H Salzer

University of Vienna, Wien, Vienna, Austria

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Publications (226)388.69 Total impact

  • A Tammaa · N Fritzer · P Lozano · A Krell · H Salzer · M Salama · G Hudelist ·
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    ABSTRACT: Evaluation of the interobserver agreement and accuracy of transvaginal sonography (TVS) for deep infiltrating endometriosis (DIE) and endometriomas. Sixty-seven consecutive patients were enrolled from January 2013 to January 2014 referred to a pelvic pain clinic and scheduled for laparoscopy and were prospectively examined by two experienced sonographers (observer A and B) independently and blinded to the others results. Gwet's first order agreement coefficient (Gwet's AC1) was used to calculate interobserver agreement and diagnostic accuracy of TVS as well as sensitivity, specificity, positive and negative predictive value (PPV, NPV) of TVS (observer A and B) when compared to laparoscopy. Sixty-five out of 67 patients were finally analysed. The level of agreement between observer A and B (Gwet's AC1), sensitivity/specificity were as following: vagina (Gwet's AC1: 0.933; 62%/94%; 82%/94%), bladder (Gwet's AC1: 1.00; 67%/97%; 67%/97%), uterosacral ligaments (USL) (Gwet's AC1: 0.84; 73%/83%; 53%/93%), adnexia (Gwet's AC1: 0.95; 71%/93%; 71%/93%), rectovaginal septum (RVS) (Gwet's AC1: 0.95; 40%/90%; 33%/87%) and rectosigmoid (Gwet's AC1: 0.98; 93%/96%; 94%/98%) reflecting high interobserver agreement. With the exception of DIE affecting the RVS, similar results were observed when TVS was compared with laparoscopy. TVS is a highly accurate and reproducible method for non-invasive diagnosis of DIE in well-trained staff. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 03/2015; 75(07). DOI:10.1002/uog.14843 · 3.85 Impact Factor
  • G Hudelist · N Fritzer · A Tammaa · A Krell · F Berger · N Szabo · P Lozano · M Kurleto · H Salzer ·

    Geburtshilfe und Frauenheilkunde 06/2014; 74(05). DOI:10.1055/s-0034-1374745 · 0.94 Impact Factor
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    ABSTRACT: How long does it take to be proficient in diagnosing pouch of Douglas (POD) obliteration and deep infiltrating endometriosis (DIE) of the rectum with transvaginal sonography (TVS)? Sonographers familiar with the general use of TVS are expected to be proficient in the diagnosis of endometriosis nodules of the rectum and the detection of POD obliteration using the 'sliding sign' after ∼40 examinations, performed in a referral clinic for pelvic pain. With rectal DIE, the reasons for the obvious diagnostic problems are complex. Menstrual pain or cramps are still considered to be 'normal' and do not provide a reason for patients and even health-care providers to seek expert help. Furthermore, the performance of TVS for diagnosing pelvic endometriosis has been shown to be accurate only in experienced hands. This prospective study included 121 selected patients with suspected endometriosis. Symptomatic patients, referred to a pelvic pain clinic, were examined by an expert sonographer (E.S.) and consecutively by two trainees (T1/2). The learning curve using the cumulative sum shows that the trainees, listed as T1/T2, reached the predefined level of proficiency in detecting bowel nodules after examining 42 and 37 patients, for T1 and T2, respectively. The prevalence rate of bowel nodules demonstrated by the ES was 21%. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) as well as the accuracy for TVS of T1 and T2 in comparison with the results of ES were 72 and 89, 96 and 95, 87 and 80, 90 and 98, and 89 and 94%, respectively. The prevalence rate of POD obliteration, as demonstrated by a negative sliding sign, was 27%. The trainees reached the predefined level of proficiency after examining 42 and 33 patients, for T1 and T2, respectively. The sensitivity, specificity, PPV, NPV as well as the accuracy of TVS for T1 and T2 in comparison with the results of the ES were 83 and 89, 95 and 95, 91 and 80, 90 and 98, and 91 and 94%, respectively. We performed this analysis in a tertiary referral centre with a high number of advanced cases of DIE, not reflecting a standard population. Integrated in TVS training courses, typical sonographic video clips for DIE of the rectum, including the use of disease-specific signs, could help to improve diagnostic accuracy in DIE and shorten diagnostic delays. No funding was received for this study. None of the authors has any competing interests.
    Human Reproduction 04/2014; 29(6). DOI:10.1093/humrep/deu078 · 4.57 Impact Factor
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    N Fritzer · A Tammaa · H Salzer · G Hudelist ·
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    ABSTRACT: Dyspareunia, a common symptom of endometriosis, severely affects quality of sex life in affected women. The objective of the present work was to review the effect of surgical resection of endometriosis on pain intensity and quality of sex life. MEDLINE and EMBASE databases were searched for papers investigating the outcome after surgical endometriosis resection on dyspareunia and quality of sex life measured via VAS/NAS respectively via standardised measuring instruments. Data did not permit a meaningful meta-analysis. Out of 64 papers, three studies fulfilled the predefined inclusion criteria involving 128 patients with endometriosis and dyspareunia preoperatively. All included studies showed a significant postoperative reduction (p<0.05) of dyspareunia after a follow-up period of 12 up to 60 months. Sex life also improved significantly (p<0.05), and predominantly evaluated parameters like quality of life and mental health. Intra- and postoperative complications were described in two out of three studies. Surgical excision of deep infiltrating endometriosis is feasible and improves dyspareunia and quality of sex life significantly.
    European journal of obstetrics, gynecology, and reproductive biology 11/2013; 173(1). DOI:10.1016/j.ejogrb.2013.10.032 · 1.70 Impact Factor
  • G Hudelist · N Fritzer · A Thomas · C Niehues · P Oppelt · D Haas · A Tammaa · H Salzer ·
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    ABSTRACT: STUDY QUESTIONWhat is the length of the diagnostic delay for endometriosis in Austria and Germany, and what are the reasons for the delay?SUMMARY ANSWERThe diagnostic delay for endometriosis in Austria and Germany is surprisingly long, due to both medical and psychosocial reasons. WHAT IS KNOWN ALREADYDiagnostic delay of endometriosis is a problematic phenomenon which has been evaluated in several European countries and in the USA, but has not been reported for Germany and Austria. STUDY DESIGN, SIZE, DURATIONA cross-sectional, questionnaire-based multicentre study was conducted in tertiary referral centers in Austria and Germany. From September 2010 to February 2012, 171 patients with histologically confirmed endometriosis were included. PARTICIPANTS, SETTING, METHODS Patients with a previous history of surgically proven endometriosis, internal diseases such as rheumatic disorders, pain symptoms of other origin, gynecological malignancy or post-menopausal status were excluded from the analysis. Patients with histologically confirmed endometriosis completed a questionnaire about their psychosocial and clinical characteristics and experiences. Of 173 patients, two did not provide informed consent and were excluded from the study. MAIN RESULTS AND THE ROLE OF CHANCEThe median interval from the first onset of symptoms to diagnosis was 10. 4 (SD: 7. 9) years, and 74 of patients received at least one false diagnosis. Factors such as misdiagnosis, mothers considering menstruation as a negative event and normalization of dysmenorrhea by patients significantly prolonged the diagnostic delay. No association was found between either superficial and deep infiltrating endometriosis or oral contraceptive use and the prolongation of diagnosis. LIMITATIONS AND REASONS FOR CAUTIONThere was a possible selection bias due to inclusion of surgically treated patients only. WIDER IMPLICATIONS OF THE FINDINGSSeveral factors causing prolongation of diagnosis of endometriosis have been reported to date. The principal factors observed in the present study are false diagnosis and normalization of symptoms. Teaching programs for doctors and public awareness campaigns might reduce diagnostic delay in Central Europe. STUDY FUNDING/COMPETING INTEREST(S)No competing interests exist.
    Human Reproduction 09/2012; 27(12). DOI:10.1093/humrep/des316 · 4.57 Impact Factor
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    Nadja Fritzer · Ayman Tammaa · Heinrich Salzer · Gernot Hudelist ·
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    ABSTRACT: The aim of the present work is to give a critical and detailed reflection on the effects of surgical resection of deep infiltrating endometriosis regarding reduction of symptoms, psychological well-being and quality of life. The current evidence strongly supports the effectiveness of radical laparoscopic resection in relieving endometriosis-associated symptoms and enhancing psychological well-being. In addition, studies suggest a general improvement of quality of life, however, further studies are needed to support this observation.
    Women s Health 07/2012; 8(4):427-35. DOI:10.2217/whe.12.19
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    ABSTRACT: Most patients with a positive sentinel lymph node (SN) have no further metastases in the axillary lymph nodes and may therefore not benefit from axillary lymph node dissection. In patients with melanoma, evaluation of the centripetal depth of tumor invasion in the SN, also known as the S classification of SN, and microanatomic localization of SN metastases were shown to predict non-SN involvement. This phenomenon has been less extensively studied in breast cancer. We sought to validate the S classification and microanatomic location of SN metastases in breast cancer patients with regard to their predictive value for non-SN involvement and overall survival (OS). A total of 236 patients with positive SN followed by axillary lymph node dissection were reevaluated according to the S classification and the microanatomic location of SN (subcapsular, parenchymal, combined subcapsular and parenchymal, multifocal, extensive) metastases to predict the likelihood of non-SN metastases and OS. S classification and the microanatomic location of SN metastases were significantly correlated with non-SN status (P < 0.001). Especially patients with a maximum depth of invasion ≤0.3 mm (stage I according to the S classification) and those with SN metastases only in subcapsular location had a low probability of further non-SN metastases (7.8 and 6.1%) and a good prognosis for OS. S classification and microanatomic location of SN metastases predicts the likelihood of non-SN involvement. Especially patients with subcapsular or S stage I metastases have a low probability of non-SN metastases and a good prognosis for OS.
    Annals of Surgical Oncology 06/2011; 18(6):1691-7. DOI:10.1245/s10434-010-1545-7 · 3.93 Impact Factor

  • Geburtshilfe und Frauenheilkunde 05/2009; 69(05). DOI:10.1055/s-0029-1225081 · 0.94 Impact Factor
  • S Bassim · A Tammaa · J Reininger · H Salzer ·

    Geburtshilfe und Frauenheilkunde 05/2009; 69(05). DOI:10.1055/s-0029-1225078 · 0.94 Impact Factor

  • Geburtshilfe und Frauenheilkunde 05/2009; 69(05). DOI:10.1055/s-0029-1225202 · 0.94 Impact Factor
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    ABSTRACT: Increased plasma free fatty acid (FFA) levels are a feature of insulin resistance and type 2 diabetes. The aim of the present study was to assess the effect of L-carnitine supplementation on plasma lipids and the expression of enzymes in peripheral mononucleated cells (PMNC) involved in the regulation of fatty acid and glucose oxidation. L-Carnitine supplementation of 2 g/day resulted in a significant decrease in plasma FFA and in a less pronounced diminution of the plasma triacylglycerols. In addition, a concomitant increase in the relative mRNA abundances of carnitine acyltransferases (5- to 10-fold) and of the carnitine carrier OCTN2 (12-fold) in PMNC of pregnant women was found. The results of the present study provide evidence that L-carnitine supplementation in pregnancy (2 g/day) avoids a striking increase in plasma FFA, which are thought to be the main cause of insulin resistance and consequently gestational diabetes mellitus.
    Gynäkologisch-geburtshilfliche Rundschau 05/2009; 49(4):230-5. DOI:10.1159/000301075

  • Geburtshilfe und Frauenheilkunde 11/2008; 45(11):761-768. DOI:10.1055/s-2008-1036132 · 0.94 Impact Factor
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    ABSTRACT: One-half of breast cancer patients with positive sentinel lymph node (SN) have no further metastases in the axillary lymph node basin. The aim of the present study was to identify patients with positive SN who are unlikely to have further metastases in the axillary lymph node basin, using a new classification of SN, namely the S-classification. Specimens of positive SN were subjected to a pathological review according to the previously published S-classification. S-stages of positive SN were correlated with the status of further metastases in the axillary lymph node basin after axillary lymph node dissection (ALND). Of 117 patients who underwent sentinel lymph node biopsy, 36 (30.8%) had a positive SN and were subjected to level I and II ALND. The occurrence of positive nonsentinel nodes was significantly related to the S-stage of SN. No patient with stage SI had additional metastases in the nonsentinel lymph nodes, while 14.3% of patients with SII stage disease and 60.9% of patients with SIII disease had other non-SN that were metastatic. S-stages of positive SN are highly predictive for axillary nonsentinel node status. Especially patients with SI sentinel node metastases appear to be at low risk for further nonsentinel node metastases.
    Annals of Surgical Oncology 04/2008; 15(3):848-53. DOI:10.1245/s10434-007-9694-z · 3.93 Impact Factor
  • H Lass · A Fink · H Hartleb · M Riegler-Keil · A Steiner · H Salzer ·

    Geburtshilfe und Frauenheilkunde 05/2007; 67(05). DOI:10.1055/s-2007-983436 · 0.94 Impact Factor
  • M Brunbauer · H Lass · B Klemensich · H Salzer ·

    Geburtshilfe und Frauenheilkunde 05/2007; 67(05). DOI:10.1055/s-2007-983482 · 0.94 Impact Factor
  • S Bassim · A Tammaa · H Salzer ·

    Geburtshilfe und Frauenheilkunde 05/2007; 67(05). DOI:10.1055/s-2007-983550 · 0.94 Impact Factor
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    ABSTRACT: Salvage chemotherapy in advanced ovarian cancer is not yet standardized. Twenty-one consecutive patients progressing on or relapsing after previous platinum-containing treatment were eligible for treatment with ifosfamide 5 g/m(2) infused over a 24-hour period every 3 weeks in a Phase II trial. After an initial bolus of 1 g/m(2) of mesna, mesna was applied at a dosage of 5 g/m(2) concomitantly with ifosfamide followed by additional dosages of 200 mg 3 times at 4-hour intervals after termination of the ifosfamide infusion. The rate of objective responses was 19 percent, with a 95%CI [5.45-41.91 percent]. One patient achieved a pathologic complete remission (pCR) and 3 patients a clinical partial remission (PR). Median time-to-progression was 3 months. One patient was a long-term survivor. Main toxicities according to NCI-CTC included Grade 4 neurotoxicity in one patient, Grade 3 gastrointestinal toxicity in 5 patients, Grade 3 infection in one patient, and Grade 3 and 4 leucopenia in 6 and 2 patients, respectively. Monotherapy with ifosfamide represents an active regimen for salvage chemotherapy in advanced ovarian cancer patients progressing on or relapsing after previous platinum-pretreatment, even yielding a long-term surivor.
    Cancer Investigation 03/2006; 24(1):22-7. DOI:10.1080/07357900500449595 · 2.22 Impact Factor
  • S. Bassim · M. Lange · H. Salzer ·

    Geburtshilfe und Frauenheilkunde 01/2006; 66(1):59-62. DOI:10.1055/s-2006-923764 · 0.94 Impact Factor
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    ABSTRACT: Levels of oestrogen receptor (ER) and progesterone receptor (PgR) in ovarian cancer tissue were examined with regard to their prognostic importance for survival in 179 patients with primary epithelial ovarian cancer stage III or IV in relation to: FIGO-stage, histological type, histological grade, age, ascites, and postoperative residual tumour. Hormone receptor content was determined with the DCC-method, receptor values higher than 9 fmol/mg protein were considered positive. Response to postoperative chemotherapy was significantly correlated with PgR content (80% responders in the group with PgR positive tumours and only 61% responders in the group with PgR negative tumours). A Cox proportional hazards regression model identified histological grade, residual tumour, age and PgR content as independent prognostic factors for survival in advanced epithelial ovarian carcinoma. PgR content had particularly significant prognostic relevance for patients with postoperative residual tumour mass ≤2 cm in diameter. Within this group of patients, those who are PgR positive have a 2-years survival probability of 83% compared with only 51% in the Pg R-negative group.
    BJOG An International Journal of Obstetrics & Gynaecology 08/2005; 97(8):706 - 712. DOI:10.1111/j.1471-0528.1990.tb16243.x · 3.45 Impact Factor
  • H. Lass · M. Brunbauer · S. Wildhofen · O. Merl · A. Tammaa · H. Salzer ·

    The Breast 02/2005; 14. DOI:10.1016/S0960-9776(05)80090-6 · 2.38 Impact Factor

Publication Stats

818 Citations
388.69 Total Impact Points


  • 1980-2005
    • University of Vienna
      • • Clinic for Internal Medicine I
      • • Department of Medicinal Chemistry
      • • Department of Gynecology
      Wien, Vienna, Austria
  • 1991
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
  • 1987
    • Technische Universität München
      München, Bavaria, Germany
  • 1976-1986
    • Medical University of Vienna
      Wien, Vienna, Austria