scholarly journals Diagnosis and Treatment Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015-085, February 2019) – Part 2, Hemostaseology, Andrology, Genetics and History of Malignant Disease

2019 ◽  
Vol 79 (12) ◽  
pp. 1293-1308 ◽  
Author(s):  
Bettina Toth ◽  
Dunja Maria Baston-Büst ◽  
Hermann M. Behre ◽  
Alexandra Bielfeld ◽  
Michael Bohlmann ◽  
...  

Abstract Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German-language interdisciplinary S2k guideline on “Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)” was published in February 2019. The guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aim In one third of cases, the cause of involuntary childlessness remains unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. There is no standard treatment concept for these patients at present, as there are currently no standard multidisciplinary procedures for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnosis and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations This second part of the guideline describes the hematological workup for women as well as additional diagnostic procedures which can be used to investigate couples and which are carried out in cooperation with physicians working in other medical fields such as andrologists, geneticists and oncologists.

2019 ◽  
Vol 79 (12) ◽  
pp. 1278-1292
Author(s):  
Bettina Toth ◽  
Dunja Maria Baston-Büst ◽  
Hermann M Behre ◽  
Alexandra Bielfeld ◽  
Michael Bohlmann ◽  
...  

Abstract Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German/Austrian/Swiss interdisciplinary S2k guideline on “Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)” was published in February 2019. This guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aims One third of the causes of involuntary childlessness are still unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. At present, there is no standard treatment concept, as currently no standard multidisciplinary procedures exist for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnostic workup and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations The first part of this guideline focuses on the basic assessment of affected women, including standard anatomical and endocrinological diagnostic procedures and examinations into any potential infections. Other areas addressed in this guideline are the immunological workup with an evaluation of the patientʼs vaccination status, an evaluation of psychological factors, and the collection of data relating to other relevant factors affecting infertility. The second part will focus on explanations of diagnostic procedures compiled in collaboration with specialists from other medical specialties such as andrologists, human geneticists and oncologists.


2021 ◽  
Vol 81 (07) ◽  
pp. 749-768
Author(s):  
Tewes Wischmann ◽  
Ada Borkenhagen ◽  
Matthias David ◽  
Almut Dorn ◽  
Christoph Dorn ◽  
...  

Abstract Aim The purpose of this official guideline published and coordinated by the German Society for Psychosomatic Gynecology and Obstetrics [Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe (DGPFG)] is to provide a consensus-based overview of psychosomatically oriented diagnostic procedures and treatments for fertility disorders by evaluating the relevant literature. Method This S2k guideline was developed using a structured consensus process which included representative members of various professions; the guideline was commissioned by the DGPFG and is based on the 2014 version of the guideline. Recommendations The guideline provides recommendations on psychosomatically oriented diagnostic procedures and treatments for fertility disorders.


2021 ◽  
Vol 81 (03) ◽  
pp. 279-303
Author(s):  
Ute Schaefer-Graf ◽  
Regina Ensenauer ◽  
Ulrich Gembruch ◽  
Tanja Groten ◽  
Maria Flothkötter ◽  
...  

Abstract Aims Obesity is an increasing problem, even in young women of reproductive age. Obesity has a negative impact on conception, the course of pregnancy, and neonatal outcomes. Caring for obese pregnant women is becoming an increasingly important aspect of standard prenatal care. This guideline aims to improve the care offered to obese pregnant women. Methods This S3-guideline was compiled following a systemic search for evidence and a structured process to achieve consensus. Recommendations Evidence-based recommendations for the care of obese pregnant women were developed, which cover such as areas as preconception counselling, identification of risks, special aspects of prenatal care and prenatal diagnostic procedures, intrapartum management, and long-term effects on mother and child.


2019 ◽  
Vol 79 (10) ◽  
pp. 1043-1060 ◽  
Author(s):  
Dominik Denschlag ◽  
Sven Ackermann ◽  
Marco Johannes Battista ◽  
Wolfgang Cremer ◽  
Gerlinde Egerer ◽  
...  

Abstract Aims This is an official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Because of their rarity and heterogeneous histopathology, uterine sarcomas are challenging in terms of how they should be managed clinically, and treatment requires a multidisciplinary approach. To our knowledge, there are currently no binding evidence-based recommendations for the appropriate management of this heterogeneous group of tumors. Methods This S2k guideline was first published in 2015. The update published here is the result of the consensus of a representative interdisciplinary group of experts who carried out a systematic search of the literature on uterine sarcomas in the context of the guidelines program of the DGGG, OEGGG and SGGG. Members of the participating professional societies achieved a formal consensus after a moderated structured consensus process. Recommendations The consensus-based recommendations and statements include the epidemiology, classification, staging, symptoms, general diagnostic work-up and general pathology of uterine sarcomas as well as the genetic predisposition to develop uterine sarcomas. Also included are statements on the management of leiomyosarcomas, (low and high-grade) endometrial stromal sarcomas and undifferentiated uterine sarcomas and adenosarcomas. Finally, the guideline considers the follow-up and morcellation of uterine sarcomas and the information provided to patients.


2018 ◽  
Vol 78 (04) ◽  
pp. 364-381 ◽  
Author(s):  
Bettina Toth ◽  
Wolfgang Würfel ◽  
Michael Bohlmann ◽  
Johannes Zschocke ◽  
Sabine Rudnik-Schöneborn ◽  
...  

Abstract Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration.


2009 ◽  
Vol 150 (46) ◽  
pp. 2101-2109 ◽  
Author(s):  
Péter Csécsei ◽  
Anita Trauninger ◽  
Sámuel Komoly ◽  
Zsolt Illés

The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.


Author(s):  
Mirazkar D. Pandareesh ◽  
Vivek Hamse Kameshwar ◽  
Kullaiah K. Byrappa

: Prostate cancer is a multifactorial disease that mainly occurs due to the accumulation of somatic, genetic and epigenetic changes, resulting in the inactivation of tumor-suppressor genes and activation of oncogenes. Mutations in genes, specifically those that control cell growth and division or the repair of damaged DNA, make the cells grow and divide uncontrollably to form a tumor. The risk of developing prostate cancer depends upon the gene that has undergone the mutation. Identifying such genetic risk factors for prostate cancer pose a challenge for the researchers. Besides genetic mutations, many epigenetic alterations including DNA methylation, histone modifications (methylation, acetylation, ubiquitylation, sumoylation, and phosphorylation) nucleosomal remodelling, and chromosomal looping, have been significantly contributed to the onset of prostate cancer as well as the prognosis, diagnosis, and treatment of prostate cancer. Chronic inflammation also plays a major role in the onset and progression of human cancer, via. modifications in the tumor microenvironment by initiating epithelial-mesenchymal transition and remodelling the extracellular matrix. In this article, the authors present a brief history of the mechanisms and potential links between the genetic aberrations, epigenetic changes, inflammation and inflammasomes that are known to contribute to the prognosis of prostate cancer. Furthermore, the authors examine and discuss clinical potential of prostate carcinogenesis in relation to epigenetics and inflammation for its diagnosis and treatment.


2006 ◽  
Vol 53 (1) ◽  
pp. 73-75
Author(s):  
N. Miletic ◽  
D. Stojiljkovic ◽  
M. Inic ◽  
M. Prekajski ◽  
A. Celebic ◽  
...  

Great importance in detecting cancer in the phase of in situ lays in the fact that the epithelial layer is deprived of blood and lymph vessels, so metastases may develop only when basal membrane has been broken. This paper includes 46 operated women in whom it preoperatively had been verified suspect non-palpable lesion. The preoperative diagnostics included use of high- resolution mammography, aimed mammography, palpatory examination, as well as fine-needle aspiration (FNA), biopsy and cytologic analysis of the sample. The methodology of this work implies the use of stereotaxic marking, specimen mammography and ex-tempore pathohistology analysis. Out of 46 investigated patients in clinical stage T0N0M0, in whom there were no signs of malignant disease, and according to suspect lesion of initial screening mammography, malignant lesions of breast tissue were diagnosed in 19 patients (41%) intraoperatively. Three of these lesions (15,8%) were histopathologically verified as in situ. Comparing our results with data of the Institute of oncology and radiology of Serbia hospital registry (IORS) for the year 2001, from 1173 patients registered with malignant lesions, only 16 ones (1,4%) had in situ cancer, operated on the basis of the suspect mammography of clinical stage T0N0M0. Statistically significant difference was found related to the number of detected cancers in this early phase of the breast malignant disease. This limits surgical intervention to tumorectomy, with preservation of the remaining breast tissue, what brings to healing, justifying in that way, screening examinations and routine application of the most contemporary diagnostic procedures.


2020 ◽  
Vol 14 (2) ◽  
pp. 241-259
Author(s):  
Dirk Werle ◽  
Uwe Maximilian Korn

AbstractResearch on the history of fiction of the early modern period has up to now taken primarily the novel into consideration and paralleled the rise of the novel as the leading genre of narrative literature with the development of the modern consciousness of fictionality. In the present essay, we argue that contemporary reflections on fictionality in epic poetry, specifically, the carmen heroicum, must be taken into account to better understand the history of fiction from the seventeenth century onwards. The carmen heroicum, in the seventeenth century, is the leading narrative genre of contemporary poetics and as such often commented on in contexts involving questions of fictionality and the relationship between literature and truth, both in poetic treatises and in the poems themselves. To reconstruct a historical understanding of fictionality, the genre of the epic poem must therefore be taken into account.The carmen heroicum was the central narrative genre in antiquity, in the sixteenth century in Italy and France, and still in the seventeenth century in Germany and England. Martin Opitz, in his ground-breaking poetic treatise, the Buch von der Deutschen Poeterey (1624), counts the carmen heroicum among the most important poetic genres; but for poetry written in German, he cites just one example of the genre, a text he wrote himself. The genre of the novel is not mentioned at all among the poetic genres in Opitz’ treatise. Many other German poetic treatises of the seventeenth century mention the importance of the carmen heroicum, but they, too, provide only few examples of the genre, even though there were many Latin and German-language epic poems in the long seventeenth century. For Opitz, a carmen heroicum has to be distinguished from a work of history insofar as its author is allowed to add fictional embellishments to the ›true core‹ of the poem. Nevertheless, the epic poet is, according to Opitz, still bound to the truthfulness of his narrative.Shortly before the publication of Opitz’ book, Diederich von dem Werder translated Torquato Tasso’s epic poem Gerusalemme liberata (1580); his translation uses alexandrine verse, which had recently become widely successful in Germany, especially for epic poems. Von dem Werder exactly reproduces Tasso’s rhyming scheme and stanza form. He also supplies the text with several peritexts. In a preface, he assures the reader that, despite the description of unusual martial events and supernatural beings, his text can be considered poetry. In a historiographical introduction, he then describes the course of the First Crusade; however, he does not elaborate about the plot of the verse epic. In a preceding epyllion – also written in alexandrine verse – von dem Werder then poetically demonstrates how the poetry of a Christian poet differs from ancient models. All these efforts can be seen as parts of the attempt to legitimate the translation of fictional narrative in German poetry and poetics. Opitz and von dem Werder independently describe problems of contemporary literature in the 1620s using the example of the carmen heroicum. Both authors translate novels into German, too; but there are no poetological considerations in the prefaces of the novels that can be compared to those in the carmina heroica.Poetics following the model established by Opitz develop genre systems in which the carmen heroicum is given an important place, too; for example, in Balthasar Kindermann’s Der Deutsche Poet (1664), Sigmund von Birken’s Teutsche Rede- bind- und Dicht-Kunst (1679), and Daniel Georg Morhof’s Unterricht von der Teutschen Sprache und Poesie (1682). Of particular interest for the history of fictionality is Albrecht Christian Rotth’s Vollständige Deutsche Poesie (1688). When elaborating on the carmen heroicum, Rotth gives the word ›fiction‹ a positive terminological value and he treats questions of fictionality extensively. Rotth combines two contradictory statements, namely that a carmen heroicum is a poem and therefore invented and that a carmen heroicum contains important truths and is therefore true. He further develops the idea of the ›truthful core‹ around which poetic inventions are laid. With an extended exegesis of Homer’s Odyssey, he then illustrates what it means precisely to separate the ›core‹ and the poetic embellishments in a poem. All these efforts can be seen as parts of the attempt to legitimize a poem that tells the truth in a fictional mode.The paper argues that a history of fictionality must be a history that carefully reconstructs the various and specifically changing constellations of problems concerning how the phenomenon of fictionality may be interpreted in certain historical contexts. Relevant problems to which reflections on fictionality in seventeenth-century poetics of the epic poem and in paratexts to epic poems react are, on the one hand, the question of how the genre traditionally occupying the highest rank in genre taxonomy, the epic, can be adequately transformed in the German language, and, on the other hand, the question of how a poetic text can contain truths even if it is invented.


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