Stationäre Rehabilitationsmaßnahmen bei gynäkologischen malignen Erkrankungen

In Germany about 41% of malignant neoplasies of women are carcinomas of mamma, cervix, Corpus uteri and ovary. Therapy of these malignomas consists of surgery, radio-, chemo- or hormonotherapy. Apart from therapeutic effects primary therapy may have negative effects in different physical, psychical and social aspects. These side effects are the concern of stationary oncological rehabilitation. Interdisciplinary cooperation makes it possible to consider the individual requirements of the patient.     

Nachsorgeuntersuchungen bei gynäkologischen Malignomen

Routine follow-up of patients with gynecologic cancer includes the detection of a recurrence or metastases as well evaluation and therapy of treatment-related problems, reintegration into the daily routine and the assessment of follow-up data. After adjuvant therapy patients should be seen every 3 months during the first 3 years followed by every 6 months until 5 years after diagnosis and thereafter annually. Follow-up is continued until the risk of recurrence is negligible. Palliative patients should be followed-up appropriate to their individual needs and circumstances.     

Ureterläsionen bei gynäkologischen Eingriffen

Ureteral lesions during gynecological surgery are underreported. Between 2000 and 2011 a total of 173 cases were brought before the north German arbitration committee. In 82 patients (47.4%) medical malpractice was found with liability in 78 (45.1%) patients. Ureteral lesions cause a high rate of errors in comparison with only 28 % of medical errors in all other medical specialties.     

Partnerschaftskonflikte und therapeutische Ansätze bei gynäkologischen Patientinnen

Different gynecological problems can be accompanied by couple conflicts: infertility problems, transition to parenthood, antenatal and postpartum depression, sexual problems, chronic pelvic pain and chronic vulvar pain syndrome, cancer. In relation to couple conflicts different therapeutic approaches are discussed: psychoanalytical therapy, family therapy, behavioral therapy and person-centered therapy. The psychoanalytical concept concentrates on the couple as two individuals with their own biographies, which may lead to conflicts in their relationship. As a result therapy aims at the individual biography of each partner. Family therapy seeks to influence the partners to negotiate and change their couple rules and communication rules through reflection and experimentation. Behavioral couple therapy focuses on exercises to improve reciprocal activities, communication, conflict-resolution and problem-solving. Person-centered approaches aim at improving one's self-congruence in order to arrive at a clearer appreciation of the relationship to one's partner. The article shows that couple conflicts based on a bio-psycho-social model should be considered and treated in the beginning, during maintenance or as a consequence of gynecological symptoms.     

Hormonsubstitution bei gyn?kologischen Malignomen

A clinical challenge is the hormone therapy (HT) with sex steroids for complaints following gynecologic malignancies. The evidence regarding HT in perimenopausal and postmenopausal women was checked in the S3 guidelines on hormonal therapy in the perimenopause and postmenopause (http://www.dggg.de/fileadmin/public_docs/Leitlinien/2-1-4-ht-lang-hp.pdf). Corresponding statements and recommendations can be found in these guidelines. The aim of this review is to present the heterogeneous studies in the issue of HT after malignant diseases and to provide a basis for therapeutic decisions by physician and patients. A significant number of women suffer from the characteristic symptoms, including vasomotor symptoms and vaginal atrophy, due to the oncologic therapy that abruptly induces premature iatrogenic ovarian failure. Other women are in the natural perimenopausal or postmenopausal situation and are therefore burdened by these complaints. On the one hand the potential promotion of tumor growth by hormone therapy and on the other hand the maximum effective reduction of symptoms must be considered.     

Krankenheimtransport bei gynäkologischen Problemen und Schwangerschaftskomplikationen auf Reisen

The German Automobile Club (ADAC) offers car and health insurance for domestic and foreign travel and is thus confronted with a myriad of cases within Germany and abroad involving gynecology and obstetrics. Many of these acute problems arising during vacation or travel entail a hospital stay abroad or sometimes rather expensive transfer back to Germany for inpatient treatment. Depending on the severity of the illness and the clinical picture, complex problems often appear during transport, which require application of all medical possibilities extending even to intensive emergency care. Rapid return home is always aspired in cases of less than adequate treatment. When, however, the quality of care meets German standards, the risks involved for the patients during transportation should be weighed carefully. Many of the problems occurring during travel can already be solved and minimized by the local gynecologist.