Combined treatment of inoperable carcinomas of the uterine cervix with radiotherapy and regional hyperthermia. Results of a phase II trial.

AIM: The disappointing results for inoperable, advanced tumors of the uterine cervix after conventional radiotherapy alone necessitates improving of radiation therapy. Simultaneous chemotherapy or altered radiation fractionation, such as accelerated regimen, increase acute toxicity and treatment is often difficult to deliver in the planned manner. The purpose of this phase II study was to investigate the toxicity and effectiveness of a combined approach with radiotherapy and regional hyperthermia. PATIENTS AND METHODS: From January 1994 to October 1995 18 patients with advanced carcinomas of the uterine cervix were treated in combination with radiotherapy and hyperthermia. The patients were treated with 6 to 20 MV photons delivered by a linear accelerator in a 4-field-box technique to a total dose of 50.4 Gy in 28 fractions. In the first and fourth week 2 regional hyperthermia treatments were each applied with the Sigma-60 applicator from a BSD-2000 unit. After this a boost to the primary tumor was given with high-dose-rate iridium-192 brachytherapy by an afterloading technique with 4 x 5 Gy at point A to a total of 20 Gy and for the involved parametrium anterioposterior-posterioanterior to 9 Gy in 5 fractions. RESULTS: The acute toxicity was low and similar to an external radiotherapy alone treatment. No Grade III/IV acute toxicity was found. The median age was 47 years (range 34 to 67 years). In 16 of 18 patients a rapid tumor regression was observed during combined thermo-radiotherapy, which allowed the use of intracavitary high-dose-rate brachytherapy in these cases. Complete and partial remission were observed in 13 and 4 cases, respectively. One patient did not respond to the treatment. The median follow-up was 24 months (range 17 to 36 months). The local tumor control rate was 48% at 2 years. Median T20, T50 and T90 values were 41.7 degrees C (range 40.3 to 43.2 degrees C), 41.1 degrees C (range 39.2 to 42.5 degrees C) and 39.9 degrees C (range 37.7 to 41.9 degrees C), respectively. Cumulative minutes of T90 > 40 degrees C (Cum40T90) and cumulative minutes, which were isoeffective to 43 degrees C, were calculated (CEM43T90, CEM43T50, CEM43T20). CEM43T90 was found to be a significant parameter in terms of local tumor control for the 4 hyperthermia treatments (p = 0.019). CONCLUSIONS: This treatment modality has proved to be feasible and well tolerable. The rapid tumor shrinkage in the combined approach of radiotherapy with hyperthermia before beginning brachytherapy seems to be a good prerequisite for improving of the disappointing results in cure of advanced cancer of the uterine cervix.

[A case of septic ovarian vein thrombosis]. / Ein Fall von septischer Ovarialvenenthrombose.

Puerperal ovarian vein thrombosis commonly originates from purulent necrotic endomyometritis. The incidence is published to be 1 to 600 deliveries. According to the puerperal uterine drainage, the predominant location is the right ovarian vein in 90% of all cases. The leading symptoms are lower abdominal pain, fever and leucocytosis. Discrepancy between the given clinical picture and the insignificant findings on gynaecologic examinations is common.

[Percutaneous catheter embolization of the of the internal iliac artery in life-threatening gynecological bleeding]. / Perkutane Katheterembolisation der Arteria iliaca interna bei lebensbedrohlichen gynäkologischen Blutungen.

16 patients with life-endangering hemorrhages caused by gynecologic malignancies have been treated with the percutaneous transcatheter embolisation. In general for embolisation of the internal iliac artery gelfoam was used. Life-endangering bleeding could be stopped in all cases, only 3 mild persistent bleedings and another recurrence of hemorrhage could be controlled conservatively. Major-complications did not occur. The significant advantage of catheter embolisation in controversy to surgical treatment is discussed.

[Hormonal contraception in the male]. / Hormonale Kontrazeption beim Mann.

PIP: Representatives of the feminist movement have argued with increasing emphasis that the man should bear responsibility for contraception equal to the responsibility of the woman. From the endocrinological point of view, however, hormonal contraception is quite different for men. It is in principle simpler to interrupt a cyclic phenomenon such as ovulation than it is to stop the continual production of million of spermatozoa which are always available for impregnation. This constant production of spermatozoa depends upon constant stimulation by gonadotropins, and much higher doses of steroids are required than are for prevention of ovulation. In the man the basal gonadotropin secretion must be suppressed by high doses of hormone; in the woman it is sufficient to suppress the spikes in gonadotropin secretion. Luteinizing hormone, follicle stimulating hormone and prolactin all play a role in the synthesis of testosterone. Several approaches to hormonal contraception have been suggested, including suppression of gonadotropin secretion at the hypothalamus-pituitary level by sexual steroids, by direct influence on spermatogenesis by suppressing individual steps in the development or by inhibition of spermatic ripening in the epididymis. Animal experiments have demonstrated that an immunological approach against luteinizing hormone can interrupt spermatogenesis, but since steroid synthesis would also be affected, this approach must await isolation and characterization of the specific mechanism of inhibition.^ieng

[Contraception in adolescents]. / Kontrazeption bei Jugendlichen.

PIP: Psychosocial problems of contraceptive use among adolescents are reviewed. Consideration is given to contraceptive counseling, permanent contraceptive methods, and hormonal contraception. The geographical focus is on developed countries.^ieng

[In vitro studies of amniotic fluid and intrauterine growth retardation]. / In vitro Untersuchungen von Fruchtwasser und intrauterine Retardierung.

Until now the intrauterine growth retardation remains as an insufficiently solved problem. The 3H-thymidine incorporation into the DNA of the isolated islets of Langerhans of neonatal Lewis rats was used as a marker for cell dividing activity in vitro. There was no inhibition effect on the 3H-thymidine incorporation in the presence of amniotic fluid from pregnancies with intrauterine growth retardation compared to those of normal pregnancies.

Correlates of temperate and intemperate attitudes toward alcohol use.

The relationship between alcohol attitudes and the personality variables of locus of control and authoritarianism was investigated for a sample of 791 high school students. Authoritarianism was negatively related to indiscriminate attitudes and positively related to responsible attitudes toward alcohol use for both males and females. The locus of control dimension correlated with alcohol attitudes for females only. The findings provide information useful in the identification of adolescents at risk for problematic drinking.

[Results of a prepartal monitoring program in twin pregnancies]. / Ergebnisse eines präpartalen Betreuungsprogramms der Zwillingsschwangerschaft.

152 multiple pregnancies were examined retrospectively. In one group (A) of 59 multiple pregnancies was no therapy, whereas in the other one (B) of 93 multiple pregnancies the duration of pregnancy was prolonged by an early diagnosis using ultrasound, taking out of working process, cerclage in the 16th to 20th gestational week, compulsory hospitalisation (29th to 36th gestational week) and tocolysis and induction of labor in the 39th gestational week. By this duration of pregnancy could be prolonged about 17 days. 36th week could be reached by 82 per cent of the so tended pregnancies, 37th week by 35 per cent. Comparing the two regimes the mean birth weight of twin I increased significantly from 2170 to 2420 g and of twin II from 2210 to 2390 g. The percentage of neonates over 2000 g rose from 53,4 per cent to 72.8 per cent. Perinatal mortality decreased from 8.4 per cent to 3.3 per cent.

[New aspects of the Heidenreich and Beck perfusion method in urodynamics. I: Practical experience with a complex urodynamic work station]. / Neue Aspekte der Perfusionsmethode nach Heidenreich und Beck in der Urodynamik. Teil I: Praktische Erfahrungen mit einem komplexen urodynamischen Arbeitsplatz.

122 patients with urinary incontinence of all degrees and 32 controls are investigated by means of a complex urodynamic unit constructed by the authors. Essential part is a robust selfmade three-canal-catheter of heatsealed angiographic material with an external diameter of 10 Charr., which undamagedly can be used at least forty times. The unit enables to do cystometries and simultaneous cystourethrotonometries with electromyography of pelvic floor and mictiometries. The investigations are possible at a normal expense in lying or sitting and all intermediate positions. Many urometric parameters had been determined with aid of perfusion uromanometry according to the principle of Heidenreich and Beck. New combinations had been elaborated. The functional length of urethra in stress profile, the maximal urethral closing pressure, the electronically registered urethral closure pressure, the depression factor and the stress quotient are of special importance. By means of these criteria the qualification of the apparently old fashioned perfsuion uromanometry for a modern urodynamic diagnosis could be demonstrated. The results are compared with those obtained with microtransducer technique.

[New aspects of the Heidenreich and Beck perfusion method in urodynamics. II: Effect of examination position on parameters of urethral pressure profile]. / Neue Aspekte der Perfusionsmethode nach Heidenreich und Beck in der Urodynamik. Teil II: Der Einfluss der Untersuchungsposition auf die Parameter des Urethradruck-Profils.

The perfusion urethrotonometry was used in this study in 34 patients both in lying and upright position as paired comparisons. The following problems could be solved: 1. Using the complex urodynamic unit of the authors examinations are possible in vertical position successfully. 2. The urethral pressure profiles are equivalent qualitatively in both examination positions. 3. The analysis of the profiles of both positions on principles demonstrates the same valuation. In case of incontinence the relevant parameters for diagnosis (functional length of urethra in stress profile, electronically registered urethral closure pressure in stressful situation, transmission and depression factor and stress quotient) show clearer in the upright position than in the lying one. In continent women the change of position has no significant influence. If the criteria in lying position are not well defined, the urethral pressure profile in upright position should be done as additional examination.

[The action of oxyfedrine on haemodynamics, inotropism and blood perfusion of the partially ischaemic myocardium after digoxin premedication. Studies on anaesthetized dogs (author's transl)]. / Die Wirkung von Oxyfedrin auf Hämodynamik, Inotropie und Durchblutung des partiell ischämiegeschädigten Myokards nach Prämedikation mit Digoxin. Untersuchungen am narkotisierten Hund.

The effect exerted on the partially ischaemic heart when administering 0.9 mg/kg L-3-(beta-hydroxy-alpha-methylphenethylamino)-3'-methoxypropiophenone (oxyfedrine, ildamen) approx. 10 min after i.v. application of 0.05 mg/kg digoxin was tested on 20 dogs previously anaesthetized with propiomazine-pentobarbital. The following parameters were studied and subsequently compound with the results of former trials of ours' without digoxin premedication: aortic pressure (ASP, ADP), left-ventricular pressure (LVSP, LVEDP), heart rate (HR), cardiac output (HMV), stroke volume (SV), dp/dtmax, dp/dtmax/IP, t-dp/dtmax, blood flow in the normal and partially ischaemic myocardium, the latter being measured with heat conductance probes and labelled microspheres. ASP and ADP show the same reduction--as compared with the control value--both after the administration of oxyfedrine with and without digoxin premedication. After digoxin premedication oxyfedrine led to a somewhat less marked reduction of LVSP; on premedication with digoxin LVEDP was slightly increased whereas it was reduced after additional administration of oxyfedrine as was also the case without digoxin pretreatment. The increase in HR after oxyfedrine is almost the same as without digoxin pretreatment. Also the increase in HMV and the SV lowering are not influenced by digoxin. By administration of oxyfedrine dp/dtmax is always increased by the same amount, starting from the already increased value after digoxin premedication, which is probably an additive effect. The same applies to the quotient dp/dtmax/IP. After oxyfedrine the time t-dp/dtmax is lowered by the same amount, irrespective of a digoxin premedication. Oxyfedrine does not produce a further increase in the heat conductance values after previous application of digoxin; when measuring the blood flow with labelled microspheres the same result was found, which means that by previous administration of digoxin the circulatory effect of oxyfedrine is obviously inhibited. Summing up one can say that by combining the active principles digoxin and oxyfedrine the function parameters of the heart can be influenced only positively.

[Surgical treatment of prolapse of vaginal stump (author's transl)]. / Zur operativen Behandlung des Scheidenstumpfprolapses.

Prolapse of the vaginal stump, following hysterectomy, is relatively rare. Its treatment is not always gratifying for its high rate of recurrence. -- While there is a great number of proposed surgical approaches to prolapse, the author actually resorted to one vaginal and one abdominal method for his own surgical treatment of 24 patients with prolapse of the vaginal stump. The vaginal method was the one proposed by Symmonds and Pratt and the abdominal was promontory fixation. The latter method appeared to be the safest with regard to recurrence.