Rolle der Angiogenese und ihrer Inhibitoren in der Gynäkologie

Angiogenesis describes the neoformation of blood vessels which develop by budding and sprouting of the existing vessel system. Solid tumor growth is dependent on the surrounding growing capillary network providing the tumor with essential nutrients and oxygen. The pathophysiological role of angiogenesis could be shown for multiple benign (endometriosis, menorrhagia, leiomyomatosis, ovarian hyperstimulation syndrome, preeclampsia and placental hypoperfusion syndrome) and malignant (especially metastasized and therapy-refractory breast cancer, ovarian cancer, cancer of the fallopian tube and the primary peritoneal cancer) diseases. Diseases that are very much dependent on (neo) angiogenesis can be treated with various anti-angiogenic agents. Due to the broad spectrum of side effects of established angiogenesis inhibitors which are mostly given in combination with chemotherapeutic agents, this therapeutic approach is mostly limited to malignant diseases, such as breast cancer, ovarian cancer, cancer of the fallopian tube and primary peritoneal carcinoma. This review provides an overview of the current state of knowledge in the anti-angiogenic therapy of gynecological diseases and will give a perspective of potential future implications of new therapeutic agents.     

Neue Aspekte der ovariellen Stimulation

New aspects of ovarian stimulation for assisted reproduction techniques focus on minimizing patient burden and therapeutic risks while maintaining the classic concept of gonadotropin stimulation in combination with gonadotropin releasing hormone (GnRH) analogues. The introduction of a long-acting follicle stimulating hormone (FSH) preparation (corifollitropin alfa) allows dispensing with daily injections during the first week of stimulation while achieving comparable ovarian responses and clinical outcome. Another milestone is the possibility of completely avoiding ovarian hyperstimulation syndrome (OHSS) by the use of GnRH agonists for ovulation induction in a GnRH antagonist protocol for patients with suspected high response. Various treatment modalities are still under discussion to optimize the outcome of infertility therapy in patients with previous or suspected poor response (POR). In summary, the introduction and new combination of preparations allows a more individualized ovarian stimulation in order to optimize treatment outcome and minimize risks and patient burden during assisted reproduction techniques.     

Juveniles Glaukom bei Propionazid?mie

Propionic acidemia (PA) is a rare autosomal recessive disorder resulting from deficiency of the biotin-dependent enzyme propionyl-CoA carboxylase, which is necessary for the catabolism of branched chain amino acids and odd-chain fatty acids. Although optic atrophy was documented in four cases, no glaucomatous optic atrophy has yet been described. This article describes the first case of a 12-year-old boy with PA showing bilateral glaucomatous optic disc atrophy due to dysgenetic changes of the angle of the anterior chamber.     

Cardiorespiratory response to exercise in Ebstein's anomaly

Fourteen patients with unrepaired Ebstein's anomaly underwent maximal exercise testing between October 1982 and April 1984. Compared with control subjects, these patients had significantly lower values for total work performed, exercise time, maximal oxygen uptake, blood oxygen saturation at rest and during exercise, and heart rate and systolic blood pressure during maximal exercise. They had a significant increase in heart rate at rest. The ventilatory equivalent for oxygen was increased significantly both at rest and during exercise. Thus, patients with Ebstein's anomaly have decreased exercise tolerance owing to both cardiac and respiratory limitations.     

Straddling atrioventricular valve: two-dimensional echocardiographic diagnosis, classification and surgical implications

The usefulness of subclassifying the anatomic variations of straddling and overriding atrioventricular (AV) valve by 2-dimensional echocardiographic observation were evaluated. Chordae straddling into a contralateral ventricle were subdivided into type A (chordae inserting into the contralateral ventricle near the crest of the ventricular septum), type B (chordae inserting along the contralateral ventricular septum) and type C (chordae inserting into the free wall or papillary muscles of the contralateral ventricle). Overriding AV valve anulus was described as minor (less than 50% of the anulus committed to the contralateral ventricle), major (about 50% of the anulus committed to each ventricle), and double-inlet ventricle (greater than 50% of both AV valves committed to a single ventricular chamber). In 52 patients straddling AV valve was diagnosed by echocardiography and confirmed by direct examination at surgery or autopsy. In 60 of 66 straddling AV valves (91%), the diagnosis and the degree of straddling (type A, B or C) were correctly identified by 2-D echocardiography. Major associated cardiac defects included double-outlet right ventricle (31%), complete transposition (23%), corrected transposition (19%), double-inlet ventricle (19%) and other complex defects (8%). Twenty-two patients (42%) had right-sided straddling, 21 (40%) had left-sided straddling and 9 (17%) had straddling of both AV valves. In 41% of the patients, straddling AV valve had a major impact on the type of surgery or the surgical outcome. Of these valves, 52% were type C (severe), 26% type B and 22% type A straddling.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intestinal oxalate and calcium absorption in recurrent renal stone formers and healthy subjects

The fractional intestinal absorption of oxalate and calcium was investigated by isotope techniques in 20 normal subjects and in 12 idiopathic calcium oxalate stone formers. The greatest amount of 14C-oxalate was excreted during the first six hour period in controls as well as in stone formers. The stone formers had a greater intestinal uptake of oxalate (11 +/- 5.1%) than the controls (6.2 +/- 3.7%; p less than 0.01). There was no significant relationship between the fractional absorption of oxalate and the total urinary oxalate excretion. The stone formers also had a higher fractional uptake of calcium compared to the controls (55 +/- 11% vs. 47 +/- 9.1%; p less than 0.05). There was a positive relationship (r = 0.47) between the urinary excretions of calcium and oxalate in the stone formers. During these conditions no correlation could be demonstrated between the fractional absorptions of oxalate and calcium, neither in the stone formers nor in the controls. In conclusion, patients with recurrent formation of calcium oxalate containing stones appear to have an enhanced intestinal uptake of both oxalate and calcium. This disturbance could be of primary pathogenic importance for their stone forming propensity.     

Tumoren des Fußskeletts

About 3–4% of all tumors and tumor-like lesions of the skeleton are located in the foot. Many of these lesions have a predilection for certain locations, so that the spectrum of entities occurring in the foot differs from the rest of the skeleton. Despite the fact that practically any entity can occur in the foot in rare cases, taken together the ten most frequent lesions make up for the vast majority of tumors and tumor-like lesions of the foot. The differential diagnosis of these lesions follows the general principles that apply in the rest of the skeleton. It is based on the analysis of the lesion’s X-ray morphology and location, the patient’s age, and in certain entities, the MR morphology. This article describes the most important tumors and tumor-like lesions of the foot, their differential diagnosis, and the principles of local staging.