Fertilit?tserhaltende Therapien bei Uteruskarzinomen

Approximately 42% of all cervical and 7.5% of all endometrial cancer patients are diagnosed at an age when they have potentially not yet realized or completed family planning. In the early stages of these diseases most patients undergoing appropriate therapy can be cured. However, standard therapies are incompatible with the wish to conceive so that there is a need for alternative concepts allowing preservation of fertility. For both tumor entities corresponding treatment plans and operative procedures have been published. Previous studies have shown that preservation of fertility and successfully completed pregnancies can be achieved. A careful selection of suitable patients is mandatory as clinical understaging leads to an oncologically inappropriate therapy and therefore to an avoidable increase in risk of recurrence.     

Schilddrüse und Schwangerschaft

Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function. Both overt and subclinical hypothyroidism have adverse effects on the course of pregnancy and development of the fetus. Hypothyroidism should be diagnosed and corrected before initiation of pregnancy. If hypothyroidism is diagnosed during pregnancy, thyroid function should be normalized as rapidly as possible. Adequate iodine intake is important. By hyperthyroidism differentiation of Graves’ disease from gestational thyrotoxicosis is possible by evidence of autoimmunity (morphologic change of goiter and TSH-receptor antibodies). For overt hyperthyroidism due to Graves’ disease or hyperfunctioning thyroid nodules antithyroid drug therapy should be either initiated or adjusted to maintain the maternal thyroid hormone levels for free T4 in the upper reference range for nonpregnant women. TSH screening should be obtained of patients who are at increased risk (such as miscarriage, preterm deliver miscarriage or history of thyroid disease, Age >?30 years, goiter, autoimmune disease such as diabetes mellitus type 1).     

Pneumonie und diffus parenchymale Lungenerkrankungen im Lungenultraschall

Approximately 200,000 cases of ambulant pneumonia per year are currently anticipated in Germany. In order to reduce complications and to further minimize lethality a rapid diagnosis as well as efficient and quick therapy are significant factors within the medical treatment and the diagnosis can be achieved promptly with the aid of lung ultrasound. This article illustrates the sonomorphology of pneumonia as well as diffuse parenchymal lung disease and presents recent studies on the topic. Furthermore, lung ultrasound is compared with other diagnostic methods.     

Knöcherne Stressreaktionen des Fußes im Sport

Stress reactions and stress fractures are defined as structural damage to bone caused by repetitive stress or stereotypical loading. The balance between loading and unloading of bone is disrupted in stress reactions and stress fractures through the sport-specific demands and by the exogenous or endogenous risk factors present. In sports orthopedics the localization of stress reactions and stress fractures are subdivided into high risk fractures and low risk fractures. Conventional diagnostic radiology can initially be inconclusive. With symptoms persisting over 2 weeks further diagnostics using magnetic resonance imaging (MRI) should be performed. In the area of the foot stress reactions and stress fractures can often occur bilaterally or multifocally and most commonly affect the second metatarsals followed by the third metatarsals. Fractures of the fifth metatarsal, second metatarsal base, medial malleolus as well as navicular and sesamoid fractures are high risk fractures requiring special clinical and radiological monitoring. Basically, conservative treatment using the 2-phase model is the treatment of choice. In delayed union or severe pain surgical treatment is indicated.     

Myokardiales Risiko bei Karotisendarteriektomie und Stent

Carotid stenosis is an important cause of ischaemic stroke. Carotid endarterectomy (CEA) reduces the risk of stroke among patients with symptomatic and asymptomatic carotid stenosis. Stent treatment has emerged as an alternative to surgery but is associated with a higher risk of periprocedural stroke. Randomised trials have yielded conflicting results regarding the risk of myocardial infarction (MI) with stenting and CEA. These differences are mostly explained by differences between trials in study populations, as well as assessment and definition of MI. Considering all available randomised trial data, periprocedural MI is more common with CEA than with stent treatment. As with periprocedural stroke, periprocedural MI also leads to a decrease in long-term survival. Thus, MI must be regarded a serious adverse event complicating carotid interventions. Stent treatment therefore represents an alternative to CEA among patients with clear indication for carotid revascularisation who are considered at increased risk for coronary events.