Endokrinologie der humanen Plazenta

The placenta, a fetal organ at the feto-maternal interface, produces an amazing array of hormones, known to be produced in fact only in the hypothalamus or pituitary gland. Its special anatomy and its functional role as a barrier between fetal and maternal blood circulations enable a selective action of placental hormones either on the mother or the developing fetus. Knowledge concerning placental hormones has increased over the past decades, but some questions still remain. One of these questions is the relevance of hormone substitution in case of a placental insufficiency, as is usually done for other endocrine organs.     

Mesotheliale Proliferate bei Rektumkarzinom

In an epiphrenic lymph node of a 55 years old female patient who underwent surgical resection of a rectal adenocarcinoma epitheloid proliferations with papillary and solid growth pattern were seen additional to a metastasis of the carcinoma. Adjacent vessels contained similar infiltrates. Immunohistochemically a co-expression of pan-keratin, calretinin and WT1 was seen, suggestive for a diagnosis of a metastasis of a malignant mesothelioma. However, radiologic examination yielded no morphologic correlate to this suspicion. Further immunohistochemical work-up showed positivity for desmin, negativity for EMA, GLUT1, p53 and a low ki67-fraction of 2–3?%. Therefore, a final diagnosis of benign mesothelial proliferations disseminated into the lymph node and the adjacent vessels was made.     

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.