[HPV infection in women : Diagnostics, treatment and the relevance of vaccination]. / Humane Papillomavirusinfektion bei Frauen : Diagnostik, Therapie und Bedeutung der Impfung.

BACKGROUND: Benign, premalignant and malignant changes in the anogenital region, as in the oropharynx are often affected by a persistent HPV infection. Since a causal therapy isn't possible, the focus is on early diagnosis of dysplasia. Better knowledge of the human papilloma virus led to the development of the HPV vaccine and now primary prevention of cancer is possible. These findings will also influence the German cervical cancer screening. OBJECTIVES: This article illustrates prevalence, significance, diagnostics, treatment and prevention of HPV infection and HPV-associated diseases in women. MATERIAL AND METHODS: A literature research under pubmed.de has been carried out. In addition up-to-date guidelines and internet-based sources were considered. RESULTS: Persistent infection can lead to dysplasia and carcinoma of the cervix, vagina and vulva, the anus and the oropharynx. In future an additional HPV testing is planned to be integrated in the German screening for cervical cancer for women above 35 years. Management of dysplasia is operative or topical. Accordingly, a primary prevention through vaccination is even more important. The German Standing Vaccination Committee recommends the vaccination for girls and boys between 9 to 14 years. CONCLUSION: HPV vaccination is a secure and efficient procedure to prevent cancer. In the following years it is of great importance to improve acceptance and vaccination rates.

[Prospective performance evaluation of first trimester screenings in Germany for risk calculation through http://www.firsttrimester.net]. / Prospektive Testleistungsbewertung des Ersttrimester Screenings in Deutschland bei Risikoberechnung über http://www.firsttrimester.net.

BACKGROUND: In 2008, 2 351 first trimester screenings were calculated by a newly developed internet database ( http:// www.firsttrimester.net ) to evaluate the risk for the presence of Down's syndrome. MATERIAL AND METHODS: All data were evaluated by the conventional first trimester screening according to Nicolaides (FTS), based on the previous JOY Software, and by the advanced first trimester screening (AFS). After receiving the feedback of the karyotype as well as the rates of the correct positives, correct negatives, false positives, false negatives, the sensitivity and specificity were calculated and compared. RESULTS: Overall 255 cases were investigated which were analysed by both methods. These included 2 cases of Down's syndrome and one case of trisomy 18. The FTS and the AFS had a sensitivity of 100%. The specificity was 88.5% for the FTS and 93.0% for the AFS. CONCLUSION: As already shown in former studies, the higher specificity of the AFS is a result of a reduction of the false positive rate (28 to 17 cases). As a consequence of the AFS with a detection rate of 100% the rate of further invasive diagnostics in pregnant women is decreased by having 39% fewer positive tested women.

[Retroperitoneal xanthofibrogranulomatosis]. / Die retroperitoneale Xanthofibrogranulomatose.

Retroperitoneal xanthofibrogranulomatosis has so far been reported less than 50 times in the world literature. It has not been classified with retroperitoneal fibrosis or neoplasia. The clinical, radiological and histological features, and the problems of diagnosis, are discussed with reference to another case. The classification of the condition is considered in relation to the available literature. Diagnosis and possible treatment are also discussed.

[Sonography of the diaphragmatic pleura in tumor patients]. / Sonographie der Pleura diaphragmatica bei Tumorpatienten.

Report on twelve patients suffering from malignant primary disease associated with pleural effusion and diaphragmatic metastasis, basically diagnosed via sonography. In no case tumour formation could be detected by x-ray film. Cytohistological evidence of diaphragmal metastasis can be found by sonographically detected pleural tumours malignant effusion must be assumed, despite negative exudate cytology. In such cases diagnostic thoracoscopy is not necessary.

Ultrasonography of achilles tendons in primary hypercholesterolemia. Comparison with computed tomography.

Tendon xanthoma are a hallmark of familial hypercholesterolemia and are among its earliest clinical manifestations. Achilles tendon size, advanced to a generally accepted marker, is virtually specific for the disease and easily accessible for measurement. Hypercholesterolemic patients with coronary heart disease have been reported to have larger diameters of the Achilles tendons than patients without coronary problems. Furthermore, Achilles tendon xanthomas have been shown to regress with treatment of the lipid disorder. Mainly radiological procedures were applied in the past to evaluate the diameters of the Achilles tendon but their use is limited by radiation protection. We have used real-time ultrasonography to evaluate the Achilles tendons of 38 patients with primary hypercholesterolemia and 32 normocholesterolemic controls. The anterior posterior diameter in the patients was 13.4 +/- 5.9 mm (range 6-20 mm) and 5.7 +/- 0.7 mm (range 5-8 mm) in the control group. In 8 patients with newly diagnosed and previously untreated hypercholesterolemia the thickness correlated highly with their age. The Achilles tendons in about half of the patients (n = 21) showed a homogeneous thickening, whereas the others revealed an inhomogeneous thickening indicating the presence of circumscribed xanthoma. Upon comparison of the ultrasonographic procedure with an established method (computed tomography) in 18 patients and 8 normal volunteers a highly significant correlation (r = 0.96) proved the validity of the sonography. We show that real time ultrasonography is a valid procedure to assess Achilles tendon diameters in patients with primary hypercholesterolemia. It can be applied frequently and may be useful to follow xanthoma regression during lipid lowering treatment.

[Accidental finding of a giant retroperitoneal lipoma in a traumatic rupture of the renal parenchyma]. / Zufallsbefund eines retroperitonealen Riesenlipoms bei traumatischer Nierenparenchymruptur.

With a rate of 0.1-3% of all tumour cases primary retroperitoneal neoplasms are very rare. Malignant tumours predominate. Preoperative radiological clarification as regards tumour status is very unsafe unless there are indications of infiltrating growth and metastases. In some cases, computed tomography can supply pointers to the kind of the tumour.

[Case examples of rare locations of aneurysms]. / Fallbeispiele seltener Aneurysmalokalisationen.

We describe four cases of rare aneurysm localisations, one case of an aneurysm of the hepatic artery, two cases of aneurysms of the superior mesenteric artery and its branches and, as an extreme rarity, one case of an aneurysm of the superior gluteal artery (only three known cases up to now). All cases were documented by arteriography/DSA, ultrasonography and computed tomography. We refer to incidence, aetiology, symptomatology, and possible complications as indicated by literature.

[Advantages of computerized tomography diagnosis in acetabular fractures]. / Vorteile der Computertomographie-Diagnostik bei Acetabulumfrakturen.

There is a comparison of conventional radiographs and computed tomography in 23 patients presenting acetabular fracture. Four patients were treated conservatively because of their CT-findings. The result was successful. Surgery took place in 19 patients. Intraoperative findings verified CT-diagnosis in all cases, while diagnosis with conventional radiographs in 3 projections had to be corrected in 8 of 19 cases. Advantages of CT in acetabular fracture: 1. always manageable, 2. correct topography of fracture, 3. discovery of small especially intraarticular bone fragments, 4. judgement of congruity of the joint, 5. clear decision of management. 6. definite surgical approach. In conclusion, the CT-scanning of acetabular fractures is preferable for correct classification as opposed to conventional radiographs; if only plain X-ray films are available CT-scanning is to be required.

[Radiotherapy of cervix and uterus carcinomas (Marburg results of 1960 to 1975)]. / Beitrag zur Strahlentherapie der Kollum- und Korpuskarzinome (Marburger Ergebnisse 1960 bis 1975).

The authors present the therapy results and complications of 479 patients with carcinomas of the cervix and 241 patients with carcinomas of the body of the uterus. The five-year survival rate of the patients with carcinomas of the cervix is 57%. The first five years after diagnosis were survived by 79.6% of the patients in stage I, 57.3% of the patients in stage II, 31.1% of the patients in stage III, and 5.9% of the patients in stage IV. 60% of these patients were only submitted to percutaneous and intracavitary irradiation, and 40% were irradiated after operation. The five-year survival rate of the patients with carcinoma of the body was 74.3%. This rate was 80.8% in stage I, 77.5% in stage II, 57.5% in stage III, and 30% in stage IV. The operation frequency was relatively high with 74%, only 26% of these patients were only treated by radiotherapy. The percutaneous radiotherapy was performed exclusively under high voltage conditions, preponderantly according to the method of Marburg which allows a homogenous, small-field irradiation of the small pelvis with a dose until 45 Gy, but which deliberately does not expose to radiation the para-aortal lymph nodes. In the years of 1966 to 1971, a comparison with the method established in Düsseldorf was made. This method is working with two big U-shaped stationary fields including the para-aortal lymph nodes. The central part of the pelvis is collimated when percutaneous irradiation is applied, and the intracavitary treatment is applied with a higher dose, correspondingly. The present analysis of the treatment results of both methods does not show any significant difference as to the survival time. The incidence of fistulas, however, a severe late complication, which is 2.4% for the method of Marburg, is markedly lower than that of 8.6% for the other method. Prognostic factors and therapeutic aspects are discussed in detail.