Uwe Ulrich

High Apoptotic Index Correlates to p21 and p27 Expression Indicating a Favorable Outcome of Primary Breast Cancer Patients, but Lacking Prognostic Significance in Multivariate Analysis

This study was performed in order to investigate the role of the apoptotic index (AI) as a prediction parameter for the prognosis of patients with primary breast cancer. AI was determined by DNA fragmentation on 298 primary breast cancer samples and compared to clinically established breast cancer parameters. Additionally, we determined the expression of functional parameters including proliferating cell nuclear antigen, p21waf and p27kip by immunohistochemistry. The mean AI was found to be 11.9% (range, 0–90%). 189 tumors (63.4%) were negative for apoptosis, while 109 tissue samples (36.6%) were apoptotic with >5% positive cells. Using univariate analysis (χ2 test), the AI did not show any significant correlation to one of the established prognostic parameters of primary breast cancer (p > 0.05). In contrast, we found a significant positive correlation to the expression of the cell cycle inhibitors p21waf (p = 0.04) and p27kip (p = 0.024). During the clinical follow-up (median observation time for disease-free survival 87 months), several clinically established prognostic parameters including menopausal status, nodal status, tumor size, tumor grade, and hormone receptor expression could be confirmed and were analyzed with respect to the AI in the tumor. Furthermore, AI displayed a significant positive correlation to disease-free survival using Kaplan-Meier survival analysis (log-rank test, p = 0.04). However, AI lost its prognostic significance in multivariate analysis based on the Cox proportional hazard model (relative risk 0.8, confidence interval 0.52–1.33, p = 0.44). Our data indicate that high apoptotic rates in cancer tissues are indicative of a favorable patient outcome. However, the AI was not an independent factor. The study provides indirect evidence that this process may involve cell cycle inhibitors physiologically.

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.

Laparoscopic staging in advanced cervical cancer: the pros and cons of an oncological concept

In this paper, the concept of laparoscopic pretreatment staging in women with advanced cervical cancer is surveyed. While a number of authors have demonstrated the potential advantages of surgical staging for optimum individual treatment planning, clear definition of the radiation field, and potential avoidance of radical hysterectomy, an additional operation including para-aortic lymphadenectomy with considerable learning curve must also be considered. In one study, the negative effect of surgical staging on the survival of patients with cervical cancer has been reported. A positive effect of surgical staging on the prognosis of patients with advanced cervical cancer has not yet been shown. In conclusion, this concept must be further evaluated in specialized centers until a clear recommendation can be made.

Recommendations for the surgical treatment of endometriosis-part 1: ovarian endometrioma.

Study questionWhat does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide?Summary answerThis document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age.What is already knownEndometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis.Study design, size and durationA working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery.Participants/materials, setting and methodsThis document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis.Main results and the role of chanceThe document presents general recommendations for surgery of endometrioma and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them.Limitations and reasons for cautionOwing to the limited evidence available, recommendations are mostly based on clinical expertise.Wider implications of the findingsThese recommendations complement previous guidelines on the management of endometriosis.Study funding/competing interestsThe meetings of the working group were funded by ESGE, ESHRE and WES. CB declares to be a member of the independent data monitoring committee for a clinical study by ObsEva and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences and Volition. ES received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest.

Laparoscopic-assisted vaginal hysterectomy with laparoscopic pelvic and paraaortic staging for early endometrial cancer

While abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy is still considered the gold standard for the surgical treatment of endometrial cancer, the laparoscopic-assisted vaginal hysterectomy (LAVH) plus laparoscopic lymphadenectomy has been performed in FIGO stage I endometrial cancer in selected centers for about a decade. Clinical studies have shown that the frequency of intra- and postoperative complications, the pelvic and paraaortic lymph node yield, and—more importantly—the overall survival, are similar both with the laparoscopic-assisted vaginal approach and the abdominal approach in stage I disease. Blood loss and duration of hospital stay may even be reduced with the LAVH. In summary, provided there is compliance with established oncologic guidelines, LAVH with pelvic and paraaortic lymphadenectomy can probably be performed in patients with endometrial cancer FIGO stage I without safety loss.

Operative Therapie der Endometriose

ZusammenfassungDie operative Therapie der Endometriose ist als die wichtigste therapeutische Maßnahme anzusehen. Die Hauptindikation für eine Operation ist der starke Schmerz, die Sterilität sowie eine progressive Veränderung der Organanatomie. Ziel ist es, die Endometriose zu inaktivieren bzw. zu beseitigen. Der Widerspruch zwischen einer vollständigen Entfernung der Endometriose und dem Wunsch nach Organerhalt erfordert individuelle Lösungen. Die Auswahl der Operation erfolgt in Abhängigkeit des Alters, der Vorgeschichte, der anatomischen Situation und des Wunsches der Patientin. Die Entscheidung operative Laparotomie oder endoskopischer Eingriff wird durch den Befund und die Erfahrung des Operateurs bestimmt. Die Adenomyosis uteri wird meist durch eine Hysterektomie therapiert, wobei auch hier konservative Operationsverfahren zur Anwendung kommen. Die Ergebnisse der operativen Therapie zeigen bei entsprechender Indikationswahl und individueller Operationsplanung eine hohe Erfolgsrate. Endoskopische Operationen scheinen der konventionellen Laparotomie überlegen zu sein.AbstractSurgery is the most important approach to endometriosis. The main indications for surgery are severe pain, sterility and progressive changes to the anatomical structures of pelvic organs. The aim is to inactivate and/or remove the endometriotic lesions. There is a tension between complete removal of all endometriotic tissue and the desire to preserve the organs, which means that individually tailored treatment strategies are necessary. The surgical procedure selected depends on the patient’s age and previous medical history, the anatomical situation and the patient’s wishes. The surgeon’s experience is the decisive factor in the decision on whether a laparotomy or laparoscopic surgery is done. Adenomyosis is genereally treated by hysterectomy in most cases; conservative surgical procedures can be successful in selected cases. The success rates after surgical treatment of endometriosis are high, providing that patients are carefully selected and the surgery is individually planned. On the whole, endoscopic surgery seems to be superior to conventional laparotomy.

Laparoskopische Therapie der Endometriose@@@Laparoscopic treatment of endometriosis

ZusammenfassungDie operative Entfernung der Endometriose gilt nach derzeitigem Wissensstand als optimale Therapie zur Kontrolle der Symptome und bei Sterilität. Wenn möglich, wird man hierfür die Laparoskopie einsetzen. Ungelöste Probleme sind die Persistenz und die Rezidivneigung der Erkrankung.AbstractIn endometriosis, surgical removal of manifestations of the disease is considered the state-of-the-art treatment for both symptom control and infertility. While whenever possible, laparoscopic surgery should be employed, both persistence and recurrence are unsolved problems of the disease.