W Pritze’s research while affiliated with Freie Universität Berlin and other places

OBJECTIVE: Aim of the study was to evaluate the importance of cystoscopy and rectoscopy in the preoperative management of histologically confirmed endometrial cancer. MATERIAL UND METHODS: 1. A survey was carried out in all gynecological departments in Germany to find out whether cystoscopy and rectoscopy are routinely performed during the preoperative management of histologically confirmed endometrial cancer. 2. An evaluation was made of the cystoscopy and rectoscopy findings in 220 patients with endometrial cancer and compared with the surgical findings. RESULTS: Neither carcinoma of the urinary bladder nor carcinoma of the rectum is frequently found as a secondary neoplasm to endometrial carcinoma. The percentage of urinary bladder or rectum infiltration is below 1 % when endometrial cancer is diagnosed first. Thus, these neoplasms are very rarely diagnosed using cystoscopy and rectoscopy at this point. 127 gynecological departments participated in the survey. The assessment of the relevance of cystoscopy and rectoscopy in the preoperative management of histologically confirmed endometrial cancer varied significantly between these clinics. CONCLUSION: Preoperative cystoscopy and rectoscopy should only be performed during the first diagnosis of endometrial carcinoma in cases where there is a well-founded suspicion of infiltration and in cases with FIGO stage III-IV.

Objective: Aim of the study was to evaluate the importance of cystoscopy and rectoscopy in the preoperative management of histologically confirmed endometrial cancer. Material und Methods: 1. A survey was carried out in all gynecological departments in Germany to find out whether cystoscopy and rectoscopy are routinely performed during the preoperative management of histologically confirmed endometrial cancer. 2. An evaluation was made of the cystoscopy and rectoscopy findings in 220 patients with endometrial cancer and compared with the surgical findings. Results: Neither carcinoma of the urinary bladder nor carcinoma of the rectum is frequently found as a secondary neoplasm to endometrial carcinoma. The percentage of urinary bladder or rectum infiltration is below 1 % when endometrial cancer is diagnosed first. Thus, these neoplasms are very rarely diagnosed using cystoscopy and rectoscopy at this point. 127 gynecological departments participated in the survey. The assessment of the relevance of cystoscopy and rectoscopy in the preoperative management of histologically confirmed endometrial cancer varied significantly between these clinics. Conclusion: Preoperative cystoscopy and rectoscopy should only be performed during the first diagnosis of endometrial carcinoma in cases where there is a well-founded suspicion of infiltration and in cases with FIGO stage IIIIV.

Angeborene oder erworbene arteriovenöse Malformationen (AVM) des Uterus sind selten. Sie können bei prä- und postmenopausalen Frauen auftreten. Gemeinsam sind beiden AVM-Typen die multiplen, chaotischen Gefäßvernetzungen und -anomalien, die alle Schichten des Uterus durchziehen und bis unter das Endometrium reichen können. Das Hauptsymptom ist die Blutungsstörung. Die vaginale farbkodierte Doppler-Sonographie (FKDS) ist die diagnostische Methode der Wahl, die Hysterektomie bei der symptomatischen Patientin die Therapie der Wahl. Hinweisend könnte der hysteroskopische Nachweis des Fehlens eines intrauterinen Korrelates für die prägnanten Ultraschallbefunde sein.

Endogenous retroviral sequences resulting from ancient retrovirus infections of germline cells account for up to 8% of the human genome. Most of these sequences are highly truncated, have been altered by mutations, and do not encode functional genes. However, some members of the human endogenous retrovirus (HERV)-K family are remarkably intact and display high genetic homology to mouse mammary tumor virus (MMTV), a retrovirus causing breast cancer in mice. Two full-length HERVs (K113 and K115) have been reported to show insertional polymorphism. We used PCR to investigate the presence of these two HERVs in 102 female breast cancer patients and an equal number of age-matched controls with no history of malignancy (age range: 25-92 years). The two groups showed no significant difference in frequency (HERV-K113, 16.7% vs. 12.7%; HERV-K115, 4.9% vs. 9.8%) and no apparent association with histology, age at diagnosis, receptor status, HER-2/neu status, or TNM stage at diagnosis. This suggests that the two HERV-Ks do not play a pathogenetic role in the majority of breast cancer patients, though they may be involved in a minority of patients. The results are discussed.

Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. A 30- year-old woman (II-gravida, I-para) suffering for about 18 hours from "upper abdominal pain" was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a hemorrhagic shock, she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a intraabdominal bleeding (such as spleen rupture or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated. Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.

This study was performed to determine if keratin 18 (K18) has prognostic significance in breast cancer cell lines and patients with breast carcinoma. Paraffin sections of primary breast carcinoma tumors and human breast carcinoma cell lines were examined for K18 expression by immunohistochemical staining with the monoclonal antibody CK2. K18 protein expression was low in highly metastatic cell lines and, conversely, high in weakly metastatic cell lines, suggesting that it may function as a prognostic indicator. K18 expression was consequently examined in 134 patients with breast cancer. The staining intensity was compared with clinicopathological variables and follow-up data spanning 8 years. A definitive positive staining was observed in 22 (16.4%) women. The mortality rate was 4. 5% in the K18-positive group and 44.6% in the K18-negative group. Multivariate analysis found K18 expression to be an independent and significant predictor for overall survival.

A case report is presented on a hepatocellular carcinoma (HCC) during pregnancy, in which a massive increase in alpha-fetoprotein (AFP) was found during a routine screening for neural tube defects in the 17th week of pregnancy. The amniocentesis revealed a normal AFP level in the amniotic fluid. Liver sonography in the 21st week of pregnancy showed a 5-cm tumor, which was interpreted as nodular focal hyperplasia. In the control sonography in the 32nd week of pregnancy, there was growth to 12 cm. The subsequently performed magnetic resonance imaging and fine-needle aspiration led to the diagnosis of a HCC. Delivery was performed in the 34th week of pregnancy by cesarean section, and surgical therapy of the HCC followed.

Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.