Phase Locking the Spin Precession in a Storage Ring.

This Letter reports the successful use of feedback from a spin polarization measurement to the revolution frequency of a 0.97 GeV/c bunched and polarized deuteron beam in the Cooler Synchrotron (COSY) storage ring in order to control both the precession rate (≈121 kHz) and the phase of the horizontal polarization component. Real time synchronization with a radio frequency (rf) solenoid made possible the rotation of the polarization out of the horizontal plane, yielding a demonstration of the feedback method to manipulate the polarization. In particular, the rotation rate shows a sinusoidal function of the horizontal polarization phase (relative to the rf solenoid), which was controlled to within a 1 standard deviation range of σ=0.21 rad. The minimum possible adjustment was 3.7 mHz out of a revolution frequency of 753 kHz, which changes the precession rate by 26 mrad/s. Such a capability meets a requirement for the use of storage rings to look for an intrinsic electric dipole moment of charged particles.

Computational framework for particle and spin simulations based on the stochastic Galerkin method.

An implementation of the polynomial chaos expansion is introduced as a fast solver of the equations of beam and spin motion of charged particles in electromagnetic fields. We show that, based on the stochastic Galerkin method, our computational framework substantially reduces the required number of tracking calculations compared to the widely used Monte Carlo method.

How to Reach a Thousand-Second in-Plane Polarization Lifetime with 0.97-GeV/c Deuterons in a Storage Ring.

We observe a deuteron beam polarization lifetime near 1000 s in the horizontal plane of a magnetic storage ring (COSY). This long spin coherence time is maintained through a combination of beam bunching, electron cooling, sextupole field corrections, and the suppression of collective effects through beam current limits. This record lifetime is required for a storage ring search for an intrinsic electric dipole moment on the deuteron at a statistical sensitivity level approaching 10^{-29} e cm.

New Method for a Continuous Determination of the Spin Tune in Storage Rings and Implications for Precision Experiments.

A new method to determine the spin tune is described and tested. In an ideal planar magnetic ring, the spin tune-defined as the number of spin precessions per turn-is given by ν(s)=γG (γ is the Lorentz factor, G the gyromagnetic anomaly). At 970 MeV/c, the deuteron spins coherently precess at a frequency of ≈120 kHz in the Cooler Synchrotron COSY. The spin tune is deduced from the up-down asymmetry of deuteron-carbon scattering. In a time interval of 2.6 s, the spin tune was determined with a precision of the order 10^{-8}, and to 1×10^{-10} for a continuous 100 s accelerator cycle. This renders the presented method a new precision tool for accelerator physics; controlling the spin motion of particles to high precision is mandatory, in particular, for the measurement of electric dipole moments of charged particles in a storage ring.

Comparison of in-vitro falloposcopy with tubal histology in the diagnosis of fallopian tube pathology.

In order to assess the diagnostic quality of falloposcopy in relation to pathomorphology, a consecutive series of 30 Fallopian tubes obtained from surgical salpingectomy cases were prospectively examined by in-vitro falloposcopy and histology. Falloposcopy was performed using an over-the-wire catheterization system and a 0.5 mm falloposcope with 3000 pixels. Assessment of the specimens included the description of lumen geometry, intraluminal changes and status of the mucosal surface. Falloposcopy classified 14 tubes as normal and 16 pathological. Histology resulted in 17 normal versus 13 pathological tubes. Pathologies included lumen obstructions and dilatations, intraluminal synechiae and mucosal damage. Sensitivity and specificity of falloposcopy were calculated to be 0.85 and 0.71; positive and negative predictive values were 0.69 and 0.86. It was concluded that falloposcopic findings indeed reflect and successfully differentiate normal and pathological conditions allowing adequate and reproducible image interpretation. However, variations of the diagnostic accuracy with the type of pathology and the tubal segment have to be taken into account before clinical consequences are drawn from a falloposcopic investigation.

[Laparoscopy in (apparently) benign ovarian tumors between benefit and catastrophy and the deceptive safety of laparoscopic lap sacs]. / Die Laparoskopie bei ("vermutet") benignen Ovarialtumoren zwischen Benefit und Katastrophe und die trügerische Sicherheit laparoskopischer Bergesäcke.

Endoscopic ovarian surgery is currently spreading tremendously, but also rather uncritically. The technical possibilities both of organ preserving and ablative endoscopic surgery are controversial, so that structuring of the indication for an endoscopic procedure as well as optimization of the endoscopic removal of ovarian tumor or adnexae is of utmost relevance. Therefore, a study was performed at the Department of Obstetrics and Gynaecology of the Heidelberg University with the following aims: Risk evaluation of operating into an ovarian malignancy at endoscopy for "presumably" benign cystic ovarian tumors in n = 100 cases in Heidelberg and literature survey Analysis of problems and complications during clinical application of laparoscopic lap sacs for removal of cystic adnexal tumors or adnexae (n = 50) Experimental examination of the risk of an endoscopic lap sacs to rupture during a procedure The risk of endoscopically operating into an ovarian cancer lies between 0.4 and 3% according to literature data. Despite maximal preoperative selection, mainly by ultrasound examination, in our group of 100 patients, in three women without preoperative signs of malignancy but with discreet intracystic structures in the ultrasound, an endoscopic adnexectomy with complete removal in a lap sac was performed, and though immediate section for microscopic examination was negative, final histology revealed one ovarian cancer la and 2 borderline tumors, same stage. In the time period analyzed, three further patients were referred to our center for secondary, delayed (median 3 months) staging after endoscopic procedures for presumed benign lesions. Clinical application of lap sacs proved the necessity of an intensive training. In 3 patients an intraperitoneal rupture of the sac occurred. Typical problems were volume discrepancies between sac respectively abdominal incision and tissue to be removed (28% of cases). The risk of rupture of the various lap sacs examined differed significantly (p < 0.05). Due to the complex pathological nature of cystic adnexal tumors, a 100% selection for the endoscopic approach is not feasible. Therefore, an endoscopic procedure should only be performed after optimal preoperative diagnosis and, in case of the slightest doubt, only if intraoperative microscopic examination is available, and the possibility to perform an immediate staging laparotomy. Sufficient information of the patient is relevant. Laparoscopic removal of tumor or adnexae should be performed in a lap sac. However, there is no absolute certainty of preventing spillage even with the lap sac, since not all endoscopic sacs available are of a sufficient quality.

Value of endometrial biopsies and serum hormone determinations in women with infertility.

Premenstrual endometrial biopsies were performed in 324 infertile women. Their hormonal status was established in the early follicular phase of the same cycle (FSH, LH, oestradiol-17 beta, testosterone, DHEAS, TSH and prolactin, the latter two both basally and following TRH stimulation). In the luteal phase, oestradiol-17 beta and progesterone concentrations were determined three times between the fifth and tenth hyperthermic days, as was prolactin, both basally and following metoclopramide stimulation. All pregnancies occurring before January 1986 were recorded. Seventy-five per cent of the biopsies were evaluated on the expected ovulation date from the basal temperature charts, 77% according to the next onset of menstruation. Twenty-six per cent of the biopsies were out of phase, and 7% displayed abortive secretion. A significant correlation existed between endometrial profiles and the characteristics of the cycle, stimulated TSH and prolactin levels, and with testosterone and FSH concentrations. No correlation of the endometrial status with midluteal oestradiol or progesterone concentrations was found. While various hormones of both the follicular and luteal phases correlated significantly with the pregnancy rate, the same was not demonstrated for the state of endometrial biopsy. Therefore, following exclusion of organic explanations of infertility in women with biphasic cycles, the determination of progesterone and oestradiol-17 beta in the luteal phase was considered. In women with reduced concentrations of these hormones, androgens, gonadotrophins, prolactin and TSH should be determined. Endometrial biopsy is valuable only if pregnancy fails to occur, despite therapeutically normalized hormone concentrations.

DNA flow cytometry, clinical and morphological parameters as prognostic factors for advanced malignant and borderline ovarian tumors.

Patients with malignant ovarian (n = 111) and borderline (n = 8) tumors (FIGO stage III/IV) underwent surgery and chemotherapy and were analyzed clinically (age, residual tumor after surgery) and morphologically (type, grade, psammoma body content), and by means of flow cytometry (DNA ploidy, S-phase fraction). Follow-up was 12-72 months for investigation of survival. Patients under 60 years of age (n = 18) with malignant tumors showed longer survival than patients over 60 (n = 93) (P = 0.078). Residual tumor was relevant for prognosis in malignant tumors only if macroscopically there was no residual disease (n = 13). There were no significant differences between residual tumors less than or equal to 2 cm (n = 61) and greater than 2 cm (n = 37). WHO typing was of little importance for survival analysis. Compared to borderline tumors (n = 8), serous (n = 65), endometrioid (n = 13), nonclassifiable (n = 12), mucinous carcinomas (n = 8), and nonepithelial tumors (n = 12) had a poor prognosis. Psammoma bodies were found in 25 patients with serous carcinomas, 7 of them had a high content. The prognosis for these 7 patients was much better than that for patients with a moderate or low psammoma body content (P = 0.006). Twenty-three epithelial tumors were graded G1, 28 were G2, and 47 were G3. However, grading was considered only as a prognostic factor in serous carcinomas (n = 65) (P = 0.028). A total of 199 DNA histograms from 119 patients were analyzed by flow cytometry (FCM). There were no correlations between tumor type and DNA ploidy or S-phase fraction. Seven of eight borderline tumor and all serous carcinomas with a high content of psammoma bodies were diploid combined with a low (less than or equal to 4%) S-phase fraction. DNA ploidy and S-phase fraction were excellent prognosticators. Of 99 epithelial malignant tumors, 35 were diploid and 64 were aneuploid. An S-phase fraction less than or equal to 4% was found in 39 patients, 4.1-10% in 73 patients, and greater than 10% in 23 patients. Diploid tumors and tumors with a low S-phase fraction showed the best survival (P = 0.007, resp. 0.0001). Our study emphasizes the importance of an accurate histology, including information on psammoma body content, and the importance of DNA flow cytometry. The advantage of FCM is that the results are simple, reproducible, and objective.

[Ultrasonography in the primary diagnosis and follow up of ovarian tumors]. / Ultrasonographie zur primären Diagnostik und Verlaufskontrolle bei Ovarialtumoren.

Preoperative sonographic data in 317 patients who underwent surgery at the University Women's Clinic Heidelberg for an ovarian tumour during a 6 years' observation period, were compared with the results of clinical examination. The prognostic value of both techniques was examined, by relating the findings (as to tumour size, demarcation from the uterus) to the postoperative histological or cytological diagnosis. In the 214 cases of benign and 103 of malignant ovarian tumours a correct diagnosis was provided by ultrasound in 88% and 74% respectively. Thus significantly more often than by clinical examination alone (p less than 0.001 for benign and p less than 0.01 for malignant tumours). The sonographic findings in 49 patients during follow-up after surgery for ovarian carcinoma and polychemotherapy were checked by a second look laparotomy. The detection rate of tumour progression, recurrence, residual tumour or remission was of 98%.

[Vascular abnormalities of the umbilical cord--incidence, significance and possibility for prenatal ultrasonic detection]. / Gefässanomalien der Nabelschnur--Inzidenz, Bedeutung und Möglichkeit der pränatalen ultrasonographischen Erfassung.

Vascular anomalies of the umbilical cord are amongst the most frequent congenital malformations, their incidence being 0.2% to 1.4%. As a result of the latter the risk of occurrence of other malformations and chromosomal anomalies is markedly elevated. Between January 1977 and July 1987 a total of 78 cases (0.51%) of umbilical cord vascular anomalies were recorded at the Department of Gynaecology of the University of Heidelberg. Malformations occurred in 37% of the foetuses involved. 28% showed retarded growth and 9% had an abnormal set of chromosomes. Anomalies of the urinary tract and malformations of the thoracic organs were very frequent. Total mortality after the 28th pregnancy was about 14%. Currently available high-resolution real-time ultrasound equipment can show up even prenatally pathological variations of the umbilical vascular pedicle (e.g. a single umbilical artery). Because of the manifold risk involved, routine ultrasound control is recommended. If this anomaly is diagnosed, the pregnancy should be classified and treated immediately as a high-risk pregnancy.

[Diagnosis of benign and malignant ovarian tumors]. / Zur Diagnostik von benignen und malignen Ovarialtumoren.

The present paper reports on the value of gynecological-clinical examinations and preoperative ultrasonography in the diagnosis of benign and malignant ovarian tumors. Out of a group of 42 patients, in all of whom "ovarian cyst" had only been diagnosed clinically, 14% were not found to be suffering from this condition at surgery. In a comparison of preoperative gynecological-clinical and ultrasonographic findings (in 68 patients) it proved possible to determine the side on which the tumor was localized, its actual size, the extent to which it was delimited from the uterus, and its consistency (whether solid or cystic) significantly better by ultrasonography (p less than 0,01). However, the results of this study indicate that 2% of the cases diagnosed ultrasonographically as "benign ovarian tumor/ovarian cyst" are likely to be ovarian carcinomas. In the group of patients with malignant ovarian tumors also (42 patients), there was a significant difference in the preoperative diagnosis "suspected ovarian carcinoma". On the basis of clinical findings it was only diagnosed in 45%, while it was found in 74% by ultrasonography (p less than 0,01). In 3 cases with ovarian carcinoma there was no pathologic palpation finding, and in only one other case was a "suspected ovarian cyst" diagnosed. By means of ultrasonography, on the other hand, all of the cases of ovarian carcinoma were classified either as "ovarian carcinoma" or as "cystic-solid/complex abdominal tumor". The most frequent diagnoses on the basis of the sonographic scan (approx. 90%) were cystic-solid ovarian tumors, followed by cystic-ventriculated ovarian tumors with solid portions and finally solid ovarian tumors with only a few cystic portions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sonographic diagnosis of severe fetal malformations]. / Sonographische Diagnostik schwerer fetaler Fehlbildungen.

The present paper reports on results of ultrasonographic examination in the identification of severe congenital malformations in the period between 1975 and 1982. The incidence of severe congenital malformations in relation to the total number of births during this period was 159 out of 11,372 (1.4%). In 144 cases with severe malformations at least one antenatal ultrasonographic examination had been performed. According to their topographic location, 42% of these were head/neural tube defects, 38% trunk/organ defects, only 2% were severe defects of the extremities and 18% were rare fetal malformations. As a result of previous ultrasonographic examinations at specialists' practices 60% of the cases were referred to the authors' clinic for further clarification with a correct diagnosis or a suspected fetal malformation. Of all the sonographically demonstrable structural defects of the fetus, 81% of all severe fetal defects seen at the authors' clinic during the period in question were identified correctly. If the observation period is divided into the years 1975 to 1979 and 1980 to 1982, there is a striking rate of increase in the number of antenatal ultrasonographic diagnoses which were correct, from 71% in the first period to 86% between 1980 and 1982. Most of the false-negative ultrasonographic findings were congenital cardiac abnormalities, since up to that point no special fetal echocardiographic examinations had been performed. In the entire period covered by the investigation there was only one false-positive finding ("Potter's syndrome"). Forty-six per cent of the ultrasonographically demonstrated severe fetal malformations were diagnosed before the end of the 24th week of pregnancy, and 54% after the end of the 24th week of pregnancy. Only in 60 out of 141 cases (43%) with severe fetal malformations was the quantity of amniotic fluid found to be normal; 26% of the cases had hydramnios and 31% oligohydramnios. Pathologic movement behaviour had been registered ultrasonographically in 43% of the cases with severe fetal malformations; biometric dimensions of the biparietal cranial diameter and the transverse diameter of the thorax (greater than 10th percentile to 90th percentile, according to the percentile growth curves of Schmidt, 1982) corresponding to gestational age had only been measured in 30% and 50%, respectively, of the cases with fetal malformations. During the entire period covered by the investigation, from 1975 to 1982, only 16 children born at term (between the 38th and 42nd weeks) had severe malformations which had not already been diagnosed.(ABSTRACT TRUNCATED AT 400 WORDS)

[Carcinoma formation in a neovagina following vaginoplasty]. / Karzinomentstehung in der Neovagina nach Vaginalplastik.

A carcinoma occurs only very rarely in a neovagina. This extremely rare occurrence is a suitable example of an exogenous carcinogenesis. Only 6 cases have so far been reported in literature. The clinical and morphological features are discussed on the basis of the author's own observations on one of his patients.

[Clinical and patho-anatomic aspects of metastases of breast cancer]. / "Klinische und patho-anatomische Aspekte zur Metastasierung des Mammakarzinoms.

The importance of carcinoma of the breast in female malignancies demands a critical examination of the condition of metastases by means of certain clinical and pathological data. The clinical data and the results of autopsies of 384 patients with breast carcinoma were examined. The frequency and the chronology of occurrence of metastases put out metastases of lymphnodes , skeleton, lung, liver and local recurrences. The importance of the mediastinal lymph node metastases in the distribution of metastases in thoracical organs was established and is discussed. The relation of frequency of the metastases to primary tumour staging (TNM) shows a 63% rate of metastases in patients with No and 86% in patients with N+. A comparison of two decades (I = 1960-1969; II = 1970-1979) shows certain trends 1. In decade II more patients with primary stage T1-T2 NoMo were found in autopsies having less metastases. 2. More local recurrences and metastases of genital organs were diagnosed. 3. In decade II more "late-metastases" (2-10 years after primary diagnosis) were found. These developments are explained by better primary diagnostic methods, more frequent follow-up examinations after primary therapy, and more frequent application of secondary therapies (chemotherapy, radiotherapy).

[Potentials and limits of conventional differential diagnosis of the endometrium]. / Möglichkeiten und Grenzen der konventionellen Differential-diagnostik am Endometrium.

The reproducible identification of various histological types of the endometrium is of special interest for many reasons. The controversy in endometrial classification and terminology led us to study the algorithm of conventional endometrial diagnosing. This study is to examine the significance of historical morphologic parameters for differential diagnosis by semiquantitative or binary recording and computer-assisted evaluation. The results are based on cross-tables and cluster-analysis. The statistical test showed that most of the historical parameters were neither adequate for reclassification nor exclusion of historical typing of the endometrium. An objective and reproducible classification of endometrial changes by using binary parameters can only be achieved for specific histological types of normal endometrium and several types of hyperplastic endometrium. The dedifferentiated carcinoma is a diagnosis "per exclusionem ", since nearly all of the binary parameters cannot be analysed. The individual borderline lesions cannot be differentiated from each other by descriptive parameters. They cannot even be distinguished from the highly differentiated endometrial carcinomas. This kind of differential diagnosis is obviously not based on conventional formalistic criteria but on nonquantifiable empirical data. This might be a reason for the above mentioned controversy in endometrial diagnosis and terminology.

[Considerations on computer-assisted pattern recognition in the endometrium]. / Uberlegungen zur rechnergestützten Befundanalyse am Endometrium.

Histomorphological diagnosing very much depends on subjective empiric data. In histomorphology of the endometrium nomenclature as well as diagnostic classification lack uniformity and are full of controversy in literature. This results in opposing assessments of dignity of endometrial hyperplasias and prognosis of varying grades of carcinoma differentiation. One of the reasons is the lack of objective and reproducible diagnostic categories, not yet found. Morphometry with so-called computer-assisted interactive pattern recognition systems might offer the solution to numerous problems. Since there are no specific parameters for diagnostic identification of endometrial hyperplasias and carcinomas, only a combination of sensitive and reproducible parameters can allow for diagnostic identification. We report on our first computer-assisted pattern recognition studies and results that appear to provide an adequate basis for leaving descriptive diagnosing and turning to objective diagnosing. Such an objective diagnosing might not only be of clinical and therapeutic significance but also provide a new evaluation of the today's significance -- still full of controversy -- and prospective potency of endometrial hyperplasias. In computer-assisted interactive pattern recognition also lies the possibility of a contribution to objective tumour grading that appears to have high prognostic significance.

[Therapy in metastasizing ovarian cancer--survival rate correlated with histological and cytological grading as prognostic factors]. / Therapie beim metastasierenden Ovarialkarzinom--Uberlebensrate in Abhängigkeit vom histologischen und zytologischen Grading als prognostischen Faktoren.

The histologic grading especially of the modified Broders'-Grading is a suitable prognostic factor in Ovarian Carcinoma. Our investigations show this to be especially true after failure with first line chemotherapeutic agents. These morphologic gradings should especially be used for the selection for high risk patients and for the treatment planning in ovarian carcinoma.

[Clinical demands on the morphologist in the area of surgical gynecology]. / Klinische Forderungen an den Morphologen im Bereich der operativen Gynäkologie.

At present in gynecologic oncology no therapeutic strategy is possible without exact histopathological diagnostic procedures according clinical rationales. Describing morphological records, exact details are therefore necessary on clinical staging, histological grade and type of the tumor. This requires a standardized preparation technique and a clinically adapted microscopic working procedure on surgery material. Above all this is necessary for discrimination of defined early cancerous changes and invasive carcinomas.--Analysis of tumor metric is more and more completed by methods of picture analysis (tissue-texture). The principals of an optimal cooperation between clinicians and morphological workers in gynecologic oncology are presented as an example on common used macroscopic and microscopic preparation methods at the histological laboratory of the Department of Gynecologic Morphology at the University Hospital Heidelberg.

[Morphology and clinical aspects of malignant mixed müllerian tumors of the corpus uteri]. / Morphologie und Klinik der malignen Müllerschen Mischtumoren des Corpus uteri.

Mixed muellerian tumours of the uterus are more common today than uterine leiomyosarcomata. There is a world wide increase in the incidence in the last few years. In the past 15 years we observed 20 mixed muellerian tumours of the uterine body. The patients are usually 10 years older than women with endometrial carcinoma or leiomyosarcoma of the uterus. Morphologically homologous and heterologous tumours must be differentiated. Characteristic is the marked polypoid growth. There is a close correlation between tumour stage and microscopic tumour grading. Tumours with high malignancy are usually in stage I or II. The prognosis correlates well with the grade and stage of the tumour, therefore the elaboration of a prognostic index is necessary. The survival rates are low. Mixed muellerian tumours are not at all or very little influenced by radiotherapy. The single or combined chemotherapies in use o date have not shown satisfactory success. As complete as possible surgical removal is therefore important. It cannot as yet be predicted whether our present combined treatment in stage III and stage IV by operation and post-operative combined chemotherapy with CYVADIC is liable to increase the survival rates.