A Scharl

Klinikum Sankt Marien Amberg, Amberg, Bavaria, Germany

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Publications (126)191.02 Total impact

  • R Gaetje, A Scharl, M Kaufmann, A Ahr
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    ABSTRACT: Bleeding disorders are one of the most frequent gynecological problems. The causes of bleeding disorders, and their frequency in particular, vary depending on the age of the woman affected. In premenopause and perimenopause, the most frequent causes are hormonal, in up to 90 % of cases, as well as organic changes in the uterus such as myomas, adenomyosis uteri, or endometrial polyps, in up to 70 % of cases. Coagulation defects cause increased bleeding, particularly in girls and young women, with no other recognizable cause. The treatment of bleeding disorders is causally based, although if the woman does not wish to have children, the therapeutic algorithm in many cases leads to similar symptomatic measures. The following therapeutic approaches, listed in order of increasing efficacy, are mainly used in the treatment of increased bleeding: gestagen, estrogen-gestagen combination, levonorgestrel (Mirena) and endometrial ablation or myoma enucleation, with comparable success rates, and finally hysterectomy. Embolization of the uterine artery in myomas or adenomyosis uteri, nonsteroidal anti-inflammatory drugs, and antifibrinolytic agents represent alternatives that may be useful in individual cases. The paper provides an overview of the various causes, useful diagnostic measures, and treatment options in uterine bleeding disorders.
    Zentralblatt für Gynäkologie 09/2006; 128(4):196-201.
  • Zentralblatt Fur Gynakologie - ZBL GYNAKOL. 01/2006; 128(4):196-201.
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    ABSTRACT: Laparoscopy is used for most surgical procedures in gynaecology. In general complications are rare. However, one of the most critical steps is the initial laparoscopic entry into the peritoneal cavity. According to the literature serious complications occur in approximately 1-2/1 000 cases. Whereas major vascular injuries are mainly recognised immediately, delayed recognition of bowel injuries is frequent. Complication rates of different entry procedures used in gynaecological laparoscopy are similar even in high risk patients (intraperitoneal adhesions, obesity). Utilising an open - instead a closed - entry (either by Veress needle or first trocar) technique or alternativ entry positions are suggested by some authors. This review presents data available in the literature and highlights that open laparoscopy is no gold standard.
    Zentralblatt für Gynäkologie 01/2006; 127(6):380-4.
  • A. Ahr, A. Scharl
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    ABSTRACT: 95% der Patienten mit Harnwegsinfekten, die ein Urologe in seiner Praxis behandelt, sind Frauen, die eine rezidivierende Bakteriurie haben. Entsprechend leiden 5–10% aller erwachsenen Frauen unter rezidivierenden Harnwegsinfektionen. Früher war man der Ansicht, dass Anomalien des Harntraktes, vesikoureteraler Reflux, Harnstauung, die vergleichsweise kürzere Harnröhre oder eine zu enge Harnröhre Ursachen für diese Infektanfälligkeit sind.
    12/2005: pages 271-285;
  • 12/2005: pages 477-533;
  • A. Scharl, A. Ahr, U.-J. Göhring
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    ABSTRACT: Zusammenfassung Ovarialkarzinome und Plazentatumoren gehören zu den seltenen Erkrankungen, die eine Schwangerschaft komplizieren können. Um so mehr stellen sie für die Betroffene, deren Angehörige sowie die betreuenden Ärzte eine besondere Konfliktsituation dar. Eine frühzeitige Diagnosestellung und adäquate Therapie ist von entscheidender Bedeutung. Die Planung der Therapie wird von zahlreichen Faktoren wie dem Schwangerschaftsalter, dem Stadium und der Prognose der Tumorerkrankung sowie dem Kinderwunsch der Patientin beeinflusst und muss ausführlich mit der Patientin und deren Angehörigen besprochen werden. Eine enge Zusammenarbeit mit Pränatalmedizinern, Onkologen, Neonatologen und Psychologen ist unabdingbar. Dieser Beitrag gibt einen Überblick über Ovarialkarzinome in der Schwangerschaft und gestationsbedingte Trophoblasterkrankungen mit den gängigen Therapieempfehlungen.
    12/2005: pages 447-461;
  • 12/2005: pages 21-35;
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    ABSTRACT: A case of 56-year-old patient is presented with the diagnosis "carcinoma of the cervix". She suffered from brown, bad smelling vaginal discharge since half a year without any pain. Three weeks before she had noticed a postmenopausal bleeding. At the examination under anaesthesia with cysto- and rectoscopy we saw a rectovaginal fistula. In the vagina a white plastic object was found which could not be removed. Some days later a hysterectomy with extraction of the foreign body (aerosol cap) was done and the fistula was treated together with the surgeons. There was no evidence of a carcinoma. The patient suffers from multiple sclerosis since 20 years. On asking she told us that the foreign body was in place since about two years. She was not willing to relate any other information.
    Zentralblatt für Gynäkologie 05/2005; 127(2):96-8.
  • Zentralblatt Fur Gynakologie - ZBL GYNAKOL. 01/2005; 127(6):380-384.
  • Zentralblatt Fur Gynakologie - ZBL GYNAKOL. 01/2005; 127(2):96-98.
  • S D Costa, R Souchon, A Scharl
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    ABSTRACT: In spite of the fact that breast cancer is a systemic disease, local control plays an important role in its management. While surgical, radiotherapeutic and systemic therapy of primary breast cancer are performed according to widely accepted guidelines, the management of ipsilateral breast tumor relapse (IBTR) is still a matter of individualised concepts because of the lack of randomised studies. IBTR represents a significant medical problem, since the recurrence rate is 5-15 % after 5 years and 20-25 % after 10 years. Incidence is higher in younger patients, in tumors with an extensive intraductal component, positive tumor margins, axillary lymph node metastases, negative steroid hormone receptors and high proliferative activity. Distant metastases after IBTR occur more often if the interval between primary diagnosis and IBTR is short (e. g. less than 4 years). Diagnosis of IBTR include breast palpation, mammography and breast ultrasound. In addition breast MRI can be used to further differentiate between benign and malignant lesions after breast conservation. Standard therapy in this setting remains mastectomy. Breast-conserving surgery may be considered in the context of clinical trials for patients with certain favorable features. Breast irradiation after secondary breast-conservation can be carried out in some cases. Some local relapses after breast-conserving surgery have a poorer prognosis, and the addition of adjuvant systemic therapy should be considered in addition to mastectomy. The heterogeneous nature of locoregional relapses has made it difficult to conduct prospective randomized clinical trials. However, many retrospective data exist, making it possible to recommend rational treatment approaches for these patients.
    Zentralblatt für Gynäkologie 09/2004; 126(4):244-51.
  • A. Scharl, S. D. Costa
    Geburtshilfe Und Frauenheilkunde - GEBURTSH FRAUENHEILK. 01/2004; 64(4):420-422.
  • S. D. Costa, R. Souchon, A. Scharl
    Zentralblatt Fur Gynakologie - ZBL GYNAKOL. 01/2004; 126(4):244-252.
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    ABSTRACT: Dynamic enhanced magnetic resonance (MR) mammography and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) of the breast were directly compared preoperatively in suspicious breast lesions. Forty-two breast lesions in 40 patients were examined with a three-dimensional dynamic MR imaging series and FDG-PET. The MR and PET examinations were evaluated separately and the results were compared with the histological findings. The sensitivity and specificity of each method were calculated. The diagnostic value of both modalities as single diagnostic tool and in combination was investigated. Nineteen malignant and 23 benign breast lesions were proven histologically. Magnetic resonance mammography and FDG-PET showed a sensitivity of 89 and 63%, respectively. The specificity was 74 and 91%, respectively. The combination of both imaging methods decreased the not-required biopsies from 55 to 17%. Only one false-negative finding-a patient pre-treated with chemotherapy-was observed in both methods. The combination of MR mammography and FDG-PET can help to decrease biopsies of benign breast lesions. Because of their high cost, these modalities should only be used in problematic cases to either rule out or to demonstrate malignancy. The best diagnostic strategy is achieved using MR mammography first. If the diagnosis is still questionable, FDG-PET can be performed.
    European Radiology 08/2003; 13(7):1651-6. · 4.34 Impact Factor
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    ABSTRACT: To determine whether patients with high-risk metastatic breast cancer draw benefit from combination chemotherapy as first-line treatment. A total of 260 women with measurable metastatic breast cancer fulfilling high-risk criteria, previously untreated with chemotherapy for their metastatic disease, were randomized to receive either mitoxantrone 12 mg/m(2) or the combination of fluorouracil 500 mg/m(2), epirubicin 50 mg/m(2) and cyclophosphamide 500 mg/m(2) (FEC) every 3 weeks. Treatment was continued until complete remission plus two cycles, or until disease progression. In the case of partial remission or stable disease, treatment was stopped after 12 cycles. Second-line treatment was vindesine, mitomycin and prednisolone. Gain from treatment was estimated using a modified Brunner's score composed of time to progression, patients' rating of the treatment benefit, alopecia, vomiting and performance status. After recruitment from 1992 to 1997 and observation from 1997 to 1999, the final evaluation showed that single-agent treatment with mitoxantrone does not differ significantly from combination treatment with FEC in terms of response, objective remission rate, remission duration, time to response, time to best response, time to progression or overall survival. There was, however, a significant difference in gain from treatment using a modified Brunner's score favoring the single-agent treatment arm. There was no evidence that any subgroup would fare better with combination treatment. No significant difference was detected between the treatment with mitoxantrone as a single agent and the combination of low-dose FEC in terms of response or survival; therefore, the imperative of the necessity of first-line combination chemotherapy for patients with high-risk metastatic breast cancer may be questioned. Since toxicity and quality of life score favored the single-agent mitoxantrone treatment arm, this treatment may be offered to patients preferring quality of life to a potential small prolongation of survival.
    Annals of Oncology 12/2002; 13(11):1717-29. · 7.38 Impact Factor
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    ABSTRACT: Trophoblast injury may be one of the possible causes of fetal distress associated with chemotherapy administered during pregnancy. The purpose of this study was to investigate the ex vivo chemosensitivity of normal trophoblasts (NTB) against commonly used antineoplastic agents. Using the newly developed ex vivo ATP-based trophoblast assay (ATP-TBA), 31 NTB freshly sampled from human placentas (gestational week 7-42) were tested against dactinomycin (Act-D), 5-fluorouracil (5-FU), 4-OOH-cyclophosphamide (4-HC), vincristine (VCR) and methotrexate (MTX) alone or in combination with calcium folate (LV). All agents were studied at concentrations relevant to clinical dosages normally used for chemotherapy of solid neoplasms. Of 31 samples studied with the ATP-TBA, 20 (65%) were evaluable. VCR, Act-D and 4-HC were the most active drugs with 55, 45 and 45% of samples responding ex vivo. Antimetabolites were less active, producing ex vivo response rates of 25 (MTX) and 20% (5-FU), respectively. MTX activity was largely neutralized by adding LV. The chemosensitivity of NTB showed considerable inter-individual variations and did not decrease with increasing gestational age. We therefore conclude that NTB of any gestational age exhibit considerable ex vivo sensitivity against common anticancer agents which is comparable to that observed for various solid tumors. The ATP-TBA may be helpful in planning future trials with both single agents and drug combinations in order to standardize and optimize chemotherapy during pregnancy.
    Anti-Cancer Drugs 09/2002; 13(7):701-8. · 2.23 Impact Factor
  • Zentralblatt für Gynäkologie 06/2002; 124(5):293-303.
  • Zentralblatt für Gynäkologie 06/2002; 124(5):284-92.
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    ABSTRACT: For many tumors, pathological subclasses exist which have to be further defined by genetic markers to improve therapy and follow-up strategies. In this study, cDNA array analyses of breast cancers have been performed to classify tumors into categories based on expression patterns. Comparing purified normal ductal epithelial cells and corresponding tumour tissues, the expression of only a small fraction of genes was found to be significantly changed. A subset of genes repeatedly found to be differentially expressed in breast cancers was subsequently employed to perform a classification of 82 normal and malignant breast specimens by cluster analysis. This analysis identifies a subgroup of transcriptionally related tumours, designated class A, which can be further subdivided into A1 and A2. Correlation with classical clinicopathological parameters revealed that subgroup A1 was characterized by a high number of node-positive tumours (14 of 16). In this subgroup there was a disproportionate number of patients who had already developed distant metastases at the time of diagnosis (25% in this subgroup, compared with 5% among the rest of the samples). Taken together, the use of these differentially expressed marker genes in conjunction with sample clustering algorithms provides a novel molecular classification of breast cancer specimens, which facilitates the identification of patients with a higher risk of recurrence.
    The Journal of Pathology 11/2001; 195(3):312-20. · 7.59 Impact Factor
  • Geburtsh Frauenheilk. 01/2001; 61(12):954,963.

Publication Stats

561 Citations
191.02 Total Impact Points

Institutions

  • 2001–2006
    • Klinikum Sankt Marien Amberg
      Amberg, Bavaria, Germany
  • 1992–2006
    • Goethe-Universität Frankfurt am Main
      • Klinik für Frauenheilkunde und Geburtshilfe
      Frankfurt am Main, Hesse, Germany
  • 2002
    • Bozeman Deaconess Hospital
      Bozeman, Montana, United States
  • 1986–1999
    • University of Cologne
      • • Department of Gynaecology and Obstetrics
      • • Department of Nuclear Medicine
      Köln, North Rhine-Westphalia, Germany
  • 1990–1995
    • University of Chicago
      • Department of Obstetrics & Gynecology
      Chicago, IL, United States
  • 1991–1993
    • The University of Chicago Medical Center
      • Department of Obstetrics and Gynecology
      Chicago, Illinois, United States
  • 1991–1992
    • University of Illinois at Chicago
      • Department of Obstetrics and Gynecology (Chicago)
      Chicago, IL, United States
  • 1989
    • Pathologisches Institut Bremerhaven
      Bremerhaven, Bremen, Germany
  • 1988
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      Erlangen, Bavaria, Germany