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Background: Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

Purpose: The purpose of this study was to determine the value of dynamic pelvic floor MRI relative to standard clinical examinations in treatment decisions made by an interdisciplinary team of specialists in a center for pelvic floor dysfunction., Methods: 60 women were referred for dynamic pelvic floor MRI by an interdisciplinary team of specialists of a pelvic floor center. All patients were clinically examined by an urologist, gynecologist, a proctological, and colorectal surgeon. The specialists assessed individually and in consensus, whether (1) MRI provides important additional information not evident by physical examination and in consensus whether (2) MRI influenced the treatment strategy and/or (3) changed management or the surgical procedure., Results: MRI was rated essential to the treatment decision in 22/50 cases, leading to a treatment change in 13 cases. In 12 cases, an enterocele was diagnosed by MRI but was not detected on physical exam. In 4 cases an enterocele and in 2 cases a rectocele were suspected clinically but not confirmed by MRI. In 4 cases, MRI proved critical in assessment of rectocele size. Vaginal intussusception detected on MRI was likewise missed by gynecologic exam in 1 case., Conclusion: MRI allows diagnosis of clinically occult enteroceles, by comprehensively evaluating the interaction between the pelvic floor and viscera. In nearly half of cases, MRI changed management or the surgical approach relative to the clinical evaluation of an interdisciplinary team. Thus, dynamic pelvic floor MRI represents an essential component of the evaluation for pelvic floor disorders.

The molecular prevalence of human parvovirus B19V (B19V) in bone marrow (BM) samples from 120 cases with cytopenias of unknown etiology was compared with that in samples from 45 BM donors (control group 1) and 120 oncohematological patients (control group 2) to determine the role that B19V genotypes may play in unexplained cytopenias. Of the 285 participants, the BM samples of 39 (13.7%) contained B19V DNA (21 with genotype 1, 5 with genotype 2, and 13 with genotype 3). The prevalences of B19V were similar between case and control subjects (15.0% versus 12.7%, respectively). Genotypes 2 and 3 were associated with older age and were detected in similar proportions between case and control group 2 subjects. The results of this study do not support a role for B19V genotype variants in the etiology of unexplained cytopenias.

Background: Genetic variability is a major feature of human immunodeficiency virus type 1 (HIV-1) and is considered the key factor frustrating efforts to halt the HIV epidemic. A proper understanding of HIV-1 genomic diversity is a fundamental prerequisite for proper epidemiology, genetic diagnosis, and successful drugs and vaccines design. Here, we report on the partial and near full-length genomic (NFLG) variability of HIV-1 isolates from a well-characterized cohort of recently infected patients in São Paul, Brazil., Methodology: HIV-1 proviral DNA was extracted from the peripheral blood mononuclear cells of 113 participants. The NFLG and partial fragments were determined by overlapping nested PCR and direct sequencing. The data were phylogenetically analyzed., Results: Of the 113 samples (90.3% male; median age 31 years; 79.6% homosexual men) studied, 77 (68.1%) NFLGs and 32 (29.3%) partial fragments were successfully subtyped. Of the successfully subtyped sequences, 88 (80.7%) were subtype B sequences, 12 (11%) BF1 recombinants, 3 (2.8%) subtype C sequences, 2 (1.8%) BC recombinants and subclade F1 each, 1 (0.9%) CRF02 AG, and 1 (0.9%) CRF31 BC. Primary drug resistance mutations were observed in 14/101 (13.9%) of samples, with 5.9% being resistant to protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTI) and 4.9% resistant to non-NRTIs. Predictions of viral tropism were determined for 86 individuals. X4 or X4 dual or mixed-tropic viruses (X4/DM) were seen in 26 (30.2%) of subjects. The proportion of X4 viruses in homosexuals was detected in 19/69 (27.5%)., Conclusions: Our results confirm the existence of various HIV-1 subtypes circulating in São Paulo, and indicate that subtype B account for the majority of infections. Antiretroviral (ARV) drug resistance is relatively common among recently infected patients. The proportion of X4 viruses in homosexuals was significantly higher than the proportion seen in other study populations.

Background: Therapy possibilities are limited in patients with cervix carcinoma and thrombocytopenia., Case Report: We describe a 50-year-old woman with inoperable cervical carcinoma and chronic lymphatic B cell leukemia (B-CLL). Due to thrombocytopenia, a combined radiochemotherapy could not be performed. Intensitymodulated radiotherapy (IMRT) aiming at maximal bone sparing was planned. After a total dose of 45 Gy, a laparoscopic omentum plastic was performed to enable radiotherapy (RT) to full dose. 3 days later, an external beam boost was restarted to a cumulative dose of 50.4 Gy. Regular blood analysis showed low but stable blood counts. 4 weeks after RT, magnetic resonance imaging (MRI) showed a 30% regression of the tumor volume and, after transfusion of fresh-frozen plasma, a hysterectomy could be performed. 6 months after therapy, no recurrence or late toxicities had occurred., Conclusion: The clinical implementation of IMRT may potentially improve the therapeutic outcome of patients with cervix cancer, allowing dose escalation without increasing normal-tissue toxicity., (Copyright 2010 S. Karger AG, Basel.)

Background: The genetic diversity of the human immunodeficiency virus type 1 (HIV-1) is critical to lay the groundwork for the design of successful drugs or vaccine. In this study we aimed to characterize and define the molecular prevalence of HIV-1 subclade F1 currently circulating in São Paulo, Brazil., Methods: A total of 36 samples were selected from 888 adult patients residing in São Paulo who had previously been diagnosed in two independent studies in our laboratory as being infected with subclade F1 based on pol subgenomic fragment sequencing. Proviral DNA was amplified from the purified genomic DNA of all 36 blood samples by 5 fragments overlapping PCR followed by direct sequencing. Sequence data were obtained from the 5 fragments of pure subclade F1 and phylogenetic trees were constructed and compared with previously published sequences. Subclades F1 that exhibited mosaic structure with other subtypes were omitted from any further analysis, Results: Our methods of fragment amplification and sequencing confirmed that only 5 sequences inferred from pol region as subclade F1 also holds true for the genome as a whole and, thus, estimated the true prevalence at 0.56%. The results also showed a single phylogenetic cluster of the Brazilian subclade F1 along with non-Brazilian South American isolates in both subgenomic and the full-length genomes analysis with an overall intrasubtype nucleotide divergence of 6.9%. The nucleotide differences within the South American and Central African F1 strains, in the C2-C3 env, were 8.5% and 12.3%, respectively., Conclusion: All together, our findings showed a surprisingly low prevalence rate of subclade F1 in Brazil and suggest that these isolates originated in Central Africa and subsequently introduced to South America.

The aim of this study was to define the prevalence of human T cell lymphotropic virus types 1 and 2 in patients who were positive for human immunodeficiency virus type 1 in the State of São Paulo, Brazil. We evaluated 319 individuals infected with HIV type 1 who were attended at specialized clinics in two cities (Ribeirão Preto and São Paulo). The patients were interviewed and tested for antibodies against HTLV types 1 and 2 (Orthoâ HTLV-1/HTLV-2 Ab-Capture enzyme immunoassay). Direct DNA sequencing of polymerase chain reaction products from the tax region of HTLV type 2 and the long terminal repeat region of HTLV types 1 and 2 were performed to differentiate and determine the subtypes. The overall prevalence of anti-HTLV type 1 and 2 antibodies was 7.5% (24/319; 95% CI: 5.2-11.5). HTLV type 1 and 2 infection was associated with a history of injected drug use and with antibodies for hepatitis C virus (p < 0.001), but not with age (p = 0.2), sex (p = 0.9), sexual behavior or serological markers for sexually transmitted diseases (anti-Treponema pallidum, anti-human herpesvirus type 8 or anti-hepatitis B virus antibodies) (p > 0.05). HTLV DNA was detected in 13 out of 24 samples, of which 12 were characterized as HTLV subtype 2c and one as HTLV subtype 1a. Among the 12 HTLV type 2 samples, seven were from injected drug users, thus indicating that this route is an important risk factor for HTLV type 2 transmission among our population infected with HIV type 1.

The human immune deficiency virus (HIV) exhibits strikingly tremendous amount of genetic variability. Such feature is critically important for the virus to adapt to environmental changes by escaping the host immune system and by escaping candidate vaccine. Therefore, understanding of such diversity is fundamental for the design of successful drugs or vaccine, which is urgently needed to bring the HIV/AIDS epidemic under control. In this study, we investigated the magnitude of diversity of the HIV-1 near full-length genomes from patients previously assigned as infected with non-recombinant HIV-1 subtypes B and F1 variants based on small portion of viral genome. HIV-1 proviral DNA was extracted from 14 samples previously classified in our laboratory as six subtypes B and eight subtypes F on the basis of small amplicon sequencing. Reamplifications of DNA from these samples were carried out by an overlapping PCR followed by direct sequencing. The data were phylogenetically inferred. Sequence analysis revealed that two out of six partially identified subtype B and six out of eight partially identified subtype F were in fact BF recombinants throughout their full genomes. Two pairs BF recombinants had identical genomic recombination structure and distinct from the Argentinean CRF 12&#95;BF strains, probably represents a novel circulating recombinant forms in Brazil. Our data provided new genetic material of some of the HIV-1 subtypes currently circulating in the country and points to the widespread of BF recombinants which are expected to change the epidemic nature by approaching the level of subtype B in Brazil.

Indication for fertility preserving surgery results from the patient's age, the histologic tumor type and the stage of the ovarian malignancy. Approximately 80-85 % of these lesions are ovarian cancers. 10-15 % tumors with low malignant potential (LMP) and approx. 5 % germ cell tumors. Of the ovarian cancers approx. 15 % of LMP tumors 50 %, and of germ cell tumors more than 90 % occur in patients below 40 years of age, in which fertility preserving surgery might be considered. An adequate operative staging permits a conservative procedure for ovarian cancers stage Ia. Due to the good prognosis of LMP-tumors (10 year survival, all stages, approx. 90 %) and the low rate of recurrences after conservative surgery of 6.8 % (10/147), a fertility preserving operation is feasible in select cases also in more advanced stages than Ia. In cases of germ cell tumors, which in the majority of cases are unilateral, even if the tumor extends beyond the ovaries, an adnexectomy will suffice. A successful chemotherapy, e.g. with bleomycin, etoposid, and cisplatin leads to remission rates of > 90 %. The reduced number of patients treated according to the above criteria in 90 % had a normal menstrual cycle after surgery and chemotherapy. Besides numerous case reports on successful pregnancies, there are also reports in literature on results in larger patients groups. Thus it has been reported that of 99 patients with an ovarian cancer stage I. 56 underwent conservative surgery. Child-bearing desire, present in 17 of these women, could be fulfilled in all cases (Colombo et al. 1995). Bianci and coworkers also described successful pregnancies (14/48) after conservative treatment of tumors of LMP. Numerous case reports have been published showing that after fertility preserving surgery of germ cell tumors pregnancies may also be successful. Since especially in ovarian cancers recurrences may occur at a later time, a hysterectomy with removal of the contralateral adnexa is suggested after complete family planning or when the patient enters the menopause. The possibilities offered by in vitro-fertilization have theoretically enlarged the spectrum of fertility preserving surgery. Thus, individual authors propose the conservation of the uterus after bilateral ovarectomy-keeping the option of a pregnancy by oocyte donation open for the patient. As further alternative conservation of a restovary after removal of the uterus and one adnexa is discussed. In these cases the patient's oocytes are preserved for feasible in vitro-fertilization in a "substitute" mother. Results of such fertility preserving procedures have not yet been published.

Both nuclear DNA content and S-phase fraction (SPF) can be helpful in predicting prognosis in certain malignancies. We investigated in a retrospective study the prognostic significance of nuclear DNA content and SPF as measured by flow cytometry of tumor specimens from 162 women with nonpretreated surgically staged FIGO stage I endometrial cancer using clearly defined inclusion criteria. A total of 139 (86%) cases were found to be diploid, whereas 23 (14%) were aneuploid. Ploidy showed a correlation with histologic grade, estrogen as well as progesterone receptor levels, and depth of myometrial infiltration. Univariate analysis of follow-up data showed an increased relative risk (RR) for recurrence-free survival (RFS) for grade 3 tumors (RR = 2.11, ns), for age (RR = 1.04, P = 0.023) as a continuous variable, and for SPF in diploid tumors (RR = 3.10, P = 0.035). In addition, univariate analysis of overall survival revealed similar results with a slightly increased relative risk for ploidy (RR = 1.52, ns). Multivariate analysis of RFS showed age as the only independent prognostic factor. Multivariate analysis of RFS for diploid tumors showed no independently significant factor; however, age as a continuous variable with a relative risk of 1.04 and SPF with a relative risk of 2.94 were of borderline significance. Our results suggest that abnormalities of the nuclear DNA content and SPF in this homogeneous group of patients are associated with clinical and morphological prognosticators; however, ploidy is no independent prognostic factor for RFS. For diploid tumors, SPF might be a possible independent prognostic factor.

Purpose: We report two randomized trials of adjuvant systemic therapy in 747 patients < or = 65 years of age with histologically proven node-positive breast cancer., Patients and Methods: Patients were selected for the two trials on the basis of lymph node and hormone receptor status. The only stratification was based on the treating institution. In patients with a lower probability of recurrence (n = 276), a comparison between endocrine therapy (tamoxifen [Tam] 30 mg/d for 2 years) and chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] intravenously [IV], six cycles every 4 weeks) was performed. In patients with a higher risk of recurrence (n = 471), a comparison between chemotherapy alone (doxorubicin plus cyclophosphamide [AC] i.v., eight cycles every 3 weeks) and the same chemotherapy plus Tam was made., Results: Overall, we found that CMF and Tam are equally effective in a subgroup of patients with a relatively good prognosis (low-risk patients). However, in the subset of women < or = 49 years old, a significantly greater disease-free survival (DFS) rate (P = .01) and overall survival (OS) rate (P = .002) was observed following therapy with CMF compared with Tam. In patients > or = 50 years old, the opposite was found, and Tam appeared to be superior to CMF (DFS, P = .003; OSm P = .5). These results must be interpreted cautiously, since a post-hoc stratification of patients by age (< or = 49, > or = 50) was performed, and significantly more younger, low-risk patients were randomized to receive chemotherapy alone and more older patients to receive Tam alone. Among patients with a relatively poor prognosis (high-risk patients), a combination of AC plus Tam was equivalent to AC and, when women were analyzed by age, this was found to be true of patients < or = 49 years as well. However, the addition of Tam to AC in women age > or 50 years resulted in a statistically significantly higher DFS (P = .01) and a trend toward better OS compared with women who received AC alone., Conclusion: Further trials are required to analyze the role of combined simultaneous or sequential chemoendocrine adjuvant treatment or each single therapy alone in defined risk-adapted subsets of node-negative and node-positive patients.

Three hundred and nine malignant endometrial tumors were biochemically analyzed with respect to estrogen (ER) and progesterone (PR) receptors. Fifty-seven percent of endometrial carcinomas were ER and PR positive (greater than or equal to 50 fmole/mg of cytosol protein); 24% were negative for both receptors. Five sarcomas and 16 of 21 mixed müllerian tumors were receptor negative. Receptor status correlated with clinical stage and grade of histological differentiation, but not with myometrial invasion. Anamnestic data on patients showed no differences between those with receptor-negative and receptor-positive tumors. Five-year survival rate (stage I) and median survival time (stages II-IV, recurrences) for patients with ER+/PR+ and ER-/PR+ endometrial cancer were significantly better than for ER-/PR- and ER+/PR- patients. A multivariate analysis demonstrated progesterone receptor as a significant prognostic factor next to clinical stage. Estrogen receptor had no significant prognostic relevance. A retrospective analysis of gestagen treatment and progesterone receptor status confirms the importance of PR, possibly independent of hormonal treatment.

Fifty patients with advanced (stage III or IV) ovarian carcinoma were followed-up until the date of their death or their fifth year of survival. Prognostic factors, including those currently in use, as well as ploidy and proliferation, chemoresistance testing and hormone receptor levels of the tumours were analysed for predictive value and independence from each other. In the univariate analysis, only stage, residual tumour, second-look status, chemoresistance, ploidy and proliferation were significantly correlated with survival. After being tested in a multivariate Cox regression model, however, only the results of chemoresistance testing at initiation of therapy, and second-look status at a later point, retained prognostic significance. Within the group of patients with a positive second-look, i.e., with the worst prognosis, the chemoresistance test was still able to discriminate between two subgroups with significantly different survival.

The different prognoses for patients with adenocarcinomas and squamous cell carcinomas of the cervix uteri were proved by matched-pair analysis. One hundred forty-four patients with adenocarcinoma treated in 1964-1985 were compared in a ratio of 1:2 with 268 patients with squamous cell carcinoma comparable in age, stage, and treatment modality. In both groups 45% of patients were in stage I, 38% in stage II, 15% in stage III, and 2% in stage IV. Five- and 10-year survivals of patients with adenocarcinoma were significantly lower than for those with squamous cell carcinoma (53% resp. 42% vs 68% vs 58%, P = 0.006). In an analyses of patients' prognosis according to clinical stage there was no significant difference between both groups in stages III and IV treated exclusively by radiotherapy. No significant differences were found in stage I and II patients treated by radical surgery. However, the most significant difference in prognosis was seen in stage I and II patients treated by radiotherapy. Five-year survival was 58.6% in stage I adenocarcinomas compared with 85.0% in squamous cell carcinomas. It can be concluded from these results that a discussion of the problem of FIGO staging is more necessary than a discussion of the different radiosensitivities of these two histological types. Surgical treatment must have the same priority as radical surgery or staging laparotomy for exact histologic staging in adenocarcinomas of the cervix uteri.

Six human endometrial cancers in different clinical stages were xenotransplanted into thymusaplastic nude mice. Estrogen and progesterone receptors in the tumor tissue were determined in each case. Two carcinomas with both estrogen and progesterone receptors showed a better clinical course and grew more slowly in nude mice than the four carcinomas with no receptors at all. Treatment with the antiestrogen Tamoxifen in the carcinoma with positive estrogen receptors showed a significant growth retardation compared with the control group. Estrogen treatment gave accelerated growth, whereas gestagen treatment showed no significant effect. The progesterone receptor content of the receptor-positive tumor tissue might have been too small. None of the four receptor-negative carcinomas showed any influence of tumor growth during endocrine therapy. The results demonstrate the importance of receptor determination as a prognostic sign and, further, allow the endocrine therapy of endometrial carcinomas to be complemented with Tamoxifen in estrogen-receptor-positive tumor tissue.

Over the past 20 years, 16 pregnancies with thrombocytopenia were observed. Fourteen of these cases were afflicted with immune thrombocytopenic purpura (ITP, M, Werlhof). Antenatal treatment of the mothers (e.g., with corticosteroids) varied and is discussed. The methods of delivery were spontaneous vaginal (nine) or cesarean section (five). Except for one neonatal death (28th week of gestation), no significant hemorrhagic morbidity occurred. On the basis of this experience and the literature, an individual management of delivery for parturient patients with ITP is proposed.

In a cooperative study specimens of 37 patients with stage III and IV ovarian carcinomas who had been treated with chemotherapy were investigated utilizing flow cytometry and an in vitro short-term test for predicting resistance. Patients with aneuploid tumors had significantly shorter survival rates than did those with diploid tumors. Patients whose tumors showed a low G0/G1 cell proportion or a high proliferation pool (S- and G2/M cell-proportion) seemed to die earlier. There was also a tendency for patients with in vitro resistant tumors to die earlier under chemotherapy than those with sensitive tumors.

Twenty-nine patients with advanced previously untreated epithelial ovarian cancer (FIGO stage III + IV) received induction chemotherapy with CAP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2 and cis-platinum 50 mg/m2). Of twenty patients whose post-surgical tumor size was greater than 2 cm, fifteen (75%) achieved objective response. The median duration of complete response is greater than 20 months and the median duration of partial response is greater than 11 months. Among the 75% responders (15 of 20) overall, eleven were determined by surgical evaluation and four by clinical evaluation. The response rate in the present study compares favorably with previously reported studies. Toxicity from the CAP regimen was frequent and often severe but no irreversible side effects or treatment related deaths were observed. It is concluded that the CAP regimen appears to be an effective drug combination against advanced ovarian cancer that may improve overall response and ultimate survival of previously untreated patients.

In two cooperative studies surgical specimens of 187 tumors of patients with non-small cell lung carcinomas (NSCLC) and 37 tumors of patients with ovarian carcinomas (OC) were investigated by means of flow cytometry (ICP-22). From NSCLC30 cases were classified as tumors with DNA diploidy, 119 as tumors with DNA aneuploidy containing one abnormal DNA stemline, and 38 as tumors with DNA aneuploidy containing more than one abnormal DNA stemline. Seven tumors of patients with OC were classified as tumors with DNA diploidy, and 31 as tumors with DNA aneuploidy (three cases had more than one abnormal DNA stemline). The DNA index values of NSCLC range from 0.7 to 4.5 and the values of OC from 0.8 to 2.7 (DNA diploid = 1). A relationship between DNA content and distribution of the cell cycle phases was observed. The results of DNA content analysis have prognostic importance with regard to the length of survival time. Patients with aneuploid and high proliferative tumors had shorter survival times than did those with diploid or near diploid tumors and tumors with low proliferative activity.

Routine transplantations of gynecological malignomas on thymus aplastic nu/nu mice (NMRI) are reported. In the course of five years more than 450 different malignous tumours were successfully xenotransplanted on nude mice subcutaneously. The take-off-rate was different: ranging from fifty percent of mamma carcinomas to almost eighty percent of ovarian carcinomas. For experiments not the take-off-rate is relevant, but growth acceleration, and therefore the number of tumours for experimental therapy shrinks to less than twenty percent of mamma carcinomas and to about fifty percent of ovarian carcinomas. The human origin of the xenotransplants-even in later animal passages-could be determined in all cases by the presence of isoenzymes Es D, LDH 1 and LDH 2. But the growing rate of mitosis indicates a change of cell proliferation of the xenotransplants. Experimental chemotherapy was performed with accepted clinical drugs (Cyclophosphamide, Platin, Adriamycin), different growth retardation was observed dependent on tumour kind: i.e. ovarian carcinomas were stronger retarded than cervical and endometrial cancers. Yet in ovarian carcinomas the individual comparison between effect in xenotransplant and patient is full of problems. The nude mice model is excellent as a preclinical prediction for the effect of newly developed cytostatics or the relevance of different therapeutical approaches.

By means of an ocular micrometer the maximal vertical thickness of 100 stage I melanomas was measured in mm. Depths of invasion were classified into five categories of patients, whose survival rates were compared. A correlation was found to exist between the thickness of the tumour and the prognosis. 92% of patients with lesions less than 0,70 mm thick survived more than 5 years; 68% of patients with lesions between 1,41 and 2,10 mm thick survived more than 5 years; and only 31% of patients with lesions more than 2,80 mm thick survived 5 or more years.

Granuloma venereum is an infectious disease usually found in tropical and subtropical regions. Most of the cases observed in Europe are infections from these tropical and subtropical countries. Here we report on a case of granuloma venereum which brought us some difficulties regarding differentiation from carcinoma of the penis.

Not only the effect of cytostatic drugs and hormones, but also that of ionizing radiation can be tested after transplantation of human tumoral tissue into nu/nu mice with thymic aplasia. In this study, the effects of high voltage irradiations dosed up to 60 Gy (fractionation 2 X 5 Gy per week) to three carcinomas of the endometrium, three carcinomas of the cervix, three ovarian carcinomas, and one mammary metastasis of an immunoblastic sarcoma were observed during a period of 120 days. This irradiation plan could be performed without problems in eight cases, in two cases it had to be stopped after 50 Gy. Nine tumors decreased significantly in size, reaching sizes which were below those measured before irradiation. In six among the nine cases, the tumors grew again after different periods of observation. In case of rather long periods of observation, those points within the curves of development can be taken as efficacy indices which are representing the lowest or the initial values of tumor sizes. In another study, the effects of high voltage irradiation to tumors of the nude mouse are correlated to those found in the corresponding patients.

Current surgical techniques in conservative treatment of breast cancer are shown: quadrantectomy, tumorectomy, axillary dissection. Therapeutic problems in such treatment are tumor size (bigger than 2 cm diameter) and the measures to be taken regarding metastatic axillary lymph nodes. Specially important is the histological evaluation of the tumor excision to guarantee a tumor-free rim. Good cooperation between surgeon, pathologist, and radiotherapist must be stressed.

An investigation was conducted in order to determine the effect of combined high voltage irradiation and the sensitizing drug misonidazole (Ro-07-0582) on human gynecologic carcinomas transplanted into nu/nu mice with thymic aplasia. Two carcinomas of the endometrium, two carcinomas of the ovaries, and one carcinoma of the cervix were submitted to Co-60 irradiation with and without misonidazole. The tumor growth was compared to that of control groups. The dosage and fractionation of the high voltage irradiation (2 x 5 Gy/week, total dose 60 Gy) were adapted to clinical data. Misonidazole (1 mg/kg body weight) was administered by intraperitoneal injection 15 minutes before the irradiation. Compared with the control animals, the locally irradiated tumors showed a slower growth or even a regression. The administration of misonidazole, however, did not produce significant differences in our five cases. Some reasons for this absence of the radiosensitizing effect of misonidazole are briefly discussed.