Frauen?rztlich-p?diatrische Kooperation

During recent decades, prenatal medicine has had a substantial influence on obstetric management. As a result, some of the obstetric problems such as correct estimation of the delivery date or detection of multiple pregnancies can be considered as resolved. However, we are now confronted with other medical questions, which we try to sort out by assessing patient-specific risks. The detection of fetal anomalies plays a major role in the reduction of postnatal morbidity and mortality.     

Vulv?re Pr?kanzerosen

Human papilloma virus (HPV)-induced vulvar intraepithelial neoplasia (VIN) is the most common premalignant lesion of the vulva (90% of VIN). The incidence of this disease has increased over the last decades, and is presently approximately 5?C7/100,000 women/year in Germany. The median age of affected women is 46 years, and the disease is often multifocal and multicentric. Non-HPV-induced VIN is rare (10%) and is mainly found in older women. The symptoms of women presenting with VIN are often unspecific, such as itching and burning sensations or a palpable lesion, and the diagnosis is made by colposcopy and biopsy. The standard therapy is complete excision with free margins either surgically or by laser vaporization. The immunomodulator imiquimod is highly effective but not licensed for this disease but may be applied in off-label use. The second most common premalignant lesion is Paget??s disease, and a biopsy is used to verify the diagnosis suspected by colposcopy. Therapeutic intervention consists of wide excision or laser vaporization and recurrences are frequent.     

Elective induction: When? Ever?

The frequency of labor induction has increased significantly in recent years. Although medically indicated inductions comprise a portion of this increase, elective inductions have increased in frequency as well. Given that elective inductions, by definition, provide no benefit from a strictly medical standpoint, it is particularly important to evaluate whether women who undergo these inductions incur greater risks than those who labor spontaneously. This article will assess whether elective inductions are associated with changes in pregnancy outcomes, and evaluate how these associations are influenced by parity and cervical ripeness.     

Repopulation gesch?digter Hodenkan?lchen

One side effect of cancer treatment is temporarily or permanently impaired spermatogenesis. As infertility reduces the life quality for those affected, it is recommended that adult patients cryopreserve semen samples prior to cancer therapy. However, this approach does not restore fertility and cryopreservation of semen samples is not an option for prepubertal patients. Currently, clinicians can only offer this latter patient group an option to cryopreserve testicular tissue, which contains somatic cells as well as undifferentiated germline stem cells. In recent years, stem cell based approaches including germ cell transplantation assays and the autotransplantation of testicular tissue have been established using animal models. However, for a transfer of these experimental methods into the clinic, it is essential to establish standardized protocols for the cryopreservation of testicular tissue, the culture of germline stem cells and the quality control of obtained sperm. In this article, the current state of research is outlined and the requirements for a transfer of these approaches into the clinic are highlighted.     

Fertilit?tsprotektion bei M?nnern

Cryopreservation of sperm obtained from ejaculates or testicular tissue is a suitable procedure to establish a fertility reserve in tumor survivors facing infertility as a consequence of exposure to gonadotoxic site effects from intensive oncological chemotherapy and radiotherapy. Due to the absence of mature germ cells, cryopreservation of sperm from prepubertal patients is not an option. Preclinical studies on testicular stem cells have improved the understanding of gonadotoxic site effects and revealed novel procedures for conservation, culture and transplantation of germ line stem cells which provide interesting novel concepts for male fertility but also created exciting options for fertility preservation. This review depicts the physiology of male germ cell production, analyzes the clinically relevant problems and presents novel experimental methods which could provide future stem cell-based options for fertility preservation.     

Notf?lle im Krei?saal

Neonatal or maternal emergencies are rare events in clinical practice, although threatening for both mother and child. Obviously, most emergencies cannot be foreseen but clinicians must be aware of their possible occurrence. For situations, such as shoulder dystocia, risk factors are established like elevated body-mass index (BMI) of the mother, estimated birth weight more than 4000?g, macrosomia and diabetes. All emergencies have in common that they need a defined emergency communication pathway. Emergency strategies and emergency reactions are essential to cope with rare situations. Team training which is obligatory in aviation, needs to be implemented in any guidelines provided. The so-called management of the unexpected needs to be part of routine medical education for the students, residents and for the staff.     

Pr?implantationsdiagnostik und Pr?implantationsscreening

Preimplantation genetic diagnosis (PID) can offer the possibility for couples with severe genetic diseases to have a healthy child without a??trial pregnancy?? with all the psychological and physical side-effects. Previously the wording of the Embryo Protection Act (ESchG) in Germany prohibited investigations and selection of embryos using preimplantation diagnosis in Germany. The decision of the Federal High Court of July 2010 has now cleared the way for treatment of couples with severe genetic diseases and triggered a discussion on a new act for regulation of preimplantation diagnosis in Germany. In contrast to expectations preimplantation screening (PGS) as a screening method for aneuploidy did so far not show any improvement in pregnancy rates for older women. The current results of the ESHRE PGS (European Society of Human Reproduction and Embryology-Preimplantation Genetic Screening) Task Force study will be presented in this article.     

糖尿病会遗传?会传染?

李先生的爷爷和爸爸都得了糖尿病,四个哥哥中,有两个也得了糖尿病!最近他也出现了口干症状,于是向医生忧虑地发问:"我将来会不会也患上糖尿病?"这样的担忧很多家里有糖尿病患者的人都有.那么到底糖尿病会不会遗传呢. 糖尿病遗传?NO! 科学家们在调查中发现,糖尿病人的亲属比非糖尿病亲属者发病率高.其父或其母有糖尿病者分别为8.33％,其亲胞有糖尿病者发病率为1.62～5.85％.糖尿病病人遗传给下一代的不是病的本身,而是遗传容易发生糖尿病的体质,即突变基因遗传,临床称之为糖尿病易感性.糖尿病易感者,对胰岛素的适应能力很差,易发生糖尿病.     

Nahrungserg?nzungsmittel zur Pr?vention �C Heil oder Hybris?

According to the German Nutrition Society (DGE) and the Federal Institute for Risk Assessment (BfR) in healthy subjects the daily allowance of micronutrients can be covered by adequate nutrition even under the present conditions. Solely in demographic groups with increased requirements, the supplementary intake of certain nutrients such as iron, iodine, and calcium as well as folate and vitamin D may be considered. Nevertheless, in Germany every third woman and every fourth man use dietary supplements on a regular basis, commonly without consulting their physician, which carries the risk of inadequate dosages and possible interactions with drugs. In contrast to pharmaceuticals there is no need to demonstrate their efficacy in clinical trials for marketing dietary supplements. Data as to the general supplementation of vitamins and minerals to prevent cardiovascular events and cancer are controversial, and their use is a tight balancing act between risk and benefit.     

Wann braucht die Gyn?kologie die Nachbardisziplinen?

Gynecology is a cross-sectional discipline. Gynecologists provide lifelong treatment for women: they prescribe the pill, carry out cancer prevention, medication treatment and must be manually skilled in obstetrics. They must be well-informed on the physiology and pathophysiology of mother and child and be good at ultrasound diagnostics. The diagnosis and treatment of prolapse of the uterus will also be a deciding factor for the future of the discipline. The surgical and medicinal treatment of cancerous diseases in women is a substantial component of the discipline and part of the self-image. Last, but not least, the delicate consultation and understanding for psychological problems of patients also belong to the discipline. With this broad spectrum of activities is it possible to deal with technical questions without any assistance? The answer of the author is yes, if the necessary training has been undertaken.     

Gyn?kologische Krebserkrankungen w?hrend der Schwangerschaft

Gynecological cancer in pregnant women is rare. Nevertheless malignancies contribute significantly to indirect maternal mortality. The coincidence with pregnancy does not specifically influence the prognosis of gynecological cancerous diseases. Early diagnosis and adequate therapy are the factors of major impact on the general prognosis of cancer in pregnancy. Patient management should be performed at a perinatal and oncological center, best after inclusion in a clinical trial. The option of a successful pregnancy following oncological therapy is frequently a challenge for female cancer patients in younger age. Fertility rates as well as the implementation of fertility preserving techniques in the therapeutic concept are of great importance for these women. Intensive maternal involvement in the difficult and ambiguous medical considerations regarding the greatest possible conflict of interest between mother and fetus ?C life versus life ?C is mandatory.