[Therapy studies of the Austrian Breast Cancer Group (ABC)]. / Die Therapiestudien der Austrian Breast Cancer Group (ABC).

The Austrian Breast Cancer Group (ABC) consisting of more than 60 participating centers in Austria has randomized more than 5800 patients in 11 randomized trials since 1984. At present, roughly 30% of all patients with the diagnosis primary breast cancer are accrued in protocols throughout the country. Due to specific activities, the breast conservation rate raised from an initial 20% to more than 60% in the last years. Multicenter trials are not only the basis for progress in medicine but also tools for quality control and quality improvement.

The serum tumor marker M3/M21 in the follow-up of breast cancer patients.

The aim of this study was to evaluate the new serum tumor marker M3/M21 in comparison to CA 15-3, CEA and MCA in the follow-up of breast cancer patients. We investigated 267 serum samples from 35 patients suffering from invasive breast cancer, International Union Against Cancer (UICC) stage pT1 to pT4. Cut-off values for M3/M21, CA 15-3, CEA, and MCA were 25 U/I, 30 U/I, 5 ng/ml and 11 U/I, respectively. Serum tumor marker results were correlated with the results of the clinical and radiological examinations. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of serum CA 15-3, CEA and MCA were 47/85/61/76%, 24/90/55/70% and 39/84/55/73%, respectively. Serum M3/M21 showed a sensitivity of 45%, specificity of 81%, PPV of 73% and NPV of 69%. The combination of CA 15-3 and M3/M21 increased the sensitivity to 55%, with a specificity, PPV and NPV of 83%, 79% and 86%, respectively. CA 15-3 measurements showed a lead time effect in 5 patients, ranging from 3 to 7 (median 4.1) months. The combination of CA 15-3 and M3/M21 provided lead time effects in 7 cases, ranging from 2 to 8 (median 5.7) months. We conclude that the detection of breast cancer recurrence with CA 15-3 is improved by combination with M3/M21.

Serum evaluation of basic FGF in breast cancer patients.

Basic fibroblast growth factor (bFGF) is a potent endothelial cell mitogen found in a variety of normal and tumour tissues and is of prognostic relevance in human malignancies such as renal cell carcinoma and leukaemia. This study presents the data of 104 serum samples of 20 patients suffering from breast cancer. Mean serum levels of bFGF in these patients were 13.9 +/- 17. 1 (min 0, max 56.4) pg/ml and 2.4 +/- 5.9 (min 0, max 24.7) pg/ml, respectively (p = 0.01). Basic FGF reached a sensitivity of 61% at a specificity of 87% when applying a cut-off level of 5 pg/ml. A continuous increase of bFGF serum levels before the clinical detection of relapse (lead time) was seen in 3 out of 8 cases with a mean lead time of 4 months. Preoperative serum levels were not of prognostic value and showed no correlation with axillary lymph node metastasis. These preliminary results indicate that, in breast cancer patients, soluble bFGF may be useful in early detection of primary tumours, recurrences and monitoring of therapy.

Infiltrating ductal carcinoma of the breast: extensive intraductal component has no impact on lymph node involvement and survival.

The extensive intraductal component (EIC) in infiltrating ductal carcinoma (IDC) was reported to be a predictor of local recurrence. We investigated the influence of this histopathological parameter on nodal status and overall survival. In 115 patients suffering from an IDC with tumor stage FIGO I and II, 35 were EIC positive. We did not find a correlation with the nodal status. The mean follow up was 73 (+/- 38) months. EIC showed no influence on overall survival. Based on our findings, the presence of EIC is not a criterion for therapeutic decisions in IDC.

[Morbidity and mortality of retarded and normal weight premature infants]. / Morbidität und Mortalität bei retardierten und normalgewichtigen Frühgeborenen.

Differences of fetal outcome between appropriate for gestational age (AGA) and small for gestational age (SGA) preterm newborns with birth weight below 2500 g and gestational age ranging from 27 to 36 weeks have been evaluated. As described by Rohrer SGA have been divided into symmetrical retarded and asymmetrical retarded newborns using ponderal index. Therefore distribution of ponderal index on our local population has been analysed. SGA more often had an Apgar score below 6 five minutes post partum (p = 0.01) and their mothers more often announced abuse of nicotine during pregnancy. AGA have been on respiratory ventilation significantly longer than SGA (p = 0.001) and photo therapy because of hyperbilirubinaemia more often had to be performed on AGA (p = 0.02). AGA have spent a longer time at the neonatal intensive care unit than SGA (p = 0.0006). No differences could be found in mortality between AGA and SGA. Preterms with low ponderal index had no different outcome than SGA with normal ponderal index.

Microsurgical treatment of tubal sterility using the CO2 laser: a reasonable alternative to IVF in cases of tubal sterility.

A retrospective analysis of women treated microsurgically using the CO2 laser in sterility treatment was performed. The aim of the study was to determine women's personal feeling about the procedure, prognostic factors, success rates, and complications. Included were 192 patients with tubal occlusions or pelvic adhesions treated by means of CO2 laser microsurgery between February 1984 and July 1992. A standardized questionnaire was used to evaluate women's procedure-related stress, extrauterine and intrauterine pregnancy rates, pregnancy complications, and postoperative complaints. In 75 cases, records and questionnaires contained sufficient data and were included for further analysis. Adhesiolysis alone, unilateral neosalpingostomy, bilateral neosalpingostomy, or new implantation was done in 7%, 52%, 33%, and 8%, respectively. In the range of 1-10, a medium degree procedure-related stress (mean 4.3, range 1-10) was expressed by the treated women. No surgery-related complications were observed. The overall pregnancy rate was 37.3%, and 10.7% were tubal pregnancies. In 26.7%, fertility surgery resulted in intrauterine pregnancies, and 21.3% of the treated women delivered living children. Three women had two consecutive pregnancies after surgery. Women with intrauterine pregnancy, extrauterine pregnancy, and no pregnancy had a mean age of 29.5 +/- 3.8, 27.3 +/- 5.3, and 32.3 +/- 4.2 years, respectively (p = NS). Mean duration of infertility before start of surgical treatment was 42.4 +/- 34.6, 41.6 +/- 25.8, and 48.8 +/- 33.2 months, respectively (p = NS). Intraabdominal instillation of streptokinase to prevent reformation of adhesions had no significant impact on tubal patency results or pregnancy rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Necrotizing fasciitis arising from episiotomy.

Necrotizing fasciitis is a fatal, rapidly progressive, often initially unrecognized condition. Mortality rates range from 30% to 76%. Prognosis depends on the delay of diagnosis, antimicrobial treatment and surgical excision of all necrotic tissue. A case of postpartum perineal necrotizing fasciitis arising from episiotomy is presented. Prompt recognition and aggressive therapy resulted in a favorable outcome despite significant morbidity.

[Obstetric management of patients with HELLP syndrome]. / Geburtschilfliches Management bei Patientinnen mit HELLP-Syndrom.

The syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP-Syndrome) is a severe form of preeclampsia and eclampsia. The clinical course is characterized by right upper quadrant and epigastric pain, hypertension, proteinuria and edema. Maternal and neonatal morbidity are high. The underlying cause for this pregnancy-related syndrome is still unclear. As soon as a reliable diagnosis is established handling of patients suffering from HELLP-Syndrome is ambivalent: Immediate termination of pregnancy, however, poses a problem at early gestational age. Therefore some authors have advocated a conservative management. At our department active management and delivery by Caesarean section as soon as possible has gained acceptance in the past 5 years. We report our experience with 23 patients over a 12 year period, and with 4 patients from the intensive care unit (N = 27). Mean gestational age was 33.5 weeks (+/- 4.8) and the mean birthweight was 1922.5 g (+/- 971.5). 19 patients were delivered by Caesarean section. Most complications were based on a delayed delivery and subsequent deterioration of maternal condition. Reduction of the time interval between establishment of diagnosis and termination of pregnancy (1980-1985-3 days; 1986-1992-12 hours) resulted in a better outcome. We recommend intensive laboratory screening and exact clinical examination since missed or delayed diagnosis as well as delayed delivery are life threatening for mother and child. Only prompt delivery yields an improvement of prognosis.

[15 years vaginal delivery in post-cesarean status]. / 15 Jahre Entbindung bei Status post Sectio caesarea.

In a retrospective study covering a period of 15 years (1976-1991), we investigated 673 births after previous caesarean section compared to a matched pair group. During the observation period, an increase of vaginal delivery after previous caesarean section occurred. This decrease in resection rate (first five years period: 59%, 60% in the period of 1981-1985 and 42% within the last five years) could be achieved mainly in births after only one previous caesarean section. In patients with more than one previous caesarean section, the resection rate remained almost stable at 95%. The rate of complication was low in our study group, especially, if compared to studies in the USA. Three uterine ruptures with one maternal death occurred during the entire observation period. No correlation of the complication rate with an increase of vaginal delivery was observed. The more conservative obstetrical management had no negative impact on foetal outcome.

[Lead, mercury and cadmium in newborn infants and their mothers]. / Blei, Quecksilber und Cadmium bei Neugeborenen und deren Müttern.

The objective of the present study was to determine the toxic trace element status of 51 healthy Austrian women and their newborn babies. Lead, mercury and cadmium content of early breast milk, blood and urine were measured post partum by atomic absorption spectrophotometry. None of the toxic trace elements could be found in elevated concentrations; the content of mercury and cadmium in milk was below limits of detection. Mean lead concentration in breast milk was 35.8 (SD:15.0) micrograms/l. Whole blood content of lead was 37.0 (SD:12.7) micrograms/l in mothers and 26.3 (SD:11.6) in newborns. High blood concentrations of mercury were found both in mothers (4.46 micrograms/l, SD:1.95) and in umbilical cord blood (5.58 micrograms/l, SD:2.33). The corresponding values for cadmium were 0.44 (SD:0.4) micrograms/l and 0.08 (SD:0.16) micrograms/l. Urine excretion of the elements assayed was normal. Significant correlations between maternal and neonatal blood toxic mineral levels could be demonstrated in lead (p < 0.001).

Vaginosonographically guided paracentesis in a woman with severe thrombocytopenia.

Coagulation disorders and obesity might complicate transabdominal paracentesis. In a woman with severe thrombocytopenia we used the vaginal approach guided by vaginosonography to obtain ascitic fluid for analysis.

Immunohistochemical detection of mutant p53-suppressor gene product in patients with breast cancer: influence on metastasis-free survival.

Overexpression of p53-protein appears to be a common event in primary breast cancer. It has been proposed that the presence of elevated levels of this protein may be an independent prognostic factor and may be important for the ability of a tumor to metastasize. This study was performed to evaluate the influence of immunohistochemically detectable mutant p53-protein on metastasis-free survival of patients with breast cancer. Immunohistochemistry was performed on 117 paraffin-embedded biopsy specimens of consecutive patients with stage T1-T4 breast cancer, using a monoclonal antibody against p53 suppressor gene product. 29 (24.8%) specimens showed positive staining, whereas in 88 (75.2%) a negative staining reaction for p53 was found. Comparing time intervals to diagnosis of metastasis, using Kaplan-Meier curves, Log-Rank test revealed no significant differences in metastasis-free survival between p53 positive and negative patients (P = 0.32), whereas statistically significant differences were noted for tumor stage (P < 0.01), nodal status (P < 0.01), histological grading (P < 0.01) and estrogen receptor status (P = 0.03). Mutant p53-protein, as detected by immunohistochemistry in paraffin embedded tumor tissue, does not appear to influence metastasis-free survival in patients with breast cancer.

[Surgical treatment of invasive malignancies of the vulva using CO2 laser]. / Die operative Behandlung von invasiven Malignomen der Vulva unter Einsatz des CO2-lasers.

In a retrospective study, we analysed 26 CO2-laser vulvectomies within the observation period between 1982 and 1990. Indications for vulvectomies were invasive malignancies of the vulva, FIGO stage I to III. 91.7% were squamous cell carcinomas. The mean age of patients was 69.3% (43 to 87) years. Five radical local excisions, one modified radical vulvectomy and in all other cases radical vulvectomy was performed. Laser surgery of the vulva was combined with bilateral lymphadenectomy or radiotherapy of inguinal lymph nodes. If necessary, a gluteal rotation flap was built to achieve closure of the wound without tension. No serious intra- or postoperative complications were observed, wound breakdown with per secundam healing as the most common complication occurred in 29.1%. Functional and cosmetic results were examined in a detailed follow-up at least 12 months postoperatively, showing promising results (56.3% good, 37.5% satisfactory, 6.3% unsatisfactory). The surgical procedure, perioperative management, recurrence rate (3 patients, 12.5%), as well as functional and cosmetic results, are presented and discussed in detail. The use of CO2-laser in surgical treatment of vulvar malignancies improves cosmetic and functional results. This is important, particularly with regard to the increasing number of young women with vulvar neoplasia.

[The value of intraoperative rapid biopsy study in diagnosis of breast cancer]. / Die Wertigkeit der intraoperativen Schnellschnittuntersuchung in der Diagnostik des Mammakarzinoms.

432 biopsies of mammary tumours performed between 1988 and 1990 were reviewed to evaluate the accuracy of rapid frozen section diagnosis. 15 (3.47%) had to be deferred to await subsequent permanent paraffin section. There were 4 (2.55%) false negative diagnoses. These cases consisted of small, nonpalpable and in-situ lesions. No false positive diagnosis was noted during the observation period. Sensitivity of frozen section histology was 97.45%, specificity 100% and efficiency 96.53%. Rapid frozen section diagnosis is a highly accurate and reliable tool which helps to avoid a consecutive operation in patients with breast cancer.

The significance of determining CA 15-3 in the cytosol of breast cancer.

The identification of tumor markers in patients who had undergone operation for breast cancer provides important information in the follow-up in addition to evaluation by clinical and visual methods. The aim of our study was to determine the clinical prospective value of CA 15-3, mucin-like carcinoma-associated antigen and carcinoembryonic antigen in preoperative measurement of serum samples in patients with primary breast cancer, and to determine CA 15-3 and steroid receptors in the cytosol of the tumor. The results show that the most exact correlation occurred between serum CA 15-3 and the different stages of the tumor. However, there is no conclusive evidence for the prognosis and the course of the disease from preoperative findings of tumor markers in serum samples or in the cytosol of the tumor in patients with breast cancer.