Immunological characterization of mononuclear cells and morphological findings in patients with mammary carcinoma.

Mononuclear cells from peripheral blood and draining lymph nodes of 40 patients with invasive mammary carcinoma were examined for various immunological cell surface markers including surface membrane immunoglobulins and rosetting properties (E, EA, EAC). No significant relationship could be established to anyone of the following criteria for which the literature reports varying prognostic values: Clinical staging of the disease , histological tumor type, grading, nuclear differentiation, round cell infiltration, perivenous infiltration, sinus histiocytosis, and lymph node reaction patterns (lymphocyte predominance, germinal center predominance, lymphocyte depletion, unstimulated nodes). From the reported results it is concluded that the analysis of lymphocyte cell surface markers in mammary carcinoma is not a suitable parameter for supporting the existence of specific or unspecific anti-tumor immune reactions which may be suspected from certain histological reaction patterns.

[Studies of 57-co-bleomycin in patients with carcinoma colli uteri (author's transl)]. / Verteilungsstudien von 57Co-Bleomycin bei Patienten mit Carcinoma colli uteri.

The kinetics of 57Co-Bleomycin was studied in twelve patients with histologically proven carcinoma colli uteri and in ten patients with benign gynaecological conditions. Measurements were carried out on the whole body, on parts of the body and on urine and blood using a whole body counter. Excretion of the tumour-seeking radio-pharmaceutical is predominantly through the kidneys and can be described by a double compartment model. After 48 hours, 2-4% of the applied activity is still present in the body. Radiation exposure to the body, the kidneys and bladder was calculated from the measurements and MIRD tables as 0.02 rad/mci (total body), 0.4 rad/mCi (kidneys) and 0.2 rad/mCi (bladder). In view of the rapid elimination of 57Co-Bleomycin, these figures are lower than data data quoted in the literature. There was no evidence of significantly higher uptake of 57Co-Bleomycin in the carcinomatous epithelium of the collum uteri compared with benign diseases, using the total body counter in the scan node. As possible explanations for this, the authors suggest inadequate geometric resolution of the system and a low tumour/non-tumour distribution ratio.

[Renaissance of vaginal hysterectomy for cervical carcinoma. 100th anniversary of the first abdominal radical surgery of cervical carcinoma by Ernst Wertheim on November 16, 1898]. / Zur Renaissance der vaginalen Radikaloperation des Collumkarzinoms. Zum 100. Jahrestag der ersten abdominalen Radikaloperation eines Collumkarzinoms durch Ernst Wertheim am 16. November 1898.

In the 100 year long history of the abdominal radical operation of collum carcinoma, due to the continued clinical surgical and scientific work of several generations of physicians, abdominal radical operation with standardized pelvic lymphonodectomy has become the method of choice for surgical treatment of collum carcinoma since 1970. Vaginal radical operation in its various forms has since played only a very restricted role in surgical treatment of collum carcinoma. According to the opinion of the majority of cancer surgeons vaginal radical operation had to be abandoned in view of discontinuous spreading of carcinoma into the regional pelvic lymph nodes. Because of its simplicity vaginal radical operation would still be useful today for very old high-risk patients and very young women with early invasive collum carcinoma detected in cancer screening. In view of our knowledge of the lymph node problem in collum carcinoma, however, this can no longer be the vaginal radical operation of past generations. In order to prevent critical objections to vaginal radical operation, the early attempts of Stoeckel, Suboth Mitra, Bastiaanse, Navratil, Inguilla, and Akashi were resumed. Since 1989 attempts have been made to combine vaginal radical operation of collum carcinoma with laparoscopic pelvic or para-aortic lymphonodectomy. The development has passed the following stages: the development of laparoscopic pelvic and para-aortic lymphonodectomy based on staging criteria the combination of laparoscopic lymphonodectomy with vaginal radical operation of collum carcinoma the combination of laparoscopic lymphonodectomy with complete laparoscopic radical hysterectomy and only subsequent vaginal removal of organs.

[Clinical problems of the breast carcinoma in situ]. / Zur klinischen Problematik der in situ-Carcinome der Mamma

A report of carcinoma in situ of the breast, including problems of diagnosis and treatment. Over a 6-year period cut of a total of 743 carcinomas of the breast, 77 carcinomas in situ were observed. The difficulties of diagnosis are reviewed. Treatment consisted of simple mastectomy. In view of the inadequate therapeutic results it is recommended that a modified radical mastectomy should also be done in all cases of carcinoma in situ of the breast. The pros and cons of postoperative radiation are discussed.

[Classification and estimation of risks as a preoperative requirement for risk patients (author's transl)]. / Risikoklassifizierung und Risikoabwägung als Voraussetzung zur Operation von Risikopatientinnen.

The increase in gynecologic surgery for groups of risk patients, who, heretofore, have been considered as inoperable, forces us to systematize our procedures by estimating the surgical risk. The general surgical risk was high in 158 patients (10%). None of these patients died as a result of surgery. Suggestions were made, based on our own experience, for the extent of preoperative diagnostics, and for the form of the classification and estimation of risks. The improved possibilities for surgery can be extended to high-risk groups only when the existing risks are correctly estimated.

[Prevention of special complications in gynecologic operations. Part 2. Prevention of adhesions in the peritoneal region, prevention of wound healing disorders]. / Prävention spezieller Komplikationen bei gynäkologischen Operationen. Teil 2: Prävention von Adhäsionen im Peritonealraum, Prävention von Wundheilungsstörungen.

Own experiences in the prevention of certain complications of gynecological operations are presented. Prophylaxis proved to be possible intraoperatively in capillary bleedings and infections as well as postoperatively in disorders of intestinal motility, peritoneal adhesions and healing disturbances. The successful treatment of our patients in 1976 (1583 major operations including 158 patients at high risk) is summarized in suggestions for therapy.

[Clinical effectiveness and systemic toxicity of various mixtures of prilocaine and bupivacaine in axillary plexus block]. / Klinische Wirksamkeit und Systemtoxizität verschiedener Mischungen von Prilocain und Bupivacain zur axillären Plexusblockade.

The presently existing local anesthetics (LA) do not guarantee a rapid onset and simultaneously a long duration of action. The combination of a medium-long acting LA with bupivacaine, a long-acting LA with slow onset, could be means to achieve these aims. Prilocaine was chosen as the medium-long acting LA because it has the lowest toxicity of this group and for pharmacological reasons. METHODS. In a prospective, controlled double-blind study 100 patients scheduled for axillary block for elective surgical procedures of the hand or wrist were randomly assigned to five groups. Twenty patients in each group received either 40 ml prilocaine 1.5%; 40 ml bupivacaine 0.375%; 20 ml prilocaine 1% + 20 ml bupivacaine 0.5%; 20 ml prilocaine 2% + 20 ml bupivacaine 0.5%; or 20 ml prilocaine 2% + 20 ml bupivacaine 0.375%. The LA mixtures were freshly mixed 15 min prior to the axillary block. The blocks were performed using an immobile, short-beveled needle by anesthesiologists who were familiar with this technique. Analgesia was classified using the pin-prick method with 0 = no analgesia, 1 = analgesia, 2 = anesthesia. Motor blockade was classified with 0 = no motor block, 1 = paresis, 2 = paralysis. The following nerves were analyzed: ulnar, radial, median, musculocutaneous, and medial antebrachial. In 6 patients of each group plasma levels of the LA were measured by gas chromatography and methemoglobinemia was determined. Statistical analysis of the data was performed using the Student t-test and chi-square test on a level of significance of P less than 0.05. Results. All surgical procedures could be performed as planned in regional anesthesia. Twenty minutes after injection of the LA only 15% of the blocks were sufficient in the bupivacaine group, while in the other four groups 40%-50% of the blocks were complete (P less than 0.05). The degree of analgesia was deeper in the groups with 2% prilocaine and prilocaine alone than in the group with 1% prilocaine. Forty minutes after injection there were no significant differences between the groups. Motor blockade after 20 min was significantly lower in the bupivacaine group than in the prilocaine group (P less than 0.05). After 4 h all three prilocaine-bupivacaine mixtures showed a significantly more pronounced analgesia of the median nerve than the prilocaine group (P less than 0.02-0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

[Laparoscopy assisted radical vaginal hysterectomy (LAVRH) for cervical carcinoma--perioperative parameters and complications]. / Die laparoskopisch assistierte vaginale Radikaloperation LAVRO des Zervixkarzinoms--Perioperative Parameter und Komplikationsraten.

OBJECTIVE: Presently we note a standardization of techniques for laparoscopy assisted radical vaginal hysterectomy (LARVH). Altgassen et al. pointed to this fact with their evaluation of 108 operations for cervical cancer. They considered the necessity to perform 100 such operations before standardizing this method. In our survey we compare a similar number of operations performed in our department in order to prove whether Altgassen's thesis is correct, taking peri- and postoperative parameters as well as complications into consideration. For this purpose we analyzed the number of operations necessary to develop and standardize laparoscopic pelvic lymphadenectomy combined with radical vaginal hysterectomy in women treated for cervical cancer. PATIENTS AND METHODS: Between 1st August 1993 and 31st January 1999, 80 patients with cervical cancer FIGO stage Ia2-IIb were selected for laparoscopy assisted radical vaginal hysterectomy. We were able to perform this operation in 71 patients. The operation reports and records of the postoperative period were evaluated retrospectively. RESULTS: The average duration of the operation increased from 380 minutes in cervix carcinoma Ia2 to 530 minutes in cervix carcinoma IIb. The average blood loss remained the same at 1,000 ml for each operation. Correspondingly the average decrease of hemoglobin was 3.5% for all operations. The number of pelvic lymph nodes removed unilaterally varied between 6 and 13. If the group of 37 patients with cervical cancer FIGO stage Ib--particularly homogenous as far as the spread of the tumor and the course of the operation are concerned--is divided up into one group up to the 50th operation and another group after the 50th operation, the regression analysis after the 50th operation shows a statistically significantly higher number of lymphnodes (11 compared to 25; Mann-Whitney-U-Test, p = 0.00014). However no differences were found for mean blood loss (800 ml compared to 700 ml) or duration of operation (400 minutes compared to 420) (Mann-Whitney-U-Test, p > 0.05). 5% of serious complications were associated with the laparoscopic part of the procedure--a blood vessel lesion, a ureter lesion, two postoperative intraperitoneal secondary hemorrhages. 7.5% serious complications in the area of the bladder and the ureter were associated with the vaginal part of the procedure. In 6% of our procedures we observed lymphedema in the lower extremities. Deep Compartment Syndrome was observed in 5% of our patients and associated with the duration of the procedure. CONCLUSION: To implement and standardize our technique of laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy a learning phase of 50 procedures was necessary.

Prevention of rhesus isoimmunization with intravenous anti-D gammaglobulin.

The prevention of rhesus isoimmunization was studied in 2247 rhesus negative mothers given varying intravenous doses of gammaglobulin (IgG) anti-D post partum. The results obtained show that 240 microgram of IgG anti-D affords excellent protection, if the efficacy of prophylaxis is monitored by a single fetal cell count at 72 hours after injection, and further doses of immunoglobulin are given in the few cases where fetal red cells remain in the circulation.

[Comparative studies of total extraperitoneal hernioplasty in combined spinal epidural anesthesia versus balanced general anesthesia]. / Vergleichende Untersuchungen zur Durchführung der totalen extraperitonealen Hernioplastik in kombinierter Spinal-Epidural-Anästhesie versus balancierter Allgemeinanästhesie.

To appraise the clinical impact of combined spinal-epidural anaesthesia (CSE) in patients undergoing total extraperitoneal laparoscopic hernia repair (TEPP), we performed a prospective study in 40 patients. These patients were randomized to receive either CSE (n = 20) or a balanced general anaesthesia (BGA) with controlled ventilation (n = 20). The aim of the study was to determine the impact of the intraoperative gas insufflation on compensatory respiratory reactions during regional anaesthesia. Therefore, blood gas samples were drawn and additional parameters were assessed as follows: noninvasive haemodynamic, lactate and glucose levels, differential blood count, and the patients' level of comfort during the perioperative setting, which was determined by a questionnaire. In our study it was clarified that the respiratory compensation of extraperitoneal gas insufflation is not decreased by regional anaesthesia. The haemodynamic state of the patients was stabilized by early interventions. In addition--there was no evidence that the anaesthesia regime used had any influence on the so called stress-parameters. Most of the patients with regional anaesthesia showed severe agitation often accompanied by chest pain. Hence, regional anaesthesia is not recommended in this setting.

[Increasing individualization of the treatment of carcinoma of the endometrium (author's transl)]. / Zunehmende Individualisierung der Therapie des Endometriumkarzinoms

Metrium seen from 1969 to 1973 are reported. These results were compared to the results of treatment of carcinoma of the endometrium at the same institution between 1944 and 1960. There was a considerable increase of the mean age of the patients. Consequently the operability was reduced to 74.3%. The necessity to resort to primary radiotherapy rose to 25.7%. Diseases of old age were contra-indications to operative treatment. In cases generally fit for operation the contra-indications to vaginal surgery increased. Vaginal hysterectomy was therefore only employed in 78.5% of the operations. An individualization of the treatment of carcinoma of the endometrium is recommended. Continually good or improved results of the treatment are expected by individualization in the group of patients which already showed impaired health by age or concomittant diseases.

[The importance of the results of pretreatment pelvic lymphographies in the prognosis of carcinomas of the uterine cervix. A critical evaluation of the proposal to classify these tumors according to the TNM system (author's transl)]. / Lymphographieergebnis und Prognose von Kollumkarzinomen. Eine kritische Prüfung des Vorschlags zur Klassifizierung dieser Tumoren nach dem TNM-System

Between 1966 and 1969, 494 patients with carcinoma of the uterine cervix stages I a to IV were admitted in our hospital for primary treatment. In 420 of these patients with carcinoma of the cervix stage I b to IV, complete results of bilateral pretreatment pelvic lymphography are available. The correlation between the results of the lymphographies, the choice of the operative treatment and the cure rates in these 420 cases are reported. All the correlations between the results of the pretreatment lymphography and the prognosis are described. A positive lymphography was in our series of high prognostic value. A plea is therefore made to include the results of the pretreatment lymphography into the classification of carcinoma of the cervix. Classification of the carcinoma of the cervix into the TNM categories is desirable. Our series is reported in these TNM categories. The advantages of such classification are described. The morbid entity of carcinoma of the cervix becomes more transparent to the observer and the choice of operative therapy becomes easier. The prognosis is more clearly established. The proposals of the TNM committee of the UICC for the classification of carcinoma of the cervix according to the TNM categories and the staging according to these categories are discussed critically.

[Evaluation of the results of diminution mammoplasties (author's transl)]. / Zur Bewertung der Ergebnisse von Reduktionsplastiken der Mamma

The results of diminution mammoplasties are reported. From 1972 to 1974, 70 diminution mammoplasties according to Strömbeck were carried out. Indication for the operation was hypertrophy of the breasts with side effects of morbid value. In 47 patients side effects of the body posture were the leading indication. In 23 patients, psychosocial problems were the indication. Only patients with side effects of morbid value were considered to be sufficiently motivated to tolerate the total stress of the operation and the possible post-operative complications. The technical problems of the operation and the post-operative complications are described. 43 patients were followed up at least one year after the operation. In 36 patients the pre-operative complaints were alleviated by the operation. In 7 patients there was improvement. No patient had continuing pre-operative complaints. The mentally depressed and physically and psychologically in their relationship to their environment handicapped patients became usually more satisfied by the operation. Diminution mammoplasties are recommended for the operative treatment of hypertrophy of the breast with side effects of morbid value.

[The treatment of carcinoma in situ of the breast (author's transl)]. / Zur Therapie von Carcinomata in situ der Mamma

The management of 63 carcinomas in situ of the breast is reviewed. These 63 carcinomas in situ occurred among 575 carcinomas of the breast from 1969 to 1973. The treatment consisted of simple mastectomy. In cases of early invasion the axilla was explored by palpation of the adipose tissue for enlarged lymph nodes. None were found and no extirpation of the axillary nodes was carried out. Of 59 patients with carcinoma in situ of the breast, 3 later had a local recurrence. Two patients later died of distant metastases. In view of these inadequate results of simple mastectomy it is recommended that a modified radical mastectomy should also be done in all cases of carcinoma in situ of the breast.

[Organ-saving therapy of small ovarian cystomas and dermoids by surgical laparoscopy--a trial 1985-1987]. / Organerhaltende Therapie kleiner Ovarialkystome und Dermoide durch operative Laparoskopie--ein Versuch 1985-1987.

The article reports on the results of the removal of small benign ovarian tumors (teratoma, cystic adenoma) without oophorectomy. 10 patients were treated by laparotomy and 23 patients with operative laparoscopy. The laparoscopy procedure is limited to tumors not larger than 5 cm. In this procedure it is especially difficult to recognize the difference between a luteal cyst and a cystic tumor which is a already malignant. Careful preoperative and intra-operative attention must be paid to the differential diagnosis. So far, follow up of the 14 patients with cystic adenoma and the 19 patients with teratoma, has shown no recurrence of tumor in the remaining ovary.

[Endoscopic appendectomy in gynecology and obstetrics]. / Die endoskopische Appendektomie in Gynäkologie und Geburtshilfe.

From 1987 to 1990, 99 patients were treated for appendicitis. 67 patients were treated by endoscopic appendectomy, 32 patients underwent laparotomy for appendectomy. Among these 67 patients we found 4 patients with endometriosis, 6 with pelvic inflammatory disease, and 4 pregnant patients. In no case did we have difficulties during the laparoscopic operation; only 4 patients developed severe inflammatory complications during the postoperative period. For this reason, we do not perform a prophylactic appendectomy during gynaecological laparoscopies. We recommend careful postoperative treatment after laparoscopic appendectomy.