[Occupational rehabilitation of gynecologic tumor patients. Occupational rehabilitation]. / Zur beruflichen Wiedereingliederung gynäkologischer Tumorpatientinnen. Berufliche Rehabilitation.

After primary treatment due to genital and breast cancer we judged with a total of three hundred and sixty three (363) working women the reintegration into their former jobs. The rate of rehabilitation amounted to 37.2 per cent. The temporary prescription of sheltered jobs--i.e. of work which corresponds with the needs of rehabilitation--was for 56.1 per cent of the women, whereas 23 per cent of the women had to take up a job other that before. In the first place the after-care covers general and gynaecological examination aiming at uncovering recurrence and second tumours and the earliest possible phase, and in the second place special attention is given to the therapy of hormonal deficiency, post treatment effects and incidental cases. The results which the team of specialists from many fields had got from group as well as individual talks are the basis for a follow-up care, mainly done by the psychologists. As a result of this a classification into some possible intervention groups. Special attention has to be given to women where there has been a family history with oncological diseases. A thoroughly coordinated and well-balanced approach to the gynaecological tumour--after-care is indispensable, i.e. it has to integrate firmly the occupational rehabilitation and to bear in mind never to ask too much of the patient.

[Hormone receptor status in adenomatous hyperplasia of the endometrium and endometrial carcinoma]. / Hormonrezeptorstatus bei adenomatöer Hyperplasie des Endometriums und Endometriumkarzinom.

1. In glandular hyperplasia and endometrial carcinoma a correlation exists between the increased proliferation rate and the rise of the ER/PR-quotient. 2. The decline of both receptor concentrations and the increase of ER/PR-Quotient in the tumor and neighbouring, non-diseased tissue was demonstrated with increasing dedifferentiation, comparing endometrial carcinoma of different stages (G1 and G2, respectively). 3. In adenomatous hyperplasia the two receptors are significantly increased compared to normal cycling and glandular-hyperplastic endometrium, respectively; there the ER/PR-quotient is smaller than 1. After gestagen therapy decrease of both receptor concentrations demonstrates the success of therapy on one hand. On the other hand the higher decrease of PR shows, that duration and success of therapy could be limited temporally. 4. In endometrial carcinoma, especially in case of progression, recurrence and/or metastases, the determination of receptor status could be useful for therapy conception in the individual patient.

[Technics of induced abortion]. / Schwangerschaftsabbruchtechniken.

From a survey, showing the available techniques at all the actual stand of abortion techniques in the different phases of pregnancy up to the second trimester are reported. Up to the 6th week of pregnancy vacuum curettage with a small canula, intravaginal and systemic application of prostaglandin-analoga as well as antigestagens are available. If there is an unproblematic situation in the first trimester up to the 12th week of pregnancy dilatation and curettage is the routine. In case of an individual risk there is a choice between save methods of dilatation with various applicable prostaglandins and - analoga as well as synthetic hydrophilic dilatators. Operation will be finished by section curettage or the classic curettage. In favour of the combined local systemic use of prostaglandins and analoga, installation methods are leaved. Oxytocin and application of synthetic hydrophilic dilatators are still important. Additional indications are necessary for operations at the uterus. Prophylaxis and metaphylaxis to avoid damages following treatment are reviewed.

[Comparison of the results of a prenatal care program in twin pregnancies in years with and without ultrasound screening]. / Vergleich der Ergebnisse eines Betreuungsprogramms der Geminischwangerschaften in Jahren ohne und mit Ultraschall-Screening.

It should have been tested if a reduction of perinatal morbidity and mortality of twin pregnancies is possible by starting intensive care earlier. 68 gemini pregnancies of the report period I (1978-80) which were not diagnosed early and 66 gemini pregnancies of the report period II (1982-84) with early diagnosis by sonography-screening have been compared. The prenatal care programme carried out both in out-patients clinic and inside the hospital is illustrated. Perinatal mortality declined from 5.88 per cent in report period I to 3.79 per cent in report period II.

[Puerperal infections]. / Puerperale Infektionen.

6 patients with serious wound infections and severe endomyometritis in the childbed were treated. Problems with early diagnosis of sepsis and of bacterial shock have been referred. Therapy has to consider early surgical intervention high dosage antibiotic treatment and early therapy of shock.

[Transposition of the ovaries for function preservation in radical surgery and post-irradiation of cervical carcinoma]. / Transposition der Ovarien zur Funktionserhaltung beim radikal operierten und nachbestrahlten Zervixkarzinom.

It is recommended to leave behind the ovaries in their place in radical surgery of cervical cancer, if post-operative irradiation is not necessary. In cases of post-operative radiation therapy it is possible to preserve the function of the remaining ovaries by their transposition out of the irradiation area during operation. The operative technique for ovarian (adnexal) transposition will be demonstrated, and first informations about experiences and results are given. In 44 patients with cervical cancer from stage T1 b No Mo to T2 N1Mo a Wertheim-Meigs-operation with simultaneous ovarian transposition was performed, and 30 of them had a post-operative radiation therapy. In 44% of the radiation group was no change, in 24% a small restriction, and in 32% a total loss of ovarian function. The reasons of the unsuccessful lifting procedure are discussed, and possibilities for improvement of this management are shown.

Radical pelvic surgery versus radical surgery plus radiotherapy for stage Ib carcinoma of the cervix uteri. Preliminary results of a prospective randomized clinical study.

In a preliminary report of a prospective controlled study treatment results and therapy morbidity of 60 patients with stage pT1bNoMo carcinoma of the uterine cervix treated by radical surgery only (Wertheim-Meigs) were compared with those of 60 patients treated by radical surgery followed by a postoperative external radiotherapy. The median duration of follow-up was 44 (24--72) months. Comparing the survival probability analyzed by life-table-method up to 18 months there was a significant better result for patients treated with surgery only. However, after that the study demonstrated comparable therapeutic results with the two therapeutic regimens. There was no difference of tumor size in patients who died after surgery alone and those who died after combined therapy. The therapy morbidity was slightly greater in patients treated by combined therapy. Especially lymphedemas of the leg developed more frequent in patients treated with combined surgery and radiotherapy. Preliminary analysis of the study does not demonstrate any beneficial effect of postoperative radiotherapy followed a radical hysterectomy with pelvic lymphonodectomy in cervical cancer stage pT1bNoMo, but optimal staging, radical surgery and carefully histological examination of the removed tissue are essential needs for this approach.

[Effectiveness of programme for early detection of recurrence of endometrial carcinoma (author's transl)]. / Zur Effektivität eines Programmes der Rezidivfrüherkennung beim Endometriumkarzinom.

An intensive after-care programme for early detection of recurrence was applied to 340 patients with endometrial carcinoma. This approach proved to be effective by comparison with a control group, since 26 cases of recurrence (7.6 per cent), largely without symptoms, were identified sooner after primary therapy. While only some of the author's efforts for early recurrence detection were translatable into recurrence therapy, they feel that they should continue their after-care programme within justifiable limits. More information on therapeutic results regarding recurrence of endometrial carcinoma is expected to become available in the forthcoming years. Programme effectiveness must be judged by survival result rather than by expenses.

[Problems of radiotherapy in radically removed cervix cancers in stages T1b NO MO. Preliminary results of a randomized clinical trial]. / Zur Problematik der Nachbestrahlung beim radikal operierten Zervixkarzinom im Stadium T1b NO MO. Vorläufige Ergebnisse eines randomisierten klinischen Versuches.

A prospective controlled study was undertaken for the purpose of establishing the usefulness of postoperative radiotherapy following radical surgery of cervical carcinoma, Stage pT1b NO MO. A random selection was made of 120 patients who were either treated exclusively by radical surgery (Wertheim-Meigs) or in whom radical surgery was followed by postoperative telecobalt irradiation of the minor pelvis 50 to 52 Gy). No significantly difference were found to exist between the two therapeutic approaches, after an average period of follow-up observations of 33 months (between twelve and 60 months). The incidence of lymphoedema was increased with significance in those patients who had been irradiated.

[Effectiveness of programme for early detection of recurrence of cervical carcinoma (author's transl)]. / Zur Effektivität eines Programmes zur Rezidivfrüherkennung beim Zervixkarzinom.

Various diagnostic methods, generally suitable for early diagnosis of carcinoma recurrence, were used in a systematic localised search programme on 799 patients with invasive cervical carcinoma. The practicability of a concept for early detection of recurrence was verified and established by shortening of latency from first manifestation to recurrence and by more frequent detection of recurrent processes even without symptoms. Reported are methods selected from the programme for their suitability for early recurrence detection. These were necessarily restricted to detection of localised recurrence, following radiological or combined treatment, whereas early detection of parametrial and pelvic wall recurrences seemed to be purposeful, too, when preceded exclusively by primary surgical therapy. Rates of survival, following at least one year of recurrence observation, were encouraging and the support of the view that early detection of recurrence might help to improve the chance of healing.

[Lymphographic studies into lymphogenic expansion of malignant ovarian tumours (author's transl)]. / Zur lymphogenen Ausbreitung maligner Ovarialtumoren aus lymphographischer Sicht.

Malignant ovarian tumours in 199 patients were studied for their lymphogenic expansion, depending on histological tumour types and on criteria for classification by stage. The condition of the tumour capsule was found to be the most important indicator to incipient lymphogenic dissemination, with an exception being recordable only from dysgerminomas. These insights together with additional considerations have formed a background against which recommendations are made for indications for lymphography of patients with malignant ovarian tumours.

[Determination of radicality of iliacal lymphonodectomy in Wertheim's radical operation (author's transl)]. / Radikalitätsbestimmung der iliakalen Lymphonodektomie im Rahmen der Wertheimschen Radikaloperation.

Lymphographic radicality may be determined by presurgical and postsurgical lymphography with measurement of radicality of iliacal lymphonodectomy. Lymphographically uncontrasted lymph nodes, as recordable from Wertheim's radical operation, accounted for 20 per cent in a surgical specimen. Radicality of lymph node counts can be calculated, for all practical purposes, by the following formula: RZ = Number of presurgical lymph nodes - posts, nodes.100 Number of presurgical lymph nodes Radicality, which can be calculated by surface and volume measurements of extirpated lymph nodes, is about 20 per cent in excess of the value obtained by counting. The latter approach was found to be suitable for research, in particular. Determination of radicality of lymphonodectomy is a practically useful aid in deciding post-surgical irradiation of patients who have undergone radical surgery for carcinoma of the cervix.

[Experience from amniofoetography in second half of pregnancy (author's transl)]. / Erfahrungen zur Amniofetographie in der 2. Hälfte der Schwangerschaft.

Fourteen amniofoetographies were evaluated in tabulated form, with methods and results being reported in this paper. Indications were limited. The importance of amniofoetography to differential diagnosis was found to be based on the specificity of ultrasonographic findings as well as on the disclosure of atresia in the gastro-intestinal tract and of congenital hydrops in cases of hydramnion.

[Early diagnosis of relapses of cervical and endometrial carcinomas (author's transl)]. / Frühdiagnostik von Rezidiven des Zervix- und Endometriumkarzinoms.

A systematic screening-programme for tumor recurrence diagnosis was carried out in 773 patients with cervical or endometrial carcinomas. In comparison with two other patient groups in this patients an earlier diagnosis of tumor recurrences was possible and more relapses were detected in the subclinically symptomless phase. Considering the primary therapy a practicable scheme for diagnosis is proposed.