, and 28 were alive with recurrence of disease. These rare cancers can be aggressive, and account for a greatly disproportionate number of deaths from uterine cancers. Treatment for this rare disease should be performed according to international protocols in order to have the most updated information.

Attitudes towards contraception in three different populations.

OBJECTIVE: To investigate contraceptive behavior of women belonging to three different ethnic and/or socioeconomic populations as well as to evaluate the main sources of information concerning contraception in each population. METHODS: 150 Muslim women living in Germany (group A), 120 Muslim women living in Thrace, Greece (group B) and 140 Christian Orthodox women living in Thrace, Greece were enrolled in the study. Attitudes concerning contraceptive practices were assessed by means of a questionnaire. Demographic and socioeconomic characteristics of each group were compared with the method of contraception used. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Turkey's test, chi-square test and multiple logistic regression analysis. RESULTS: The contraceptive pill (41.7%), the condom (35.1%), periodic abstinence (24.4%) and interrupted coitus were the most common methods of contraception. The gynecologist (23.4%), the family consultant (12.0%) and the sexual partner (10.2%) were the most usual sources of information. The use of contraceptive pills was more frequent among Muslims from Germany and Christians from Greece (p < 0.001), while the use of condoms was more frequent among Christians from Greece (p = 0.019). The use of IUDs was more frequent among Muslims from Germany and Greece (p = 0.039). CONCLUSIONS: Our study results reveal that there are behavioral differences between race/ethnic groups and minorities regarding contraceptive practices, probably due to different cultural, socioeconomic and educational factors.

Laparoscopic treatment of ovarian dermoid cysts.

Dermoid cysts are the most common germ cell tumors of the ovary in women of reproductive age. We report 67 cases of patients with dermoid cysts (mean age, 31.31 years) originating from the ovary treated from 1994 to 2006 at the Obstetrics and Gynecology Department of Aschaffenburg Hospital-Clinic in Germany. Most patients (60) underwent cyst removal. In two patients salpingo-oophorectomy was performed and in five partial oophorectomy was performed. Additional surgery ensuing laparotomy was never necessary. None of the patients had long-term postoperative complications. Two patients were at nine and 15 weeks of gestation and postoperatively were well following termination of pregnancy. In a group of 43 women, who desired pregnancy, 37 pregnancies resulted. The overall intrauterine pregnancy rate was 83.7%; one patient had an ectopic pregnancy (2.32%). To receive more information on this disease, treatment should be performed according to international protocols.

Contribution of laparoscopy in young women with abdominal pain.

This study retrospectively evaluates the laparoscopic treatment of acute abdominal pain in 120 young girls aged 13 to 25 years from 1990 to 1995. Seventy-two (60%) of all operations were emergency procedures. Of these, 55 had functional ovarian cysts, eight patients were operated on for adnexal torsion and nine patients had other adnexal conditions. Ovarian cyst resection was performed in 46 patients and ovarian cyst coagulation in 17 patients. In the rest of the 48 patients (40%), 31 (26.67%) cases had pelvic inflammatory disease, three (2.5%) benign ovarian tumors, two (1.6%) ectopic pregnancies, one (0.8%) a paraovarian cyst and 11 (5%) endometriosis. Laparoscopy appeared to be a safe and effective surgical procedure.

Digit-color synaesthesia only enhances memory for colors in a specific context: A new method of duration thresholds to measure serial recall.

For digit-color synaesthetes, digits elicit vivid experiences of color that are highly consistent for each individual. The conscious experience of synaesthesia is typically unidirectional: Digits evoke colors but not vice versa. There is an ongoing debate about whether synaesthetes have a memory advantage over non-synaesthetes. One key question in this debate is whether synaesthetes have a general superiority or whether any benefit is specific to a certain type of material. Here, we focus on immediate serial recall and ask digit-color synaesthetes and controls to memorize digit and color sequences. We developed a sensitive staircase method manipulating presentation duration to measure participants' serial recall of both overlearned and novel sequences. Our results show that synaesthetes can activate digit information to enhance serial memory for color sequences. When color sequences corresponded to ascending or descending digit sequences, synaesthetes encoded these sequences at a faster rate than their non-synaesthetes counterparts and faster than non-structured color sequences. However, encoding color sequences is approximately 200 ms slower than encoding digit sequences directly, independent of group and condition, which shows that the translation process is time consuming. These results suggest memory advantages in synaesthesia require a modified dual-coding account, in which secondary (synaesthetically linked) information is useful only if it is more memorable than the primary information to be recalled. Our study further shows that duration thresholds are a sensitive method to measure subtle differences in serial recall performance. (PsycINFO Database Record

Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015)

Background: Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

Phage and host genetic determinants of the specific anticodon loop cleavages in bacteriophage T4-infected Escherichia coli CTr5X.

Anticodon loop cleavages of two host tRNA species occur in bacteriophage T4-infected Escherichia coli CTr5X, a host strain restricting phage mutants deficient in polynucleotide kinase (pnk) or RNA ligase (rli). The cleavage products accumulate with the mutants but are further processed in wt infection through polynucleotide kinase and RNA ligase reactions. Inactivating mutations in stp suppress pnk- or rli- mutations in E. coli CTr5X and, as shown here, also abolish the anticodon nuclease, implicating the stp product with this activity. We show also that there exist other suppressing mutations of a pnk- (pseT2) mutation that appear not to affect the anticodon nuclease and are not in stp. It has been shown that a single locus in E. coli CTr5X, termed prr, determines the restriction of pnk- or rli- mutants. A transductant carrying prr featured upon infection the anticodon nuclease reaction products, suggesting that prr determines the specific manifestation of this activity. However, prr does not encode the tRNA species that are vulnerable to the anticodon nuclease.

Red, green, blue equals 1, 2, 3: Digit-color synesthetes can use structured digit information to boost recall of color sequences.

Digit-color synesthetes report experiencing colors when perceiving letters and digits. The conscious experience is typically unidirectional (e.g., digits elicit colors but not vice versa) but recent evidence shows subtle bidirectional effects. We examined whether short-term memory for colors could be affected by the order of presentation reflecting more or less structure in the associated digits. We presented a stream of colored squares and asked participants to report the colors in order. The colors matched each synesthete's colors for digits 1-9 and the order of the colors corresponded either to a sequence of numbers (e.g., [red, green, blue] if 1 = red, 2 = green, 3 = blue) or no systematic sequence. The results showed that synesthetes recalled sequential color sequences more accurately than pseudo-randomized colors, whereas no such effect was found for the non-synesthetic controls. Synesthetes did not differ from non-synesthetic controls in recall of color sequences overall, providing no evidence of a general advantage in memory for serial recall of colors.

The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015).

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover.

Paracrine actions of oxytocin, prostaglandin F2 alpha, and estradiol within the human corpus luteum.

Human luteal cells are known to interact in an auto- and paracrine fashion using a variety of substances, including prostaglandins (PGs), steroids, and peptides. In cultures of dispersed luteal cells obtained from several animal species prostaglandin F2 alpha (PGF2 alpha) and oxytocin (OXT) inhibit progesterone (P) secretion, indicating a luteolytic effect of these substances. The disadvantage of luteal cell cultures is that the different luteal cell types do not communicate with each other, i.e. auto- and paracrine effects cannot be studied. Therefore, we used a microdialysis tubing, which is implanted in human corpora lutea (CL) kept under short term organ culture conditions. Ringer's solution is pumped through the dialysis tubing, and substances secreted by the luteal tissue can be determined in the effluent fractions. This system also allows topical application of substances with putative intraluteal effects. In the present report we used PGF2 alpha, OXT, and estradiol (E2) to examine the effects of these substances on the respective other hormones and on P release from young human CL. Intraluteal application of PGF2 alpha stimulated OXT, E2, and P release. OXT was stimulatory to E2 and P secretion, an effect that can be blocked by a specific OXT antagonist and by tamoxifen. Elevation of intraluteal E2 concentrations also had marked stimulatory effects on P secretion. From luteal cell culture experiments it is known that PGF2 alpha and OXT have direct inhibitory effects on P production, but both substances stimulate E2 release. It was also shown that E2 counteracts the inhibitory effects on P release. Therefore, the PGF2 alpha- and OXT-induced E2 release may be responsible for the increased P release. This assumption is further substantiated by the observation that intraluteally applied E2 stimulates P secretion, and preexposure of human CL to tamoxifen prevents the OXT-induced stimulation of P, but not E2, secretion. We conclude that in young human CL, PGF2 alpha and OXT have dual effects: direct inhibitory effects on P release and E2-mediated stimulatory effects, which in young CL result in a net stimulation of P secretion.

Laboratory scale production of monoclonal antibodies in a tumbling chamber.

A simple device for laboratory scale production of monoclonal antibodies has been developed. Hybridomas were cultured in four individual dialysis tubes containing 40-50 ml medium with 10% foetal calf serum, surrounded by 1.5-2 litres supply medium without any serum supplement. Once placed on a roller the special design of the apparatus leads to an eccentric rotation, thus keeping the cells in a stable homogeneous suspension. The system is automatically gassed, and this makes long term cultivation possible. Several hybridomas were tested over a culture period of at least 3 weeks, with supply medium changes every 3-4 days. Cell densities of up to 2.5 x 10(7)/ml and antibody concentrations of 0.3-1.9 mg/ml after purification were obtained. Results with this in vitro system allow a complete renunciation of the established in vivo method. The so called 'tumbling chamber' apparatus is easy to handle and to sterilize, is economic and universally adaptable in any research laboratory.

Comparison of six different commercial IgG-ELISA kits for the detection of TBEV-antibodies.

BACKGROUND: Tick-borne encephalitis virus (TBEV) is a pathogenic human flavivirus endemic in some parts of Europe and Asia. Commercial enzyme immunoassays (EIA) for the detection of IgG antibodies are often used in TBEV-seroprevalence studies, as well as for the confirmation of a successful vaccination against TBEV. However, the detection of TBEV-specific antibodies can be biased by the cross-reactivity between different flavivirus genera. OBJECTIVES: To compare different EIA test systems for the detection of TBEV-IgG antibodies. STUDY DESIGN: Six commercial EIA kits for the detection of TBEV-specific antibodies are compared, using serum panels (n=139) of subjects with a documented clinical history (109 sera from TBEV infected patients, 30 sera from people vaccinated against TBEV). For the analysis of possible cross-reactivities, 24 sera from yellow fever vaccinated people and 13 sera positive for Dengue virus-specific antibodies were also included. RESULTS: The sensitivity of the different TBEV test systems ranges from 73 to 99%. However, when testing the yellow fever and Dengue virus positive specimens, problems with the flavivirus cross- reactivity become obvious, resulting in specificities between 14 and 81%. CONCLUSIONS: This study shows the necessity of further improvement of the existing TBEV test systems regarding both sensitivity and specificity.

Urinary cGMP excretion after hormone replacement therapy in postmenopausal women.

It is well established that estrogens and progestogens are able to influence the vasotonus in postmenopausal women. The present study was undertaken to find out if the NO/cGMP-system is involved in this hormone action. Urinary cGMP excretion which can reflect intracellular cGMP production elicited by NO (EDRF) was investigated in 20 postmenopausal women. In an open cross-over study design norethisterone acetate was administered orally for 8 days, estradiol valerate orally for 9 days and a combination of both substances for 12 days. After all three treatment phases urinary cGMP expressed as percentage of the pretreatment value was increased at a statistically significant level. Due to high individual variations no significant differences could be found among the values after the three treatment phases. It was concluded that the NO/cGMP-system may play a role in maintaining vasotonus in postmenopausal women under hormone replacement therapy.

Age, metabolism and oral contraception.

PIP: Because of the elevated risk of pathological problems for women over 35, the recommendation for an oral contraceptive (OC) must be carefully considered after the physician has studied the individual's health history and assessed the risks. The physician is responsible for understanding specific needs of each patient as well as understanding risks inherent with the aging process of the female population such as an increased risk of diabetes, a rise in weight and blood pressure, and an increased risk of heart disease. The administration of exogenous hormones and the affect of these hormones pertaining to each of the risk areas is studied. Studies concluding that estrogen deficiency is related to hypertension risk seem to support the assumption that estrogens counteract the development of hypertension. However, other studies have shown an increase in the incidence of hypertension following OC intake. Exogenous hormones have not been linked to an increase in the volume of fat cells. Oral contraceptives do not increase the risk of diabetes if there is no genetic disposition to the disease; patients who do show evidence of the existing disease should be carefully monitored. A further conclusion is that oral contraceptives have a minimal affect on blood clotting. The most effective way to limit health hazards is by limiting the dosage and the frequency of hormonal contraceptives. With careful medical supervision, older women can be open to alternative methods of contraception including oral contraceptives with a minimal level of use.^ieng

Lipid metabolic changes during hormonal treatment of endometriosis.

Three groups of patients with pelvic endometriosis were treated with medroxyprogesterone acetate (MPA) 50 mg/day (n = 10), lynestrenol (LYN) 10 mg/day (n = 25) and danazol (DAN) 600 mg/day (n = 25) respectively. Total cholesterol, triglycerides, alpha-lipoprotein, prebetalipoprotein, beta-lipoprotein cholesterol, high-density (HDL) and low-density (LDL) lipoprotein and apolipoprotein A1 and B concentrations were determined before treatment and after 3 and 6 mth of therapy. Whereas lipid, lipoprotein and apolipoprotein levels did not change in the MPA group, the patients on LYN and in particular those on DNA showed marked changes in lipoportein patterns. Alpha-lipoprotein, HDL and apolipoprotein A1 levels fell, while beta-lipoprotein, LDL and apolipoprotein concentrations rose, these changes being statistically significant. No alterations were seen in the serum levels of cholesterol, triglycerides or prebetalipoprotein cholesterol. In view of a possible relationship between high LDL and low HDL levels and a risk of accelerated coronary arteriosclerosis in women it was concluded that progestogen-induced alterations in lipoprotein patterns should be avoided as far as long-term treatment is concerned and where additional risk factors are present.

Effects of medrogestone and conjugated oestrogens on serum lipid and lipoprotein concentrations.

Twenty patients, aged 30-60 yr, who had undergone bilateral ovariectomy, were treated orally with 5 mg medrogestone (6,17-dimethylpregna-4,6-diene-3,20-dione) and 1.25 mg conjugated oestrogens per day, according to a constant dosage pattern during the cycle (22 + 6 days). The lipids and lipoproteins were determined twice before the start of therapy and 3, 6 and 12 mth thereafter. The lipids were quantified enzymatically and the lipoproteins by quantitative lipoprotein electrophoresis. Whilst cholesterol and triglyceride concentrations showed no detectable change, a slight but significant increase was seen in the high-density alphalipoprotein (HDL) cholesterol concentrations. The low-density beta-lipoprotein (LDL) cholesterol level showed a moderate fall. There was a resultant reduction in the beta/alpha-lipoprotein ratio. Accordingly, the apoprotein A1 concentrations were found to be elevated, while apoprotein B tended to fall to lower levels during therapy. When these changes are measured by the lipid metabolism risk criterion for the occurrence of coronary heart disease applicable to post-menopausal patients, the effects of the above-mentioned combination may be regarded as entirely favourable.

Effect of 17 alpha-ethinylestradiol, levonorgestrel, 3-keto-desogestrel, and gestodene on calcium influx via voltage-gated calcium channels in human aortic smooth muscles.

The effect of the synthetic estradiol, 17 alpha-ethinylestradiol, and three progestogens on calcium influx was investigated in cell cultures of human aortic smooth muscle. Neither the synthetic estrogen nor the progestogens levonorgestrel, 3-keto-desogestrel, and gestodene showed, in the concentration range of 10(-9) to 10(-6) M, a significant effect on calcium influx both alone or in equimolar estrogen-gestagen combinations. The results indicate that these substances, commonly used in contraceptive pills, do not change vasotonus interfering with calcium homeostasis.

Effect of two oral contraceptives containing ethinylestradiol and levonorgestrel on serum and urinary surrogate markers of endothelial function.

OBJECTIVE: To investigate the effect of two oral contraceptives containing 0.02 mg ethinylestradiol and 0.1 mg levonorgestrel (Formulation A, Leios), and the other containing 0.03 mg ethinylestradiol and 0.15 mg levonorgestrel (Formulation B, Stediril 30) on the serum and urinary concentrations of various markers reflecting the status of vascular tone and development of atherosclerosis. The adhesion molecules E-selectin, inter-cellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and homocysteine were included as serum markers and cGMP, prostacyclin and its antagonist thromboxane as urinary markers. METHODS: In a comparative, double-blind, randomized, parallel group study, 34 women received formulation A and 33 women formulation B. Serum samples were collected before treatment and after 3, 6 and 12 cycles. Nocturnal urine was collected before treatment and during cyclic treatment after 3 and 12 cycles. Serum and urinary markers were measured by enzyme immunoassays. RESULTS: E-selectin levels were significantly reduced by both contraceptives after 3, 6 and 12 months compared to pretreatment levels. A slight increase in ICAM concentrations was observed for both contraceptives after 6 cycles, but this fell to pretreatment levels after 12 cycles. VCAM values were significantly lowered after 3, 6 and 12 months by both contraceptives. No significant changes were found in serum levels of homocysteine. No significant differences were found between treatment groups for the serum markers. Both contraceptives significantly enhanced urinary cGMP excretion after 12 cycles. The prostacyclin metabolite remained unchanged in the case of both formulations, but the excretion of the thromboxane metabolite was significantly decreased after 12 cycles. Thus, the ratio of prostacyclin to thromboxane, decisive for the resulting effect on vascular tone, increased significantly. CONCLUSION: These results indicate that the low-dose oral contraceptives can reduce the production of adhesion molecules which play a crucial role in the early stages of atherosclerosis. In addition, these contraceptives can shift the balance of vascular tone towards dominance of vasodilatory substances after 12 cycles of treatment. Thus, the positive influence of these contraceptives on the various markers investigated may improve vascular tone and impede development of atherosclerosis.