Andreas D. Ebert

Implementation of certified endometriosis centers: 5-year experience in German-speaking Europe.

The idea of quality improvement in the management of endometriosis has been brought to attention throughout Europe. This - first and foremost - includes the implementation of centers specialized in treating endometriosis. This leads to qualification of both physicians and other medical staff, enforcement of research efforts, and informing the patients, the public, politicians, healthcare providers, and industry. Given limited budgets, focusing on the existing national commitment may be the first step.

Daily Vaginal Application of Dienogest (Visanne©) for 3 Months in Symptomatic Deeply Infiltrating Rectovaginal Endometriosis: A Possible New Treatment Approach?

A 27-year-old patient suffering from deeply infiltrating rectovaginal endometriosis was treated with 2 mg/day dienogest vaginally for 3 months. The therapy was tolerated very well. The patient reported less side effects compared to the oral use of dienogest. After 3 months of dienogest treatment, the rectovaginal gynecological examination identified the visible vaginal part of endometriosis in remission. The firm endometriosis node approximately 3 cm in size and approximately 10 cm ab ano was still palpable, but it was much less painful. The laboratory values for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were unremarkable, with an LH/FSH quotient of 0.7 during dienogest treatment, while 17-β estradiol and progesterone were suppressed. At palpation and vaginal ultrasonography, there was no change in the findings before and after 3 months of dienogest treatment, but the patient was now de facto asymptomatic. To the best of our knowledge, this is the first report of a vaginal dienogest treatment in symptomatic deeply infiltrating rectovaginal endometriosis. Vaginal administration of dienogest should receive further investigation in pharmacokinetic and clinical studies.

Selective Progesterone Receptor Modulators for the Medical Treatment of Uterine Fibroids with a Focus on Ulipristal Acetate

Uterine fibroids are the most frequent benign tumours in women of child-bearing age. Their symptoms are diverse and the quality of life of the women affected can be significantly impaired. While treatment to date has been primarily by means of surgical intervention, selective progesterone receptor modulators (SPRMs) open up new medication-based treatment options. EMAs Pharmacovigilance Risk Assessment Committee (PRAC) has recently completed its review of ESMYA® (ulipristal acetate, 5 mg), following reports of serious liver injury, including liver failure leading to transplantation in postmarketing settings. We will provide some information on the PRACs recommendations to minimize this risk. Nevertheless, the effectiveness and safety of the SPRM ulipristal acetate (UPA), both with regard to preoperative administration and with regard to an intermittent administration as long-term treatment for patients with symptomatic uterine fibroids, have been shown in several clinical studies (PEARL I–IV).

Health economic burden of deep infiltrating endometriosis surgically treated in a referral center

Purpose This retrospective study aimed to describe patient characteristics of women with deep infiltrating endometriosis [DIE] affecting the bowel and bladder treated in a referral center in Germany, and to calculate direct costs during inpatient stay for surgery. Methods Patient characteristics and cost-relevant factors of women with DIE of the bladder or bowel surgically treated during 2008-2012 in a referral center were gathered from medical records. Patient economic data were retrieved from the hospitals finance and accounts department. Results One hundred and forty-eight cases with clinical information and cost data were analyzed retrospectively. Most cases had bowel endometriosis (91%) and were classified as severe (66%). The women analyzed were in their reproductive peak years (34 years; SD 6.3 years), of normal weight (body mass index [BMI] 23; SD 4.0) and most of them were employed (80%). Nearly all women (95%) were affected by multiple symptoms at hospital admission and the majority had a prior diagnosis of endometriosis (76%). Mean total costs per case were €11,458 (95% CI: €10,589-€12,326). Forty-four percent of the total costs were mean staff costs (€5,039), 30% were mean infrastructure costs (€3,425) and 26% mean material costs (€2,993). Conclusions This study is the first to estimate the surgery-related direct costs of DIE in Germany from a hospitals perspective based on data from a specialized center. Resource utilization and total costs of DIE are substantial.

Verfahren in der Geburtshilfe. Die Sectio als Ausnahme – Geburtshilfe vor 50 Jahren (1965)

von geburtsmechanischem Denken bestimmt. Die Sectio wurde nur bei absoluter Unvermeidbarkeit als ultima ratio akzeptiert. Hinter dem Ziel der Spontangeburt um jeden Preis traten andere Gesichtspunkte zurück, wie Geburtsdauer, Belastung der Kreißenden oder potentielle Gefahren für das Kind. Für letztere gab es ohnehin nur wenige Kriterien [...]. In den 60er Jahren setzte dann eine Revolution im geburtshilflichen Denken und Handeln ein [...]“, so charakterisiert Schmidt-Matthiesen 1988 in seinen Lebenserinnerungen die Geburtshilfe der 1950erund frühen 1960erJahre in Deutschland. Dazu ergänzend Bickenbach in seiner Eröffnungsrede im Oktober 1964 auf dem 35. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe: „[...] Der Geburtshelfer hat bei allen Überlegungen und Handlungen seit jeher an zwei Menschenleben zu denken, an die Mutter und das Kind. In der Vergangenheit ist daraus nicht selten eine Konkurrenz der Pflichten geworden, die oft zu Ungunsten des Kindes entschieden wurde und zum Verlust des Kindes führte. Die heutige Geburtshilfe ist nur noch selten vor derartige Entscheidungen gestellt [...]“ (Bickenbach [1], zit. [2]).