[Birth rate, stillbirth rate and infant mortality of legitimate and illegitimate newborn infants in Austria 1987-1996: an ecological study]. / Geburtsgewicht, Totgeburtenrate und Säuglingssterblichkeit von ehelichen und unehelichen Geborenen in Osterreich von 1987 bis 1996: eine Ekologische Studie.

BACKGROUND: The infant mortality in babies of single mothers in Great Britain is 33% higher than in babies of married mothers. There exists hardly any recent publication on infant mortality and stillbirth rate in association with the marital state of the mother from other European countries. METHODS: From 1987 to 1996 birth weight, stillbirth rate and infant mortality of all Austrian legitimate and illegitimate births were registered by the Austrian Central Statistical Office. Differences between the legitimate and illegitimate newborns were analysed. RESULTS: Within the observation period there was a clear overall reduction (48%) of infant mortality from 9.8 to 5.1 per 1000. Overall stillbirth rate remained stable at 3.7 per 1000 births. The birth weight of illegitimate infants was significantly lower and their weighted average stillbirth rate was 20.4% higher (range -10% to +48%) over the ten year observation period. The weighted average infant mortality during the observation period was 24% higher (range 0% to +44%) for illegitimate infants. CONCLUSION: In Austria illegitimate birth was associated with lower birth weight, higher stillbirth rate and increased infant mortality between 1986 and 1997.

[Initial experiences with ambulatory irrigation hysteroscopy]. / Erste Erfahrungen mit der ambulanten Flüssigkeitshysteroskopie.

During one year, 120 patients were referred for outpatient diagnostic hysteroscopy. The most common indications were abnormal uterine bleeding (67%), followed by sterility and infertility, respectively (18%). The uterine cavity was visualised in 103 patients, and about half of the patients (50.5%) had demonstrable uterine pathology. 75 patients (72.8%) did not experience any pain during or after the examination and 28 women (27.2%) reported varying levels of pain. In 17 cases (14%) passage through the internal cervical os was either not possible for anatomical reasons or was not tolerated by the patients. However, diagnostic hysteroscopy, combined with directed biopsy where appropriate, is now considered the method of choice for identifying intrauterine pathology. Performed in an outpatient setting, diagnostic hysteroscopy using a fluid distention medium is largely pain-free and hardly accompanied by side effects, provided patients are thoroughly counseled beforehand. Essential preliminaries for a successful examination are careful patient selection, a clear clinical indication and, above all, the skilled coordination between eye and hand. More widespread use of diagnostic hysteroscopy may spare numerous women the stress of curettage while at the same time facilitating optimal selection of those cases really requiring further medical examination or therapy.

Hystero-salpingo scintigraphy: a routine investigation in sterile women?

Based on the spontaneous migration of radioactive tracer from the posterior vaginal fornix to the ovaries and peritoneal cavity, several attempts were made to assess hystero-salpingo scintigraphy (HSS). The low acceptance rate by sterile women of routine investigation of tubal function may be due to a fear of radiation exposure and unpleasant examination procedures. Our protocol for HSS adopts a low dose of radioactive tracer (0.2-0.3 mCi), a defined mode of application (between the external and internal os of the cervical canal) and a short imaging time (60 min). From 1990 to 1992, we investigated 60 fallopian tubes in 32 sterile women by HSS, hystero-salpingography (HSG) and/or chromopertubation during laparoscopy (LPSC). The results of HSG and HSS corresponded in 15 of 49 fallopian tubes, LPSC and HSS in 9 of 24. None of the 32 patients had become pregnant naturally during the average observation period of 17 months. Two patients became pregnant after in-vitro fertilization. HSS, performed according to our protocol, causes less pain and results in a lower dose of radiation than HSG (about 50%). It is well accepted by patients and is easy to perform. As an investigation of tubal function, HSS may serve as an additional examination technique in cases of presumed tubal sterility.

Three-dimensional video-endoscopy: clinical use in gynaecological laparoscopy.

We describe a system that displays the abdominal organs in three dimensions during laparoscopy. The system consists of a single-rod-lens endoscope and two integrated microchip cameras. The surgeon has to wear active-liquid-crystal shutter-glasses to obtain a three-dimensional impression during the operation. Improved orientation in the abdominal cavity allows exact handling of surgical instruments. The three-dimensional system permits surgery with more accuracy, speed, dexterity, and safety than conventional two-dimensional systems.

Combined use of 123I-labelled BCD-F9 and 4C4 monoclonal antibody with dissimilar specificity for breast cancer: implication for the detection limit of immunolymphoscintigraphy in the assessment of axillary lymph node metastases.

To determine whether the detection limit of immunolymphoscintigraphy (ILS), reported to be > or = 1 cm, can be improved by comparing imaging after administration of breast cancer-specific monoclonal antibody (MAb) BCD-F9 and breast cancer-nonspecific 4C4, 25 patients with suspected breast cancer were given injections of both 123I-labelled MAbs. The ILS was performed independently for both MAbs, the 4C4 scans serving as an ipsilateral negative control, and was used preoperatively to detect lymph node metastases. Twenty-one patients had breast cancer of whom 11 patients suffered from axillary involvement. Single interpretation of BCD-F9 scans gave true positive results in six of 11 and true negative results in 12 of 14 patients, whereas combined interpretation of BCD-F9 and 4C4 scans gave true positive results in nine of 11 and true negative results in 14 of 14 patients. On the basis of comparison of scintigrams of both MAbs, ILS allowed the detection of lymph node metastases 0.3-0.8 cm in diameter (n = 3). Immunohistochemistry of BCD-F9 and 4C4 MAbs of tumour-free and tumour-bearing lymph nodes correlated with ILS, with the exception of one patient. The study suggests that comparing scans obtained with BCD-F9 and 4C4 MAbs may improve the detection limit of ILS in the preoperative staging of axillae.

[First use of a 3D video-endoscope in gynecology]. / Erstmaliger Einsatz eines 3D-Videoendoskopes in der Gynäkologie.

A new 3D-videoendoscope offers a three-dimensional visualisation of organs and anatomical structures during laparoscopy. This system consists of a stereoendoscope, two microchip cameras and an electronic control system. The use of liquid crystal (LC)-shutterglasses gives a three-dimensional impression to the examiner. The advantages of this 3D-videoendoscopic system are: exact preparation and more rapid application of endoscopic suturing techniques.

[Isotope nephrogram in follow-up of radically operated cervix cancers]. / Isotopennephrogramm in der Verlaufskontrolle radikal operierter Zervixkarzinome.

257 patients suffering from cervical cancer (stage I and II according to FIGO classification) were included in this retrospective study. All of them underwent radical surgery between 1978 and 1987, including pelvic lymphadenectomy. In addition to conventional follow-up procedures, isotope nephrograms (ING) were performed as a routine measure. ING curves reflect renal function and serve as a highly sensitive qualitative parameter of urine flow. It may therefore be used as indirect indicator of pathologic changes in the small pelvis, such as recurrent disease. Follow-up period was between 3 and 10 years. Chi-square test was used to determine the probability of correlation between the evidence of pathologic ING-curves (yes/no) and a) lymph node status (pos/neg), b) patients, who underwent adjuvant radiotherapy (yes/no), or c) patients, who revealed recurrent disease (yes, no). All of the subgroups showed significant positive correlation. Pathological ING curves appeared a) in 61% of patients having a positive lymph node status (n = 66, p = 0.001), in 88% of patients, who developed recurrent disease (n = 56, p = 0.001) and in 44% of patients, who received adjuvant irradiation therapy (n = 131, p = 0.05). The high degree of sensitivity of ING concerning urinary tract obstruction seems to justify the routine use of this method in the follow-up of these patients. It should help to identify impaired renal function in good time.

[Ovarian cancer after hysterectomy]. / Ovarialkarzinom nach Hysterektomie.

Between 1978 and 1988 we treated 538 patients at our department because of ovarian cancer. Among them were 37 patients, who had undergone hysterectomy before. When ovarian cancer was diagnosed, 28/37 were already in stage III or IV according to the FIGO classification (75.7%). Theoretically in 37/538 (6.8%) of our patients ovarian cancer could have been prevented by prophylactic oophorectomy during the previous hysterectomy performed because of other reasons. Current possibilities of hormone replacement could facilitate such a decision in individual cases.

[Lymphoscintigraphy with (123)I-marked epidermal growth factor in cervix cancer]. / Lymphszintigraphie mit 123I-markiertem epidermalem Wachstumsfaktor beim Zervixkarzinom.

Several malignant neoplasms express high levels of epidermal growth factor receptors. The aim of this study was to assess whether 123I-labeled epidermal growth factor can concentrate in lymph node metastases of squamous cell carcinomas of the cervix. 14 patients with advanced cervical cancer were selected because of their high probability of lymph node metastases. Planar scintigrams were recorded from the lower and upper abdomen following subcutaneous injection of 123I-labeled epidermal growth factor into the web space of each foot. Scintigraphic images were interpreted without knowledge of computerized tomography scan (n = 13) and ultrasound (n = 9) results from the pelvic lymph nodes. In 2 patients, histological verification was performed by diagnostic biopsy of pelvic lymph nodes. Nodal involvement was confirmed by computerized tomography for 4 of the 11 positive scans and by ultrasound for 2. In 11 out of 14 patients an increased uptake of 123I-labeled epidermal growth factor could also be seen in the primary tumour. Our findings suggest that targeting of cervical cancer lymph node metastases can be achieved by in vivo binding of 123I-labeled epidermal growth factor with receptors on tumour cell surfaces.

[Ferritin level in newborn infants after prepartal iron medication]. / Ferritinspiegel von Neugeborenen nach präpartaler Eisenmedikation.

Aim of the study was to find out the influence of iron medication of pregnant women on the iron levels of their newborn. In a prospective randomised study the iron-substituted group (n = 57) was treated with 2 x 1 Aktiferrin comp. Kps. (Merckle) during pregnancy, starting from the 22nd week. The control group (n = 46) had no medication during pregnancy. The substituted group had statistically significantly higher serum ferritin levels in the 30th week of pregnancy (p less than 0.048), higher levels measured in the cord blood at birth (p less than 0.001), and also the newborn of this group had statistically significant higher serum ferritin levels than the newborn of the control group (p less than 0.001). Our conclusion is that prepartal iron medication leads to increased iron stores in the newborn.

Lymphoscintigraphy with 123I-labelled epidermal growth factor.

We have used 123I-labelled epidermal growth factor (EGF) scans to study 14 patients with advanced cervical cancer. Abnormal lymph node imaging was seen most clearly 6-8 h after the injection and revealed abnormal uptake by pelvic lymph nodes in 11 patients. 4 of these 11 had abnormal computerised tomographic and ultrasound scans; in the other 7 conventional radiology did not confirm the presence of disease.

Lymphoscintigraphy using epidermal growth factor as tumour-seeking agent in uterine cervical cancer.

Fourteen patients suffering from advanced inoperable cervical cancer were investigated by planar scintigraphy after subcutaneous administration of a radiolabelled (I-123) epidermal growth factor (EGF). The objective of the study was to test whether labelled EGF concentrates in lymph node metastases of squamous cell cancer of the cervix uteri. Scintigraphic results were correlated with the gynecological findings, computed tomography (CT), ultrasound (US) and in two patients with histology. A series of scintigrams were performed up to 24 hours post injection. Slight activity in liver and kidneys was found already 30 min after s.c. injection of EGF. Optimal imaging quality for the lymphatics was obtained at 6-8 hours post injection. Accumulation in the pelvic lymph nodes was documented by the region of interest technique (ROI). Lymph nodes of the inguinal and iliac communis region were marked in all cases. Due to this, accumulation of EGF could not be called selective. In 11/14 patients hot spots were correlated to other pelvic lymph nodes. In 4/11 patients with positive EGF-scanning metastatic disease was confirmed by CT scan and/or US examination. 2/11 patients underwent a Probatoria operation. The respective histological reports confirmed our scintigraphic results. In conclusion, labelled EGF did not fulfil our theoretical expectations of excellent accumulation in lymph node metastases and cannot at present be recommended for routine clinical use.

[The development of immunoscintigraphy into a routine method]. / Die Entwicklung der Immunszintigraphie zur Routinemethode.

Immunoscintigraphy (IS) along with nuclear magnetic resonance, is the most recent method in malignant tumour imaging. In the following, the development of IS is shown up from the very beginning to the routine standard of today.

[Practical use of blood flow measurement with pulsed ultrasound in the 3d trimester of an at-risk pregnancy]. / Praktische Anwendung der Blutflussmessung mit gepulstem Ultraschall im 3. Trimenon bei Risikoschwangerschaft.

Using a pulsed Doppler technique measurements of blood flow of the arcuate artery, umbilical artery and foetal aorta were performed in the third trimenon in a group of 163 patients with risk pregnancies and compared with the weights of the newborn. In normal values of blood flow of the arcuate artery (n = 144) less than 10% of the weights of the newborn were below the tenth percentile. In pathological values (n = 19) about 42% newborn werde below the tenth percentile. In normal values of blood flow of the umbilical artery (n = 158) about 10% of the newborn were below the tenth percentile. In pathological values (n = 5) all newborn were below the tenth percentile. In normal values of blood flow of the foetal aorta (n = 139) about 12% of the newborn were below the tenth percentile. In pathological values (n = 4) all newborn were below the tenth percentile. Of the group with "normal" blood flow data a sub-group was formed with flow values between the first and second standard deviation. These were labelled "suspicious" and had shown a significant correlation with the birth weights of the newborn. Based on these experiences a schema was prepared comprising the blood flow measurements and cardiotocography, from which recommended clinical procedures were derived.

Diagnostic and intraoperative immunoscintigraphy in ovarian cancer.

A new strategy for tumor detection using immunoscintigraphic techniques was used in an attempt to improve the diagnostic potential of conventional external immunoscintigraphy. Twelve patients who were strongly suspected to either suffer from primary or recurrent ovarian cancer were investigated as follows: radioimmuno-scintigraphy (RIS) by means of radiolabelled antibodies was performed in all patients prior to operation (first or second look). During the operative procedure, which always took place immediately after completion of the diagnostic RIS, a hand-held gamma-ray detection probe, especially developed for this purpose was used for the purpose of identifying radiolabelled tumor sites intra-operatively in the open abdomen. In 10 out of 12 of the investigated patients, Radioisotope-Assisted Surgery (RAS) could be performed successfully. The count rates in cancer sites ranged from 150-250 cts per 6 s vs. 30-50 cts per 6 s in normal tissues. While the presence of malignant-tumor sites could always be predicted by conventional RIS, RAS failed twice, but revealed more accurate information concerning the real extent of the disease.

Prostaglandin injection for termination of tubal pregnancy: preliminary results.

A variety of conservative surgical techniques is available for the termination of ectopic pregnancy with preservation of the tube. We report on a new treatment by means of intratubal prostaglandin F2 alpha application followed by intramuscular administration of a prostaglandin E2 derivative (sulprostone) for 3 days. Only 5 of the 30 patients enrolled had to undergo laparotomy later. The results were compared with those obtained by different surgical procedures during the 2 preceding years. Hysterosalpingography was performed in 12 patients of the prostaglandin treated group and 14 of the surgically treated group. Tubal patency was demonstrated in 11 patients of the PG group but only in two patients of the surgically treated group.

PIP: Injection of PGF2alpha intratubally, with other conservative management, was compared in 30 consecutive women with proven ectopic pregnancy, to 100 prior women treated surgically. The patient group were all 45 admitted after November 1987 to University of Vienna Hospital with suspected ectopic pregnancy, later proven in 30 by history, positive hCG, ultrasound and laparoscopy; the controls were 74 confirmed cases out of 101 suspected ectopic pregnancies admitted from January 1986- October 1987. They were treated with 5 or 10 mg PGF2alpha (Miniprostin F2alpha, Upjohn, Vienna), injected transabdominally with a 17-gauge needle, during laparoscopic visualization. In 6 patients, 2-3 mg Pgf2alpha was injected into the corpus luteum, but this practice was discontinued when 3 developed tachycardia, hypertension and extrasystole. 25 mg estrogen was injected into the ovary as a luteolytic subsequently. Most women also received PGE2 (Sulprostone, Schering, Berlin) twice daily im, although 4 could not tolerate side effects of nausea and vomiting. All women had hCG levels daily. 5 were treated by laparotomy because of rising hCG or clinical indications. In the control group 74 (73.3%) had laparotomy, and of these, 39 had total or partial salpingectomy, and 21 salpingotomy. Hysterosalpingography demonstrated tubal patency in 11 of 12 PG treated women tested to date; in contract, of 14 of the controls tested, none had patent tubes. 4 of the PG group have since conceived and delivered term infants. The benefits of this conservative method of treating ectopic pregnancy are apparent in the reduced morbidity, shorter hospital stay, simpler treatment technique, lower costs, and especially the higher rate of subsequent tubal patency and fertility.