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Der CO2-Laser wird zur Anwendung bei rekonstruktiven Operationen vorgestellt. An cornua uteri und Harnblasen von Kaninchen wurden Exzisionen vorgenommen. Die freien Wundrander wurden adaptiert und laserkoaguliert. Nach diesen Eingriffen blieben 70% (Uterus) bzw. 90% (Harnblase) der Organe voll funktionsfahig.

UNLABELLED Tissue slides of 230 epithelial ovarian cancers were examined by two different pathologic teams to determine the following details: histological pattern, grade of polymorphy, mitotic index, density of chromatin, presence of nuclei and macronuclei, lymphocytic infiltration, psammoma bodies, and necrosis. For statistical evaluations the data were presented together with stage, age and survival times in form of an information vector for each of the 230 patients and analysed using hazard-models (Cox 1972, Carter 1983) and contingency tables. RESULTS The agreement between the 2 pathologic teams was good. There were many interrelated histological concomitants, such as polymorphy and chromatin density, and as nuclei and macronuclei. Necrosis was relatively independent. Significant effects on prognosis could be demonstrated for polymorphy, chromatin density, mitotic index, histologic pattern, (macro)nuclei. Polymorphy was the best histological prognostic indicator and, together with necrosis, produced the best prognostic grading system.

For 230 patients with common epithelial ovarian cancer, the prognostic impact of age was examined. Statistical analysis was done using proportional hazard models, 3- and 5-year survival rates and median survival of stratified groups, and the Kaplan-Meier mean. Taking the age-adjusted mortality into account, the prognosis of the older patients was significantly worse. This effect depended primarily on early mortality (survival time less than 2 months). A comparative analysis was made of the prognostic factors age, grade, and stage, taking into account the correlation between factors. This analysis showed that, for our series, age was of lesser prognostic significance than grading, and both of these were of much less prognostic importance than staging.

95 patients with advanced and recurred gynecological carcinomas (57 ovarian carcinoma, 22 cervical carcinoma) were treated by a platinum (CDDP) based polychemotherapy platinum, adriamycine, cyclophosphamide (PAC); platinum, adriamycine, bleomycine (PAB), 22 out of 48 patients with low differentiated epithelial carcinoma of the ovary stage III and IV achieved a remission (13 CR; 9 PR). Today 6 of the CR-patients survive 23 months without recurrence; 7 had a medium survival of 17 months. Medium survival of PR-patients was 15 months. 6 NED-patients survive 22 months without recurrence and 2 NED-patients died after 19,5 months. The overall response rate (CR, PR, NED) was 63%. A retrospective comparison with 78 patients (low differentiated ovarian carcinoma stage III and IV) treated by a cyclophosphamide monotherapy shows an elevated 2-year survival rate of the PAC treated patients. The other patients suffered from carcinoma of the mamma, the tubes, the corpus uteri, the vagina, and the vulva. The therapeutic effect of CDDP based polychemotherapy cannot be judged because of the small number of cases; but the side effects at these patients were registered thoroughly. Side effects of totally 514 therapeutic cycles (460 mg CDDP per patient, 78 mg CDDP per cycle) are presented.

Retrospectively we have compared the efficacy, the immediate complications, and the side effects during termination of 727 first trimester pregnancies with and without preoperative cervical dilatation by sulprostone. All these patients had been admitted to the Frauenklinik der Medizinischen Hochschule L ubeck for legal abortion; 365 of them got a single intramuscular injection of 500 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 4% Hegar less than 6); 81 patients got a single intramuscular-intracervical injection of 25 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 16% Hegar less than 6); in 281 patients evacuation of the uterus was carried out in dilating the cervix mechanically. This route without preoperative dilatation by the prostaglandin analogue sulprostone gave the highest rate of complications. Only in regard to a complete evacuation of the uterus a single intramuscular-intracervical injection of sulprostone resulted in a diminution of the complications. However, a single intramuscular injection of 500 micrograms sulprostone prior to vacuum aspiration offered a practical, effective and relatively side-effect free method of cervical dilatation.

At the department of gynecology of the universities of Lübeck and Bonn 18 in part pretreated patients with advanced or relapsing cancer of the breast were treated with a DDP-containing polychemotherapy. For 14 of the 18 women the PAC or PEC regime was beneficial: 9 had complete or partial remission and 1 patient had a no change situation; 4 women showed no evidence of disease. The time of survival after the chemotherapy treatment was two month in the minimum and more than 50 month in the maximum (20 month in the average). As side effects, in particular leucocyte-depression and nausea as well as vomiting of various degrees were observed; alopecia was seen in every case. The success of DDP-containing chemotherapy in the treatment of breast cancer is of note, but in the future it will be important to define subgroups that would most benefit from PAC- or PEC-treatment without substantial negative side effects.

Carcino-embryonic antigen (CEA) was determined by means of solid-phase radio-immuno-assay through one year in 83 patients with Groups I through IV cervical carcinoma. The intention was to test CEA diagnosis for its value as tumour marker in therapeutic monitoring and detection of recurrences. CEA values prior to treatment were above normal, that is in excess of 2.5 ng/ml, in 42.8 per cent of the cervical carcinoma patients. CEA values declined during therapeutic radium and cobalt 60 irradiation in 81 per cent of those patients in whom original values had been increased to more than 2.5 ng/ml. No substantive change was recordable from those patients in whom original values had been below 2.5 ng/ml. Recurrence diagnosis gave good agreement between CEA levels and clinical findings in 58 per cent of the cases, falsely negative data in 37 per cent and falsely positive values in four per cent. The development of recurrence was repeatedly sensed by means of CEA determination up to six months before clinical manifestation in 72 patients who had been under long-time monitoring. The usefulness of CEA determination in therapeutic monitoring and after-care of patients with cervical carcinoma was found to be limited to the effect that only increased values were of clinical relevance, whereas no conclusions whatever could be drawn from low values.

Tissue slides of 230 epithelial ovarian cancers were examined by two different pathologic teams to determine the following details: histological pattern, grade of polymorphy, mitotic index, density of chromatin, presence of nuclei and macronuclei, lymphocytic infiltration, psammoma bodies, and necrosis. For statistical evaluations the data were presented together with stage, age and survival times in form of an information vector for each of the 230 patients and analysed using hazard-models (Cox 1972, Carter 1983) and contingency tables.The agreement between the 2 pathologic teams was good. There were many interrelated histological concomitants, such as polymorphy and chromatin density, and as nuclei and macronuclei. Necrosis was relatively independent. Significant effects on prognosis could be demonstrated for polymorphy, chromatin density, mitotic index, histologic pattern, (macro)nuclei. Polymorphy was the best histological prognostic indicator and, together with necrosis, produced the best prognostic grading system.

The animal experiments reported in this paper were applied to the uterine cornu of rabbit for the purpose of finding out whether CO2 laser could be used for successful salpingolysis. -Continuous intraluminal pH measurement was undertaken along with laser irradiation. Second-look operations were performed and accompanied by repeated pH measurement and histological tissue tests, after four weeks had elapsed from irradiation, in an attempt to verify radiation effects. Short-time pH decline was observed. Neither any adhesion nor induration was found to exist any longer in the irradiated area, four weeks after surgery. Low-residue healing of the uterine cornua, with no involvement of internal functional layers, was histologically confirmed. - The above experiments are likely to show that laser radiation has been of little functional and morphological impact upon the uterine cornu of rabbit. The authors, therefore, support the idea of using CO2 laser in salpingolysis to cut adhesions close to the fallopian tube and to stop bleeding at the same time.

CO2-Laser is presented for application in reconstructive operations. At cornua uteri and urine bladders of rabbits excisions were undertaken. The free wound edges were approximated and coagulated by laser irradiation. After these operations 70% (uterus) respectively 90% (urine bladder) of the organs remained fully functionable.

Retrospectively we have compared the efficacy, the immediate complications, and the side effects during termination of 727 first trimester pregnancies with and without preoperative cervical dilatation by sulprostone. All these patients had been admitted to the Frauenklinik der Medizinischen Hochschule L ubeck for legal abortion; 365 of them got a single intramuscular injection of 500 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 4% Hegar less than 6); 81 patients got a single intramuscular-intracervical injection of 25 micrograms sulprostone 8-10 hours prior to vacuum aspiration (failure 16% Hegar less than 6); in 281 patients evacuation of the uterus was carried out in dilating the cervix mechanically. This route without preoperative dilatation by the prostaglandin analogue sulprostone gave the highest rate of complications. Only in regard to a complete evacuation of the uterus a single intramuscular-intracervical injection of sulprostone resulted in a diminution of the complications. However, a single intramuscular injection of 500 micrograms sulprostone prior to vacuum aspiration offered a practical, effective and relatively side-effect free method of cervical dilatation.

95 patients with advanced and recurred gynecological carcinomas (57 ovarian carcinoma, 22 cervical carcinoma) were treated by a platinum (CDDP) based polychemotherapy platinum, adriamycine, cyclophosphamide (PAC); platinum, adriamycine, bleomycine (PAB), 22 out of 48 patients with low differentiated epithelial carcinoma of the ovary stage III and IV achieved a remission (13 CR; 9 PR). Today 6 of the CR-patients survive 23 months without recurrence; 7 had a medium survival of 17 months. Medium survival of PR-patients was 15 months. 6 NED-patients survive 22 months without recurrence and 2 NED-patients died after 19,5 months. The overall response rate (CR, PR, NED) was 63%. A retrospective comparison with 78 patients (low differentiated ovarian carcinoma stage III and IV) treated by a cyclophosphamide monotherapy shows an elevated 2-year survival rate of the PAC treated patients. The other patients suffered from carcinoma of the mamma, the tubes, the corpus uteri, the vagina, and the vulva. The therapeutic effect of CDDP based polychemotherapy cannot be judged because of the small number of cases; but the side effects at these patients were registered thoroughly. Side effects of totally 514 therapeutic cycles (460 mg CDDP per patient, 78 mg CDDP per cycle) are presented.

In a retrospective study on 167 ovarian cancer patients the presenting symptom was defined via anamnesis. This parameter was correlated to others characterising the cancer and the patient: age, parity, menopause, stage, extent of operation, tumor residue, postoperative therapy, induction of remission and several morphological data. The prognostic significance was analysed using Hazard-models (Cox 1972, Carter 1983) and contingency tables.The presenting signs and symptoms were: atypical bleeding in 44 patients, pain in 75 patients and other signs in 48 patients. These signs and symptoms were significantly correlated with tumor residue, and were more frequently seen in mucinous and endometrioid carcinomas. There were no significant correlations to the other examined parameters, but there was a trend for patients with atypical bleedings to be diagnosed at early stages and their survival prognosis was significantly (p less than 0.01) better compared with that for patients with pain or other presenting signs or symptoms.

Wegen des hohen Morbiditats- und Mortalitatsrisikos bei den klassischen Methoden des Schwangerschaftsabbruchs hat die Anwendung von Prostaglandinen zur risikoarmeren Abortauslosung im 2. Trimenon eine grose Bedeutung erlangt. Um jedoch wirksam zu sein, mussen die naturlichen Prostaglandine F2α und E2 aufgrund ihrer geringen biologischen Halbwertzeit hoch dosiert werden. Dieses bedingt haufig auftretende Nebenwirkungen sowie eine Pra- und Begleitmedikation.

Rabbit oocyte maturation was induced by i.v. injection of 100 mU/HCG. Six hours later the animals were sacrificed, their granulosa cells cultured 7-10 days and their oocytes incubated in different media for 5-6 h. The oocytes were then examined microscopically. The appearance of a polar body was taken as an indication that maturation had progressed. The results presented show that maturation of rabbit oocytes can be inhibited by granulosa cells in vitro (OMI = oocyte maturation inhibitor), the activity of OMI is influenced by gonadotrophins and cumulus cells have a facilitatory effect on OMI. The results give the first indication that OMI exists in rabbits and may contribute to the discussion about the existence of OMI in other species (e.g. the pig).

During the past 25 years 730 patients with ovarian carcinoma were registered at the Medical School Luebeck. Therapy and development of all cases were documented by codification sheets.

Nach Abschlus der klinischen Prufung von Sulproston (Nalador) bestatigt auch die praktische Erfahrung, das es sich um ein sehr uterusspezifisches Praparat handelt: Bei effektiver Abortinduktion wird eine geringere Nebenwirkungsrate als mit nativen Prostaglandinen beobachtet (1–3).

11 patients with advanced, recurrent mamma cancer were treated by a PAC polychemotherapy. The therapy was well tolerated, the incidence of side effects was low. All patients responded to therapy (7 NED, 3 CR, 1 PR). 2 patients died, one commited suicide, the other died after having developed hepatitis. Of the remaining 9 patients 7 survive recurrence free; medium follow up 20 months. These data are in accordance with results obtained by Kolarić et al. [2] and Forastiere et al. [1] who showed platinum to be effective in the treatment of mamma cancer.

UNLABELLED In a retrospective study on 167 ovarian cancer patients the presenting symptom was defined via anamnesis. This parameter was correlated to others characterising the cancer and the patient: age, parity, menopause, stage, extent of operation, tumor residue, postoperative therapy, induction of remission and several morphological data. The prognostic significance was analysed using Hazard-models (Cox 1972, Carter 1983) and contingency tables. RESULTS The presenting signs and symptoms were: atypical bleeding in 44 patients, pain in 75 patients and other signs in 48 patients. These signs and symptoms were significantly correlated with tumor residue, and were more frequently seen in mucinous and endometrioid carcinomas. There were no significant correlations to the other examined parameters, but there was a trend for patients with atypical bleedings to be diagnosed at early stages and their survival prognosis was significantly (p less than 0.01) better compared with that for patients with pain or other presenting signs or symptoms.

Die einmalige intramuskulare Gabe von 500 μg Sulproston 8–10 Std vor Vakuumaspiration oder Kurettage ermoglicht eine einfache, schonende, risikoarme und die Patientin wenig belastende Interruptio im I. Trimenon.