Specialist Life—Heinz Koelbl

Nationwide Analysis on Surgical Staging Procedures and Systemic Treatment for Patients With Endometrial Cancer in Germany

ObjectiveIn 2009 and 2006, the Arbeitsgemeinschaft Gynäkologische Onkologie evaluated therapeutic approaches for endometrial carcinoma (EC) in Germany.Methods and MaterialsA questionnaire was developed and sent to 775 German gynecologic departments in 2009 (500 in 2006). The results of the questionnaires were compared with each other and with the recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie’s guideline. Subgroup analyses were performed, dividing the participating centers into small and large centers and into centers with less and more experience with EC.ResultsResponses were available in 33.3% in 2009 and 35.8% in 2006. Comparing 2009 with 2006, it became apparent tha…

Cerebral metastases of an endometrial stromal sarcoma: report of the first case.

Endometrial stromal sarcomas (ESSs) of the uterus are rare gynecological malignancies. Common locations of distant metastases are vagina, vulva, lung, mediastinum, abdomen, bones and ovaries.We present the case of a 69-year-old woman with a Federation of Gynecology and Obstetrics (FIGO) IIb (classification 2009) ESS of the uterus of high-grade malignancy. Initially, a hysterectomy Piver II and total colpectomy were performed, followed by pelvic field irradiation. 8 months later, the patient suffered seizures and hemiparesis. A computed tomography (CT) scan revealed cerebral metastases, and irradiation of the brain was initiated. After completion of the staging examinations, additional metas…

Functional analysis ofp53 gene and the prognostic impact of dominant-negativep53 mutation in endometrial cancer

In addition to the loss of function, mutant p53 can possess a dominant-negative effect on wild-type p53 and may also exert gain-of-function activity. It is not clear whether the functional status of p53 mutation contributes to differences in outcome in endometrial cancer. We collected a total of 92 RNA samples of high quality from endometrial cancer tissues, and the samples were subjected to yeast functional assay and sequencing for p53 mutations. The detected mutant p53 genes were further investigated for their dominant-negative activity using a yeast-based transdominance assay. p53 mutation was found in 24 out of 92 (26.1%) tumors, of which 10 exhibited no dominant-negative activity (rece…

The impact of treatment for genital cancer on quality of life and body image—results of a prospective longitudinal 10-year study

Abstract Objective . To evaluate the impact of treatment for genital cancer on quality of life and body image to determine patients' therapy-related needs for quality improvement of medical care before and after surgery. Methods . We started to evaluate women with cervical cancer planned for pelvic exenteration in 1993 and integrated women planned for a Wertheim–Meigs surgery in 1995 before surgery, 4 and 12 months after surgery. Thanks to funding since 1999, more than 400 patients with a diagnosis of genital ( n = 185) or breast ( n = 217) cancer participated in this prospective study until July 2003. In this paper, we will focus on n = 129 women with cervical cancer. The assessment protoc…

Reconstructive surgery following resection of primary vulvar cancers.

Objective. This study describes the surgical treatment and follow-up of 213 patients with primary vulvar cancer; particular attention is given to reconstructive surgical procedures. Methods. The clinical and pathological parameters of the patients were recorded according to standardized procedures, and the data concerning type of operation, surgical reconstruction and postoperative course of disease (recurrence-free and overall survival) were analyzed. Results. In about one-third of the cases, plastic surgery reconstruction involving skin-flaps was performed. In the present group of patients, plastic surgery procedures led to an elevated degree of operability as well as to more satisfactory…

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence.

Abstract Objectives To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence. Study design A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January…

Immunoglobulin Kappa C Has Independent Prognostic Significance in Node-Negative Breast Cancer.

Abstract Background: Utilizing microarray based gene-expression analysis of fresh-frozen tissue we could recently demonstrate the prognostic impact of a B cell metagene in node-negative breast cancer (Cancer Res 68: 5405-5413, 2008). In the present study we investigated the prognostic significance of immunoglobulin kappa c (IGKC) in formalin-fixed paraffin embedded (FFPE) breast cancer specimens of 363 node-negative breast cancer patients which were not treated in the adjuvant setting.Methods: RT-PCR was used to analyze mRNA expression of IGKC in FFPE tissue of 363 patients with node-negative breast cancer. Additionally to IGKC we examined the prognostic impact of age, histological grade, t…

P02.40: The influence of maternal age on the association of an isolated fetal intracardiac echogenic focus and fetal aneuploidy

decided to follow up the pregnancy during two weeks and perform the cordocentesis in this time, karyotope was normal. At 26 weeks we found progressive changes in fetal anatomy: heart herniation became larger, left lobe of liver began to protruse, the absence of the sternum and cartilaginous parts of the ribs was confirmed. Patient was offered pregnancy termination because of the impossibility of surgical correction. Radiography, CT and morphology of abortus confirmed ultrasound diagnosis of isolated absence of the sternum and cartilaginous parts of the ribs.

Surgical therapy of recurrent vulvar cancer.

Objective The success of various surgical interventions in 201 cases with recurrent vulvar carcinoma was examined in the light of patients' pretreatment, surgical therapy, plastic reconstruction, and postoperative disease course. Study design A databank of standardized clinical data was analyzed using statistical procedures. Results Therapy was selected on an individual basis according to tumor status. Recurrence at a site distant from the primary tumor, particularly in the inguinal region, indicated a markedly unfavorable prognosis. In contrast, tumors recurring locally did not exhibit any significant differences. Plastic surgery reconstruction led to improvements with respect to operabili…

Female pelvic congenital malformations

A B S T R A C T The second part of this review deals with the quality of life of patients with congenital pelvic malformations, focusing on the sexuality, reproductive outcomes and overall psychological impact of the women affected. The presence of deformed pelvic anatomy, congenital or iatrogenic, and therefore of altered urinary, anal or sexual functions, are not only a physical limitation but seriously compromise psychological health from childhood. These difficulties jeopardise the thorny path from childhood to adult life through adolescence, and if neglected, could be responsible for seriously impairing quality of life in adulthood, in terms of mental health and psychosocial functions.…

Association Between CYP2D6 Polymorphisms and Outcomes Among Women With Early Stage Breast Cancer Treated With Tamoxifen

Context The growth inhibitory effect of tamoxifen, which is used for the treatment of hormone receptor–positive breast cancer, is mediated by its metabolites, 4-hydroxytamoxifen and endoxifen. The formation of active metabolites is catalyzed by the polymorphic cytochrome P450 2D6 (CYP2D6) enzyme. Objective To determine whether CYP2D6 variation is associated with clinical outcomes in women receiving adjuvant tamoxifen. Design, Setting, and Patients Retrospective analysis of German and US cohorts of patients treated with adjuvant tamoxifen for early stage breast cancer. The 1325 patients had diagnoses between 1986 and 2005 of stage I through III breast cancer and were mainly postmenopausal (9…

Ultrasound imaging of the pelvic floor: Where are we going?

We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the …

Transforming Growth Factor Beta 1 Serum Levels in Patients with Preinvasive and Invasive Lesions of the Breast

Transforming growth factor beta (TGF-beta)1 is thought to be involved in breast carcinogenesis. TGF-beta1 acts in an antiproliferative manner in the early stages of breast carcinogenesis, but promotes tumor progression and metastases in the advanced stages of the disease. No data have been published on serum TGF-beta1 in breast cancer. We investigated TGF-beta1 serum levels in patients with breast cancer (n=135), ductal carcinoma in situ (DCIS) I to III (n=67) or fibroadenoma (n=35), and in healthy women (n=40) to determine its value as a differentiation marker between malignant, pre-invasive and benign diseases and as a predictive marker for metastatic spread. Median (range) TGF-beta1 seru…

Monocyte Chemoattractant Protein-1 Serum Levels in Patients with Breast Cancer

The chemokine monocyte chemoattractant protein (MCP)-1 is thought to be involved in breast carcinogenesis. We evaluated MCP-1 serum levels in patients with breast cancer (n = 135), ductal carcinoma in situ (DCIS) I-III (n = 30), benign breast lesions (n = 143) and in healthy women (n = 27). We determined the value of MCP-1 serum levels as a differentiation marker between malignant, preinvasive and benign breast diseases and as a predictive marker for the biological phenotype of breast carcinoma. Median (range) MCP-1 serum levels in patients with breast cancer, DCIS I-III, benign breast lesions and healthy women were 200 (57-692) pg/ml, 194 (58-525) pg/ml, 174 (39-529) pg/ml and 175 (67-425)…

Phase 2 Trial of Docetaxel, Gemcitabine, and Oxaliplatin Combination Chemotherapy in Platinum- and Paclitaxel-Pretreated Epithelial Ovarian Cancer

Background: This phase 2 trial was designed to evaluate the efficacy and toxicity of a combination of docetaxel, gemcitabine, and oxaliplatin for platinum- and paclitaxel-pretreated epithelial ovarian cancer. Patients and Methods: Heavily pretreated patients (N = 30; median age, 61 years) received docetaxel, 55 mg/m2; gemcitabine, 500 mg/m2 (day 1); and oxaliplatin, 70 mg/m2 (day 2) biweekly. Twelve patients had platinum-sensitive disease, and 18 patients had platinum-resistant disease. Results: Median follow-up was 18.6 months. No differences in patient characteristics were observed between patients with carboplatinum-sensitive and carboplatinum-resistant disease. In patients with carbopla…

Isolation of fibroblasts for coating of meshes for reconstructive surgery: differences between mesh types.

Aims: An extensive colonization of surgical meshes with autologous fibroblasts may reduce complications. Therefore, we aimed to establish a technique that allows isolation and propagation of fibroblasts from vaginal biopsies. Using these cells we tested the applicability of several clinically applied meshes for fibroblast coating. Materials & methods: Fibroblasts were isolated from vaginal tissue after digestion with collagenase. Characterization was performed by immunostaining for cytokeratin 5, 6 and 14, smooth muscle actin and vimentin. A semiquantitative technique was applied to determine the degree of mesh coating 5 h and 5 weeks after seeding of fibroblasts. Seven meshes of diffe…

A polymorphism of the interleukin-1 receptor antagonist plays a prominent role within the interleukin-1 gene cluster in vulvar carcinogenesis

Abstract Objective . The interleukin-1 (IL-1) family, that is, IL-1α and β and the IL-1 receptor antagonist (IL-1RA), is known to modulate various tumorgenic and tumorcidal effects in humans. Its biological function in squamous cell carcinogenesis of various anatomical sites has been stressed. Although various studies showed a certain association between genes encoding the IL-1 family and human malignancies, no data with respect to vulvar cancer have been published to date. Methods . We ascertained four polymorphisms of the IL-1α gene ( IL1A C[−889]T), the IL-1β gene ( IL1B promoter C[-511]T and IL1B exon 5 position +3953), and the IL-1RA gene ( IL1RN intron 2) in 68 patients with surgicall…

Re: Kulseng-Hanssen S, Husby H, Schiotz HA. 2006. The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome? Neurourol Urodyam 26:115–121

Role of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1) for prognosis in endometrial cancer

Abstract Background. Urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1) contribute to the invasiveness of many carcinomas. Here, we studied a possible association between cytosolic uPA and PA-1 concentrations in tumor tissue with prognosis in patients with endometrial cancer. Methods. Cytosolic concentrations of uPA and PAI-1 were determined in 69 primary endothelial adenocarcinomas using an enzyme-linked immunoassay (ELISA). A possible influence of uPA and PAI-1 was studied by multivariate Cox regression adjusting for the established clinical prognostic factors FIGO-stage, grading, depth of invasion, diabetes mellitus and age. Results. Both uPA ( …

Long-term outcome prediction by clinicopathological risk classification algorithms in node-negative breast cancer--comparison between Adjuvant!, St Gallen, and a novel risk algorithm used in the prospective randomized Node-Negative-Breast Cancer-3 (NNBC-3) trial.

Background: Defining risk categories in breast cancer is of considerable clinical significance. We have developed a novel risk classification algorithm and compared its prognostic utility to the Web-based tool Adjuvant! and to the St Gallen risk classification. Patients and methods: After a median follow-up of 10 years, we retrospectively analyzed 410 consecutive node-negative breast cancer patients who had not received adjuvant systemic therapy. High risk was defined by any of the following criteria: (i) age 2 cm. All patients were also characterized using Adjuvant! and the St Gallen 2007 risk categories. We analyzed disease-free survival (DFS) and overall survival (OS). Results: The Node-…

Gonadal damage and options for fertility preservation in female and male cancer survivors.

It is estimated that in 2010, 1 in every 250 adults will be a childhood cancer survivor. Today, oncological surgery, radiotherapy and chemotherapy achieve relatively high rates of remission and long-term survival, yet are often detrimental to fertility. Quality of life is increasingly important to long-term survivors of cancer, and one of the major quality-of-life issues is the ability to produce and raise normal children. Developments in the near future in the emerging field of fertility preservation in cancer survivors promise to be very exciting. This article reviews the published literature, discusses the effects of cancer treatment on fertility and presents the options available today …

What's hot from the ICS Annual Meeting 2006

Can we prevent incontinence?: ICI-RS 2011

Aims A review of the current state of research with regard to prevention of incontinence. Methods The search was limited to English language publications on the topic of incontinence prevention. Results Incontinence is associated with a range of risk factors, most of which are modifiable. Lifestyle changes with behavioral modifications that can prevent urinary incontinence (UI) need to be adopted from an early phase of life. Pregnancy per se for the woman, independent of labor and delivery practice, is a risk factor for UI. The influence of estrogen is still under discussion as to its direct influence to UI. For both men and women, there is a correlation between pelvic-floor related surgery…

Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period

Please cite this paper as: Albrich S, Laterza R, Skala C, Salvatore S, Koelbl H, Naumann G. Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG 2012;119:51–61. Objective  To evaluate morphology and integrity of the levator ani muscle (LAM) with three-dimensional ultrasound early in the postpartum period. Design  Prospective cross-sectional observational study. Setting  University hospital in Germany. Population  Women after vaginal delivery and caesarean section with no previous vaginal delivery. Methods  Three-dimensional perineal ultrasound was performed between 48 and 72 hours postpartu…

Pharmacotherapy of female urinary incontinence

Urinary incontinence is a major clinical problem and a significant cause of disability and dependency in older adults. Overall, the prevalence of urinary incontinence approaches 55% among women aged over 55 years. The past few years have seen significant advances in the pharmacotherapy of overactive bladder and stress incontinence. The review examines the evidence regarding their benefits and side-effects.

Female pelvic congenital malformations. Part I: embryology, anatomy and surgical treatment.

This review covers the most important female congenital pelvic malformations. The first part focuses on the embryological development of the urogenital and anorectal apparatus, morphological features, and the diagnostic and surgical approach to abnormalities. Comprehension of the embryological development of the urogenital and anorectal apparatus is essential to understand the morphology of congenital pelvic abnormalities and their surgical treatment. Congenital pelvic malformations are characterized by specific common features; the severity of which often subverts the pelvic morphology completely and makes it difficult to comprehend before surgery. The development of imaging, mainly magnet…

Phase II trial of docetaxel and carboplatin in recurrent platinum-sensitive ovarian, peritoneal and tubal cancer

Abstract Objective. Docetaxel and carboplatin are active in relapsed ovarian, peritoneal and tubal cancer. Recently, two prospective-randomized trials showed an advantage of carboplatin combination regimen with paclitaxel or gemcitabine over carboplatinum alone in platinum-sensitive cases. The question on the most effective combination with the best tolerable side effects still needs to be answered. Methods. Eligible patients had recurrent ovarian, peritoneal or tubal cancer (platinum-free interval >6 months), performance status 0–2 and normal bone marrow, renal and hepatic function. 25 patients (age 18–75 years) were enrolled into this phase II trial. Patients with debulking operation of r…

Estrogen-metabolizing gene polymorphisms in the assessment of breast carcinoma risk and fibroadenoma risk in Caucasian women.

BACKGROUND Genes encoding enzymes involved in estrogen metabolism are held to be candidate genes for associations with breast disease. In these candidate genes, no critical combination of single-nucleotide polymorphisms (SNPs) for assessing breast carcinoma risk has been reported to date. METHODS In a large case–control study, the authors investigated 10 estrogen-metabolizing SNPs in 396 patients with breast carcinoma, 154 patients with fibroadenoma, and 1936 healthy control patients without breast carcinoma in their personal history. The following 10 SNPs were analyzed using sequencing-on-chip technology via a solid-phase polymerase chain reaction assay performed on oligonucleotide microar…

Effects of anemia correction with epoetin beta in patients receiving radiochemotherapy for advanced cervical cancer

Patients with cervical cancer frequently suffer from anemia. This two-stage, adaptive-design study investigated the effect of anemia correction with epoetin beta on treatment outcomes. Patients with stage IIB–IVA cervical cancer received radiochemotherapy (RCT) and were randomized to epoetin 150 IU/kg three times weekly (n = 34) or standard care (control; n = 40) for up to 12 weeks. Primary end point for stage 1 aimed to establish a correlation between anemia correction and treatment failure (no complete response or relapsing within 6 months after RCT initiation) as a proof of concept before moving into stage 2. Secondary end points included progression/relapse-free survival, overall surviv…

Reproduction beyond cancer: A message of hope for young women

Abstract Objective. Aggressive chemotherapy and radiotherapy or radical oncological surgery in young women with cancer has greatly enhanced these patients' life expectancy, but these treatments often cause infertility or premature ovarian failure due to a massive destruction of the ovarian reserve. The objective of this review is to discuss the effect of the various cancer treatments on fertility and present the various fertility sparing operations and fertility preservation strategies. Method. An extensive survey of the most up-to-date literature was performed. Results. This review discusses the impact of current cancer treatment on fertility potential and the various surgical and assisted…

976Screening for cervical cancer with Human Papillomavirus testing: stand-alone is preferable over co-testing with cytology

Abstract Background Cervical cancer screening can be conducted with cytology and Human Papillomavirus (HPV) testing but few studies have compared the latter directly to concomitant testing (co-testing). We compared these strategies to determine appropriate screening. Methods Within a randomised population-based cohort study conducted around Mainz, Germany, eligible women (≥30 years) were screened via Pap smear, liquid-based cytology (LBC) and HPV testing (HC2) and HPV genotyped post hoc (PCR). These tests formed three strategies: cytology (Pap or LBC) and HPV (HC2 or PCR) stand-alone and co-testing. Screen positives and 5% negative women were invited to colposcopy. Absolute and relative sen…

Defining female voiding dysfunction: ICI-RS 2011

Whilst symptoms of bladder outlet obstruction (BOO) and post micturition symptoms are more commonly reported in men a significant number of women may also complain of voiding dysfunction. However, despite the recent advances in the standardisation of terminology of lower urinary tract dysfunction there remains a lack of consensus regarding a precise diagnosis and definition of voiding abnormalities in women. In addition voiding symptoms may co-exist with storage symptoms as well as those associated with urinary incontinence. Consequently many patients present with a spectrum of different urinary symptoms, related to both storage and voiding, which may be multifactorial in origin or be relat…

The effect of hormonal status on the expression of estrogen and progesterone receptor in vaginal wall and periurethral tissue in urogynecological patients

Abstract Objective Our objective was to study the expression of estrogen receptor (ER) isoforms ER alpha (α) and ER beta (β) and of progesterone receptor (PR) in the vaginal wall and in periurethral tissue of women who underwent urogynecological surgical treatment with reference to estrogen status. Study design The study included 89 patients undergoing vaginal surgery for urogynecological conditions. Patients’ history and clinical data including estrogen status and body mass index (BMI) were evaluated. Biopsies from the vaginal wall and from periurethral tissue were obtained during surgery. The expression of ER α and β and of PR in vaginal wall and periurethral tissue was measured by RT-PCR…

Mesh complications following prolapse surgery: management and outcome.

Abstract Objective This is a description of complications following prolapse surgery with the use of alloplastic materials, the management and outcome. Study design 54 women have been referred to Mainz, urogynecology referral center due to complications following mesh-augmented prolapse surgery. Results The complaints who lead to the admission are expressed by the new terminology and standardized classification for complications arising directly from the insertion of prostheses and grafts in female pelvic floor surgery [1] . Pain (66.7%), mesh erosion (55.6%) and vaginal discharge (48.1%) were the most frequent complaints. Revision was performed after a median time of 27.2 months post mesh …

Reconstructive plastic surgery in the treatment of vulvar carcinomas

Abstract Objective The results obtained using plastic surgery reconstruction in 207 patients with a primary or recurrent vulvar carcinoma were analyzed with regard to the surgical procedures applied, pre-treatment and post-operative findings, along with the long-term oncological disease course. Study design Standardized data concerning the surgical procedures applied and clinical factors were collected in a databank and statistically analyzed. Results The flaps employed were termed either ‘local' (cutaneous or fasciocutaneous; n =84) or ‘regional' (myocutaneous, n =123). For local flaps, the rate of secondary healing was 31%, dropping to 20% for regional flaps. Such healing disturbances oft…

Re: Dalpiaz O, Curti P. 2006. Role of Perineal Ultrasound in the Evaluation of Urinary Stress Incontinence and Pelvic Organ Prolapse: A Systematic Review. Neurourol Urodynam 25:301–306

Immunoglobulin Kappa C Predicts Overall Survival in Node-Negative Breast Cancer

Background: Biomarkers of the immune system are currently not used as prognostic factors in breast cancer. We analyzedthe association of the B cell/plasma cell marker immunoglobulin kappa C (IGKC) and survival of untreated node-negative breast cancer patients.Material and Methods: IGKC expression was evaluated by immunostaining in a cohort of 335 node-negative breast cancer patients with a median follow-up of 152 months. The prognostic significance of IGKC for disease-free survival (DFS) and breast cancer-specific overall survival (OS) was evaluated with Kaplan-Meier survival analysis as well as univariate and multivariate Cox analysis adjusted for age at diagnosis, pT stage, histological g…

The physician-patient relationship before cancer treatment: a prospective longitudinal study.

Abstract Objectives . To evaluate quality of life before surgery for genital cancer to determine risk factors that might influence the physician–patient relationship. Methods . From 1993 until 2003, 129 women with cervical cancer entered this prospective study. Patients were contacted 1 to 5 days before surgery by a psychologist or psychotherapeutically trained physician on the surgical ward. The semistructured interview included questions on the patient's psychosocial well-being according to criteria of the biographic interview technique. The preoperative anxiety level was evaluated by the STAI and quality of life by the Cancer Rehabilitation Evaluation System (CARES) and EORTC questionnai…

Role of the progesterone receptor for paclitaxel resistance in primary breast cancer

Paclitaxel plays an important role in the treatment of primary breast cancer. However, a substantial proportion of patients treated with paclitaxel does not appear to derive any benefit from this therapy. We performed a prospective study using tumour cells isolated from 50 primary breast carcinomas. Sensitivity of primary tumour cells to paclitaxel was determined in a clinically relevant range of concentrations (0.85-27.2 microg ml(-1) paclitaxel) using an ATP assay. Chemosensitivity data were used to study a possible association with immunohistochemically determined oestrogen and progesterone receptor (ER and PR) status, as well as histopathological parameters. Progesterone receptor (PR) m…

The extracorporeal perfusion of the female pig detrusor as an experimental model for the study of bladder contractility.

Aims The objective of the study was to establish an experimental model for the extracorporeal perfusion of the pig detrusor. In order to validate this model we examined some biochemical parameters and determined the effect of carbachol on the contractility of perfused female pig bladders. Methods Twenty-six pig bladders were perfused with Krebs–Ringer bicarbonate-glucose buffer for a period up to 5 hr with the aim to preserve a viable organ, which would be responsive to contraction-inducing agents. The intravesical pressure of the bladder as well as the intraarterial pressure of the vesical arteries were recorded before and after administration of carbachol. Results The perfusate pH, lactat…

Coordinates in the Universe of Node-Negative Breast Cancer Revisited

Abstract We present a global picture of the natural history of node-negative breast cancer in which two of three important biological processes have outstanding prognostic consequences. We propose that the transition from slow to fast proliferation of the tumor leads to the most dramatic aggravation of prognosis. Second, immune cell infiltration is of major importance to prevent disease progression in fast-proliferating breast carcinomas, regardless of estrogen receptor status. In the absence of endocrine treatment, steroid hormone receptor expression as a third axis is of limited prognostic importance. Dissecting tumors according to these three major biological axes will allow further unde…

Prediction of late metastasis in node-negative breast cancer.

10551 Background: Prediction of late metastasis is of clinical relevance in breast cancer. However, systematic genome-wide studies to identify genes associated with increased risk of metastasis 5 or more years after surgery are scarce. Methods: We examined the natural course of disease in three previously published cohorts (Mainz, Rotterdam, Transbig) including 766 node-negative breast cancer patients with gene array data who did not receive systemic chemotherapy in the adjuvant setting. We established a Cox regression based method adjusted for multiple testing that identified genes predicting late metastasis (5 or more years after surgery). Only those genes were accepted that showed simil…

Prognostic Effect of Epithelial Cell Adhesion Molecule Overexpression in Untreated Node-Negative Breast Cancer

Abstract Purpose: Epithelial cell adhesion molecule (Ep-CAM) recently received increased attention not only as a prognostic factor in breast cancer but also as a potential target for immunotherapy. We examined Ep-CAM expression in 402 consecutive node-negative breast cancer patients with long-term follow-up not treated in the adjuvant setting. Experimental Design: Ep-CAM expression was evaluated by immunostaining. Its prognostic effect was estimated relative to overexpression/amplification of HER-2, histologic grade, tumor size, age, and hormone receptor expression. Results: Ep-CAM status was positive in 106 (26.4%) patients. In multivariate analysis, Ep-CAM status was associated with disea…

The effect of cancer treatment on female fertility and strategies for preserving fertility.

Aggressive chemotherapy and radiotherapy in young patients with cancer has greatly enhanced the life expectancy of these patients, but these treatments often cause infertility because of the massive destruction of the ovarian reserve resulting in premature ovarian failure (POF). This review focuses on the effect of cancer treatments on fertility and on the various surgical and assisted-reproduction innovations that are available to provide the patient with the option of future pregnancies. As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better inte…

Quality of life and adjuvant tamoxifen treatment in breast cancer patients

About two-thirds of all breast cancer patients are treated with adjuvant hormonal therapy. Side effects of tamoxifen and their effects on physical, emotional and social functioning have been shown to impair the quality of life. Aim of this paper was to evaluate the side effects and level of influence on the physical, emotional and social functioning caused by tamoxifen treatment. For assessment of quality of life an own questionnaire was designed. Between January 2001 and December 2003, 136 women with breast cancer and adjuvant tamoxifen therapy were included in this study. Data of side effects, physical and mental health and patients' self-evaluation identified detrimental effects on patie…

Complications following the use of alloplastic materials in urogynecological surgery

Abstract Study design 118 patients, who were admitted from 2005 to 2008 to our department due to complications following mesh implantation, were included in a retrospective survey. We investigated patient symptoms, findings and subsequent patient management. There was a re-evaluation of symptoms in a follow-up eight weeks after the revision procedure. Data from our urogynecological file archive were used. Results The main complaints were de novo urgency, pain and recurrent urinary tract infections. The main findings were mesh erosion and infections including abscess formations and osteomyelitis. Before being admitted to our department, 42 patients (35.6%) had already undergone at least one …

Patient goals after incontinence procedures: does the single-incision sling satisfy them?

Abstract Objective This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT). Method Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degr…

Impact of mode of delivery on levator morphology