Search

It is reported on the possible role of the radioimmunological estimation of placental protein 12 (PP 12; insulin-like growth factor binding protein 25, IGF-BP 25) in pleural effusions of patients with lung cancer, with pleural carcinosis of extrathoracal carcinomas and benign pleural diseases, respectively. There are more PP 12, IGF-BP 25-positive cases at benign diseases than at carcinomas at all. It is discussed the possible importance of PP 12, IGF-BP 25 as a binding protein of growth factor s IGF-I and -II. The clinical validity should be analysed in more detail on the basis of the estimation of more patients.

It should be solved the question if the estimation of the TSA-concentrations in various body fluids of patients with ovarian tumour like conditions (n = 11), and benign (n = 28) and malignant (n = 25) cystic ovarian tumours can be used as a tumour marker with an additional clinical information. The determination of the concentrations were carried out in blood sera, cyst and peritoneal fluids. The periodate-thiobarbituric acid-assay was used to measure the TSA-contents. The sensitivity of pre-therapy TSA-concentrations in serum for malignant cystic ovarian tumours is 0.59 at a prevalence of 0.55; the specificity has a value of 0.79. There is no improvement of clinical validity through a pre-therapy TSA/total protein (TP)-ratio in serum (sensitivity 0.41; specificity 0.71). There are no useful clinical data of simultaneous estimation in serum, tumour cystic and peritoneal fluids of the same patient.

Concentrations of secretory immunoglobulin A (S-IgA), pregnancy associated alpha 2-glycoprotein (alpha 2-PAG) and circulating immune complexes (CIC) were estimated in serum samples of 20 blood donors, 14 patients with benign mamma tumors, 44 patients with mastopathies and 33 patients with breast cancer disease. The proteins were determined by means of the single radial immunodiffusion and the polyethylene glycol precipitation. S-IgA serum concentrations of the cancer group compared with those of the benign tumors, were increased significantly (benign tumors: mean = 40.27 mg/l; s = 15.61; carcinoma disease: mean = 78.87 mg/l; s = 72.80). alpha 2-PAG serum concentrations of the cancer-and benign tumor group as well as the mastopathy group were also increased significantly in comparison with the blood donor group (blood donors: mean = 143.75 mg/l; s = 198.50; benign tumors: mean = 295.85 mg/l; s = 232.64; mastopathies: mean = 190.86 mg/l; s = 177.77; carcinoma disease: mean = 192.52 mg/l; s = 172.88).

Carcinoembryonic antigen (CEA) was assayed by radioimmunoassay in serum of 47 patients with cystic ovarian tumors, in 51 cases of cyst fluids of ovarian tumors and ovarian cysts, and in 16 cases of peritoneal effusions (ascites). In order to differentiate between cystic tumors and retentional cysts there was found, in consideration of a changed prevalence (0.65), a sensitivity of 55% and a specificity of 94%. The predictive value in regard to a positive assay result was 94% and in regard to a negative one was 53%. Elevated CEA-levels in ovarian tumor cyst fluids are mainly diagnostic for mucinous ovarian tumors. In regard to elevated CEA-levels in cyst fluids of ovarian tumors it is claimed the laparotomy and histological investigation.

Carcinoembryonic antigen (CEA) was assayed by radio immunoassay in serum of 87 patients with breast cancer and 85 patients with benign breast tumors from 1983 to 1986. The sensitivity of 43%, the specificity of 89%, the predictive values in regard to a positive assay result of 75% and in regard to a negative assay result of 67% was determined in consideration of a changed prevalence. It is referred to the importance of the estimation of CEA in the individual diagnosis, monitoring and follow up of patients with breast cancer. It is claimed the follow up for the premature recording of a recurrency the aid of CEA-estimation in always the same technical variant at the same patient.

Cytologic findings and the histologic diagnosis are compared in 326 cervical cones. Out of the Pap III ("with cytologic control") group, cases named "Pap III with necessity for histologic diagnosis" were evaluated separately. In this subgroup of Pap III, we have found prestages or early stages of cervical cancer.

Four years experiences with a computer-assisted program for early detection of prestages and early cervical cancer in the district Rostock are reported. 96 265 women were examined. Pathological papsmears were found in 0.72%. The importance of a differential diagnosis of Papanicolaous group III is underlined.

In a 12 years old patient with asymmetric mixed gonadal dysgenesis (karyotype 45, XO/46,XY) a stimulation test with arginine, gonadotropin-releasing hormone (GRH) and thyreotropin-releasing hormone (TRH) was performed before and after exstirpation of the gonads as well as after application of sex steroids. FSH, LH, PRL, HGH, TSH, testosterone and oestradiol were determined by radioimmunoassay. The results show an intact hypothalamo-pituitary axis which reacts with a normal negative feedback with respect to the secretion of gonadotropins after application of sex steroids.

The clinical aspects of pregnancy, parturition and childbed in a young primigravida, who had the Ehlers-Danlos syndrome, are reported. The whole course was without complications, contrary to other bibliographies. A survey of the family gave no evidence, that the characteristic was familial. Possibilities of danger are showed.

Surgery is generally accepted as the basis of therapy in endometrial carcinoma. In stage I disease with well-differentiated lesions (G I), the mainstay and generally accepted basis for management is surgical, usually extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy. In the cases of stage I and dedifferentiated lesions (G II/G III) bilateral pelvic lymphadenectomy is performed additionally. The surgical method in stage II lesions is radical abdominal hysterectomy, bilateral pelvic lymphadenectomy, and bilateral salpingo-oophorectomy.

Gynecological mass-screening leads to a decrease of prevalence and incidence of cervical cancer and precancerous conditions. In Rostock a program for early detection of cervical cancer was developed. Organization, application of computer in this model and the expenses of a computer assisted mass-screening-program are discussed. In order to facilitate comparison between various centers, a generally accepted classification and terminology of colposcopic, cytologic and histologic findings are essential. First epidemiological results of Rostock's women are demonstrated to characterize the screened population.

CEA estimations are effected in serum samples and in cervico vaginal fluids (n = 144) of patients with cervical condylomas, cytological undecided and cytological positive findings and in follow up performed histology. 21 healthy women were used as a control group. For taking cervico-vaginal fluids 5 ml isotonic NaCl solution were instilled in the fornix vaginae. After that 5 ml of the solution mixed with cervico vaginal fluids were aspirated. A polyclonal anti-CEA-antiserum was applied to radioimmunoassay. Remarkable high concentrations were found in cervico vaginal fluids compared with serum values. (Table: see text). In cases of cervical condylomas and cervical intraepithelial neoplasia significant increased CEA levels were determined in fluids compared with the control group. These results must be seen in consideration that the local CEA concentrations are scattered over a brand range. Regarding to CEA serum concentrations only slight increased values were found in cases of CIN I/II. (table; see text) Therefore CEA-serum estimations are not a diagnostic tool in CIN. The normal range of 10 micrograms/l was exceeded in only one sample of CIN II.

In the years 1983 to 1986 concentrations of CEA in serum samples of 63 female patients with endometrial cancer have been estimated with help of a radioimmunoassay. In all histopathological stages 25 per cent elevated CEA-concentrations could be found pretherapeutically. It is given the semilogarithmic representation of the CEA-values of the individual basic lines in the posttherapeutical follow up. Main field for estimations of CEA-concentrations in serum is only the performance of a posttherapeutical monitoring of the operated and irradiated endometrial cancer.

In the years of 1981 to 1983 15 pregnant patients had to be operated on because of suspected appendicitis. In 10 patients acute symptoms of inflammation of the appendix could be proved histologically. Morbidity rate was 2.1 per thousand related to a over-all of 4766 births in the 3 years.

We estimated serum levels of progesterone and the most important binding proteins in follicular and luteal phase at women without breast disease with biphasic or anovulatory cycle and female patients with benign or malignant breast diseases. There was an increase of the median value of acidic alpha-1-glycoprotein in the luteal phase at female patients with premenopausal breast cancer. The importance of serum levels of the bioavailable sexual steroids for the recognition of women with breast diseases is discussed.

In 62 cases of dysplasia and 104 carcinomata in situ (in addition 15 microcarcinomata) a topographic localization on the surface of the portio uteri is demonstrated. The paraffin embedded undivided cones were cut into slices with constant distances of 0.75 mm. There are different types of localization. We observed in nearly 50% of carcinomata in situ and in nearly 66% of dysplasia a circular distribution. 20% of the carcinomata in situ were found in a largeness of a quarter of the surface of portio or smaller. The strongest alterations in carcinomata in situ (and microcarcinomata) are localized on the upper part of the uterine orifice.

The levels of total protein, Ig, AFP, beta-HCG, CEA, SC, SP1 and alpha 2-PAG were measured in cystic and peritoneal effusions obtained from 70 females with benign and malignant ovarian tumors. This study was carried out to test out parameters those are useful for tumor monitoring of ovarian cancer. Our results indicate that determining CEA in peritoneal effusions could be one of useful methods in tumor monitoring of mucinous cystadenocarcinomas in cases of known histology and praetherapeutic estimated CEA levels in cystic or peritoneal effusions. Our results demonstrate that CEA-levels greater than 100 micrograms/l are mostly found in mucinous cystadenocarcinomas and in mucinous cystadenomas, too. High cystic CEA levels support the histology aiming for demonstration of mucinous component.

There was the evaluation of circulating T-cells with the help of the E-rosette-assay in patients with breast cancer (n = 52), carcinoma of the cervix uteri (n = 29), carcinoma of the endometrium (n = 32) and carcinoma of the ovary (n = 7). Twenty seven healthy female blood donors were used as control group. There was no statistically significant difference between the total and active E-rosette values of the patients with tumours and the control group. Patients with breast cancer pT1N0 had significant lower total E-rosette values (Gpt/l) than patients with higher tumour stadium (p less than 0.05). The white blood cell count showed a statistically significant leucocytosis in cancer patient groups versus control persons (p less than 0.05).

A case of a cavernous haemangioma of the umbilical cord not far from the stillborn infant of 30 weeks gestation is reported. Autopsy revealed no intrauterine growth retardation, malformation and fetopathia. The placenta shows disorders of vasculartiy.

Atypical epithelium, adjacent to normal tissue, was removed along with diagnostic conisation from 243 patients with in situ carcinoma. That approach actually proved to be the adequate therapy. Not a single recurrence was recorded from any of the patients over follow-up periods between two and 13 years. The causes of possible "recurrences" are discussed. There is no need, at present, for giving up the proven therapeutic concept to cope with in situ carcinoma, provided that certain conditions are duly observed.

1. In 232 diagnostical cervix-conisations (almost exclusively on account of positive papsmears) there were 119 carcinomata in situ and 17 microcarcinomata. In accordance and in comparison with other investigators the frequency of microcarcinoma - related to carcinoma in situ - runs up to approximately to 14%. Microcarcinoma was found in 6% of dysplasia and in 10% of all carcinomata in situ. 2. For early clinical diagnosis (for instance papsmears and colposcopy) as well as for therapy the topographical distribution of microcarcinoma is of importance; they have been found almost exclusively on the upper part of the uterine orifice. The treatment of microcarcinoma by means of conisation is being evuluated. An individually differentiated operative therapy is aimed at, by no means, however, the so-called "radical cancer-therapy". 3. Observations concerning cancerogenesis of the carcinoma cervicis are not only of theoretical interest. The "oligophasic" cancerogenesis from dysplasia has been observed - about one fifth of all cases of microcarcinomata came into existence that way. Relatively often a cytotest showed in these cases a Papanicolaou group III. The latter fact should be taken into account in our present time for a differential cytology.

Two years experiences with a computer-assisted program for early detection of prestages and early cervical cancer in Rostock-city are reported. 65% = 27028 women finally cooperated. Pathological papsmears were found in 0,52%. 9 cases of severe dysplasia, 30 carcinomata in situ, 3 cases of early invasion, 3 micro- and 5 macrocarcinomas were observed. Accessory findings were seen in 10,2%.

At present the diagnosis "endometritis" is diagnosed too frequently by the histological examination of the endometrial biopsies. An essential cause is the misconstruction of cells of the endometrial stroma. This investigation is based on the histological diagnosis of 3729 endometrial biopsies. 229 cases represent changes of the endometrium after pregnancy (abortion, birth). Among 3500 endometrial biopsies 9 cases (=0,3%) had been diagnosed as "nonspecific chronic endometritis". The histological signs of the endometritis are described.

The E rosette test was made at 35 women with disturbances in early pregnancy (gestational weeks 8 to 12). 61 women with normal pregnancy and 33 nonpregnant women were taken as control persons. There were no significant differences between procentual and absolute numbers of E rosettes of women with deranged pregnancy, of women with normal pregnancy and nonpregnant women. We did not learn to differentiate between Abortus imminens (with intact pregnancy) and real occurred fetal death by the E rosette test. Pregnant women had higher leucocyte values and procentual lymphocyte rates than nonpregnant women.

Three techniques for ambulatory diagnosis of female sterility are compared and critically assessed for their potential benefits and drawbacks. They are endometrial biopsy on the first day of cycle, hysterosalpingography in combination with CO2 pertubation, and hydrotubation, using 0.06 per cent phenolphthalein (Speck's test). There were many more inherent benefits than drawbacks, primarily with regard to informative value and avoidance of undesirable side effects. Good economy, convenient technical applicability, and relief of ward and operation theatre personnel are additional factors in favour of the above ambulatory approaches.

48 fertile women took in three weeks 1 mg ethinylestradiolsulfonate weekly and in the 4th week 10 mg norethisterone acetate, respectively d-norgestrel in different dosages (0,5 mgs, 1,0 mgs, 1,5 mgs or 3,0 mgs). On this 48 women 69 abrasiones were made between the first and 37th treatment cycles in order to estimate the endometrium. Ethinylestradiolsulfonate caused for the most part a proliferation of endometrium, which reached to a glandulare cystic hyperplastic endometrium. We did not observe a reduction of the endometrial respond to this depot-estrogen in dependence on the time of taking. Norethisterone acetate and d-norgestrel effected on a different proliferated endometrium a secretory transfer mation always.48 women, aged 17-41, were treated with weekly dosages of 1 mg ethinylestradiolsulfonate (EES) and a 10 mg dosage of norethisterone acetate (NEA) or a .5 mg.-3.0 mg. dosage of d-norgestrel(d-N) every 4 weeks. 69 abrasions of the endometrium were taken from these patients between the 1st-37th treatment cycles. The EES caused a hyperpasia of the endometrium, increasing with the length of use. The patients given the NEA and d-N developed retronuclear basal secretory vacuoles and an overabundance of glycogen in the abrasion material, which was not dependent on the dosage of the gestagen which was given.

Clinical report on 234 vaginal radical hysterectomies carried out in the years 1959 to 1970 at the department of obstetrics and gynecology of the university of Rostock. 84% 5-year recoveries. No primary operative mortality, low morbidity. 5-year recovery is 76%, if cancer does exceed 20 X 20 mm at the surface and/or 10 mm extent at the depth. If cancer does not exceed this three-dimensional measurement 5-year recovery is 91%. There was concluded firstly that the possibility of metastases in the pelvic lymph nodes is dependent from the size of the primary tumor and secondly that before treatment a subtile diagnostic procedure secures that only good cases of cervical cancer FIGO stage I b are operated on by radical vaginal hysterectomy (Schauta-Amreich). Also in some cases of microcarcinoma a Schauta-operation is indicated. Our proposal is a reduced radicality with regard to the removal of the parametrium in these caces.

Two years experiences with a computerassisted program for early detection of prestages and early cervical cancer in Rostock-city are reported. From 43.000 women invited to take part in the examination, 27.028 = 65% finally cooperated. Pathological Pap-smears were found in 134 cases (= 0,52%). Histological examination in 51 cases (= 0,2%) showed 1 Erosio vera (false positive), 9 severe dysplasia, 30 carcinomata in situ, 3 early invasions (microinvasive cancer), 3 microcarcinoma and 5 macrocarcinoma. Accessory findings were seen in 10,2%. A good organized mass-screening-system with unique nomenclature, diagnostic and treatment of cervical cancer and its prestages gives the best supposition to cut down its rate of incidence.

Cytologic findings and the histologic diagnosis are compared in 326 cervical cones. We have found following ratio of the groups Papanicolaou (Pap) III: Pap IV--in dysplasia 1: 1: 1, in "more dysplasia than carcinoma in situ (CIS)" 1:2:2. The Pap IV dominates in "pure" CIS and in cones with "more CIS than dysplasia". We take out of the Pap III ("with cytologic control") cases named "Pap III with necessity for histologic diagnosis". We have found in this subgroup of Pap III prestages or early stages of cervical carcinoma.

Placental Protein 12 (PP 12) concentrations were measured by a radioimmunoassay in cyst and peritoneal fluids and in serum samples respectively of patients with tumor like conditions and benign and malignant cystic ovarian tumours. PP 12 can not recommended as a serum tumour marker in ovarian cancer. It must be proved the value of PP 12 in follow up of ovarian cancer with help of more extensive sample material. There are many cysts in tumour like conditions with measurable PP 12-concentrations.

Labour was induced by intravenous infusion of prostaglandin F2alpha (PGF2alpha) in 12 patients with hydatidiform mole. After a mean infusion time of 15 h 51 min and a mean dosage of 25,1 mg PGF2alpha, the infusion of 5 to 40 mug PGF2alpha/min led to 1 to 3 cm dilatation of the cervix. In this way, it was possible to perform a mild evacuation of the molar tissue with vacuum curette or fixation forceps and curette. Under continued PG-infusion the uterus was contracted in the time of evacuation of hydatidiform mole. At present the preoperative dilatation of the cervix by means of PG-induced labour and vacuum curettage is the method of choice in the management of hydatidiform mole because of its effectiveness and few undesirable side effects.

Our present knowledge of the precursors of endometrial cancer is reviewed. The endometrial cystic gland hyperplasia, atypical adenomatous hyperplasia and adenocarcinoma in situ are discussed in relation to the development of endometrial cancer.