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AIM: To evaluate the feasibility and safety of vaginal surgery for treatment of genital prolapse in overweight compared to normal weight patients aged 50 years or older. PATIENTS AND METHODS: We retrospectively reviewed the perioperative data of 93 patients aged between 50 and 87 years undergoing surgery due to pelvic floor disorders. A total of 54 women had a body mass index (BMI) of 25 kg/m(2) or higher and were defined as the study collective. Thirty-nine patients undergoing similar surgical procedures during the same period of time had a BMI less than 25 kg/m(2) and served as the control group. Operating time, duration of hospital stay, intra- and postoperative complications were evaluated as comorbidities. χ(2)-test, Fisher's exact test, Student's t-test and non-parametric Mann-Whitney U-test were applied to compare the results of both collectives. RESULTS: There were no significant differences between study and control collectives regarding time of surgery, duration of hospital stay or intra- and postoperative complications, although a significant difference was found with regard to the prevalence of pre-existing diabetes mellitus (17% in the study group, versus 5% in the control group, respectively, Fisher's exact test: p=0.04). CONCLUSION: Overweight in elderly patients undergoing vaginal surgery due to pelvic floor disorders does not affect the perioperative outcome and is not a risk factor for perioperative complications.

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PURPOSE: We investigated the morbidity in elderly patients undergoing surgery due to pelvic organ prolapse. METHODS: Perioperative data of 113 patients aged at least 50 years who underwent gynaecological prolapse surgery between 2005 and 2011 were analyzed retrospectively. Forty-eight women were older than 70 years and matched our inclusion criteria. Sixty-five patients aged 50-69 years undergoing similar surgical procedures during the same period of time formed the control group. Operating time, duration of hospital stay, intra- and postoperative complications, comorbidity, and body mass index were evaluated. RESULTS: There were no significant differences between study and control collective regarding operating time, duration of hospital stay, intra- and postoperative complications, and body mass index although a significant difference could be notified between the pre-existing comorbidity. CONCLUSION: Surgery due to a pelvic organ prolapse in patients aged more than 70 years is a feasible and save treatment to improve quality of life in elderly patients.

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PURPOSE: The aim of this study was to compare the maternal serum concentrations of the vascular endothelial growth factor (VEGF) in patients whose pregnancies were complicated by pre-eclampsia or HELLP syndrome with those of healthy pregnant controls and to study its relationship with the hormonal and nutritive function of the placenta. METHODS: The study group consisted of 30 primaparae who suffered from either severe pre-eclampsia (n = 16) or from HELLP syndrome (n = 14). 30 healthy pregnant woman of the same gestational age served as control group. Maternal serum VEGF concentrations were determined by using a commercially available Sandwich immunoassay (Quantikine(®), R&D Systeme, Wiesbaden, Germany). Estradiol, estriol and progesterone serum levels were measured by performing a radioimmunoassay (Biermann, Bad Nauheim, Germany). RESULTS: The mean serum VEGF concentration of the study group (172.0 ± 98.9 pg/ml) was significantly increased, compared with the mean serum VEGF concentration of the control group (41.4 ± 30.5 pg/ml) (U test: P < 0.001). In the subgroup of the study patients with HELLP syndrome, significantly lower VEGF levels were measured than in patients suffering from severe pre-eclampsia (109.2 ± 68.5 pg/ml vs. 219.0 ± 72.9. U test: P < 0.05). In all study and control patients, a significantly positive correlation between serum estradiol and VEGF concentration could be found (Spearman's rank correlation: P < 0.05). CONCLUSIONS: An increased placental expression due to local hypoxia and an increased extraplacental production, e.g., in endothelial cells of the fetal or maternal vascular system, in macrophages or in smooth muscle cells, could be discussed as causes for the raised serum VEGF concentration in patients suffering from severe pre-eclampsia or HELLP syndrome.

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Lichen sclerosus is found in children with an estimated prevalence of at least 1 in 900. Pigmentation in lichen sclerosus is infrequent and melanocytic proliferations in lichen sclerosis are rare and difficult to interpret. In this report, we describe the case of a prepubertal girl presenting with a junctional melanocytic nevus of the labia minora superimposed by lichen sclerosus. The lesion was completely excised and free margins confirmed by histological examination. After a 3 months course of topical clobetasol treatment the girl remained asymptomatic. No local recurrence was notified with a follow-up time of 12 months.

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AIM: The aim of our study was to evaluate pretreatment semen quality in patients with unilateral testicular cancer in comparison to semen parameters of patients suffering from other malignancies. METHODS: Semen analysis according to WHO recommendations were performed in 16 patients suffering from unilateral testicular cancer (group 1) and in 21 patients who were diagnosed to have other malignant tumors (group 2: non-Hodgkin's lymphoma: n=7, Hodgkin's disease: n=6, leukemia: n=3, osteosarcoma: n=2, rectal cancer: n=2, thyroid carcinoma: n=1) prior to anti-cancer treatment. RESULTS: Normozoospermia was observed in none of the testicular cancer patients but in five of the other patients ( p=0.047). Sperm concentration was significantly decreased in the patients of group 1 compared to those of group 2 (18.7+/-22.3x10(6)/ml versus 35.6+/-31.3x10(6)/ml, p=0.03). The percentage of rapid progressive motile spermatozoa was significantly less in testicular cancer patients than in patients suffering from other malignancies (WHO group a: 1.1+/-2.0% versus 4.7+/-5.6%, p=0.02). Normal morphological findings of spermatozoa were found in a smaller percentage in group 1 (16.2+/-6.0% versus 26.1+/-18.0%, p=0.03). CONCLUSIONS: Our investigations revealed that especially testicular cancer has an adverse influence on sperm quality. Hence, we advise careful and sufficient cryopreservation of semen in those patients taking the negative impact of cytotoxic treatments on semen parameters into account.

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OBJECTIVE: The effects of modern oral contraceptives (OC) on serum concentrations of folate and cobalamin are controversial. STUDY DESIGN: Case-control study on the cobalamin and folate status of 71 healthy female nulligravidae using "low dose" OC for >or=3 months and 170 controls. Factors interfering with vitamin metabolism were thoroughly controlled. Serum concentrations were measured by commercial assays. The results were evaluated using Mann-Whitney's U-test and chi(2) analysis. RESULTS: OC-users showed significantly lower concentrations of cobalamin than controls. The rates of women with reduced, normal, and elevated levels differed significantly. Nine users but no control had frank cobalamin deficiency without clinical symptoms. Folate levels did not differ between the groups. Vegetarian diet, smoking or obesity did not have a significant influence. CONCLUSIONS: Routine measurement of cobalamin or folate in women using "low dose" OC is not warranted. Vitamin supplementation or different contraceptive methods should be considered in women with pre-existing cobalamin deficiency or restrictive dietary habits.

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