Zentralblatt für Gynäkologie
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The results of four randomized international multicentric trials evaluating the therapeutic benefit of Herceptin in the adjuvant treatment of HER2-neu positive primary breast cancer have been reported. These reports showed that even after short term follow up one year of Herceptin resulted in improved disease free, metastases free and overall survival. Design and results of these four studies and the recommendations of national and international societies for the use of Herceptin in the adjuvant setting will be discussed.
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Epidural analgesia for labour has been associated with an increased rate of motor blockade, and instrumental and Caesarean deliveries. In recent years, these risks were significantly reduced with modern concepts of epidural analgesia, including the use of lower doses of local anaesthetics in combination with opioids. With combinations of 0.0625-0.125 % of bupivacaine plus sufentanil or fentanyl, the incidence of maternal motor blockade approximates 10 % and most parturients are nowadays able to ambulate during labour. ⋯ The most common type of anaesthesia for Caesarean delivery is spinal anaesthesia due to its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an urgent or emergent Caesarean delivery. General anaesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuraxial blockade is contraindicated.
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In spite of an increase in the number of caesarean sections, the incidence of anaesthetic-related complications remains low. This is due primarily to the increasing use of regional anaesthesia (spinal and or epidural anaesthesia) as general anaesthesia is associated with a 17-fold increase in complications, in particular failed endotracheal intubation, aspiration of gastric contents and hypoxia. It is most important that all obstetric patients deemed at risk for general anaesthesia (e. g. morbidly obese, hypertension, placenta praevia) should be identified as such by the obstetricians and referred to the anaesthetic department at an early stage. ⋯ Many of these so-called emergency cases are not real emergencies and could be equally well performed under regional anaesthesia. A continuing audit of maternal deaths in Germany should be established along similar lines to the Confidential Enquiries into Maternal Deaths in the United Kingdom. Most importantly, the increasing use of regional anaesthesia should be propagated as its use in Germany still lies well behind other countries such as Switzerland, the USA and the United Kingdom.
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A case of 56-year-old patient is presented with the diagnosis "carcinoma of the cervix". She suffered from brown, bad smelling vaginal discharge since half a year without any pain. Three weeks before she had noticed a postmenopausal bleeding. ⋯ The patient suffers from multiple sclerosis since 20 years. On asking she told us that the foreign body was in place since about two years. She was not willing to relate any other information.
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Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management. ⋯ Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.