Yvonne Bader

Risk Factors for De Novo Malignancies in Women After Kidney Transplantation: A Multicenter Transversal Study.

Objective Transplantation results in a 5-time elevated risk for a variety of malignancies (Kaposi sarcoma, skin, liver, lung, gastrointestinal cancer). A patient’s risk for malignancies could be of particular interest for the follow-up programs of patients and risk adaption after kidney transplantation. The aim of this study was to identify independent risk factors for de novo malignancies in women after renal transplantation. Methods and Materials This is a multicenter transversal study, conducted at the Medical University of Vienna and Hospital Rudolfstiftung, Vienna, Austria. We included female kidney graft recipients who were transplanted between 1980 and 2012 and followed-up at our institutions (N = 280). Clinical data of patients were extracted from hospital charts and electronic patient files. Patients were interviewed using a standardized questionnaire regarding their medical history, history of transplantation, and malignant diseases. Detailed information about present and past immunosuppressive regimens, rejection episodes and therapies, renal graft function, and information about primary disease was obtained. Diagnostic work-up and/or surgical exploration was performed if any presence of malignancy was suspected during routine follow-up. Histological specimens were obtained from all patients. Main outcome measures: the presence of de novo malignancy after kidney transplantation. Results Two hundred sixty-two women were included for statistical analysis. Median (interquartile range) follow-up period after transplantation was 101.1 (27.3–190.7) months. Thirty-two patients (12.2%) developed a malignancy: dermatologic malignancies (5.7%), breast cancer (3.4%), cervical cancer (0.8%), lung cancer (0.4%), gastrointestinal malignancies (1.5%), vulvar cancer (0.4%), and unclassified malignancies (1.9%). Median (interquartile range) time to malignancy after transplantation was 185.9 (92.0–257.6) months. Cumulative cancer rates were 4.9% (1 year), 14.4% (3 years), 16.4% (5 years), and 21.8% (10 years). Second transplantations were identified as independent risk factor for development of malignancy after transplantation. Conclusions Long-term risk of developing a malignancy after kidney transplantation is high, which might justify a follow-up of more than 10 years.

Hormonal contraception in female lung transplant recipients: a case series

We present a case series of eight female lung transplant recipients who used combined hormonal contraception (CHC). Pregnancies after lung transplantation are rare1 but can put the woman and the fetus at high risk. It has been reported that pre-eclampsia develops in approximately 25% of lung recipients, often leading to preterm delivery and low birth weight.2 Little is known about the influence of pregnancy per se on the risk of transplant rejection, although the rejection rate seems similar to that in the non-pregnant population.2 However, the National Transplantation Pregnancy Registry (NTPR) reported that 27% of woman in the lung transplant pregnancy cohort experienced a rejection episode, with 21% experiencing graft loss within 2 years after pregnancy. Thus, this group of women is considered high risk when compared with other solid organ recipients and are often advised against pregnancy. Although it is recommended that women use a safe and reliable method of contraception, the safety of hormonal contraception in female lung transplant recipients might be problematic. Despite the fact that the effect of estrogens on the pulmonary vascular system remains poorly understood, higher estrogen levels in women may predispose them to having a more vulnerable pulmonary circulation, which could more easily foster the development of pulmonary arterial hypertension.3 Hence, the aim of this study was to evaluate the safety of CHC in women after lung transplantation. From January 2009 to December 2012, eight women who were already …

Management of uterine ectopic pregnancy – local vs. systemic methotrexate

The aim of this study was to compare ultrasound‐guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration.

Measurement of Thermal Effects of Doppler Ultrasound: An In Vitro Study

Objective Ultrasound is considered a safe imaging modality and is routinely applied during early pregnancy. However, reservations are expressed concerning the application of Doppler ultrasound in early pregnancy due to energy emission of the ultrasound probe and its conversion to heat. The objective of this study was to evaluate the thermal effects of emitted Doppler ultrasound of different ultrasound machines and probes by means of temperature increase of in-vitro test-media. Methods We investigated the energy-output of 5 vaginal and abdominal probes of 3 ultrasound machines (GE Healthcare, Siemens, Aloka). Two in-vitro test objects were developed at the Center for Medical Physics and Biomedical Engineering, Medical University Vienna (water bath and hydrogel bath). Temperature increase during Doppler ultrasound emission was measured via thermal sensors, which were placed inside the test objects or on the probes’ surface. Each probe was emitting for 5 minutes into the absorbing test object with 3 different TI/MI settings in Spectral Doppler mode. Results During water bath test, temperature increase varied between 0.1 and 1.0°C, depending on probe, setting and focus, and was found highest for spectral Doppler mode alone. Maximum temperature increase was found during the surface heating test, where values up to 2.4°C could be measured within 5 minutes of emission. Conclusions Activation of Doppler ultrasound in the waterbath model causes a significant increase of temperature within one minute. Thermally induced effects on the embryo cannot be excluded when using Doppler ultrasound in early pregnancy.