[Results of surgical treatment of vulvar cancer]. / Resultate der operativen Behandlung des Vulvakarzinoms.

129 patients with carcinoma of the vulva were treated at the Dept. of Obstetrics and Gynaecology from 1966-1985. FIGO stage I was observed in 21% of the cases, FIGO stage II in 50%, FIGO stage III in 10% and FIGO stage IV in 8% of the patients. In 10% of the patients, definite classification was not possible. Mean age at the onset of the disease was 66.2 years, the mean time of observation 63 months. Kraurosis of the vulva or leukoplakia were simultaneous phenomena recorded locally in 67% of the patients. Histological investigation showed squamous cell carcinoma in 93% of the cases. The tumours were most frequently observed on the labia and the clitoris. 98% of the patients underwent surgery, 64% radical vulvectomy with inguinal lymph node disection. 56% of the patients of this group had a 5-year survival rate, which was 47% for the entire group of patients. Wound healing disorders were the most frequently observed postoperative complications. Metastasis to the inguinal lymph nodes at the time of diagnosis is the critical point of the prognosis. In the absence of lymph node involvement, 68% of the patients achieved a 5-year survival, in the presence of lymph node involvement, the 5-year survival rate was only 13%. Results obtained by this study support the view, that radical surgery at the earliest possible time is the treatment of choice for carcinoma of the vulva.

[Results of testing tumor resistance (in vitro--in vivo) in breast cancer]. / Resultate der Tumorresistenz-Testung (in vitro--in vivo) bei Mammakarzinomen.

In-vitro sensitivity to cytostatics was tested in 281 carcinomas of the breast using the test method introduced by Volm. The Adriamycin 3H-uridine test system was chosen for the analysis. Altogether, 84.7% of the tumors were testable. A correlation with the subsequent in-vivo result was found in 219 of the breast cancer patients. Only 8% of the breast cancers were unequivocally sensitive to the test (uridine incorporation rate less than 55% for verification). The mean uridine incorporation rate was 577 CPM. Neither tumor size, lymph node status, nor the estrogen and progesterone receptor content of the tumor cells influenced the test result. With regard to the breast carcinoma, no relationship was found between the predictive information and the subsequent in-vivo response to chemotherapy. This applied to both short-term observation periods of three to six months as well as longer-term follow-ups. Furthermore, no connection was found between sensitivity in vitro and probability of recurrence (p = 0.69) under cytostasis. Probability of survival was higher among patients with tumors that were not sensitive to the test than among those with tumors which were (p less than or equal to 0.001). In the authors' experience the Volm chemosensitivity test only appears to furnish prognostic information about the breast carcinoma; in the light of their data the test appears rather unsuitable as an aid to deciding whether or not to institute cytostatic therapy.

[Thrombocytopenia following intracervical prostaglandin priming]. / Thrombozytopenie nach intrazervikalem Prostaglandin-Priming.

Thrombocyte aggregation with normochromic anaemia occurred in a gravida III of 27 years of age with sonographically confirmed foetal hydrocephalus, after prostaglandin E2 cervical priming. The authors discuss the differential diagnostic possibilities, but the actual genesis of the changes remains unclear. Hence, it is recommended to check with particular care especially in induction of abortion, the coagulation system with the thrombocytes, over and above the well-known prostaglandin side effects. Special attention must be paid to the occurrence of allergic reactions, and it must always be borne in mind that induction of abortion after the 14th week of gestation is a risky matter (1).

PIP: Because of a hydrocephalic fetus, the 27 year old mother opted for abortion. This was done in the 21st week of pregnancy by ordinary intracervical application of 0.25 mg prostaglandin e2 gel. 30 minutes later the patient began to complain of nausea and dyspnea. Laboratory analysis revealed leukocytosis of 20800/ml and thrombocytopenia of 22000/ml, down from 150,000 ml before the procedure. There were no clinical indications of bleeding. The leukocytosis lasted 2 days and thrombocytopenia roughly 6 days. Treatment included administration of acetylsalicylic acid 3 x 0.5 g and dipyrimadol tablets 3 x 25 mg/day. After thrombocyte count was normalized, abortion was induced by means of spasmolysis and oxytocin i.v. In this case partial resorption of the prostaglandin indicates a systemic effect. Since the half life of E and F group prostaglandins is usually 1-3 minutes, and it is almost completely eliminated after passing through the liver and lungs, a direct prostaglandin effect leading to thrombocyte aggregation lasting several days is unlikely. Absence of thrombocyte antibodies point to a drug induced immune process in which the prostaglandin molecule could appear as a hapten. Ultimately the thrombocyte aggregation described here and normochromic anemia are of unclear origin. Changes in the patients' coagulation system are probably of no functional relevance. The initial leukocytosis must be considered a nonspecific immediate reaction.