Psychometric properties and validation of two global impression questionnaires (PGI-S, PGI-I) for stress incontinence in a German-speaking female population.

AIMS: The Patient Global Index of Severity (PGI-S) and the Patient Global Index of Improvement (PGI-I) are global impression questionnaires developed in English and validated in women with stress urinary incontinence (SUI). This validation study tested the psychometric properties of German-language versions of the two questionnaires in German-speaking women with SUI. METHODS: The German-language PGI-S and PGI-I were psychometrically tested and validated using the SF-12 questionnaire, the Kinǵs Health Questionnaire (KHQ), clinical parameters, incontinence episode frequency and pad use in 311 patients before and 3 months after receiving a TVT-O or TVT tape for SUI. RESULTS: At baseline and 3 months postoperatively there was a positive correlation between PGI-S response categories and clinical parameters, IEF and pad use, and nearly all KHQ subscales. There were no correlations between response categories of PGI-S at baseline and PGI-I at 3 months and the SF-12 scales PCS-12 and MCS-12. CONCLUSION: Our results demonstrated good psychometric properties of the German-language PGI-S and PGI in German-speaking women with SUI.

Reasons for dissatisfaction ten years after TVT procedure.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the reasons for dissatisfaction 10 years after TVT placement. METHODS: Patients who underwent TVT surgery between 1999 and 2001 at two participating units were included. All patients who did not consider themselves to be cured were asked for their reasons. RESULTS: 141 out of 210 patients (81 %) were available for follow-up (median 116 months). In the group of 56 patients who did not consider themselves cured, the reasons were OAB symptoms in 29 patients (52 %), stress urinary incontinence in 13 patients (23 %), and complaints of mixed urinary incontinence in 8 patients (14 %). 85 % of all patients reporting urgency complaints at the time of follow-up and 66 % of patients with SUI at the time of follow-up did not consider themselves cured. CONCLUSIONS: In most cases overactive bladder symptoms were the reason for dissatisfaction. The results of this study support using composite outcomes to assess the results of surgery for urinary incontinence.

Immunoexpression of B7-H3 in endometrial cancer: relation to tumor T-cell infiltration and prognosis.

OBJECTIVE: B7-H3, a member of the B7 family of immune regulatory ligands regulates T cell-mediated peripheral immune response. The purpose of this study was to correlate the expression of B7-H3 and number of lymphocytes in patients with endometrial cancer. MATERIAL AND METHODS: A total of 107 patients with primary endometrial carcinoma (type I/endometrioid, n=81; type II, n=18) and endometrial hyperplasia (n=8) were investigated. Expression of B7-H3 in endometrial hyperplasia, endometrial carcinoma, and the endothelium of tumor-associated vasculature was assessed using immunohistochemistry from paraffin-embedded tissue blocks. Detection of CD8-positive tumor-infiltrating lymphocytes (TIL) and CD8-positive tumor-associated lymphocytes (TAL) was correlated with the expression of B7-H3. RESULTS: Patients with high grade tumors and patients with type II carcinomas expressed significantly more B7-H3 than low grade and endometrioid tumors (p=<0.0001 and p=0.0001, respectively). The expression of B7-H3 in the endothelium of identified vasculature in the tumor specimens showed similar results with strong relation to high grade tumors (p=0.001) and type II carcinomas (p=0.004). We found a significant correlation between B7-H3 expression on cancer cells and tumor T-cell infiltration (TIL) (p=0.017). In a univariate survival analysis, overexpression of B7-H3 in tumor cells was associated with shortened overall survival (p=0.005). CONCLUSIONS: B7-H3 is overexpressed on cancer cells and in the endothelium of tumor-associated vasculature in high grade tumors (G3) and type II carcinomas. B7-H3 expression on cancer cells is correlated with the number of T cells infiltrating the tumor. Endometrium tumor development and progression may be associated with downregulation of T-cell-mediated antitumor immunity through B7-H3.

immunohistochemical expression of survivin and γ-H2AX in vulvar intraepithelial neoplasia and low-stage squamous cell carcinoma.

Survivin inhibits apoptosis and is involved in the regulation of cell cycle progression and in the mitotic spindle formation. It is overexpressed in many cancers. The histone γ-H2AX is a marker of activated DNA damage and is overexpressed in different cancers and their precursor lesions. It also forms early during apoptosis. Eighty-seven formalin-fixed, paraffin-embedded archival vulvar tissues originating from 55 preoperatively untreated patients were immunostained with antibodies to survivin and γ-H2AX to determine their expression in normal squamous vulvar epithelia (NE, n=25), lichen sclerosus (n=10), high-grade classic vulvar intraepithelial neoplasia (n=16), differentiated vulvar intraepithelial neoplasia (n=16), and vulvar invasive keratinizing squamous cell carcinoma (ISCC, n=20; FIGO Ib). Immunostaining for both factors was scored for moderate and strong intensities with regard to quantity. Statistical analysis was performed by the χ test and Fisher exact test. Nuclear surviving expression increased from NE and lichen scleros to high-grade classic vulvar intraepithelial neoplasia, differentiated vulvar intraepithelial neoplasia, and ISCC significantly (P=0.0001) and followed the distribution of immature squamous epithelial cells. Positive scores for γ-H2AX were found in nuclei of cells in all diagnostic cohorts, in any epithelial level with some accentuation in the upper layers, was seen in pycnotic nuclei in horn pearls of ISCC and apoptotic bodies, without relevant statistical distributions. Immunoscores did not differ between grade 1 and grades 2/3. Expression patterns were different for both factors, suggesting their involvement in different biologic mechanisms as an early event leading to resistance to apoptosis in vulvar carcinogenesis.

Expression of γ-H2AX in endometrial carcinomas: an immunohistochemical study with p53.

OBJECTIVE.: The most frequently mutated gene in human cancer is p53, a gene that functions in the checkpoint response to DNA double-strand breaks. γ-H2AX is a marker of activated DNA damage and is overexpressed in many malignancies and their precursor lesions. The purpose of this study was to evaluate the association between p53 and γ-H2AX expression and the clinical value of γ-H2AX in endometrial carcinoma. METHODS.: We investigated 106 patients with primary endometrial carcinoma (type I/endometrioid, n=84; type II/non-endometrioid, n=20; mixed pattern or other histological types, n=2) who were treated at our institution between 1999 and 2009. γ-H2AX and p53 expression were assessed using immunohistochemistry from paraffin-embedded tissue blocks, and results were correlated with clinical data. RESULTS.: A strong positive correlation was observed between γ-H2AX and p53 expression (p<0.0001). Like p53, γ-H2AX staining was significantly associated with advanced tumor stage (p=0.04), histological grade (p<0.0001), histological type (p<0.0001), and vascular space involvement (p=0.05), but not with lymph node involvement (p=0.64) and patients' age (p=0.36). In a univariate survival analysis, p53 and γ-H2AX staining were associated with a shortened disease-free and overall survival but in the Cox regression analyses both parameters did not serve as independent prognostic parameter. CONCLUSIONS.: Our findings suggest that there is a link between the p53 dependent cell cycle arrest and γ-H2AX dependent DNA repair pathway in endometrial cancer. Increasing expression levels of γ-H2AX are associated with unfavourable prognostic factors in type I and type II endometrial carcinomas.

Expression of phosphorylated histone H2AX (γ-H2AX) in normal and neoplastic squamous epithelia of the uterine cervix: an immunohistochemical study with epidermal growth factor receptor.

The histone γ-H2AX is a marker of activated DNA damage and is overexpressed in different cancers and their precursor lesions, indicating a role in oncogenic transformation. Epidermal growth factor receptor (EGFR) is overexpressed in many kinds of epithelial neoplasms. This study aimed to determine whether immunohistochemical expression of γ-H2AX is involved in the progression of the morphological spectrum from normal squamous cervical epithelia (NE, n=33) to cervical intraepithelial neoplasia (CIN; CIN1, n=9; CIN2/3, n=33) and cervical invasive squamous cell carcinoma (ISCC, n=33), whether γ-H2AX expression follows the pattern of proliferation of atypical squamous cells as shown by EGFR immunoreactivity, and whether it is correlated with clinicopathologic variables in ISCC. Immunostaining for both the factors was scored semiquantitatively for moderate and strong intensities. Gamma-H2AX and EGFR expression, respectively, increased from NE and CIN1 to CIN2/3 and ISCCs significantly (P=0.0001, respectively). Gamma-H2AX reactivity was found in the nuclei of the cells of the upper epithelial levels and the cells of basal/parabasal type in variable quantities in NE and CIN; expression of γ-H2AX was seen in the nuclei of ISCC including keratinizing cells in horn pearls. EGFR staining was mainly membranous and noted in basal/parabasal cells in NE and atypically proliferating keratinocytes in CIN and nonkeratinizing cells of ISCC. In addition, immature squamous metaplasias were decorated by the antibodies used. Immunoscores for γ-H2AX and EGFR, respectively, did not differ between International Federation of Gynecology and Obstetrics stages I and II, keratinizing and nonkeratinizing ISCC, and CIN2/3 and ISCC. However, expression patterns were different for both the factors, suggesting their involvement in different biological mechanisms, with regard to γ-H2AX apart from proliferation. Overexpression of γ-H2AX in CIN2/3 and ISCC of the uterine cervix reflects the neoplastic transformation of cervical squamous epithelia in reaction to increased DNA-damage and supports the classification of dysplasia into low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions.

Undifferentiated Endometrial Sarcoma of the Ovary: A Case Report with Review of Recent Literature and Discussion of Lacking Specificity of CD10 Immunoreactivity.

Undifferentiated endometrial sarcomas (UESs) of the ovary are very rare tumors. This paper presents a case of a 56-year-old patient with a history of hysterectomy and bilateral salpingectomy seven years ago for uterine leiomyomata. Intraoperatively, a tumor originating from the left ovary, adherent to the sigmoid colon, with infiltration of the small intestine and the vaginal apex was found. Histologically, the tumor was composed of pleomorphic round and oval to spindled cells with polymorphous vesicular nuclei with coarse chromatin and large nucleoli. Mitotic activity was brisk. There were large necrotic areas. Adjacent to the tumor tissue endometrium-like glands surrounded by fibrous stroma with macrophages corresponding to ovarian endometriosis were noted. Tumor cells showed diffuse strong immunoreactivity for vimentin and patchy strong staining for CD10; no reactivities were found for AE1/AE3, desmin, S-100, LCA, CD20, c-kit, and CD31. The patient died of her neoplastic disease four months postoperatively. CD10 is frequently expressed in different gynecopathological as well as other lesions, and, thus, nonspecific without relevance to the classification of this case. Morphological features, extensive sampling, and appropriate immunohistochemistry including markers for cytokeratins and myogenic differentiation are mandatory to arrive at the correct diagnosis.

An estimation of the frequency of surgery for posthysterectomy vault prolapse.

INTRODUCTION AND HYPOTHESIS: We tried to estimate the frequency of surgery for posthysterectomy vault prolapse. METHODS: We contacted all 86 departments of gynecology in Austria and asked them about total number of hysterectomies and total number of operations for vault prolapse. We then calculated a percentage of patients undergoing surgery for posthysterectomy vault prolapse. RESULTS: Sixty-five of 86 public hospitals replied (response rate 76%) and reported a total of 7,645 hysterectomies and 577 operations for vault prolapse for the year 2005, giving a percentage of 7.16 for surgery for posthysterectomy vault prolapse. On the assumption that vault prolapse takes on the average 10 years to develop and that the number of hysterectomies decreased by 10% over 10 years, we calculated a modified frequency of 6.52%. CONCLUSIONS: We were able to calculate an estimation of the frequency for posthysterectomy vault prolapse requiring surgical repair between 6% and 8%.

Symptomatic large bowel endometriosis in a woman with a hormonal intrauterine device: a case report.

BACKGROUND: Extragenital endometriosis can occur in the rectum and sigmoid causing cyclic rectal bleeding. A hormonal intrauterine device (IUD) (20 microg/24 h levonorgestrel releasing), originally developed as an easily reversible contraceptive method, is a therapeutic option for bleeding disorders. CASE: A 34-year-old woman using depot progesterone injection (crys-talline suspension of 150 mg medroxyprogesterone acetate) for contraception was amenorrheic and asymptomatic. After switching to a levonorgestrel-releasing IUD the patient experienced irregular bleeding with concomitant dysmenorrhea and rectal bleeding. Colonoscopy revealed a sigmoid mass. Laparotomy with resection of the sigmoidal mass and ovarian cyst was performed. Histopathologic analysis confirmed the suspected diagnosis of large bowel endometriosis. CONCLUSION: In our patient, large bowel endometriosis became symptomatic 2 years after insertion of hormonal IUD. The suppressive effect of the hormonal IUD seemed to be insufficient for the control of extragenital endometriosis.