Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany.

The aim of this survey was to analyse the standard of care in diagnostic, surgery, chemotherapy and aftercare management for patients with borderline tumours of the ovary (BOTs) in Germany. A structured questionnaire comprising different dimensions was sent to all 1114 gynaecological departments. The questionnaire could be returned anonymously. The overall response rate was 29.0% (323 departments). Most departments were on secondary care (71.8%), tertiary care (23.2%) or university hospital (5.0%) level. Most clinicians performed not more than five BOT operations (89.2%) per year. Most departments (93.2%) used in addition to classical bimanual examination and vaginal ultrasound, tumour marker CA-125 detection, CT scan, MRI or PET-CT techniques. Departments in university and tertiary care hospitals performed more often a fresh frozen section (87 vs 64%). In young women, clinicians performed much seldom unilateral salpingo-oophorectomy (92%) and only in 53% biopsies of the contralateral ovary. Generally, biopsies of the contralateral ovary were performed in 4-53% of the patients. Chemotherapy was mostly favoured in 'high-risk' patients with tumour residual, microinvasion or invasive implants. Thus, a high grade of insecurity in diagnostic and therapy of BOT exists in some gynaecological departments and underlines the need for more educational and study activities.

[A look beyond urology: vaginal cancer]. / Ein Blick diesseits des Tellerrandes: Das Vaginalkarzinom.

Primary carcinomas of the vagina are very rare. Nevertheless, they need to be included in differential diagnoses when carrying out a urological examination of the pelvic floor and the vagina in patients with micturition problems, also in younger patients: we report a case of a 35-year-old woman with a primary carcinoma of the vagina and present a review of the literature.

Evaluation of a digital store-and-forward colposcopic system--a pilot study to assess usability for telemedicine.

We evaluated the diagnostic reliability of cervical examination using digital colposcopy compared with conventional binocular colposcopy. A total of 315 patients were examined and diagnosed by a colposcopist on-site. During the colposcopic examination, digital camera images were stored on a PC (median five pictures per patient). A second physician, experienced in colposcopy, re-evaluated the initial diagnostic findings using the stored digital images. The primary and secondary findings in each patient were categorized according to the Rome classification system. There was agreement between the primary and secondary examiners in 69% of cases (kappa=0.60). There was no systematic bias in terms of under- or over-rating. The proportion of non-assessable colposcopic examinations was 9%. Digital colposcopy was reliable and provided advantages in terms of a better follow-up examination and internal quality control of the diagnosis. The pilot study suggests that telecolposcopy may provide better training and further education for physicians and students, and may also improve the diagnostic possibilities in gynaecology.

[The suitability of digital colposcopy for telematic applications]. / Die Anwendbarkeit der digitalen Kolposkopie für telematische Fragestellungen.

Since carcinoma of the cervix is one of the most common cancers in women, screening of the cervix has acquired considerable importance. Colposcopy is a simple diagnostic method of detecting suspicious changes at an early stage. Shortcomings of this method are its low specificity and high inter- and intra-observer variability. A clinical pilot study was therefore carried out to investigate the advantages of a digital colposcopic system comprising a binocular colposcope coupled to a CCD camera and a computer. The aim of the study was to evaluate the reliability of diagnostic findings of the cervix obtained with digital colposcopy in comparison with standard binocular colposcopy, and to assess its suitability for telematic applications (teleconsultation, telediagnostics, treaching). A total of 315 patients were examined and statistically analysed. The patients were first submitted to a conventional colposcopic examination and a diagnosis was established. During the colposcopic examination camera images were stored on a computer, on the basis of which a second physician experienced in colposcopy reviewed the initial diagnosis. The primary and secondary findings of each patient were classified into 4 categories and compared following the Rome classification system. Agreement between the primary and secondary diagnosis was established in 69% of the cases (kappa = 0.60 +/- 0.03). No bias was observed in terms of under- or overrating. The percentage of non-assessable colposcopic examinations was 9.2%. Digital colposcopy is therefore suitable for reproducing diagnostic findings on the computer, given adequate digital image quality and a suitable classification model. The method has clear advantages with regard to follow-up, internal quality control of the diagnosis, and the training and further education of physicians and students. In the future, telecolposcopy may open up new opportunities in gynaecology.

Hypersensitivity to endotoxin and mechanisms of host-response.

It was shown here that the lethal activity of endotoxin may be considerably enhanced in experimental animals treated with different agents. Some of these agents represent killed bacteria, bacterial products or hepatotoxic agents and their sensitizing effects may be relevant to the sensitization seen during gram-negative infections. This study provided direct evidence that macrophages are cells mediating the lethal activity of endotoxin and that the direct interaction of LPS with macrophages is the first step in its initiation. Further, TNF is a macrophage mediator responsible for the induction of lethality. In normal animals as well as in the various sensitization models investigated, TNF alone was sufficient to induce lethality. Therefore, the stimulation of macrophages by LPS to produce TNF is a mechanism common to diverse lethality models. It would seem therefore that the complexity of endotoxicity in gram-negative infections is related primarily to the complexicity of the factors altering the susceptibility of the host rather than to be actual mechanisms of the lethal action of endotoxin. The identification of the factors leading to sensitization and their underlying mechanisms would contribute to a better understanding of the complex phenomenon endotoxicity.

Gamma interferon mediates Propionibacterium acnes-induced hypersensitivity to lipopolysaccharide in mice.

Pretreatment of lipopolysaccharide (LPS)-responder C57BL/10ScSn mice with killed Propionibacterium acnes enhanced tumor necrosis factor alpha (TNF-alpha) production and lethality in response to a subsequent challenge with LPS. Sensitization to LPS increased with time of pretreatment and reached its maximum after 7 days. Sensitization was paralleled by gamma interferon (IFN-gamma) production that was detectable from day 3 onward. In contrast, a similar P. acnes pretreatment of LPS-nonresponder C57BL/10ScCr mice had no apparent effect on their high resistance to LPS. Challenge with LPS at any time during the 7-day period after P. acnes treatment led to no detectable TNF-alpha formation and caused no lethal effects. The absence of sensitization in C57BL/10ScCr mice was paralleled by an absence of IFN-gamma production. Administration of monoclonal IFN-gamma antibodies in C57BL/10ScSn mice up to day 3 of P. acnes treatment completely inhibited the overproduction of TNF-alpha by LPS. Anti-IFN-gamma administered later than day 3 had only a partial, although significant, inhibitory effect. Injection of appropriate amounts of anti-IFN-gamma also abolished the development of hypersensitivity to the lethal action of LPS. The effect of exogenously administered IFN-gamma on LPS sensitivity (e.g., TNF-alpha production, lethal effects) was studied in LPS-responder and nonresponder mice. Administration of murine recombinant IFN-gamma increased the sensitivity of C57BL/10ScSn mice to LPS and established LPS responsiveness in LPS-nonresponder C57BL/10ScCr and C3H/HeJ mice. The data provide evidence that IFN-gamma mediates the sensitization towards LPS induced by P. acnes.

Combined partial trisomy 3p/monosomy 5p resulting in sonographic abnormalities.

We report here a case of partial trisomy of the short arm of chromosome 3 combined with partial monosomy 5p due to malsegregation of a balanced maternal translocation t(3;5). The newborn demonstrated esophageal atresia and complex cerebral malformations. Conspicuous sonographic findings offering the chance of prenatal detection included polyhydramnios without visualization of the stomach, as well as a single umbilical artery. The child died 8 days postpartum.

Prospective study of the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation.

UNLABELLED: The preventive effect of maternal avoidance of cow's milk and eggs on the development of atopic dermatitis and sensitization to food allergens was studied in a prospective trial with families at high risk for atopy, intervention included encouraging exclusive breast feeding for at least 3 months and delaying the controlled introduction of solid foods. In addition, one group received a maternal diet with the complete avoidance of milk and eggs in the last trimester of pregnancy and during the period of exclusive breast feeding, another group had the same diet starting after delivery, and mothers of the third group had no dietary restrictions. The period prevalences of atopic dermatitis as well as the rates of specific sensitization to eggs and milk at 6 and 12 months were not significantly different between groups. We were unable to demonstrate a significant preventive effect of maternal diet. CONCLUSION: While breast feeding should be promoted for children at risk for atopy, mothers can be encouraged to stay on normal diet during pregnancy and the breast feeding period.