ErbB-2/HER-2 protein expression, serum tumour necrosis factor-alpha (TFM-alpha) and soluble tumour necrosis factor receptor-2 (TNFR-2) concentrations in human carcinoma of the uterine cervix.

The expression of erbB-2 protein (by immunohistochemistry), serum TNF-alpha, soluble TNF-receptor 2 (sTNFR-2, ELISA) concentrations and mitogenic (LPS, ConA, PHA) induced TNF-alpha production of the peripheral blood mononuclear cells (PBMNC) were studied in 91 (UICC Stage 1: 39, Stage 2: 33, Stage 3: 14, Stage 4: 5) patients with carcinoma of the uterine cervix. During a follow-up period of seven years 30 patients died (Stage 4: 5, Stage 3: 12, Stage 2: 11, Stage 1: 2). ErbB-2 protein expression was significantly more frequent in patients with UICC Stages 3-4 (14/19), and in those with fatal outcomes (14/30, p < 0.0001, chi-square test). Serum TNF-alpha (2.70 +/- 0.69 pg/ml) and sTNFR-2 (3.85 +/- 1.05 ng/ml) concentrations were significantly lower in cancer patients (p < 0.0001, Mann-Whitney test) as compared to 64 age-matched control women (TNF-alpha: 4.32 +/- 0.36, TNFR-2: 4.85 +/- 0.82). The mitogenic induced TNF-alpha production of PBMNC was also significantly less with all the three mitogens applied (LPS: 35.24 +/- 8.84, ConA: 26.28 +/- 7.81, PHA: 20.48 +/- 7.04 pg/l million of cells/24 hours, p < 0.0001) as compared to the controls (LPS: 65.33 +/- 8.82, ConA: 51.00 +/- 8.87, PHA: 41.80 +/- 9.01). Serum TNF-alpha, sTNFR-2 concentrations and the mitogenic induced TNF-alpha production of PBMNC was significantly decreased in patients with erbB-2 positivity as compared to those with negativity. In conclusion the expression of the oncoprotein and the lower levels of the members of the TNF system seem to be poor prognostic parameters in patients with carcinoma of the uterine cervix.

Role of tumour necrosis factor-alpha in insulin resistance during normal pregnancy.

OBJECTIVE: Role of tumour necrosis factor-alpha (TNF-alpha) was studied in insulin resistance during pregnancy. STUDY DESIGN: Serum TNF-alpha (ELISA) and fasting C-peptide (Cp) (RIA) concentrations were measured in 40 healthy pregnant women (15, 12 and 13 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 25 healthy non-pregnant women in a case-control study. RESULTS: TNF-alpha (X+/-S.D.: 5.33+/-0.46 pg/ml) and Cp levels (3.37+/-1.30 ng/ml) were significantly higher in the 3rd trimester as compared with matched healthy controls (TNF: 4.07+/-0.26, Cp: 1.05+/-0.36) and to the pregnant women in 1st (TNF: 4.04+/-0.26, Cp: 1.34+/-0.59) and 2nd (TNF: 4.35+/-0.32, Cp: 1.11+/-0.35) trimesters. Significant positive linear correlation was calculated among TNF-alpha, Cp, Cp/blood glucose ratio (indirect parameters of insulin resistance) and body mass indexes (BMIs) of pregnant women (P<0.01). CONCLUSION: TNF-alpha may contribute to the insulin resistance during the course of normal pregnancy.

Data to the clinical manifestation of the Krukenberg tumour.

Ovarian cancer is one of the most frequent malignant tumours in the female population. The screening of this tumour type is unsolved. The tumours are usually diagnosed in the advanced stage; thus the results of survival are unfavourable. Their histopathological appearance has a wide variety, with the occurrence of numerous metastatic forms. In these metastatic cases the choice of treatment is more difficult and prognosis is also worse. Among the metastatic tumours, the primary tumours of the gastrointestinal tract occur the most frequently. They are known as the Krukenberg tumour. Authors present two cases of Krukenberg tumours in order to summarize our knowledge on this rare tumour type and to give some practical advice.

Pregnancy and delivery after operation for a pituitary microadenoma.

The authors report on the successful pregnancy and permanent symptom-free condition of a young woman who underwent operation for pituitary microadenoma. At the time of submitting the publication mother and child are healthy. According to the available literature this is the first such case reported in Hungary.

[Successful pregnancy after surgery for hypophyseal microadenoma]. / Hypophysis mikroadenoma mütéte utáni terhesség és szülés.

The authors report on a successful conception, development of pregnancy and lasting symptom-free post-partum state of a young female patient who has been operated previously because of an hypophysis microadenoma. Delivery ended with Cesarean section. A living and mature newborn was born, with a weight of 2900 g.

[Value of ultrasonic examination in the detection of early changes in the endometrium]. / Az ultrahangvizsgálat értéke az endometrium korai elváltozásainak felismerésében.

In order to detect early changes of endometrium the authors performed transvaginal ultrasonic examination in 15 cases and it was completed by light microscopic evaluation. Their opinion is that joint use of the two the methods can improve the possibility of early detection of hyperplasia, preblastosis and of tumors of endometrium.

Treatment experiences with intracavitary 137Cs after-loading in a five-year patient material with uterine-cervical carcinoma.

Between 1979 and 1983 a total of 106 patients with carcinoma of the cervix and 53 with that of the uterine body were treated. The irradiation treatment of the patients was carried out by after-loading, with Curietron equipment using 137Cs. Since no reports have so far been published in Hungary on a patient material treated by the above method and with caesium isotope, it seems worthwhile to review the material. Our report is concerned with parameters which enable the assessment of the after-loading method. In cervical carcinoma a five-year survival rate of 59.4% was found, with the same in uterine carcinoma being 69.8%. It should be noted that data referred to all stages in the given tumour. The tumour-free state of the surgical preparations was also examined, and finally, postirradiation complications are also reviewed. Based on our results, the intracavitary Cs137 after-loading is considered by us to be one of the safely and efficiently used procedures in the irradiation treatment of cervical uterine carcinoma.

[Prevalence, significance and therapy of premature LH rise and peak in the In Vitro Fertilization program]. / Korai LH-emelkedés és -csúcs elöfordulása, jelentösége és kezelése az In Vitro Fertilizáció programban.

The incidence of the premature LH-rise/peak has been analysed in view to the pregnancy rate in 139 HMG and combined Buserelin + HMG cycles of an IVF-ET/GIFT program. A premature LH-rise/peak seems to be correlated with a lower pregnancy rate; therefore the cancellation of the stimulation is recommended in these cases. A gonadotropin suppression by the GnRH-analog Buserelin before and during the HMG treatment proved to be a good method to prevent a premature LH-rise/peak and to decrease the number of cancelled stimulation cycles.

Atrial natriuretic peptide, volume and blood pressure regulation during exchange transfusion of the neonates.

Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were elevated being 51.7 +/- 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 +/- 4.3 vs 71.4 +/- 5.6 mmHg) and heart rate (115 +/- 5.2 vs 115 +/- 2.4 l/min). ANP levels in plasma remained unaltered (53.4 +/- 24.9 fmol/ml). Volume load of 10 ml blood transfusion increased central venous pressure by 33 per cent and ANP concentration in the plasma nearly by 30 per cent, while heart rate and blood pressure remained unchanged. Our data indicated that the heart of premature infant responds to acute volume load by increased ANP-release, while volume depletion seems not to influence hormone regulation.

[A microbiology clinic in outpatient gynecologic service]. / Klinikai mikrobiológiai ambulancia a nögyógyászati járóbeteg-ellátásban.

The authors report on their experiences gained at the sexually transmitted disease clinic they established at the First Department of Obstetrics and Gynecology of Semmelweis Medical University. A total of 456 patients presenting with signs and symptoms of lower genital tract infection have been examined in one year. The investigation of patients included aerobic and anaerobic culture of vaginal bacteria, vaginal smear and the identification of sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasmatales and Gardnerella vaginalis. The authors conclude that a sexually transmitted disease clinic is appropriate to contribute to the prevention of horizontal and vertical spread of the sexually transmitted bacterial infections.

The occurrence of Chlamydia trachomatis in the semen of men participating in an IVF programme.

Chlamydia trachomatis is one of the most common causative agents of sexually transmitted diseases. The authors studied the occurrence of C. trachomatis in the semen of 184 asymptomatic men participating in the IVF programme. Twenty-six (14.1%) of the 184 tested were positive for C. trachomatis, these patients and their wives receiving doxycycline capsules twice, 100 mg on the first day and 100 mg/day for the following 13 days. This treatment was effective in 88.5% of the cases and in the rest, treatment continued with erithromycin 250 mg four times/day for 2 weeks. The authors compared the semen parameters (cell count, motility, morphology, bovine mucus penetration and hypo-osmotic swelling test) in the infected and non-infected groups and observed no significant difference between these two groups.

The serum protein content of human follicular fluid and its correlation with the maturity of oocytes.

The authors determined, by an immunochemical method, the alpha-1-antitrypsin, Gc globulin, prealbumin, albumin, haemopexin, transferrin, haptoglobin, IgA, IgG, ceruloplasmin, alpha-2-macroglobulin contents of 98 follicular fluids, 10 peritoneal fluids and 24 blood sera. Out of these proteins analysed, change in the concentration of alpha-1-antitrypsin showed correlation with the maturity and fertilisation of the oocyte. The alpha-1-antitrypsin content was 1.6 +/- 0.26 g/l in the case of mature oocytes, and 3.1 +/- 1.12 g/l in the case of immature ones. Fertilisation was also concomitant of low alpha-1-antitrypsin levels.

Changes of serum proteins in patients with malignant gynaecological tumours.

The changes of 13 serum proteins in 53 ovarian tumour patients were studied by the radial immunodiffusion method from the beginning of treatment, during the course of disease. As to the course of the disease, in 6 of them characteristic and significant changes were observed. These were prealbumin, alpha 1-anti-trypsin, orosomucoid, coeruloplasmin, transferrin and haptoglobin. Although the differences could be evaluated as an average of investigations, the value of the examinations is greatly reduced by the very high scatter of the individual values.

Clinical experience and morphological study on the after-loading treatment of endometrial carcinoma.

According to our experience, the after-loading procedure can successfully be applied in the majority of endometrial cancer cases. Primarily, in those where corpus parameters can be accurately judged and these correspond to the doses to be applied. By devising individual doses, a tumour dose can be planned and administered which in the vesical and rectal wall is amply below the threshold value. (According to our calculations, the posterior wall of the bladder received, on an average, a dose of 5 to 30, while the anterior wall one of 15 to 35 Gy.) The relatively long time of treatment--occasionally 40 to 60 hours--are well tolerated by the patients receiving mild sedatives. The considerable protection of the small intestine is due to the protracted method of a low R/min. The lack of complications in the small intestine can be attributed to this fact. Beside all these results, application, localization and nursing can be made in a radiation-free environment. For examining the effectivity of after-loading treatment, light- and electron microscopic studies were performed in patients with endometrial carcinoma (in 6 and 8 cases, respectively) to support also morphologically the favourable results of clinical practice.

The significance of neopterin determination as a tumour marker in ovarian cancer.

The neopterin level of 164 urine samples of ovarian cancer patients was determined by high pressure liquid chromatography. Parallelly, the serum levels of CA 125, CEA and of lipid bound sialic acid were also determined. A good correlation was found both with CA 125 and with lipid-bound sialic acid. There was a closer correlation with the latter both in the patients showing remission and in the active tumour carriers. In patients with negative tumour markers (TM) in the sera examined, a tumour-free state was confirmed in 87.5% by neopterin determinations. Accordingly, authors recommend neopterin determination in patients who face a critical decision.

The importance of polyamine determination in monitoring malignant gynaecological tumours.

By thin-layer chromatography, the serum polyamine levels together with those of CA 125, CEA, lipid-bound sialic acid and urinary neopterine were determined in 56 ovarian cancer patients. A correlation was found in the group of clinically active tumour carriers between the clinical finding and the results of polyamine determination only where other tumour markers were suggestive of complete remission.

Blood flow redistribution during isocapnic hypoxia in foetal lamb.

Circulatory responses to hypoxaemia were studied in 16 foetal lambs in 120-129 and 135-145 days of gestation (term: 147 days). Under general anaesthesia catheters were inserted into the foetal vessels and the umbilical blood was measured during antipyrine infusion by the Fick steady-state diffusion method. The combined ventricular output and actual organ blood flows were calculated from injections of radionuclide-labelled microspheres into a forelimb and a hindlimb vein. Isocapnic hypoxia was produced by giving the ewe a breathing gas mixture of 9% O2 and 3% CO2 in N2 for 30 min. A significant increase was found in the blood flow of the myocardium, the lungs, the brain and in the combined ventricular output between 0.80 and 0.95 gestation times. Under isocapnic hypoxaemia blood flow increased to the brain, heart and adrenals, whilst it decreased to the lungs, kidneys, gut and carcass. The observed changes were different at the two measurement times. Under hypoxia, depending on the gestation time, the blood flow increased in the diencephalon, midbrain, hypophysis and in the cervical cord. In the cerebral, cerebellar and lumbosacral cord it remained unchanged, while decreasing in the chorioid plexus and in the hippocampus. In the gestation period under examination the foetal circulation undergoes significant redistribution.

Significance of CEA, AFP, SP1 and HCG as tumor markers in ovarian carcinoma.

The significance of CEA, AFP, HCG and SP1 determinations in 85 patients with ovarian cancer were analyzed from the point of view of evaluation of the clinical status of the patients. On the basis of the trials it was stated that a satisfactory correlation between the extension of the tumor and the serum CEA level was observed in 26.6% of the cases. The efficiency of monitoring by systematic CEA tests was found to be 17.3%. The determination of AFP and HCG is useful only in cases of tumors with specific histological structures and in problems of differential diagnostics. The testing of SP1 is of no value in clinical practice.