Neuroprotektive Ansätze

After introduction of vitreoretinal surgery more than 40 years ago, further development of the procedure involved a continuous reduction of potential toxic effects by irrigating solutions, endoillumination or mechanical manipulation. Recently, additional efforts were made to prevent neurodegeneration via pharmacological intervention. Taurine as additive for irrigating solutions can be considered as an example for neuroprotectants in vitreoretinal surgery. Approval of neuroprotective agents demands an increased effort for preclinical and clinical evaluation. To date, only few neuroprotective substances are used in clinical routine in the context of vitreoretinal surgery, however, experimental data suggest a high potential of various neuroprotective agents. The following article gives an overview of current neuroprotective approaches feasible for vitreoretinal surgery and a critical analysis of their clinical relevance.     

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.     

Gyn?kologisch-geburtshilfliche Notf?lle ? Komplikationen bei endoskopischen Eingriffen

Minimally invasive surgical interventions and techniques belong to the standard repertoire of gynecologic surgery and provide a multitude of possibilities to treat typical and seldom gynecologic diseases in an elegant and less traumatic way. Gynecology has gathered a great deal of experience in this field and many endoscopic surgical techniques have been established as standard procedures; new, innovative therapeutic approaches are continuously being evaluated. To make sure that this important surgical specialty can be offered in a safe and successful manner, knowledge about potential complications is of greatest importance for the gynecologic surgeon. This has to be considered within informed consent of the patient as well as within surgery itself. This review article provides an overview of typical, currently reported complications of gynecologic oncology as well as recommendations for gynecologic surgeons about correct management.     

H?matologische Erkrankungen in der Schwangerschaft

The management of hematologic disorders in pregnancy presents diagnostic and therapeutic challenges requiring a multidisciplinary approach. Iron deficiency is the most common cause of anemia in pregnancy. Gestational thrombocytopenia is defined by mild, asymptomatic thrombocytopenia and usually requires no therapy. Autoantibody-induced idiopathic thrombocytopenia is treated with steroids and high-dose immunoglobulins in patients with platelet counts below 30,000/??l during pregnancy and below 50,000/??l before delivery. The most common hematologic neoplasias in pregnancy include Hodgkin??s disease, aggressive non-Hodgkin??s lymphomas, and acute leukemias. Cure for the mother depends on consistent intensive chemotherapy. Chemotherapy can be administered during the second and third trimester with reasonable safety, though there is an increased fetal risk. It is important to balance the potential fetal risk against the maternal risk of an untreated neoplasia.     

Mammakarzinom

Breast cancer is the most common gynecological cancer, accounting for almost 70,000?newly diagnosed cases each year. Patients are treated using a multimodal and interdisciplinary effort. Especially the neoadjuvant treatment concept is widely used in Germany. Taxanes are increasingly being routinely used in neoadjuvant and adjuvant therapy schedules. Targeted therapy is based on the two accepted predictive markers (hormone receptor status and the expression of Her2-neu receptors). In premenopausal women, 5?years of tamoxifen remains the standard; aromatase inhibitors should be included in postmenopausal patients. Newly developed tests to predict the risk of recurrence or the benefit from conventional chemotherapies are based on gene expression profiles. The validation of these tests is currently based on retrospective data. However, future developments will provide new possibilities for individualized therapy in breast cancer patients.     

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.