SLOVENE SOCIETY

In the treatment of symptomatic endometriosis, the aim is to achieve complete surgical removal of the lesions. Primary laparotomy is often regarded as the standard surgical approach for removing intestinal endometriosis. The aim of this retrospective study was to clarify the advantages and disadvantages of combined vaginal-laparoscopic 'en-bloc' resection in comparison with primary laparotomy in patients with endometriosis spreading to the rectum. From October 2002 to June 2005, 28 patients with spreading rectovaginal endometriosis underwent surgery. Infiltration of the rectum was present in all cases. The postoperative evaluation was carried out using outpatient and in-patient medical files, histological findings, surgical reports, and follow-up of the patients for a period of up to 36 months. Anterior rectal resection due to rectal endometriosis was successfully carried out in 11 patients using a combined vaginal-laparoscopic procedure, and in nine patients via a primary laparotomy. Intra-operative conversion of the procedure from primary laparoscopy to laparotomy was necessary in eight cases due to marked adhesions or massive ureteral involvement. The hospitalization period was significantly shorter with the laparoscopic procedure than in patients undergoing laparotomy. No significant differences were found between the two methods with regard to postoperative complications, recurrence rates, establishment of an artificial anus, wound healing disturbances, or functional disturbances of the intestine or bladder. The combined vaginal-laparoscopic procedure for removing rectal endometriosis via an anterior rectal resection can be regarded as a method that is equally as effective as primary laparotomy. Further studies with longer follow-up periods are needed in order to study the long-term results, including the quality of life for the patients concerned.     

Blood markers for early detection of colorectal cancer: a systematic review.

BACKGROUND: Despite different available methods for colorectal cancer (CRC) screening and their proven benefits, morbidity, and mortality of this malignancy are still high, partly due to low compliance with screening. Minimally invasive tests based on the analysis of blood specimens may overcome this problem. The purpose of this review was to give an overview of published studies on blood markers aimed at the early detection of CRC and to summarize their performance characteristics. METHOD: The PUBMED database was searched for relevant studies published until June 2006. Only studies with more than 20 cases and more than 20 controls were included. Information on the markers under study, on the underlying study populations, and on performance characteristics was extracted. Special attention was given to performance characteristics by tumor stage. RESULTS: Overall, 93 studies evaluating 70 different markers were included. Most studies were done on protein markers, but DNA markers and RNA markers were also investigated. Performance characteristics varied widely between different markers, but also between different studies using the same marker. Promising results were reported for some novel assays, e.g., assays based on SELDI-TOF MS or MALDI-TOF MS, for some proteins (e.g., soluble CD26 and bone sialoprotein) and also for some genetic assays (e.g., L6 mRNA), but evidence thus far is restricted to single studies with limited sample size and without further external validation. CONCLUSIONS: Larger prospective studies using study populations representing a screening population are needed to verify promising results. In addition, future studies should pay increased attention to the potential of detecting precursor lesions.     

The effects of secretin on prolactin, estradiol, vasoactive intestinal polypeptide, and somatostatin levels in women

The effect of graded doses of intravenous secretin (0.5, 1.0, and 2.0 CU.kg-1.h-1) on serum prolactin and estradiol levels, as well as plasma vasoactive intestinal polypeptide and somatostatin levels was studied in 6 normally cycling and healthy women, and compared with the hormone levels obtained by a control infusion with physiologic saline (0.15 mol/l). A significant decrease in serum prolactin concentrations was found with increasing doses of secretin at steady-state levels of plasma secretin (+30 to +60 min). A significant negative correlation (p less than 0.007, r = -0.2764) existed between serum prolactin and plasma secretin concentrations at steady-state conditions. No effect of graded doses of secretin was observed on serum estradiol levels and plasma concentrations of vasoactive intestinal polypeptide and somatostatin. The results suggest a dose-related inhibitory effect of secretin on prolactin release in women.     

Number and timing of antenatal HIV testing: Evidence from a community-based study in Northern Vietnam

Background  

HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities.     

Wissenstransfer zur Reproduktionsmedizin

Background

The Internet in general and digital social networks in particular are increasingly important sources for health information; this also applies to information in the context of treatment of patients wishing for a baby. Initial studies show that patients are not only looking for factual information but also for emotional support. Whether digital social networks add to or compete with classical information and consulting is still unclear.

Methods

In order to provide a preliminary answer to this question, a literature study was conducted to determine relevant empirical findings regarding the use of the Internet and digital social networks. This was done using a keyword search in literature databases and then keyword snowballing.

Results

Information and advice from the Internet and from digital social networks can be seen as an addition to medical expertise, but are not a substitute. Digital social networks, in particular, supplement social peer groups and the relationship with physicians and will become even more important in the future.

Conclusion

For professionals active in the field of reproductive medicine, this could be an indication of deficits with regard to counseling and treatment, which in the future might be countered by providing new services.

     

Evaluation von organisierten Programmen zur Krebsfrüherkennung: Allgemeine Aspekte und aktueller Stand in Deutschland

In the past decades, it has been increasingly recognized that cancer screening is not always or not exclusively beneficial and, in the case of some measures, the negative effects may even outweigh the benefits. This has fundamentally changed the significance and emphasis placed on the evaluation of cancer screening programs. Generally, there is a distinction between an endpoint evaluation, which assesses the effectiveness or risk/benefit ratio, and a process evaluation, which aims to ensure optimum implementation of the program.Prior to the nationwide introduction of a screening measure, proof of effectiveness should ideally be provided by a randomized controlled trial (RCT), in which persons without a screening offer form the control group. From a scientific point of view, this study design is by far the best method to evaluate the endpoint, as it avoids biases that may distort the results in observational studies. RCT evidence on cancer screening measures currently offered by statutory health insurance providers in Germany – if available at all – originates exclusively from other countries.When mammography screening was introduced as the first organized screening program in Germany, comprehensive measures for process evaluation were taken. In April 2013, the legal basis for the transfer of colorectal and cervical cancer screening into organized programs was created. According to the legal provisions, both a process and an endpoint evaluation are planned for the new programs. It remains to be seen how the necessary data flows will be conceptualized and later implemented in practice.     

Associations of in Utero Exposure to Perfluorinated Alkyl Acids with Human Semen Quality and Reproductive Hormones in Adult Men

Background: Perfluorinated alkyl acids (PFAAs), persistent chemicals with unique water-, dirt-, and oil-repellent properties, are suspected of having endocrine-disrupting activity. The PFAA compounds perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are found globally in humans; because they readily cross the placental barrier, in utero exposure may be a cause for concern.Objectives: We investigated whether in utero exposure to PFOA and PFOS affects semen quality, testicular volume, and reproductive hormone levels.Methods: We recruited 169 male offspring (19–21 years of age) from a pregnancy cohort established in Aarhus, Denmark, in 1988–1989, corresponding to 37.6% of the eligible sons. Each man provided a semen sample and a blood sample. Semen samples were analyzed for sperm concentration, total sperm count, motility, and morphology, and blood samples were used to measure reproductive hormones. As a proxy for in utero exposure, PFOA and PFOS were measured in maternal blood samples from pregnancy week 30.Results: Multivariable linear regression analysis suggested that in utero exposure to PFOA was associated with lower adjusted sperm concentration (p_trend = 0.01) and total sperm count (p_trend = 0.001) and with higher adjusted levels of luteinizing hormone (p_trend = 0.03) and follicle-stimulating hormone (p_trend = 0.01). PFOS did not appear to be associated with any of the outcomes assessed, before or after adjustment.Conclusions: The results suggest that in utero exposure to PFOA may affect adult human male semen quality and reproductive hormone levels.