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Biomedical subjects

R Gaetje

Publications and source records attributed to R Gaetje.

At least 19 recordsLinked to original sources
PubMed2006

Uterotubal transport disorder in adenomyosis and endometriosis--a cause for infertility.

OBJECTIVE: Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease. DESIGN: A prospective observational study. SETTING: University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year. POPULATION: Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis. METHODS: All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG. MAIN OUTCOME MEASURES: Influence of adenomyosis on uterotubal transport capacity in endometriosis. RESULTS: In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport). CONCLUSIONS: Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.

Adenomyoma↗
PubMed2006

[Clinical management of an androgen insensitivity syndrome].

The seldom occurring androgen insensitivity syndrome is characterised by male karyotype in a phenotypical women. We report on a complete androgen insensitivity syndrome with the rare coincidence of bilateral Fallopian tubes and a testicular intraepithelial neoplasia. Additionally we discuss aspects of incidence, molecular background, characteristics, diagnostic pitfalls and therapy against the background of the current literature.

Adolescent↗
PubMed2006

[Integrin expression in eutopic and ectopic endometrium].

The significance of retrograde menstruation as a risk factor for endometriosis has been confirmed by numerous clinical observations. Integrins mediate both cell-cell and cell-matrix adhesion, and it is therefore suspected that integrins are involved in the development of endometriosis. Using immunohistochemistry, integrin expression in eutopic and ectopic endometrium is examined in endometriosis patients and control individuals. In nearly all cases, the glandular epithelial cells in the endometrium showed expression of alpha (2-), alpha (3)-, alpha (6)- and alpha (v)- integrin and a low percentage of expression of alpha (1)-, alpha (4)-, and alpha (5)-integrin. In comparison with eutopic endometrium, ectopic endometrium shows reduced expression of alpha (2)- and alpha (v)-integrin. Since no differences in alpha (2)- and alpha (v)-integrin expression were observed in eutopic endometrium between endometriosis patients and control individuals, it may be suspected that the reduced expression of these in ectopic endometrium is explained by influences in the altered environment -- e. g., in the peritoneal fluid -- on the ectopic endometrium.

Biopsy↗
PubMed2006

[Management of abnormal uterine bleeding].

Bleeding disorders are one of the most frequent gynecological problems. The causes of bleeding disorders, and their frequency in particular, vary depending on the age of the woman affected. In premenopause and perimenopause, the most frequent causes are hormonal, in up to 90 % of cases, as well as organic changes in the uterus such as myomas, adenomyosis uteri, or endometrial polyps, in up to 70 % of cases. Coagulation defects cause increased bleeding, particularly in girls and young women, with no other recognizable cause. The treatment of bleeding disorders is causally based, although if the woman does not wish to have children, the therapeutic algorithm in many cases leads to similar symptomatic measures. The following therapeutic approaches, listed in order of increasing efficacy, are mainly used in the treatment of increased bleeding: gestagen, estrogen-gestagen combination, levonorgestrel (Mirena) and endometrial ablation or myoma enucleation, with comparable success rates, and finally hysterectomy. Embolization of the uterine artery in myomas or adenomyosis uteri, nonsteroidal anti-inflammatory drugs, and antifibrinolytic agents represent alternatives that may be useful in individual cases. The paper provides an overview of the various causes, useful diagnostic measures, and treatment options in uterine bleeding disorders.

Algorithms↗
PubMed2005

[Suspicion for intraabdominal adhesions -- is open laparoscopy the gold standard?].

Laparoscopy is used for most surgical procedures in gynaecology. In general complications are rare. However, one of the most critical steps is the initial laparoscopic entry into the peritoneal cavity. According to the literature serious complications occur in approximately 1-2/1 000 cases. Whereas major vascular injuries are mainly recognised immediately, delayed recognition of bowel injuries is frequent. Complication rates of different entry procedures used in gynaecological laparoscopy are similar even in high risk patients (intraperitoneal adhesions, obesity). Utilising an open - instead a closed - entry (either by Veress needle or first trocar) technique or alternativ entry positions are suggested by some authors. This review presents data available in the literature and highlights that open laparoscopy is no gold standard.

Abdomen↗
PubMed2005

The congruity between urine and cervical swab cultures in pregnant women with versus without amniotic fluid infection.

INTRODUCTION: We observed the congruity of bacteria found in urine and cervix of pregnant women with amniotic fluid infection (AFI) compared to healthy controls. PATIENTS AND METHODS: Over three years, we prospectively analysed urine and cervical swabs cultures in 120 pregnant women in gestational week 16-20. The patient population was divided in two groups: group I patients had clinical symptoms of AFI. The rest of the patients were designated as healthy controls (group II). Congruity between findings in both groups was observed. In patients with bacterial growth, antibiotic treatment was initiated as recommended and once ended - culture probes were repeated. RESULTS: The rates of nonsignificant and significant bacteriuria were doubled in group I. Fifty-five percent (n = 33) of patients in group I had identical bacteria cultured both from the urine sample and cervical swab, in contrast to only 13.3 % in group II. Congruity was most pronounced for Klebsiella species and E. coli, the later being single most dominant isolate in regards to both cultures. After antimicrobial treatment, microbial eradication occurred in 15 patients (45.5 %). The observed incidences of abortions and preterm deliveries were significantly lower in patients with microbial eradication versus patients with microbial persistence. CONCLUSION: Patients with clinical symptoms of AFI have high risk for bacteriuria identical to bacterial culture from cervical swab. Antimicrobial treatment was effective only partially where indicated. Screening for eradication is recommended and consensus on the most appropriate therapy is needed.

Amniotic Fluid↗
PubMed2004

[New aspects in diagnosis and therapy of endometriosis].

Endometriosis and adenomyosis show a high prevalence and can be regarded as different symptoms of a unique disease - the dislocation of basal endometrium. Diagnostic methods for detecting adenomyosis are transvaginal sonography (TVS) or T-2-weighed magnetic resonance imaging (MRI). Patients with endometriosis show a significant impairment of utero-tubal sperm transport capacity, which is even increased the stronger the adenomyotic component of the disease is. Adenomyosis can be regarded as a cause for infertility especially in minor and mild forms of endometriosis and is therefore often followed by IVF/ICSI-treatment. Infertility patients with endometriosis should be counselled for intensive infertility treatment. Without a current wish for conception, fertility potential should be preserved by hormonal suppression of uterine peristalsis in order to avoid progression of the disease.

Endometriosis↗
PubMed2004

[Alternatives to hysterectomy: a review].

Total hysterectomy is considered as gold standard in the treatment of symptomatic uterine fibroids in women without reproductive wishes. However an increasing number of patients asked for alternatives to hysterectomy. Myomectomy, endometrial ablation, hormonal treatment, uterine artery embolization, and supracervical hysterectomy may be useful in the treatment uterine fibroids in an individual patient.

Embolization, Therapeutic↗
PubMed2002

Ovarian cancer antigen CA 125 influences adhesion of human and mammalian cell lines in vitro.

Despite the widespread use of CA 125 for diagnostic and therapeutic evaluation of ovarian cancer function, the molecular nature of CA 125 is only poorly understood. It has been shown that CA 125 enhances the invasiveness of a benign endometriotic cell line in vitro. The invasiveness of cells is controlled by proteolytic activity, cell motility and cell adhesion. Therefore, we determined the influence of CA 125 on the cell adhesion of human carcinoma cell lines in vitro. In all tested human and mammalian cell lines (HECIA, AN3-CA, RL95-2, SK-OV-3, OAW-42, PA-1, HeLa, MCF7, T-47D, A-673, RT112, EJ28, EEC 145, CHO, MDBK, MDCK. LLC-PK1) the cell adhesion in vitro was significantly impaired by CA 125 in a time-dependent manner. Treatment of cells with trypsin diminished the effect of CA 125 on cell adhesion for two hours. By inhibition of protein synthesis with cycloheximide (2 microg/ml) the influence of trypsin on the anti-adhesive effect of CA 125 was significantly prolonged. The results suggest that the ovarian cancer antigen CA 125 influences cell adhesion in vitro.

Animals↗
PubMed1997

Nonmalignant epithelial cells, potentially invasive in human endometriosis, lack the tumor suppressor molecule E-cadherin.

Endometriosis is one of the most frequent diseases in gynecology. It is a histologically defined nonmalignant disease in which endometrium-like tissue is found outside the uterus (for example, peritoneum, gut, or lung). The pathogenesis of endometriosis is unknown, but invasive mechanisms have been implicated in the development of the disease. Indeed, primary cells from human endometriotic biopsies but not from human endometrial biopsies are invasive in an in vitro collagen invasion assay. In this study, these in vitro invasive endometriotic cells were found to be nonmalignant epithelial cells lacking E-cadherin, which acts as an invasion suppressor molecule in carcinomas. Immunocytochemistry showed that the E-cadherin-negative epithelial cell type was increased in sections of endometriosis tissue as compared with sections of eutopic endometrium. On the basis of these data we propose that the E-cadherin-negative invasive endometriotic cells seen in vitro represent the cell population that migrates to ectopic (extrauterine) locations and thus causes endometriosis in vivo. Accordingly, the loss of E-cadherin expression is postulated to constitute a crucial mechanism in the pathogenesis of endometriosis.

Cadherins↗
PubMed1996

Interleukin-6 and soluble interleukin-6 receptor in peritoneal fluid and serum of patients with endometriosis.

OBJECTIVE: Interleukin-6 (IL-6) and soluble Interleukin-6-receptor (sIL-6R) concentrations were investigated in patients with endometriosis and other benign gynecologic diseases. METHODS: During laparoscopy or laparotomy peritoneal fluid and serum were collected from 29 patients with endometriosis, 31 patients with benign ovarian masses and 4 patients with chronic inflammation or adhesions. Interleukin-6 (IL-6) concentrations were determined by Elisa-technique. RESULTS: Patients with endometriosis stage IV revealed slightly higher IL-6 concentrations in peritoneal fluid when compared to patients with stage I to II disease and ovarian masses/ chronic inflammation. IL-6 serum concentrations were higher in case of stage I and II when compared to stage III and IV and ovarian masses/chronic inflammation. Patients with endometriosis revealed significantly higher sIL-6 receptor concentrations in peritoneal fluid and serum as compared to patients with ovarian cysts and chronic inflammation. CONCLUSION: IL-6 and soluble IL-6 receptor may be considered to be involved in endometriosis. However, the patho-physiologic mechanism must be the subject of further investigation.

Adolescent↗
PubMed1995

Invasiveness of endometriotic cells in vitro.

The pathogenesis of endometriosis is not known. The currently favoured theory is that viable endometrial cells, shed from the endometrium into the pelvic cavity by retrograde menstruation, reattach and invade other tissues. We used a collagen gel invasion assay to assess invasive potential of endometriotic cells. The invasion indices of cells from peritoneal endometriotic lesions and a metastatic bladder carcinoma cell line (EJ28) were similar (2.2-15.6 vs 8.4-11.6) whereas cells from normal endometrium and non-metastatic carcinoma cells (RT112) were non-invasive (indices < 1). Invasiveness of endometriotic cells might contribute to the pathogenesis of endometriosis.

Endometriosis↗
PubMed1994

Diagnosis of intrauterine and ectopic pregnancy at 5-7 postmenstrual weeks.

OBJECTIVES: The potential of the combined use of vaginosonography and serum beta-hCG levels for early diagnosis of intrauterine and ectopic pregnancies (5-7 weeks postmenstrual) was investigated in a multicentric study. METHODS: Three hundred and forty-nine patients underwent vaginosonographic examination and determination of serum beta-hCG. When the first examination failed in establishing a precise diagnosis, repeat examinations were performed on alternate days. RESULTS: During the first 3 weeks after the missed menses, vaginosonography can detect practically all viable intrauterine pregnancies, half of the nonviable intrauterine and viable ectopic pregnancies, and one quarter of nonviable ectopic pregnancies, respectively. It was not possible to differentiate intrauterine and ectopic pregnancies by serum beta-hCG levels. CONCLUSIONS: Vaginosonographic screening, ideally at 2 weeks after the missed menses, permits detection, localization, and dating in 80%-90% of suspected pregnancies.

Chorionic Gonadotropin↗
PubMed1994

Management of early ectopic pregnancy.

OBJECTIVE: Management of early ectopic pregnancy was investigated in a multicenter, prospective study. METHODS: Serum beta-hCG levels were monitored after therapy and correlated to the type of management, gestational age, and initial serum beta-hCG levels in 119 patients with ectopic pregnancies detected at 5-7 postmenstrual weeks. RESULTS: Salpingectomy was performed in 16 patients. No post-operative complications were reported. After conservative laparoscopic surgery of 51 ectopic pregnancies, 9 (18%) had delayed decrease or an increase of serum beta-hCG levels. Re-operations were performed in 4 (7%) patients. Similar findings were noted in 2/6 patients after conservative operations performed by laparotomy. Intrachorionic injection treatment was successful in 17/18 ectopic pregnancies, and expectant management in 7/8 patients with initial serum beta-hCG levels below 250 mIU/ml. CONCLUSIONS: Persistence of trophoblastic activity is a potential complication of conservative surgical treatment of ectopic pregnancy. A detailed diagnosis as early as 6-7 post-menstrual weeks may be the key for future non-surgical management of ectopic pregnancy.

Abortifacient Agents↗
PubMed1994

Is differentiation of benign and malignant cystic adnexal masses possible by evaluation of cysts fluids with respect to color, cytology, steroid hormones, and tumor markers?

OBJECTIVE: Differentiation of benign and malignant cystic adnexal masses by analysis of cyst fluid was investigated. STUDY DESIGN: Eighty-one cystic adnexal lesions of 80 patients were punctured intraoperatively or after surgical removal. Color of the cyst fluid, cytology, concentrations of steroid hormones (estradiol, progesterone, testosterone), and tumor markers (CEA, CA 125, CA 15-3) were correlated to histology. RESULTS: Color of cyst fluid was not reliable in the differential diagnosis of cystic adnexal masses. Cytology missed four out of seven malignant tumors. One mucinous cystadenoma was cytologically suspicious for malignancy. The combination of negative cytology, low tumor marker levels, and estradiol levels higher than 1000 pg/ml may support the diagnosis of a 'functional' cyst. Elevated CEA levels may be suspicious for all mucinous and malignant lesions. CONCLUSION: Analysis of cyst fluid could not accurately discriminate between benign or malignant tumors.

Adnexal Diseases↗
PubMed1994

Influence of gonadotrophin releasing hormone (GnRH) and a GnRH-agonist on granulosa cell steroidogenesis.

The influence of gonadotropin releasing hormone and Decapeptyl on steroidogenic activity was evaluated at concentrations of 0.1 ng/ml, 1 ng/ml and 10 ng/ml culture medium. In the granulosa cell cultures of 9 out of 18 patients addition of Decapeptyl or gonadotrophin releasing hormone to the culture media caused dose-dependent inhibition of progesterone and oestradiol secretion in vitro. The steroidogenic activity in vitro of the granulosa cells of 84 IVF cycles was correlated to the maximal serum E2 levels of the patients at induction of ovulation. The granulosa cells of patients who were stimulated including Decapeptyl produced on average higher E2 levels in vitro as compared to granulosa cells from hMG stimulation cycles. This may be regarded as an indirect clue to an inhibitory effect of Decapeptyl on oestradiol synthesis in vivo.

Cells, Cultured↗