[Rate of proliferation as a prognostic criterion in endometrial carcinoma--an immunohistochemical analysis with the monoclonal antibody KI-S1]. / Die Proliferationsrate als Prognosekriterium beim Endometriumkarzinom--eine immunhistochemische Analyse mit dem monoklonalen Antikörper KI-S1.

In a subset of 183 primarily operative treated patients of 300 patients with endometrial carcinoma an analysis of histological tumor type (n = 142), myometrial invasion (n = 115), stage (n = 114), immunohistochemically detected steroid receptor status, histologic grading (n = 152) and growth fraction, detected by immunohistochemical determination of antibody Ki-S1 (n = 130), was performed. The mean follow up was 9.1 years. By univariate analysis, age, myometrial invasion (< = 3/>3 mm), expression of steroid receptor, FIGO-stage, histologic grading and growth fraction were found to influence the overall survival rate significantly. Cox multivariate regression showed age, FIGO-stage and growth fraction to be independent predictors of overall survival. With respect to survival univariate analysis revealed progesterone receptor status, FIGO-stage, histologic grading and growth fraction as prognostic factors. By multivariate analysis FIGO-stage, histologic grading and growth fraction were found to be independent prognostic factors for survival. Multivariate and univariate analysis exhibited FIGO-stage, histologic grading and growth fraction rate to be independent predictors of a disease-free survival. Immunohistochemically detected growth fraction seems to be useful as an additional prognostic factor in endometrial cancer.

[Local therapy and adjuvant interferon therapy in genital papilloma virus infections]. / Lokaltherapie und adjuvante Interferontherapie bei genitalen Papillomvirusinfektionen.

OBJECTIVE: Is it possible to reduce the recurrence rates of HPV-positive genital tract lesions by systemic interferon alfa-2a in addition to local therapy? METHODS: Thirty-three of 63 patients with first manifestation of papillomavirus infection or monolocal manifestation were treated by local therapy. The other 30 patients with recurrent or multiorgan infections received 3 courses with 12 x 10(6) IU interferon alfa-2a subcutaneously. RESULTS: For the remaining 47 patients (16 were lost to follow-up) we found a significantly lower recurrence rate of 21% (5 of 24) in the group of interferon-treated patients compared to 52% (12 of 23) of patients treated without interferon. CONCLUSIONS: The systemic treatment of HPV-positive genital tract lesions with interferon alfa-2a in addition to CO2 laser surgery or cone biopsy seems to reduce the recurrence rates of HPV-positive lesions.

[Doppler ultrasonography differential diagnosis in twin pregnancies]. / Dopplersonographische Differentialdiagnostik bei Zwillingsschwangerschaften.

The prognostic value of Doppler sonography concerning the estimation of fetal weight and risk in case of fetal growth discrepancy was examined on the basis of 41 twin pregnancies. Between the 25th and 40th week of gestation we did 132 pulsed Doppler measurements of the thoracic aorta and umbilical artery of both fetuses. The prenatal Doppler values--the pulsatility index in aorta and umbilical artery respectively the maximal aortic flow velocity--were set against postnatal clinical data and morphological findings of placenta and umbilical cord. From a weight discrepancy of more than 20% a correlation between pulsatility difference in fetal aorta and particularly in umbilical artery with weight difference is evident. On the other hand conclusions only from discrepant Doppler values can't be drawn concerning divergent weight development. The difference between measured and normal Doppler values is decisive for the fetal outcome. Our standard Doppler values drawn from 27 normal twin pregnancies don't differ from those of normal single pregnancies. The worst prognostic criterion was the diastolic zero-flow in the umbilical artery. In case of a decreased but still detectable diastolic bloodflow the birth and neonatal condition were often normal, although the birth weight was low. In case of fetal transfusion syndrome these criteria can't be used to judge the fetal risk. On the one hand we found a normal pulsatility index in the umbilical artery of donor and recipient twin. On the other hand the maximal aortic flow velocity may be increased and the pulsatility index in this vessel may be decreased in donor as well as in recipient twin. This depends on the extent of fetal anemia respectively of cardial compensation.

[Toxic shock syndrome following cesarean section]. / Toxic Shock Syndrom nach Sectio Caesarea.

The typical onset, development and therapy of the Staphylococcus aureus exotoxin (TSST-1)-induced Toxic Shock Syndrome is reported in a case of a 32 years old I. Para/I. Gravida following caesarean section. The outcome of this rare but often lethal disease depends on early diagnosis and treatment.

[The importance of the SCC antigen in the diagnosis and follow-up of cervix carcinoma. A cooperative study of the Gynecologic Tumor Marker Group (GTMG)]. / Bedeutung des SCC-Antigens in der Diagnostik und Verlausfskontrolle des Zervixkarzinoms. Eine kooperative Studie der Gynäkologischen Tumor-Marker-Gruppe (GTMG).

SCC (squamous cell carcinoma) antigen is a subfraction of tumour antigen TA-4 isolated from cervical squamous cell carcinomas. Serum concentrations of SCC antigen were measured by radioimmunoassay in 382 control subjects, 70 women with cervical intraepithelial neoplasia (CIN), 517 with cervical carcinoma and 203 with other gynaecological carcinomas. Elevated SCC antigen levels (greater than 2.5 ng/ml) were found in 4% of normal controls, in 7% of women with CIN I-III, in 2%-23% with various forms of genital adenocarcinomas, in 55% with primary and in 76% of those with recurrent cervical squamous cell carcinoma. The positivity rate of the antigen was correlated with tumour stage (FIGO) and lymph node involvement of primary cervical squamous cell carcinomas. During long-term follow-up serum levels of SCC antigen were found to be concordant with tumour activity in 74% of cases. Patients with still elevated marker levels after therapy had twice the recurrence rate of women with normal serum values. Routine determination of SCC antigen during follow-up of cervical cancer is recommended.

Pregnancy following induction of ovulation with pure FSH after suppression of endogenous gonadotropins with subcutaneous buserelin.

Ovarian stimulation in patients with disorders of ovulation or an inadequate luteal phase using human menopausal gonadotropins (hMG) gives a low pregnancy rate with a high incidence of overstimulation and a premature LH surge. In order to overcome these problems, a new approach has been used, namely prior suppression of endogenous gonadotropins with a gonadotropin-releasing-hormone analog (LHRH) and subsequent ovarian stimulation with hMG. We present a case of ovarian stimulation with pure FSH during suppression of endogenous gonadotropins with the LHRH analog Buserelin. A clinical pregnancy was achieved in the first treatment cycle and led us to conclude that follicular development does not depend on LH stimulation. This could be of substantial interest in IVF programs.

[Monoclonal antibodies in the diagnosis and follow-up of ovarian cancer. CA 125 as a tumor marker. A cooperative study of the Gynecologic Tumor Marker Group (GTMG)]. / Monoklonale Antikörper in Diagnostik und Verlaufskontrolle des Ovarialkarzinoms. CA 125 als Tumormarker. Eine kooperative Studie der Gynäkologischen Tumormarkergruppe (GTMG).

The clinical validity of using the cancer antigen (CA) 125--a surface antigen on malignant epithelial ovarian tumors--for diagnosis and follow-up of ovarian cancer was investigated in a cooperative study. Using a monoclonal antibody (OC 125) to detect CA 125, the sera of 850 patients were analyzed by immunoradiometric assay (IRMA-Kit Centocor). For 199 patients with ovarian cancer, a preoperative sensitivity of 83% and 74% resulted for the usual cut-off points (greater than or equal to 35 and greater than or equal to 65 U/ml respectively). The positivity rates and quantiles correlated with the stage of disease (FIGO) and with the tumor debulking achieved at primary surgery. The most frequent histological types (serous cyst-adenoma and the undifferentiated carcinoma of the ovary) showed the highest positivity rates (80% and 90%, respectively, for cut-off at greater than or equal to 65 U/ml). Elevated CA 125 values were found in 74% of the cases with a relapse and in 79% of the patients with advanced disease (cut-off, greater than or equal to 65 U/ml) in the follow-up of ovarian cancer. We recommend cut-off at greater than or equal to 65 U/ml, because the values for only 1% of the female healthy controls (n = 251) were above this level. Also 17% of the patients with adnexitis and 8% with benign neoplasias of the ovary showed elevated titers. Therefore CA 125 should not be used for mass screening of ovarian carcinoma. However, it is a helpful laboratory tool in the diagnosis of recurrence and the surveillance of patients with ovarian cancer.

[Value of CA 125 in comparison to conventional tumor markers in ovarian cancer]. / Wertigkeit des CA 125 im Vergleich zu konventionellen Tumormarkern beim Ovarialkarzinom.

It was the aim of this study to evaluate the clinical significance of the monoclonal test system CA 125 in comparison to 7 conventional laboratory procedures (TPA, PHI, CEA, LDH, GGT, AP, ESR) as tumour marker in ovarian cancer. Serum samples from 327 patients with histologically proven cancer of the ovary were analysed. Marker results were correlated to tumour activity as defined by the criteria of the UICC. Furthermore, in 175/327 patients who were clinically symptom-free after primary therapy, marker courses were analysed with regard to the development of recurrence. Positive rates and median values of CA 125, TPA, PHI and ESR showed significant increases with progression of the disease, whereas correlation was less clear-cut with CEA, LDH, GGT and AP. In clinically tumour-free patients without evidence of recurrence during the further course, intermittent increases of PHI, ESR and especially TPA were found in 19-47%. However, such "false positive" marker courses were not seen with CA 125. Those patients who developed recurrent disease exhibited increasing CA 125 titres in 68%. The incidence of such "true positive" markers courses was less frequent with PHI, ESR and TPA. Our results indicate that CA 125 and--with limitations--TPA, PHI and ESR may be used in ovarian cancer control. When monitoring tumour-free patients, CA 125 exhibited the highest specificity and sensitivity. Using 65 U/ml as cut-off, a positive CA 125 titre indicates recurrent disease with great certainty. When employing PHI, ESR and especially TPA, however, the possibility of "false positive" increases has to be taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prenatal sonographic diagnosis and clinical consequences in small intestine obstruction]. / Sonographische Pränataldiagnostik und klinische Konsequenzen bei Dünndarmobstruktionen.

Fetal intestinal obstructions can be diagnosed and differentiated from other intra-abdominal lesions with prenatal sonography. The characteristic signs are persistent echo-free areas in the fetal abdomen which frequently show peristaltic movements, and the accompanying polyhydramnios. A vaginal delivery near term is desirable and tocolytic agents and therapeutic amniocentesis should be used in the event of premature labour and maternal distress due to polyhydramnios. Premature labour also necessitates the induction of pulmonary maturation with corticoids. At least weekly ultrasonic controls are advisable to detect the rare bowel perforation. In the case of an intestinal rupture, the risk of prematurity must be weighed against the risk of abacterial meconium peritonitis before labour is induced. Own observations in five prenatally diagnosed intestinal obstructions and a review of the literature confirm the proposed management in these infants.

[Combined B image Doppler sonography--measurements in the in vitro model and in fetal vessels]. / Kombinierte B-Bild-Doppler-Sonographie--Messungen am In-vitro-Modell und in fetalen Gefässen.

With the combination of B-mode real time scanner and a pulsed Doppler unit the blood flow in fetal vessels can be determined. The accuracy and limitations of the method are tested in an in-vitro-model (artificial pulsatile blood circulation in a silicon tube placed in a water bath). Conditions of measurements are constant in the circulation model. For defined pumped flow rates between 350-800 ml/min we found too high Doppler values throughout the range. Depending on the use of high-pass filters and on the higher depth of sample volume the Doppler flow shows an increasing deviation, but there is a good linearity of the Doppler values (r = 0,99). The blood flow in umbilical vein (n = 42) and fetal descending aorta (n = 65) do not differ very much in the last month of normal pregnancy. We found a significant decrease of flow in both vessels after 41 weeks of pregnancy. The clinical validity of quantitative results of Doppler-sonography is limitated by the described problems of high-pass filtering, depth of sample volume and determination of the diameter of the vessel.

[The use of sonography as a complementary procedure in the orthopedic hip diagnosis in newborn infants (a pilot study)]. / Der Einsatz der Sonographie zur Ergänzung der orthopädischen Neugeborenenuntersuchung der Hüften (Eine Pilotstudie).

In this study we tried to complete the clinical Newborn-control by sonographically investigation at the Newborn-ward. The routine clinical and sonographical combination seems to be successful. Further investigation will be necessary for the sonographic analysis of the physiologic and dysplastic acetabulum. Here we must discuss, if radiological signs can be partially translated for sonography. At last the study checked further technical-sonographical details.

[Experiences with single-shot peridural anaesthesia in obstetrics (author's transl)]. / Erfahrungen mit der Single-shot-Periduralanästhesie in der Geburtshilfe.

Analysed are the epidural anaesthesias of the years 1977 and 1978, which were carried out with the single-shot-method. Frequency of instrumental vaginal delivery of primiparae and multiparae, outcome of the newborn immediately post partum by the Apgar-score and complications compared with a group without epidural anaesthesia are being examined. There is an increase of instrumental vaginal deliveries from 5,7% to 21% after using epidural anaesthesia. Primiparae are mainly concerned by 29,2%, whereas multiparae are only concerned by 10%. The whole rate of complication is 14,4% (here of hypotension in 7,8% of the cases). Asphyxias of the newborn are not significantly more frequent in the group with epidural anaesthesia. For the time the epidural anaesthesia remains the most effective method of analgesia during the delivery, although the maternal and fetal risk should not be underestimated.