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Tamoxifen is a non-steroidal estrogen antagonist used mainly in the adjuvant therapy of breast cancer. Tamoxifen acts primarily as an antiestrogen, but also carries estrogenic effect, mainly to the endometrium. Although diverse pathological uterine findings has been described in connection with the long term use of this drug, there is no widely accepted protocol for the monitoring of the endometrium in these patients. All patients referred for gynecologic examination at the Department of Obstetrics and Gynecology University Medical School Debrecen, Hungary with previous treatment for breast cancer were involved in a screening programme. The gradual screening programme consists of: transvaginal sonography, color doppler imaging, hysteroscopy, and endometrial curettage or sampling. If any of the first steps proved to be negative, further evaluation could be avoided. Altogether 31 patients were referred for examination and transvaginal sonography alone excluded endometrial abnormality in 9 cases, while the rest of the patients went through further evaluation. The ratio of false positive results using transvaginal sonography alone was high and could be lowered with additional color doppler imaging. Endometrial pathology could be excluded in about 50% of cases without tissue sampling. Positive histology was found in 25% of patients receiving Tamoxifen. The most frequent pathological finding was endometrial polyp. In conclusion endometrial changes found by transvaginal sonography, should be further evaluated. The gradual screening procedures enable us to the proper use of more invasive procedures.

A case of maternal idiopathic thrombocytopenic purpura complicated by severe fetal thrombocytopenia is reported. Fetal thrombocytopenia was diagnosed by scalp blood-sampling during labour. With discussion of the relevant literature, the authors recommend the use of their method in thrombocytopenic patients in labour. In cases of fetal thrombocytopenia Caesarean section in recommended to prevent trauma and subsequent neonatal haemorrhagic complications.

We retrospectively reviewed all cases of ovarian malignancies during a 10-year period at the Department of Obstetrics and Gynecology, University Medical School of Debrecen, Hungary. The experience with 16 cases: three epithelial tumors, one granulosa cell tumor, 11 germ cell tumors (six dysgerminoma, four teratoma, one endodermal sinus tumor), and one metastatic ovarian cancer is discussed. Malignant ovarian tumors can best be treated with conservative surgery, followed by adjuvant chemotherapy. Survival mainly depends on tumor type and stage at the time of diagnosis.

The impact of preoperative local radiotherapy on the survival of cervix carcinoma has been evaluated retrospectively in 324 Stage Ib and IIa cases treated between 1969 and 1986 at the University Department of Obstetrics and Gynaecology of Debrecen, Hungary. One hundred and ninety nine Stage Ib cases had radical hysterectomy, 132 of them following brachytherapy. Among 125 radically operated Stage IIa cases 95 had preoperative local radiotherapy. Stage-respective survival curves of patients treated by radical surgery with or without preoperative local radiotherapy were analysed by the life-table method. The use of preoperative radiotherapy was not reflected in better survival when compared to survival of patients without it. Results suggest that preoperative local radiotherapy has a limited role in the management of patients with Stage Ib and IIa cervix carcinoma.

Beta-2-Microglobulin (b2m) and or Ca-125 levels were measured in 367 serum samples of 66 ovarian cancer patients. CA-125 was found to be a suitable tool, even in single use, to monitorise the clinical course of the disease with acceptable sensitivity (o. 89) and specificity (o. 94). B2m showed a sensitivity of the same level (o. 87) the specificity of it however proved to be low (o. 48). In consequence of its low specificity the b2m as a single marker is not applicable in ovarian cancer. However, the addition of b2m to CA-125 resulted in higher specificity and sensitivity, as b2m probably has a different spectrum and yielded correct results at that points of the follow-up where CA-125 produced pseudo-positive or pseudo-negative results. The combination of b2m and CA-125 tumormarkers seems to be a suitable tool for follow-up ovarian cancer patients under and after treatment.

Transvaginal colour Doppler was used to evaluate the blood flow patterns in pelvic vessels in a group of 315 patients including 168 with uterine tumours and 147 with adnexal masses. Neovascularization of malignant tumour tissue was successfully displayed by colour Doppler in the vases of endometrial and ovarian cancers but no abnormal blood supply was observed in the cases of early cervical cancers. A comparison between the characteristics of blood flow within benign and malignant lesions showed lower resistance index in cases of malignancy. The sensitivity, specifity, positive predictive value, negative predictive value and the diagnostic accuracy of this new method in the recognition of endometrial and ovarian cancers are higher than 95%. By the help of transvaginal colour Doppler (together with the classical methods as colposcopy, cytology etc.) it will be possible to establish of complex screening programmes for all types of gynaecological cancers.

Male rats weighing 100 g were used in a 19-day trial. The rats received diets containing varying proportions of methionine. Their absolute liver weight was lower, due to the high methionine levels, than that of the animals fed optimum rations, whereas the relative liver weight was found to be lower only in the pair-fed group. No essential differences were observed between the levels of dry matter, protein, and fat. Glycogen levels were found to be lowered only in cases when high methionine doses were administered. Pathologically low levels of glycogen were found in animals of the pair-fed group. High methionine consumption reduced the percentages of 12 glucogenetic amino acids in the liver. This, in turn, suggests an increased rate of glucose formation from amino acids, a process which was not observed in animals of the pair-fed group. High methionine doses produced a condition of hyperglycaemia, while in the pair-fed group hypoglycaemia was observed. The highest rate of secretion of thyroid hormones was found in animals receiving the optimum ration; a lower rate of secretion was observed in the animals consuming less or more methionine. In animals receiving high methionine levels the rate of hormone secretion decreased in a stepwise manner with increasing methionine supplementation. Only the highest methionine doses (5,3%) were found to have a negative effect on the maximum rate of iodine incorporation into the thyroid gland. These findings were also substantiated by histological investigations because a true pathological picture was only found in histological sections of thyroid tissue from animals fed the highest methionine doses (5,3%) The thyroid tissue of these animals consisted predominantly of small glandular alveoli whose colloid was slightly coloured. The epithelial cells of these alveoli were degenerated; some cases of liver cell disintegration and, more rarely, cellular necrosis were noted.

Cases reported here as well as the literary date tell attention to the vascular complications following contraceptive therapy. Shift of clotting-fibrinolysis system towards hypercoagulobolity is remarkable because of its role as a risk factor. If contraceptive therapy is accompanied by a condition or a disease altering clotting factors, vessel walls or circulation so that it presents an enhanced thrombosis capacity the risk may increase. In such cases indication of oral contraceptive therapy should be considered cautiously and the patients should be controlled with more intention.

The authors report on the stage distribution and 5-years survival rate of 1158 cervical cancer cases treated from 1970 to 1980 at their center. Comparing these data to those of other institutions according to the 17th volume of Annual Report on the results of treatment in gynecological cancer they found that the stage distribution of their cases is not so favourable as that of other institutions. This unfavourable stage distribution is the consequence of the insufficiency of the mass screening of cervical cancer. Their treatment results characterized by the five year survival rate correspond to the international average.

The effect on ruminal motility of NH4- or Na-acetate and Na- or K-lactate of various pH and doses infused into the jugular vein (i.v.) or carotid artery (i.a.) was studied in sheep with ruminal fistula I.v. infusion of NH4-acetate whenever it was accompanied by a considerable increase of the blood NH4 level potently inhibited the amplitude and frequency of ruminal contractions. I. a. administration produced more rapid and more apparent responses and a slightly elevated venous ammonia concentration than did the i.v. infusion. Thus the augmented blood ammonia level not only affected the smooth muscles and peripheral nerve endings but also inhibited the vegetative centres of the central nervous system. Infusion of Na-acetate and Na- or K-lactate solutions induced compensated acidosis or alkalosis which reduced the amplitude of ruminal contractions and produced respiratory disturbances. The latter were more apparent in alkalosis. In uncompensated acidosis or alkalosis, ruminal motility was permanently inhibited or abolished. The results appear to show that in not properly fed ruminants the frequently observed and long lasting compensated acidosis or alkalosis might influence the activity of the vegetative centres thus further metabolic disturbances and impaired gastrointestinal activity might follow the shifts in acid-base equilibrium.

Authors report on their experiences concerning in vitro clonogenic assay performed according to Hamburger and Salmon on solid tumor tissue samples (13 cases) and ascites cells (5 cases) obtained from 16 ovarian cancer patient. Out of the 13 solid tumors they got single cell suspension with sufficient number of cells in each case. Colony formation was observed in 10 out of 18 specimens. Dose-response curves were determined after incubation of cells with different concentrations of the following drugs: cis-platin, adriamycin and melphalan. Patients were treated with the CAP combination chemotherapy. The correlation between clinical responses and in vitro sensitivity was evaluated retrospectively. The analysis of the in vitro-in vivo correlation showed that in case of in vitro resistance against two components of the CAP combination the tumor progressed during CAP treatment. In case of in vitro resistance against one component except cis-platin CAP therapy could cause even complete response. By in vitro cis-platin resistance the maximum response with CAP treatment was partial remission.

In order to find out how short-time denutrition changes the concentration of some substances in the rumen fluid and the blood, tests with full-grown sheep were carried out. Fodder was withheld from sheep with inserted Jarrett fistulae for 48 hours after normal feeding. After 48 hours the animals were given concentrated fodder, after 52 hours exclusively hay. From the 72nd hour onwards the animals were provided with fodder as usual. Samples of the rumen fluid and blood samples were taken at the beginning of the test, after the last normal feeding and then in the 24th, 32nd, 48th, 52nd, 56th, 72nd and 96th hour. We could find out that, during the 48-hour denutrition, the pH-value of the rumen fluid turned alkaline and the concentrations of ammonia, volatile fatty acids and lactic acid decreased. The protein metabolism underwent a rapid change in the organism. The protein content of the blood plasma decreased, above all the albumin content, as well as the concentration of glycoproteins and volatile amino acids. Among the various amino acids, the concentration of glycine increased highly, that of alanine and valine just slightly. The concentration of most amino acids decreased or--of some of them remained the same. Among the paramters that are characteristic of lipid and carbohydrate metabolism, the total content of lipids and cholesterin decreased, and so did the concentration of blood sugar, lactic acid and pyruvic acid in the blood plasma. The results indicate that short-time denutrition has a considerable influence on the rumen fermentation and the intermediary metabolism of ruminants. The quickly arising lack of energy of ruminants slows down the protein synthesis and increases the glyconeogenesis from amino acids. The tissue is supplied with energy by the mobilisation of lipids.

The regulation of Na+ and water metabolism was studied in sheep with rumen fistula after water deprivation for 48 hours. Na+ and K+ concentrations were determined in blood plasma, blood, urine and saliva, with or without NaCl load. The results showed that the water content of the ruminal fluid plays an important role in the control of electrolyte and water metabolism. The absorption of water and Na+ from the rumen favours the maintenance of isosmolality and isovolaemia until the concentration of Na+ in the ruminal fluid has exceeded that in blood plasma. Thereafter the balance of water movement between rumen and extravascular space is shifted towards the rumen inhibiting thereby a further increase of Na+ concentration and ensuring the life conditions for the ruminal microbial population. During water deprivation not only water is lost but as a result of Na+ excretion relative hyponatraemia also ensues as can readily be assessed from the ratio of salivary Na+ and K+ concentrations. Upon NaCl load the salivary Na+/K+ ratio was increased indicating the extent of Na+ supply.