Werner Grünberger

Vaginoplasty using deepithelialized vulvar transposition flaps: the Grünberger method.

BACKGROUND One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few postoperative complications of vaginal contracture, and others implement autografts with a greater tendency of tissue contraction. STUDY DESIGN We report here a method of vaginoplasty using deepithelialized vulvar transposition flaps to enlarge the width of narrow vaginas found mainly in cases of congenital adrenogenital syndrome-associated vaginal atresia, but also in cases of acquired vaginal atresia (surgery and radiotherapy-induced). We used deepithelialized dermis from the labia majora to construct an enlarged vaginal entrance and cavity, a technique that is easy to learn and perform. RESULTS The healing phase of this operation is free of tissue rejection, most likely because of the close embryologic relationship of the cornified, paravaginal squamous epithelium of the labia majora and the noncornified squamous epithelial lining of the lower third of the vagina. The epithelium of the graft loses its cornified layer and becomes nonhair-bearing; its cytology and histology mimic normal vaginal epithelium. Postoperative function and sexual contentment were reported to be satisfying. CONCLUSIONS The followups of 17 patients who underwent this operation in the last 16 years show optimal cosmetic and functional results.

Multiple endometrial stromal nodules with sparce cysts and glands in the lung – A nodular variation of endometriosis that may mimic metastases of sarcoma

We report an unusual case of a nodular variation of pulmonary endometriosis. To our knowledge, there is no previous report on a morphological investigation of this entity. The etiology of this rare condition is still a matter of discussion. The well-circumscribed nodular mass is composed of cells identical to, or closely resembling, those of endometrial stroma containing sparse cysts and glands. Immunohistochemically, the cells showed an extensive co-expression of cytokeratin AE1/AE3 and vimentin and were highly positive for progesterone receptor (PRICA) and estrogen receptor (ERICA). Cells lining the cysts and glands as a monolayer were reactive for Ber-Ep4, cytokeratin Pan and cytokeratin AE1/AE3 and negative to all other markers used including PRICA and ERICA. The differential diagnosis of this entity included fibrous tumor of the pleura and metastatic low-grade-endometrial-stromal-sarcoma. The morphological findings are correlated with immunohistochemical studies and results of cell image analysis. This study details the clinicopathological features of the nodular variation of pulmonary endometriosis.

Parenchymatous pulmonary endometriosis - metastases of a low-grade endometrial stromal sarcoma?

Based on the data of a case of parenchymatous endometriosis of the lung in which three and a half years later a low-grade endometrial stromal sarcoma of the uterus was diagnosed the origin of this disease is discussed. The follow up of this patient gave the impression that the pulmonary nodules were early metastases of low-grade endometrial stromal sarcoma, which was initially not detected in the routine gynecologic examination. Furthermore, as histological and immunohistochemical examinations are not sufficient to distinguish reliable between endometriosis of the lung and pulmonary metastases from low-grade endometrial stromal sarcoma. In literature, in none of the few cases of parenchymatous pulmonary endometriosis a hysterectomy was performed to exclude a low-grade endometrial stromal sarcoma. Thus, parenchymatous pulmonary endometriosis nodules might be metastases and their occurrence should cause the treating physician to consider a distant metastatic spread from low-grade endometrial stromal sarcoma.

Dehydroascorbic Acid in Urine as a Possible Indicator of Surgical Stress

Background/Aim:L-Ascorbic acid (AA) is the predominant circulating form of vitamin C found in human blood. It has been hypothesized that surgical stress increases the vitamin C metabolite dehydroascorbic acid (DHAA). Vitamin C is mainly excreted through the kidneys. In this study, the ratio of AA to DHAA excreted in urine was determined in patients who had undergone total hip joint endoprosthesis surgery (n = 12), and the results were compared with data obtained from healthy controls (n = 12). Methods: All subjects received 1,000 mg sodium ascorbate intravenously three times a day (every 8 h) for 8 days, starting 2 days prior to surgery. Total urine was collected daily while subsequent determinations of AA and DHAA were performed photometrically. Results: Administration of vitamin C led to average daily excretions of the combined products AA + DHAA of 2,343 ± 438 mg/day (mean value ± confidence intervals). The initial average ratio DHAA/AA of all 24 probands was 0.064 (6% DHAA; 153 ± 76 mg/day). One day after surgery, an increase in the DHAA/AA ratio to 0.165 (15% DHAA; 332 ± 107 mg/day) was measured in the patients. The ratio decreased 2 days after surgery and returned to normal within 5 days. Conclusion: Our data indicate that surgery increases the oxidation of AA and urinary excretion of DHAA, as a result of the enhanced formation of free radicals.

Effect Of β-Receptor Blockers On Uterine Contractility In A Puerperal Model

β‐receptor blockers are increasingly used in the treatment of pregnancy‐induced hypertension. Hitherto an oxytocic effect on the myometrium could not be excluded. We investigated the effect of 0.8 resp 1.6 mg pindolol on uterine activity in a double blind study in comparison with a placebo group, using a puerperal model. A “paradoxical” decline in uterine activity could be demonstrated, speaking in favor of a further propagation of β‐blockers in obstetric practice.

Guidelines for treatment of breast carcinoma by the Gynecological Oncology Working Group. Gynecological Oncology Working Group

aGynäkologie LKH Bregenz; bGynäkologie Rudolfstiftung, Wien; cAbteilung für Spezielle Gynäkologie, AKH Wien; dSonderabteilung für Frauenheilkunde, LKH Salzburg; eGynäkologie LKH Graz; fPathologie Donauspital, Wien; gUniv.-Klinik für Strahlentherapie, AKH Wien; hGynäkologie Lainz, Wien; iGynäkologie LKH Salzburg; jUniv.-Frauenklinik Innsbruck; kUniv.-Klinik für Radiodiagnostik, AKH Wien, Österreich

Psychische Operationsverarbeitung nach verschiedenen Formen der Hysterektomie

Ziel unserer Studie war es, die psychische Verarbeitung der Hysterektomie (HE) nach verschiedenen Techniken der Uterusexstirpation 3. 6, 9 und 12 Monate postoperativ (p.a.) zu evaluieren. Insgesamt haben wir 41 Frauen mittels vaginaler HE (VH), abdominaler HE (AH), laparoskopisch assistierten HE (LAVH) und pelviskopischer, intrafaszialer HE (CASH) operiert und nachuntersucht. In unseren dreimonatlichen Kontrollen konnten wir hierbei 5mal ein signifikant besseres p.o. weibliches Selbstwertgefuhl und 8mal eine signifikant verringerte Trauerarbeit in der CASH-Gruppe anderen extrafaszialen Operationsmethoden gegenuber evaluieren. Zwischen VH. AH und LAVH haben wir keine signifikanten Unterschiede gefunden. Alle Daten wurden mittels eigens entwickelter Fragen innerhalb eines standardisierten Fragebogens prospektiv randomisiert erhoben (Test fur die Differenz zweier Anteilswerte, p<0,05). Multiple psychologische Interviews und der 16-Personlichkeitsfaktorentest (16 PF) sicherten die Datenzuverlassigkeit. The objective of the present study was to assess the „stress response Syndrome“ following established types of hysterectomy in cases of benign disease, 3, 6, 9 and 12 months postoperatively. A total of 41 premenopausal, sexually active women were hysterectomised using the conventional vaginal (VH), abdominal (AH), laparoscopy-asssisted (LAVH) and pelviscopic intrafascial (CASH) surgical techniques. Those who had had the CASH procedure showed a more positive personal basic seif image (5 times significant differences within one year) and less grief over the loss of the uterus (8 times significant differences within one year) than those on whom any extrafascial surgical technique had been perform ed. We found no significant differences in these parameters between VH, AH, and LAVH. Indices were evaluated according to our own scoring system, consisting of a standardised questionnaire for examining the patients in a prospective, randomised study (two-sample percentage test, p<0.05). Multiple psychological interviews and 16-Personality Factors Test (16 PF) ensured the reliability of the data.

Pregnancy and delivery in 12–14-year-old girls

Abstract This retrospective study reports the course of pregnancy and delivery in 12–14-year-old girls over an 8-year period. At the time of delivery, 44 of 13,178 mothers (0.3%) had not reached their 15th birthday. These adolescent primiparas were compared with an equal-sized group of primiparas between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%).