Intraperitoneal hyperthermic perfusion chemotherapy of patients with chemotherapy-resistant peritoneal disseminated ovarian cancer.

The purpose of this article is to evaluate in a prospective, open-label clinical trial the feasibility and efficacy of intraperitoneal hyperthermic perfusion chemotherapy (IPHC) on the survival and quality of life of patients with advanced, peritoneal disseminated ovarian cancer. Thirty-six patients with ovarian cancer were accrued for the study, their selection being based on their progression following different systemic therapies with anti-neoplastic (multiple chemotherapy-resistant or -refractory) agents. The average number of chemotherapy cycles given before the first IPHC was 12.5. The patients' average Karnofsky-performance status was 60% and 17 out of 36 patients had ascites before IPHC. The input temperature of the solution for abdominal lavage was 48-49 degrees C: the intraperitoneal temperature was 42-43 degrees C. The flow-rate of the solution for heat exchange was 190-220 ml/min with treatment lasting 1 h at temperatures greater than or equal to 42 degrees C. Median overall survival time (MOS) from first diagnosis of disease (1stDx) was 49 +/- 8 months and from the first IPHC-treatment 19 +/- 4 months. The observed 1-year overall survival rate (OSR) of all patients from the start of the first IPHC was 65 +/- 8% and the 5-year OSR was 16 +/- 7%. Malignant ascites vanished within less than 3-5 IPHCs. Quality of life could be improved. The adverse effects were mild especially compared to systemic chemotherapy. In 3 out of 162 treatments, peritoneal disturbances with symptoms of subileus were observed. We conclude that IPHC is technically feasible, safe, and associated with a marked prolongation of survival and improvement in quality of life. Even heavily pretreated patients could be treated safely. Some patients did respond to IPHC even after 25 IPHC treatments. From these results, it can be concluded that IPHC may also improve the treatment outcome of patients with ovarian cancer as salvage therapy, in second-line treatment or even as consolidation or maintenance therapy following induction chemotherapy to patients with suboptimal stage III and IV disease. This should be demonstrated in randomized controlled studies.

Effects of lithium on thrombopoiesis in patients with low platelet cell counts following chemotherapy or radiotherapy.

Therapy for neoplasma is limited by hematological side effects of tumor-destructive therapy and, in part, makes expensive supportive care necessary to overcome and treat leukopenia and thrombocytopenia and their consequences. Thrombocytopenia is a major clinical problem caused by chemotherapy and radiotherapy. An effective and very cost-effective option for treating moderate neutropenia is the administration of lithium carbonate. Lithium induces the release of colony-stimulating factors (CSF) and therefore stimulates proliferation of neutrophil granulocytes. Other cytokines, such as interleukin-1 (IL-1), IL-6, and tumor-necrosis factor-alpha (TNF-alpha), are also stimulated. Apart from granulocyte-macrophage-CSF (GM-CSF), there have as yet been no reports of lithium salts inducing early activating factors for the megakaryocytic lineage, such as IL-3, IL-11, stem cell factor and flt-3 ligand, or maturation factors, such as thrombopoietin (TPO). A statistically significant increase in the mean number of platelets for patients with cell counts below 150,000/microL on the commencement of treatment with lithium carbonate could be observed. Patient tolerability of lithium carbonate therapy is very good. Patients with persistent leukopenia and thrombocytopenia following chemotherapy or radiotherapy can be treated with this trace element very cost-effectively. Unfortunately this treatment has not gained acceptance in clinical oncology in the face of extremely cost-intensive treatment with recombinant GM-CSF, IL-11 or, potentially, thrombopoietin.

Deep hyperthermia with radiofrequencies in patients with liver metastases from colorectal cancer.

Patients at advanced stage of colorectal cancer with liver metastases have been treated with deep hyperthermia alone or in combination with chemotherapy (5-FU + FA + MMC). Hyperthermia was achieved by arrangements of capacitive electrodes with a radiofrequency field of 13.56 MHz (RF-DHT). This prospective open single-arm clinical study with 80 patients suffering from liver metastases from colorectal cancer gives some first hints, that deep RF-hyperthermia alone may have a substantial beneficial effect on overall survival time of patients with liver metastases from colorectal cancer. Long lasting no-change, partial and even some complete remissions could be observed. The overall median survival time from progression of metastases or relapse was 24.5 months and survival rates at 1, 2 or 3 years from first diagnosis of metastases or progression were twice as high as expected from patients treated with chemotherapy. The combination of hyperthermia with delayed chemotherapy did not change overall survival time. These encouraging results deserve to be confirmed in randomized clinical studies.

[Cryotherapy of condylomata acuminata]. / Die Kryotherapie spitzer Kondylome.

Between 1972 and 1982, 162 women between the ages of 15 and 66 were treated with cryosurgery at the Gynaecological Department of the Medical Academy Erfurt. 43 of these patients were pregnant between the twelfth and the thirty-second gestational week. - Until 24 months after the first cryosurgery we found one to four recurrences of condylomata acuminata in 14 patients which were treated cryosurgically again. Report is given about one case of condylomata acuminata gigantea, treated by cryosurgery, too. Contrary to electroresection and surgical resection after chlorethyl-freezing we think cryosurgery has an advantage in quickly necrosing, sequestering without further surgical measurements and healing without scars. - Therefore we consider cryosurgery as the most efficient method in the treatment of condylomata acuminata, also during pregnancy.

[LDH activity in human ovarian tissue and in ovarian carcinoma (author's transl)]. / Uber die LDH-Aktivität im menschlichen Ovarialgewebe und im Ovarialkarzinom.

Lactate-dehydrogenase activities were measured from tissue homogenates of 34 human ovaries and ovarian carcinomas. Mean activities were 265.2 nmol/s/g tissue in normal ovaries and 695.1 nmol/s/g in ovarian carcinoma tissue. One and the same ratio was obtained from two comparative group of one and the same age. The above difference was significant. No relationship was found to exist between LDH activity in tumour tissue and stage of the disease.

[Course of pregnancy following cryotherapeutic treatment of the cervix uteri]. / Schwangerschaftsverlauf nach kryotherapeutischer Behandlung der Cervix uteri.

Course of pregnancy of 26 women is reported in this paper. All of them had undergone cryosurgical treatment during or prior to one of their pragnancies. The results obtained from such surgical treatment are compared to those recorded from traditional operations on the uterine cervix. Scarless healing of the portio and full retention of its elasticity are points made to claim good functional results of cryotherapy. Suggestions are made for use of cryosurgery during pregnancy.

[Genital tuberculosis of women (author's transl)]. / Beitrag zur Genitaltuberkulose der Frau.

Genital tuberculosis of women, one of the extrapulmonary forms of tuberculosis, has remained to be in existence, though morbidity and mortality of the disease are on a declining trend. Affected are women of all age groups. A general account is given of gynaecological and obstetric aspects relating to the clinical pattern of genital tuberculosis, with reference being made to the author's own findings recorded from 155 patients in ten years, on the basis of bacteriologically or histologically secured diagnosis. These results have reaffirmed the need for complex diagnosis, therapy, and aftercare for female patients with genital tuberculosis. It is a challenge which, together with the demand for thorough prophylaxis, cannot be met unless meaningful interdisciplinary cooperation is ensured.

[New technique for use of low temperatures in uterine cavity (author's transl)]. / Eine neue Technik zur Anwendung tiefer Temperaturen im Cavum uteri.

Cases of repetitive or extremely secondary anaemia in the wake of therapy-resistant genital bleeding so far had been tackled by radium treatment, which led to radiological castration. Such approach was based on hysterosalpingography and established absence of malignancy, and it used to be applied also to younger patients with reduced or lost operability. The author have devised and tested a simple cryo-intrauterine applicator by which lasting or strong recurrent uterine bleeding can be readily controlled. Complete removal of the endometrium is now possible without any impairment of ovarian function. Foundations and methods are described in detail, with clinical conclusions being drawn.

[Anaesthesiological technique for pregnant rabbit, with consideration of foetal condition (author's transl)]. / Narkosetechnik beim trächtigen Kaninchen unter Berücksichtigung des fetalen Zustands.

Application of uninvolved propanidid-infusion anaesthesia to a rabbit in advanced pregnancy is reported in this paper. Uteroplacental circulation was found to be but slightly affected. The condition of the foetuses, consequently, may be considered sufficiently safe for intra-uterine experiments.

[Concentration of ascorbic acid in tissue of ovarian carcinoma (author's transl)]. / Der Askorbinsäure im Gewebe des Ovarialkarzinoms.

The levels of ascorbic acid were measured in the tissue of 53 ovarian carcinomas and compared to concentrations in normal human ovarian tissue. The mean ascorbic acid concentrations per gram of tissue was 218 microgram in carcinoma tissue and 382 microgram in intact ovarian tissue. The difference was significant, with p less than 0.001. A relationship was found to exist between ascorbic acid concentrations in tumor tissue, on the one hand, stages of the disease, on the other. The importance of ascorbic acid to tumour growth is discussed.

[Betaglucuronidase activity in ovarian carcinoma (author's transl)]. / Uber die beta-Glukuronidaseaktivität im Ovarialkarzinom.

Beta-glucuronidase activity was recorded from the tissue of 45 ovarian carcinomas and compared to the activity in normal human ovarian tissue. Mean activities were 1442 micrograms Ph./h/g tissue in ovarian carcinomas and 574 micrograms Ph./h/g in intact ovarian tissue. No relationship was found to exist between the amount of beta-glucuronidase activity and the stage of the disease.

[Female genital tuberculosis]. / Die Genitaltuberkulose der Frau.

As one of the forms of extrapulmonary tuberculoses the genital tuberculosis of the woman is--despite regressing numbers of morbidity and mortality--a disease still existing, which is to be found at every age. The own results of examinations and experiences which could be obtained from 140 female patients with bacteriologically and histologically ascertained diagnosis are included into the actual survey of the clinic of the genital tuberculosis from the gynaecologists and obstetrician's point of view. These results, too, emphasize the necessity of a complex diagnosis, therapy and aftercare of the female genital tuberculosis, which together with the vast prophylactic tasks may only be coped with by a rational cooperation in the interdisciplinary scale.

[Beta-glucuronidase activity in human ovarian tissue during the life- and cycle-phases of the woman]. / Die beta-Glukuronidaseaktivität des menschlichen Ovarialgewebes während der Lebens- und Zyklusphasen der Frau.

The behaviour of the beta-glucuronidase activity during the life phases and the phase of the cycle of a woman has been studied in 51 human ovaries after the Dohrmann method. The study clearly indicates a dependency on age, that is demonstrated by a rise in beta-glucuronidase activity from 536 microgram Ph/h/g ovarial tissue during full functioning to 705 microgram Ph/h/g ovarial tissue in the premenopause and by dropping to 529 microgram Ph/h/g ovarial tissue in the menopause and the senium. The premenopause values are significantly higher compared to that of the other two functional phases. The activity of the beta-glucuronidase is significantly higher in the secretory phase than in the proliferation phase. Existing relations between the beta-glucuronidase of the ovary and the gonadotropic hormones of the hypophysis and the oestrogen metabolism are discussed.

[Urinary tract infections in surgical gynecology with special reference to the urine withdrawal technic]. / Harnwegsinfektionen in der operativen Gynäkologie unter besonderer Berücksichtigung der Urinentnahmetechnik.

In a direct comparison series between 400 midstream urinesamples and 400 suprapubic aspiration specimens, but as well in an indirect comparison series of the same number of catheter urine-samples, bacteriological examinations were executed by means of the culture method before and after gynaecological operations. 19,5% of the suprapubic aspirates, 20,5% of the catheter specimens, and 25,5% of the midstreamsamples showed a significant bacteriuria. The number of false positive findings was in regard of the midstream urinesamples more than a quarter of the total infection rate. In midstreamsamples, mixed infections were 3,4 times more frequent than in catheter specimens. After a discussion of the results under special consideration of the high number of findings needing control in connection with operative problems, a valuation of the obtaining of urine in the field of operative gynaecology is demonstrated.