[Diagnosis and therapy of dystrophic vulvar diseases]. / Diagnostik und Therapie dystrophischer Vulvaerkrankungen.

Mainly women in the postmenopause suffer from dystrophic diseases of the vulva which develop in a chronically progressive way. Because of the often very irritating pruritus and the secondary alterations of the skin these diseases are mainly a therapeutical problem which can become very annoying both, the patient and the doctor. In 32 patients, the progressive development of the diseases could be stopped. Very satisfying results could be obtained by a combined treatment of a local testosterone application and the systemic regulation of the metabolism.

[Relationship between pathological incidence, social status, and sexual status of patients with cervical carcinoma (author's transl)]. / Der Zusammenhang von Erkrankungshäufigkeit, Sozial- und Sexualstatus bei Patientinnen mit Zervixkarzinom.

Case history, latest findings, and catamnesis were collected and evaluated for 528 patients with early-invasive cervical carcinoma and 170 Stage-I b patients who had undergone radical surgery. No direct relationship was found to exist between genetic and environmental factors, social status, and sexual status. Limited radical treatment of patients with early-invasive cervical carcinoma proved to be just as good in terms of healing results as radical therapy, but it was even better for the patients in terms of physical and psychic effects. Nevertheless, substantive improvement in re-integration of the patients concerned in achievable quality of life was found to be possible by complex efforts for all-embracing rehabilitation.

[Sexual rehabilitation of patients with cervix cancer]. / Sexuelle Rehabilitation bei Zervixkarzinom-Patientinnen.

The effects of therapy on the vita sexualis have a great importance in universal rehabilitation of patients with carcinomas. 168 treated women suffering from an invasive carcinoma of the cervix were consulted about their sex life and the relationship with their partner during the follow-up. Depending on the methods of therapy (radical operation, primary irradiation, combined treatment), loss of libido was seen in 53% of the patients, and loss of orgasm in 61%. The frequency of cohabitation decreased in 45% of the consulted persons. 10% of the women living in sexual partnership were of the opinion that severe disturbances in partner relations resulted therefrom. The least disturbance of the intimate relationship was found in women, who had a harmonious family background in life and who were informed to a sufficient degree.

[Therapy of mastodynia and simple mastopathy]. / Therapie der Mastodynie und der einfachen Mastopathie.

Cycle-dependent breast complaints in most cases are based on a hormonal dysbalance with estrogen predominance and development of an interstitial edema. They preferably occur between 30-50 years of age with possibly appearing mastopathic tissue changes. Whereas the treatment with antiphlogistic, diuretic and other measures only effects symptomatically, a causal therapy effect can be achieved by systemic and local hormone applications. Within the bounds of a clinical study 92 women were submitted to a local treatment with a one per cent alcoholic progesterone ointment at least lasting a period of 3 months. In 52 Patient with primary ointment treatment an essential improvement of the complaints could be reached in 87% (p less than 0.05). In 40 women with secondary local hormonal application the improvement-rate was 70%. Side effects could be not established. The good therapeutic result and acceptance of this therapy form make clear that the permission of an alcoholic progesterone ointment as standard prescription would represent a therapeutic enrichment.

[Gastrointestinal side effects of cytostatic treatment of gynecologic neoplasms]. / Gastrointestinale Nebenwirkungen bei der zytostatischen Behandlung gynäkologischer Malignome.

Gastrointestinal complaints are the most frequent side effects of antineoplastic chemotherapy behind the bonemarrow depressions. Nearly all cytostatic drugs, favourably used treating gynaecological malignant tumours, show a high complication rats on the part of the digestive organs. Primary an secondary damages can be so serious that the continuation of an effective tumour therapy becomes impossible. Whereas mucous excitement and motility disturbances are caused by local toxicity of cytostatic drugs, on the other hand central and psychogenic factors are of essential importance concerning nausea and vomiting. Therefore all these side effects could not be treated effective antiemetics alone. Only by an ingenious combination of medical treatment, psychological guidance and appropriate nutrition complaints can be relieved so far that the patients quality of life is interfered as less as possible and that a sufficient compliance may be reached.

[The epidemiology and etiology of breast cancer]. / Zur Epidemiologie und Atiologie des Mammakarzinoms.

Continuous increase of incidence of breast cancer in the last decades lead to a maximum position concerning morbidity and mortality in malignant diseases of women. Fatality of the disease couldn't be decreased, despite improved methods of health education, diagnostics and therapy so that further on early detection is of particular importance. By extensive clinical and epidemiological studies multifactorial genesis of breast cancer and the influence of different risk symptoms could be secured. The etiologically significant endo- and exogenic components have such a differentiated and complex effect that formation of risk groups is still in discussion. Considering special endocrine, genetic and environmental factors it is possible to define groups of patients whose morbidity risk is much increased. Registration and prophylactic care of such risk groups seems to be of advantage and could enable an improvement of early detection rate.

[The second-look operation in advanced ovarian cancer]. / Zur Second-look-Operation beim fortgeschrittenen Ovarialkarzinom.

In cases of progressive, primary palliatively operated ovarian carcinoma or of such with unresectable tumors (stage III and IV) antineoplastic chemotherapy is preferred. Second-look laparotomy with the aim of radical operation is indicated in cases of established tumor remission. In our clinic 37 second-look operations were carried out in the period between 1975 and 1982, in 30 cases (81%) a secondary radical operation was possible. 56.8% of the patients were relaparotomised 2 to 5 months after the first operation, 13.5% after 6 to 9 months and 29.7% not before more than 10 months after the first operation. The average age was 51.4 years. Clinically established tumor remission (CR = 14, PR = 17) was proven intraoperatively in 31 women (83.8%). In 6 cases of them (16.2%) there existed no more tumor from a histological viewpoint, and in three cases (8.1%) tumor structures could be proven only by means of a microscope. Prior to this all patients had undergone a combined chemotherapy by CPM, MTX, 5-FU and VBL, 8 women (21.6%) underwent an additional loco-regional chemotherapy by 5-FU and MTX. The 5-years survival rate amounts to 50.2%. After remission the average survival amounts to 39.8 months, otherwise it is only 14 months. This is significantly prolonged in cases of secondary operations after more than 10 months.

[Cytostatic treatment of pseudomyxoma peritonei]. / Zytostatische Behandlung eines Pseudomyxoma peritonei.

Clinic, pathomorphology and therapy of pseudomyxoma peritonei are explained and discussed by means of a women of 54 years. The prognosis in former times very bad could be improved by a combination of radical surgery and polychemotherapy.

[Therapy and course of a malignant double melanoma]. / Therapie und Verlauf eines malignen Doppelmelanoms.

A report is given on the treatment and course of disease of a 38-year-old patient suffering from a malignant melanoma (m. m.) of the vagina and of the left lower eyelid. In view of the unfavourable prognosis the achieved survival time of 79 months may be attributed to radical surgical treatment and additional combined chemotherapy.

[Infectious diseases in patients with solid tumors]. / Infektionserkrankungen bei Patientinnen mit soliden Tumoren.

In malignant diseases the prognosis of tumour and the patient's quality of life are essentially influenced by the kind and severity of the immunodeficiency. The high rate of infection of up to 40% is effected by both the basic disease and the different methods of tumour therapy as well as by numerous other endogenous and exogenous factors. Especially the myelosuppressive effect of cytostatics favours the lowered defense mechanism. Hence severe infections stand in causal relation to almost 2/3 of all deaths caused by carcinoma. Resulting from these facts it is necessary to have a tight antimicrobiological regime and to carry out a specific prophylaxis of infection in oncology. Already the first symptoms of an opportunistic infection make an instant and effective, but for the moment unspecific antibiotical combination therapy necessary. If this therapy is not effective, an antimycotical treatment should be started. The most important parameters for a success are the quick reaching of normal body temperature and the subjective well-being of the patients. By means of a useful combination of measures of primary and secondary prevention we can succeed in stabilizing the defense mechanism of tumour patients and minimizing the risk of infections.

[Malignant Brenner tumor of the ovary]. / Maligner Brennertumor des Ovars.

The case of a metastasizing malignant Brenner tumor of the ovary in a 67-year-old patient is presented. Following a subtotal operation (hysterectomy with both adnexa and omentectomy), a complete remission of 7 month duration was obtained by means of a combined chemotherapy. By changing the therapy over to cisplatinum, one succeeded up to now in controlling the local recurrence, quickly developing after that. The therapeutic proceedings in cases of such rare tumors are discussed.

[Primary, non-pregnancy-induced choriocarcinoma]. / Primäres, nicht gestationsbedingtes Chorionkarzinom.

The case of a primary chorioncarcinoma of the ovary is presented in an eighteen year old nulligravida. Following a primary operation, including the exstirpation of the inner genital organs, an antineoplastic combination chemotherapy was done. The partial remission obtained was of a duration of 5 months only, and the patient died after having survived 8 months because of metastatic generalization.

[Leydig cell tumor with pronounced virilization]. / Leydigzell-Tumor mit ausgeprägter Virilisierung.

A report is given on the rare case of a hormonactive Leydig cell-tumor in a 52-year-old patient. In spite of virilization symptoms of many years' standing, it was only because of multiple troubles with a great uterus myomatosus that she was admitted to the hospital. An ovarian tumor existing at the same time, turned out to be histologically a mere hilus cell-tumor with a strong nucleus polymorphy. In consideration of the danger of a malignant degeneration (borderline case), the patient was included in our tumor follow-up control programme.

[Recurrence following staged treatment of cervical cancer in stage Ia]. / Rezidive nach abgestufter Behandlung des Zervixkarzinoms im Stadium Ia.

From 1953 to 1982 539 patients with carcinoma of the cervix stage Ia were under medical treatment in the Gynecological clinic of the Medical Academy Dresden. Then 91.1% of the women underwent restricted-radical therapy. The achieved five-year-survival rate referred to 97.6%. Five of nine (1.7%) recurrences might have been avoided by better follow-up. A curative treatment of recurrences was possible in seven cases. Vaginal hysterectomy with vaginal cuff may be further on regarded as optimum therapy for microinvasive carcinoma of the cervix in case of a histologically secure removal of atypical epithelium.

[Secondary lymphedema in gynecologic neoplasms]. / Sekundäre Lymphödeme bei gynäkologischen Malignomen.

In spite of improved techniques for operations and radiation therapy about 10% of all patients with carcinoma of the female genitals and breasts suffer from a secondary lymphoedema of the extremities. This lymphoedema can be described as a chronical trouble complaint with multifactorial genesis and a tendency to progression. The treatment aims not only at the drainage of albuminous oedema but also at the avoidance of tissue proliferations and infections. The strategy of treatment is based on long-term-measures to empty the oedema in a complex way and needs the intensive assistance of those concerned. Only patients who are thoroughly informed about their disease are in a position to show the patience and understanding necessary to undergo the training programme and to accept the maximum load.

[Chemotherapy of endodermal sinus tumors]. / Beitrag zur Chemotherapie der Endodermalsinus-Tumoren.

Endodermalsinus tumors are rare and belong to the group of malignant gem cell tumors. Histogenetically they are differently interpreted. Their unfavorable prognosis is to be attributed to existing uncertainties regarding therapeutical procedure and to the rapid tumor expansion. Our case of an advanced endodermalsinus tumor of the right ovary was operated on palliatively and then subjected to antineoplastic chemotherapy with adriamycine, bleomycine and vincristine, subsequently with actinomycine D and vinblastine. There was a complete remission of the tumor. The patient survived for 43 months free of tumor.

[Intra-arterial chemotherapy in advanced ovarian cancers. 2. Therapeutic results in relation to prognostic factors]. / Intraarterielle Chemotherapie bei fortgeschrittenen Ovarialkarzinomen. 3. Mitteilung: Therapieergebnisse in Abhängigkeit von den Prognosefaktoren.

85 patients with advanced ovarian carcinomas were treated either intra-arterially with MTX and 5-FU, later systemically with the CMFV-combination (therapy arm A) or only systemically (therapy arm B) after randomization. The achieved rates of remission and survival time showed an obvious dependence on the histological type of tumor and on the degree of differentiation. Whereas the results of the treatment were nearly identical in both groups of treatment with badly differentiated carcinomas, a significant improvement could be achieved by the initial local treatment of well and moderately differentiated malignancies. More than one third of the cases of advanced tumors were operable by local chemotherapy. Thus the survival time could be extended. The intra-arterial chemotherapy represents an expensive, but effective method of treatment of advanced ovarian carcinomas.

[Histological verification of the recurrence of early gynecologic tumor and primary tumors by puncture biopsy]. / Histologische Sicherung früher gynäkologischer Tumorrezidive und Primärtumoren durch Punktionsbiopsie.

Needle biopsy feasible in a technically simple manner was used on 85 patients for primary histological proof of malignant tumors and tumor relapses from 1979 to 1982. The obtained tissue cylinders of about 1,2 mm in diameter and about 10 mm in length were examined histologically. A clear diagnosis could be made in 79 cases (92,8%). We did not observe any complication.

[General conservative operation in malignant ovarian tumors of the stage Ia (T1aN0M0)]. / Zur Problematik der alleinigen konservativen Operation bei malignen Ovarialtumoren des Stadium Ia (T1aN0M0).

In the Gynecological Clinic of the Medical Academy Dresden 585 women with primary malignant ovarian tumors were attended from 1953 until 1979. 118 patients (20,2%) were classified as stage I, 97 (82,2%) of them as stage Ia. A unilateral adnexectomy was carried out in only 25 women (25,8%) at stage Ia, 13 (13,4%) of them were younger than 40 and did not undergo additional therapy because they wanted to have a child. Six women were not subjected to additional treatment due to old age and general condition. Five of the 13 younger women gave birth to viable children after an average of 50 months, one patient was confined for the second time after further 24 months. Eighteen (95%) of 19 exclusively conservative operated on women survived the 5-year-period free of tumor. All these women were younger than 40. -After an average of 73 months six young women had to undergo relaparotomy and radical operation under suspicion of recurrence. In two cases a tumor recidivation was found, one where of was precancerous. Benefits and risks of the conservative approach in primary treatment are discussed and attention is drawn to the necessity of secondary radical operation.

[Rare late metastasis of a successfully treated advanced ovarian cancer]. / Seltene Spätmetastasierung eines kurativ behandelten fortgeschrittenen Ovarialkarzinoms.

A case of a 64 year old woman is reported suffering from bilateral inoperable ovarian carcinoma. Seven years before death the carcinoma was histologically confirmed by an explorative laparotomy. At this time even a diffuse peritoneal carcinosis was found. The polychemotherapy yielded to a reduction of tumor mass. This allowed a surgical radical operation two years later. During continued chemotherapy the patient was clinically and cytologically free of tumor. The death was caused by diffuse late metastases in the brain.