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  • 1
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    Comparison of preoperative serum VEGF in leiomyosarcoma and uterus myomatosus patients: A proof of concept study.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e17117-e17117
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e17117-e17117
    Abstract: e17117 Background: The preoperative differentiation of a uterine fibroid from a sarcoma is still a pending clinical problem. Currently with the suspicion of a sarcoma (LMS) the more invasive open surgical approach is recommended to minimise the risk of LMS fragmentation and distribution. In a minority of cases, a malignancy is indicated by clinical suspicion, pre-surgical imaging or routine serum blood samples (SBS). Our hypothesis postulates higher VEGF levels in LMS compared to fibroid patients in the pre-surgical SBS. To assess this hypothesis, SBS were taken from patients with the clinical suspicion of LMS after informed consent and analysed after histology confirmed the diagnosis. Methods: Case series of patients with suspected LMS over a 4year time period. Analysis was performed via SBS collected from LMS- and fibroid patients before surgery. Serum VEGF protein was measured by ELISA. The final tumor histology was obtained from the report of the institutional pathologist. VEGF-serum levels were then compared between fibroid and LMS patients using the non-parametric Mann-Whitney U test. Results: 25 patient SBS were collected prior to surgery. In 9 cases the histopathology confirmed a LMS, with heterogeneous pTNM classifications. On average, VEGF serum levels were higher in the LMS patients as compared to the fibroid patients (628,96 pg/ml vs 351,91 pg/ml; further statistics see Table 1); however, the difference was not statistically significant (Mann-Whitney-U Test, p = 0.141). Conclusions: This proof-of-concept study with a small sample size of pre-surgical SBS indicates that VEGF serum levels may be increased in patients with histologically confirmed LMS; however, larger sample sizes are needed to validate our findings. If additional studies confirm a pronounced increase in pre-surgical serum VEGF levels in LMS patients, serum VEGF levels might routinely be used to assess the risk for a LMS in patients presenting with clinical uterine fibroids. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e17117
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 2
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    Novel and flexible ultrasound simulation with smartphones and tablets in fetal echocardiography
    Springer Science and Business Media LLC ; 2022
    In:  Archives of Gynecology and Obstetrics Vol. 305, No. 1 ( 2022-01), p. 19-29
    Details
    In: Archives of Gynecology and Obstetrics, Springer Science and Business Media LLC, Vol. 305, No. 1 ( 2022-01), p. 19-29
    Abstract: Evaluation of a novel ultrasound-simulation-app for training fetal echocardiography as a possible useful addition for students, residents and specialist doctors. Furthermore, comparison to a conventional learning-method with special attention on orientation and recognition of physiological structures. Methods Prospective two-arm study with the participation of 226 clinical students. 108 students were given an extract from a textbook on fetal echocardiography (PDF-group, n  = 108) for 30 min to study. 118 students were able to use the new ultrasound-simulator-app (Simulator-group, n  = 118) to learn for 30 min. The knowledge of the students was examined both before and after the learning-period by having them identify sonographic structures in videos using single-choice selection. Results There were no significant differences between the two groups regarding age ( p  = 0.87), gender ( p  = 0.28), and the number of previously performed ultrasound-examinations ( p  = 0.45). In the Simulator-group, there was a significantly higher learning effect regarding the proportion of students with an increase of correct answers in the video test examination ( p  = 0.005). At the end of learning, the students in the Simulator-group needed significantly less time to display the structures in the app’s simulation (median initially 10.9 s vs. 6.8 s at the end; p   〈  0.001). Conclusions The novel ultrasound-simulation-app seems to be a useful addition and improvement to ultrasound training. Previous difficulties such as simultaneously having patients, ultrasound-machines, and professors at disposal can thus be avoided. This means that another important step towards remote learning can be taken, which has been proven increasingly essential lately, due to the COVID-19 pandemic.
    Type of Medium: Online Resource
    ISSN: 0932-0067 , 1432-0711
    URL: Article
    DOI: 10.1007/s00404-021-06102-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1458450-5
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  • 3
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    Immunotherapy for uterine malignancies
    Springer Science and Business Media LLC ; 2020
    In:  Der Gynäkologe Vol. 53, No. 4 ( 2020-04), p. 238-243
    Details
    In: Der Gynäkologe, Springer Science and Business Media LLC, Vol. 53, No. 4 ( 2020-04), p. 238-243
    Type of Medium: Online Resource
    ISSN: 0017-5994 , 1433-0393
    URL: Article
    DOI: 10.1007/s00129-019-04543-9
    RVK:
    XA 45550
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1459161-3
    detail.hit.zdb_id: 3122868-9
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  • 4
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    Coincidence of Intra-Abdominal Splenosis in a Patient with Advanced Ovarian Cancer: Case Report and Review of the Literature
    Georg Thieme Verlag KG ; 2021
    In:  The Surgery Journal Vol. 07, No. 02 ( 2021-04), p. e116-e120
    Details
    In: The Surgery Journal, Georg Thieme Verlag KG, Vol. 07, No. 02 ( 2021-04), p. e116-e120
    Abstract: Splenosis is a rare disease, which is often discovered incidentally years after surgical procedures on the spleen or traumatic splenic lesions. Through injury of the splenic capsule, splenic cells are able to spread and autoimplant in a fashion similar to the process of metastatic cancer. Here we present the case of a 62-year-old female patient with a palpable tumor of the lower abdomen. Her medical history was unremarkable, except for splenectomy after traumatic splenic lesion in her childhood. Clinical examination and diagnostic imaging raised the suspicion of advanced ovarian cancer, which was further substantiated by the typical presentation of adnexal masses and disseminated peritoneal metastases during the following staging laparotomy. Surprisingly, we also found peritoneal implants macroscopically similar to splenic tissue. Microscopic examination of tissue specimens by intrasurgical frozen section confirmed the diagnosis of intra-abdominal splenosis. The patient then underwent cytoreductive surgery with complete resection of all cancer manifestations, sparing the remaining foci of splenosis to avoid further morbidity. This case demonstrates the rare coincidence of intra-abdominal carcinoma and splenosis, which could lead to intraoperative difficulties by misinterpreting benign splenic tissue. Therefore, splenosis should be considered in patients with medical history of splenic lesions and further diagnostic imaging like Tc-99m-tagged heat-damaged RBC scan could be used for presurgical distinguishing between tumor spread in the abdominal cavity and disseminated splenosis. The presented case report should not only raise awareness for the rare disease splenosis, but also emphasize the need to consider the possibility of simultaneous incidence of benign and malignant intra-abdominal lesions, as to our knowledge this is the first published case of simultaneous peritoneal carcinomatosis and splenosis.
    Type of Medium: Online Resource
    ISSN: 2378-5128 , 2378-5136
    URL: Article
    DOI: 10.1055/s-0041-1731426
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2864275-2
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  • 5
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    Emergency peripartal hysterectomy – a single-center analysis of the last 13 years at a tertiary perinatal care unit
    Walter de Gruyter GmbH ; 2019
    In:  Journal of Perinatal Medicine Vol. 47, No. 2 ( 2019-02-25), p. 169-175
    Details
    In: Journal of Perinatal Medicine, Walter de Gruyter GmbH, Vol. 47, No. 2 ( 2019-02-25), p. 169-175
    Abstract: Peripartal hysterectomy (PH) is a challenging surgical procedure with elevated maternal morbidity. Methods From 2004 to 2016, 41 emergency PHs were performed at the tertiary care center of the Department of Gynecology and Obstetrics at University Hospital Ulm. In our retrospective analysis, the incidence of PH in our hospital was 12.8 per 10,000 deliveries with a maternal mortality of 2.4%. PH followed in 80.5% after cesarean section (c-section). Underlying causes/indications for PH were abnormal placentation (53.7%; n=22), uterine atony (26.8%; n=11), uterine lacerations (14.6%; n=6) and in rare cases uterine infection (4.9%; n=2). The median number of transfused products was 11 packed red blood cells (range 0–55 products), 10 fresh frozen plasma units (range 1–43) and two platelet concentrates (0–16). Results Loss of blood as estimated by surgeons was significantly correlated with actual transfused blood volume (P 〈 0.001). Clinically relevant intra- and/or postoperative complications occurred in 53.7% of patients (n=22). Abnormal placentation was the leading cause for PH with an increased incidence during the last 10 years presumptively representing the elevated rate of c-sections. Conclusion PH goes along with increased rates of blood product transfusions independently of indication for surgery and has a high morbidity with a major complication rate of more than 50%. Prepartal assessment of risk factors like abnormal invasive placenta are crucial for reducing maternal morbidity.
    Type of Medium: Online Resource
    ISSN: 1619-3997 , 0300-5577
    URL: Article
    DOI: 10.1515/jpm-2018-0149
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2019
    detail.hit.zdb_id: 1467968-1
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  • 6
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    Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital
    Georg Thieme Verlag KG ; 2019
    In:  Senologie - Zeitschrift für Mammadiagnostik und -therapie Vol. 16, No. 01 ( 2019-03), p. 59-66
    Details
    In: Senologie - Zeitschrift für Mammadiagnostik und -therapie, Georg Thieme Verlag KG, Vol. 16, No. 01 ( 2019-03), p. 59-66
    Abstract: Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U‑BCC) and the community hospital Dachau (D‑BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5 % and 87.2 % in Ulm and Dachau, respectively. SNB was performed more precisely at the U‑BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p  〈  0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U‑BCC (rs = − 0.76; p = 0.002) while it remained stable in D‑BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1 % pre Z0011 and 14.4 % postZ0011; p  〈  0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U‑BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D‑BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.
    Type of Medium: Online Resource
    ISSN: 1611-6453 , 1611-647X
    URL: Article
    DOI: 10.1055/a-0868-8241
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 7
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    Discordance in Human Epidermal Growth Factor Receptor 2 (HER2) Phenotype Between Primary Tumor and Circulating Tumor Cells in Women With HER2-Negative Metastatic Breast Cancer
    American Society of Clinical Oncology (ASCO) ; 2017
    In:  JCO Precision Oncology , No. 1 ( 2017-11), p. 1-12
    Details
    In: JCO Precision Oncology, American Society of Clinical Oncology (ASCO), , No. 1 ( 2017-11), p. 1-12
    Abstract: Discordance in human epidermal growth factor receptor 2 (HER2) status between primary tumor and metastases might have important implications for treatment response and therapy decisions. Here, we evaluate both the frequency of circulating tumor cells (CTCs) and the factors predicting HER2 discordance between primary tumor and CTCs as a potential surrogate for tumor biology and tumor heterogeneity in patients with metastatic breast cancer. Patients and Methods The number of CTCs in 7.5 mL of peripheral blood and HER2 status were evaluated in 1,123 women with HER2-negative metastatic breast cancer. HER2 discordance was defined as the presence of at least one CTC with a strong immunocytochemical HER2 staining intensity. Factors predicting discordance in HER2 phenotype were assessed using multivariable logistic regression. Results Overall, 711 (63.3%) of 1,123 screened patients were positive for CTCs (≥ one CTC). Discordance in HER2 phenotype between primary tumor and CTCs was observed in 134 patients (18.8%) and was significantly associated with histologic type (lobular v ductal; odds ratio [OR], 2.67; 95% CI, 1.63 to 4.39; P 〈 .001), hormone receptor status (positive v negative; OR, 2.84; 95% CI, 1.15 to 7.02; P = .024), and CTC number (≥ five v one to four; OR, 7.64; 95% CI, 3.97 to 14.72; P 〈 .001). Conclusion HER2 discordance between primary tumor and CTCs was observed in 18.8% of patients and was associated with histologic type, hormone receptor status of the primary tumor, and CTC number. The clinical utility of CTCs as liquid biopsy to assess tumor heterogeneity of metastatic disease and guide treatment decisions must be evaluated in prospective randomized trials.
    Type of Medium: Online Resource
    ISSN: 2473-4284
    URL: Article
    DOI: 10.1200/PO.17.00023
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
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  • 8
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    Ki67 as Proliferative Marker in Patients with Early Breast Cancer and Its Association with Clinicopathological Factors
    S. Karger AG ; 2021
    In:  Oncology Vol. 99, No. 12 ( 2021), p. 780-789
    Details
    In: Oncology, S. Karger AG, Vol. 99, No. 12 ( 2021), p. 780-789
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Ki67 as a proliferative marker has prognostic and therapeutic relevance in early breast cancer (EBC). However, standard cutoffs for distinguishing low and high Ki67 do not exist. 〈 b 〉 〈 i 〉 Material and Methods: 〈 /i 〉 〈 /b 〉 Data from all patients treated at the University Hospital Ulm for EBC between January 2013 and December 2015 with documented results for internal Ki67 assessment of the primary ( 〈 i 〉 n 〈 /i 〉 = 917) tumor were retrospectively analyzed evaluating the associations between Ki67 and other clinicopathological factors. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 595 (64.9%) patients had a Ki67 & #x3c;20% and 322 (35.1%) a Ki67 ≥20%. The median Ki67 was 10% (range 1–90%). Median Ki67 values according to the hormone receptor (HR)/ human epidermal growth factor receptor 2 (HER2) subtypes were 10% for HR-positive/HER2 negative (HR+/HER2−) disease ( 〈 i 〉 n 〈 /i 〉 = 717), 20% for HR+/HER2+ ( 〈 i 〉 n 〈 /i 〉 = 76), 30% for HR−/HER2+ ( 〈 i 〉 n 〈 /i 〉 = 45), and 60% for HR−/HER2− ( 〈 i 〉 n 〈 /i 〉 = 75). 75.2% or 89.3% of all patients with HER2-positive or triple-negative disease had a Ki67 ≥20%, respectively. Using a multivariable logistic regression with Ki67 ( & #x3c;20% vs. ≥20%) as binary dependent variable, younger age, positive nodal status, higher grading, histological nonspecific type carcinoma, negative HR status, and positive HER2 status were shown to be significantly associated with a higher proliferative index (Ki67 ≥20%). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This analysis described Ki67 in different subtypes in EBC and its association with clinicopathological factors. According to more aggressive tumor biology, the respective subgroups also showed higher median Ki67 levels. However, definition of low and high proliferation index itself is difficult. It is essential to interpret Ki67 indices carefully with regard to the own institutional values and other clinicopathological factors.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000517490
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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  • 9
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    Results of an internal audit on the survival of patients with uterine sarcoma
    Galenos Yayinevi ; 2019
    In:  Journal of the Turkish-German Gynecological Association Vol. 20, No. 1 ( 2019-3-1), p. 15-22
    Details
    In: Journal of the Turkish-German Gynecological Association, Galenos Yayinevi, Vol. 20, No. 1 ( 2019-3-1), p. 15-22
    Type of Medium: Online Resource
    ISSN: 1309-0399 , 1309-0380
    URL: Journal
    URL: Article
    DOI: 10.4274/jtgga.
    DOI: 10.4274/jtgga.galenos.2018.2018.0083
    Language: Unknown
    Publisher: Galenos Yayinevi
    Publication Date: 2019
    detail.hit.zdb_id: 2425806-4
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  • 10
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    Influence of the New FIGO Classification for Cervical Cancer on Patient Survival: A Retrospective Analysis of 265 Histologically Confirmed Cases with FIGO Stages IA to IIB
    S. Karger AG ; 2020
    In:  Oncology Vol. 98, No. 2 ( 2020), p. 91-97
    Details
    In: Oncology, S. Karger AG, Vol. 98, No. 2 ( 2020), p. 91-97
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 At the end of the year 2018, a new FIGO classification for cervical cancer was published, mainly revising stage IB and introducing a new stage IIIC, which includes irrespectively of tumor size and local spread all patients with lymph node metastasis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively analyzed all cases of cervical cancer stage I to IIB who underwent surgery as primary treatment at our institution from 2000 until 2016 and therefore had a histological confirmation of tumor stage. We reclassified all histologies according to the new FIGO classification and calculated outcome according to the new stages. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Out of 265 patients, 146 (55%) patients were reclassified into a higher FIGO stage. Most changes appeared within stage IB and from any stage to stage IIIC1. Kaplan-Meier curves for new stages showed a significant difference in disease-free survival (DFS) and overall survival (OS) between stages I versus II versus III (log-rank test, both 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Overall, patients that were upstaged had a significant worse DFS ( 〈 i 〉 p 〈 /i 〉 = 0.012) and OS ( 〈 i 〉 p 〈 /i 〉 = 0.008) than patients whose stage did not change. Similar observations were made within sub-stages, when node-positive IB or IIB tumors were upstaged to IIIC tumors. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The new FIGO classification for cervical cancer reflects the strong impact of lymph node metastases on survival and is a clear improvement compared to the old FIGO classification with regard to risk stratification.
    Type of Medium: Online Resource
    ISSN: 0030-2414 , 1423-0232
    URL: Article
    DOI: 10.1159/000503149
    RVK:
    XH 3305
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1483096-6
    detail.hit.zdb_id: 250101-6
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