"Die Regelmäßigkeit
der Regelblutung - individuell unterschiedlich aber durchschnittlich alle
28 Tage - signalisiert Frauen, dass sie sich nicht sorgen müssen,
dass also ‚alles in Ordnung' ist", sagen Prof. Paul Speiser
und Prof. Fritz Nagele, Gynäkologen am AKH. "Aber für einige
ist die Monatsblutung eine Tortur: mit Schmerzen einhergehend, unregelmäßig,
stark verlängert. Blutungsstörungen sind der häufigste
Grund für den Gang zum Frauenarzt: Jede dritte Frau geht deswegen
zum Gynäkologen - nach dem Klimakterium sind Blutungsstörungen
sogar der Grund für 70 % aller Besuche beim Gynäkologen."
"Viel
zu oft wird gleich das ganze Organ herausgeschnitten, obwohl nur ein Teil
davon krankhaft verändert ist", kritisieren die beiden Frauenärzte
am Wiener AKH Prof. Fritz Nagele und Prof. Paul Speiser den allgemeinen
Gynäkologie-Betrieb. Und weiter: "Den Schaden haben die Patientinnen:
von Beeinträchtigungen ihres Wohlbefinden bis hin zu Orgasmusproblemen
und Identitätskrisen. Denn Gebärmutter und Eierstöcke sind
frauenspezifische und daher identitätstragende Organe, zu denen Frauen
eine sehr sensible Beziehung entwickeln.
"In den letzten Monaten wurde vor allem in den Medien eine neuartige Behandlungsform von Myomen unkritisch propagiert. Die Technik der selektiven Myomembolisation stellt eine neue Methode dar, die noch nicht durch ausreichende Langzeitergebnisse untermauert ist. Die Komplikationsraten, das Follow-up, die richtige Patientenselektion sowie die notwendige (bis zu 48 Stunden) intensive Schmerztherapie postoperativ wurden von den Protagonisten dieser Therapie nicht ausreichend erwähnt. Ebenso die Tatsache, dass Erfahrungen bei Patientinnen mit noch vorhandenem Kinderwunsch fehlen, wurde nicht genügend Beachtung geschenkt. Wir sehen uns daher als Arbeitsgemeinschaft verpflichtet, darauf zu reagieren. Auf Grund der wissenschaftlichen Datenlage soll eine Myomembolisation derzeit nur unter kontrollierten Studienbedingungen durchgeführt werden. Die Patientinnen müssen über die zu erwartenden Nebenwirkungen und Komplikationsraten dieser Behandlung ausführlich aufgeklärt werden. Als Alternativen sind unbedingt die bewährten Alternativen wie operative konservative Myomenukleation, die Hysterektomie oder Zuwarten anzubieten. Dies ist auch in der Aufklärung zu erwähnen. Der Einsatz der Myomembolisation außerhalb von klinischen Studien kann erst nach Vorliegen von Langzeitergebnissen dieser Methode und Definition des geeigneten Patientenkollektivs erfolgen."
WESTPORT, CT (Reuters Health) Jan 05 - The large number of diverse treatments for interstitial cystitis (IC) reflect a lack of understanding about the management of this disease, as well as the absence of effective treatments, according to a report in the December issue of Urology. Dr. Kathleen Joy
Propert, of the University of Pennsylvania School of Medicine, Philadelphia,
and "The number
and types of treatments were evaluated with respect to baseline factors
such as prior At baseline, 105
(18%) women were not receiving therapy, according to the investigators.
One hundred The five most commonly
used therapies for IC symptoms included cystoscopy and hydrodistention
(32.9%), The researchers observed
significant associations between the number and types of therapies and
the Dr. Propert's team
concludes that "evidence-based outcomes research and randomized clinical
trials are Urology 2000;56:940-945.
WESTPORT, CT (Reuters
Health) Jan 05 - Three recent studies have documented that hormone-related What little information
exists about risk factors for fibroids is limited by numerous methodologic
deficiencies, In the first of two
studies, Dr. Eduardo Faerstein, of Universidade do Estado do Rio de Janeiro,
in Brazil, and The results confirmed
prior reports of associations between uterine fibroids and hormonal risk
factors. For The investigators
also found that African-American women were more than nine times as likely
as white In their second study,
Dr. Faerstein's group "push the field even further...with the first
systematic investigation For instance, the
researchers demonstrated significant increases in the risk of fibroids
in women with Dr. Schwartz told
Reuters Health that a particularly important result of the two studies
is the suggestion that "I think this
has been suspected for some time but not previously demonstrated in a
research study," he In the third report,
Dr. Jean Wactawski-Wende, from the University of Buffalo in New York,
and associates Of 3,171 subjects,
a total of 317 had uterine fibroids, including 196 whose fibroids were
asymptomatic and "With the exception
of advancing age, our data suggest that risk factors may not be consistent
for all racial In contrast, several
significant risk factors emerged in white women, including advancing age,
an interval of "A key question
that still needs to be answered," Dr. Schwartz said in the interview
with Reuters Health, "is Am J Epidemiol 2001;153:1-30.
Prof. Speiser hielt auf Einladung der "University NSW" am 29. Dezember einen Vortag zum Thema "Expression of CD44 Variant Proteins in Vulvar Carcinoma of Patients in Western Australia".
Prof. Speiser war vom 4. bis 10. Jänner am "Centre for Gynaecological Cancer" des "Royal Women's Hospital" in Brisbane zum gemeinsamen Operieren eingeladen. Sinn der Einladung war der Austausch von chirurgischen Techniken.
According to a recent survey by the Society for Women's Health Research (SWHR), two thirds of American women are unaware of alternatives to hysterectomy for treating excessive menstrual bleeding. Presently 1 in 5 women is affected by excessive menstrual bleeding, or menorrhagia, and experience unmanageable bleeding resulting in a constant need to change sanitary products. Due to the frequency with which hysterectomy is performed for excessive menstrual bleeding, SWHR examined physicians' and patients' awareness of hysterectomy as well as alternative options. Survey results show that doctors recommend hysterectomies to about 1 in 4 women. Of those, 82% accept their doctor's recommendation. The survey also revealed that more than one third of women who had a hysterectomy did not discuss potential alternatives with their doctor. However, the majority of physicians (75%) supported their patient's efforts to research alternatives. "Women need to know that it is appropriate to question procedures and feel comfortable discussing options with their physicians," said Phyllis Greenberger, PhD, executive director of SWHR. "Open dialogue can help women make informed choices when it comes to excessive menstrual bleeding or any condition." Hysterectomy is the second most common surgery performed on women, and may be recommended for benign uterine conditions, such as excessive menstrual bleeding or fibroids. Twenty percent of the 600,000 hysterectomies performed annually in the United States are for excessive menstrual bleeding. The procedure is also used to treat cancer and pelvic support problems. "Women with excessive menstrual bleeding may frequently find that they have to go to great lengths to prevent potential embarrassments," said Gerson Weiss, MD, professor and chairman of the Department of Obstetrics and Gynecology at New Jersey Medical School. "It's important that a woman talk with her physician about her diagnosis, as well as alternative, and perhaps less invasive options for dealing with excessive menstrual bleeding."
WESTPORT, CT (Reuters Health) Dec 06 - Tubal sterilization does not increase the risk of menstrual abnormalities, report investigators with the US Collaborative Review of Sterilization Working Group. This finding refutes accounts of the existence of a post-tubal-ligation syndrome that includes heavy bleeding and intermenstrual bleeding. Dr. Herbert B. Peterson, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues compared outcomes over 5 years of 9514 women who underwent tubal sterilization and 573 women whose partners underwent vasectomy. They report their findings in the New England Journal of Medicine for December 7. "We've had a half century of debate about whether or not the so-called post-tubal-ligation syndrome exists," Dr. Peterson told Reuters Health. "The belief that menstrual problems do occur is so widespread it's been given a name." "The proportion of women with persistent menstrual changes varied according to baseline menstrual status in both study groups," he and his associates write in the journal. "We can take a biologic explanation out of the equation," Dr. Peterson said. "That's very reassuring, that the major safety question that has been raised has been resolved. This really closes the door on that question." Dr. Peterson and his colleagues attribute reports of a post-tubal ligation syndrome to the fact that "tubal sterilization and menstrual abnormalities are common and are therefore likely to occur coincidentally." Also at issue are menstrual abnormalities that accompany the cessation of oral contraceptives upon sterilization. "It's important that women who are contemplating sterilization, if they are worried about it, can be reassured," Dr. Peterson said. "Also, women that have been sterilized and have menstrual abnormalities, and their clinicians, can look at this issue without the sterilization procedure per se being part of the equation." In an accompanying editorial, Dr. Carolyn Westhoff, of Columbia University in New York, notes that "no other study of these issues offers prospective data acquired in repeated interviews from such a large cohort over such a long period." Dr. Westhoff points out that women with less troublesome periods at baseline tended to have worsening periods over time, while those with more problematic periods tended to improve, regardless of which group they were in. She also notes that women who had average menstrual flow at baseline were much more likely to experience heavier flow in the next 5 years. "This increase in flow...not attributable to any intervention," Dr. Westhoff writes, "is a predictable change that women may appreciate being forewarned about."
Auf persönliche
Einladung des Leiters der Abteilung für Gynäkologie und
Geburtshilfe der Karl Universität in Pilsen, Dozent Rokita, hat Prof.
Speiser am 22. und 23. November 2000 folgende Operationen im Rahmen von
Lehroperationen durchgeführt: Debulkingoperation bei einer
Patientin mit Ovarialkarzinom, radikale Hysterektomie mit pelviner und
para-aortaler Lymphknotendissektion bei einer Patientin mit Zervixkarzinom,
laparoskopisch assistierte vaginale Hysterektomie bei einer Patientin
mit therapieresistenten Blutungsstörungen und eine totale laparoskopische
Hysterektomie bei einer Patientin mit Myomen. Der Aufenthalt war ein großer
Erfolg und der Beginn einer intensiven Zusammenarbeit.
Am 28. November hat Prof. Speiser, vermutlich zum ersten Mal in Österreich, eine Untersuchung bei einer Patientin mit chronischen Unterbauchschmerzen und Verdacht auf Beckenvenenstau durchgeführt. Zur Anwendung kam ein Instrument der Firma "Rocket Medicals" mit dessen Hilfe eine Kontrastmitteldarstellung der Beckenvenen durchgeführt werden kann. Die gewonnen Röntgenbilder waren von hervorragender Qualität und lieferten die gewünschte Information.
Zum Thema "IVM
bei Patientinnen mit PCO-Syndrom", "Chronic Pelvic Pain"
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