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An acute disorder of the lower abdomen requires early clarification, whether or not it is of gynaecological or surgical origin. With non-gynaecological affections, beside diverticulitis, Crohn's disease, perforations, bowel obstructions, yersiniosis, vascular diseases (acute embolism, thrombosis or dissection), urological disorders or hernias, acute appendicitis has firstly to be considered. The systematic use of the different diagnostic instruments is discussed.

An acute disorder of the lower abdomen requires early clarification, whether or not it is of gynaecological or surgical origin. With non-gynaecological affections, beside diverticulitis, Crohn's disease, perforations, bowel obstructions, yersiniosis, vascular diseases (acute embolism, thrombosis or dissection), urological disorders or hernias, acute appendicitis has firstly to be considered. The systematic use of the different diagnostic instruments is discussed.

Besides typical gynaecological tumours colorectal neoplasms, Crohn's disease, dystopic kidneys, mesenteric cysts, tumours of the small bowel, perityphlitic abscesses, retroperitoneal sarcomas, lymphomas of the ileocoecal region and, in aged patients, aneurysmatic lesions of the iliac arteries have to be considered as source of the symptoms. The systematic use of various diagnostic procedures is discussed.

Ein optimales Vorgehen bei der Diagnostik und Therapie vulvarer Praeneoplasien und Neoplasien setzt die Kenntnis einiger allgemeiner Tatsachen voraus.

Wenn man als Alterer mit diesem Thema konfrontiert wird, denkt man weniger an Strahlendosis, an Methoden, an Medikamente. Man erinnert sich vielmehr der Patienten, die man im Laufe seines Lebens behandelt hat, erinnert sich ihrer Schicksale, ihrer Verlaufe, ja, ihrer personlichen Reaktion. Aus einem solchen Erinnern gewinnt die Problematik ganz andere Konturen als die einer nuchternen Therapiefestlegung im Detail. Man kommt vielmehr zu strategischen Uberlegungen, die eine Dimension miteinbeziehen, die der programmatischen, klinischen Medizin fruher fremd war, doch allmahlich weniger fremd ist, namlich: Die menschliche Dimension.

Bei 30 Mammakarzinomen, davon 24 klinische erstbehandelte Tumoren, wurde die gewebsgebundene fibrinolytische Aktivitat mit einer Agarplattentechnik untersucht. Bei 60% der Gewebshomogenate lies sich eine z. T. erhebliche fibrinolytische Aktivitat nachweisen. 40% erwiesen sich als fibrinolytisch inaktiv. Es deutete sich eine positive Korrelation zwischen fibrinolytischer Aktivitat und Tumorgrose sowie der axillaren Metastasierungstendenz an. Bei den fibrinolytisch aktiven Fallen fanden sich gehauft Adenokarzinome. Im inaktiven Kollektiv uberwogen solide und scirrhose Formen. Der prozentuale Anteil der Karzinomzellen stand in keiner Beziehung zur fibrinolytischen Aktivitat. Die fibrinolytisch inaktiven Karzinome zeigten histopathologisch eine vollstandigere formale Adaptation an die bindegewebige Umgebung als die aktiven. Kleinzellige Infiltrate fanden sich im Stroma der fibrinolytisch aktiven Karzinome wesentlich seltener als bei den inaktiven Fallen. In der Wachstumsform der Karzinome und im Vorkommen von Faserstrukturen zeigten sich keine eindrucksvollen Unterschiede zwischen den Kollektiven. Zur Ableitung klinischer Gesichtspunkte wird es eines groseren Zahlenmaterials und einer langeren Beobachtungszeit bedurfen.

Das Cytostaticum Cyclophosphamid (ENDOXAN®) wird in vivo uber 4-Hydroxycyclophosphamid zur Wirkform „gegiftet“ bzw. aktiviert. Unsere Ergebnisse zeigen, das auf biologischem Weg aktiviertes Cyclophosphamid fur in vitro Tumorsensibilitatsteste ungeeignet ist, da die Versuchsergebnisse durch die zwangslaufig mit zugesetzten Fremdeiweise bzw. Leberextrakte verfalscht werden. Diese Schwierigkeiten lassen sich mit chemisch dargestelltem 4-Hydroxycyclophosphamid umgehen. Bei 29 Tumortestungen (14 Mammacarcinome, 8 Ovarialcarcinome, 7 weitere Malignome) wurde mit Hilfe einer Kurzzeitinkubationstechnik die Einbauhemmung von 3H-Uridin und 3H-Thymidin gepruft. 12 Tumoren zeigten deutliche, 5 weitere masige Beeintrachtigungen des Einbaus der Nucleinsaureprakursoren. 11 von 12 in vitro gegen 4-Hydroxycyclophosphamid empfindliche Tumoren reagierten auch gegenuber anderen Cytostatica sensibel. Histologisch entdifferenzierte Tumoren waren empfindlicher gegenuber 4-Hydroxycyclophosphamid als hochdifferenzierte Tumoren. Erste weiterfuhrende Untersuchungen deuten darauf hin, das das nur geringe Zeit haltbare 4-Hydroxycyclophosphamid in vitro ersetzbar ist durch 4-Hydroperoxycyclophosphamid. Diese Substanz ist bei −20° C mehrere Monate haltbar.

This is a report on 120 cases of vulvar cancer. The mean age at diagnosis was 66.5 years. 25% were younger than 60, and 10% younger than 50 years. 95% were squamous cell carcinoma. The main site of the primary lesion were the labia (71%). 55 patients had palpable nodes in the groins. 12% of all women (=28% of those treated by radical vulvectomyl) had metastases in the groins. 54 (45%) were treated by radical vulvectomy, of which 23 (43%) received postsurgical radiation. 63 patients had minor operation with consecutive radiation in 51 (81%) of them. The overall 5 year survival rate was 43%. It was 65% in the group treated by radical surgery and 24% in the group of minor surgery and radiation. The radical vulvectomy with bilateral inguinal and femoral lymphonodectomy is recommended as treatment of choice in all suitable cases. The radiation cannot replace radical surgery.

In-vitro sensitivity to cystostatic agents was tested in 137 cases of breast carcinoma, with 125 tests being analysable. Inhibition of in-vitro incorporation of 3H-uridine or 3H-thymidine into RNA or DNA of the original tumour cells after incubation with antineoplastic substances was used as the index for the in-vivo sensitivity of the tumour. 30% of the carcinoma cells were sensitive in-vitro, 70% resistant. About 75% of sensitive cancers were sensitive against several agents. Cyclophosphamide proved to be most effective in-vitro: it was tested via 4-hydroxycyclophosphamide or 4-hydroperoxycyclophosphamide. There was a correlation between histological type and in-vitro sensitivity of the cancer, as well as between proliferative activity and in-vitro sensitivity in that proliferation-active tumours were more frequently sensitive in-vitro than proliferation-poor ones. Primary tumours and metastases of the same patient frequently showed different sensitivity. In some cases the development of resistance against cytostatic drugs was demonstrated during treatment. Testing tumours against combinations of cytostatic drugs demonstrated an additive effect of the antineoplastic substances in-vitro.

Ebenso wie E 39 solubile einen hemmenden Einflus auf die Hamopoese ausubt, beeintrachtigt es auch in dosisabhangiger Weise die Funktion des aktivierten Mesenchyms. Die Hemmung ist bei intraperitonealer (bzw. intravenoser) Applikation im Tierversuch reversibel, sie schwindet nach Absetzen der Cytostatica. Bei intra- oder peritumoraler Injektion hingegen kommt es zu ausgepragter Degeneration und irreversibler Hemmung des ortlichen Mesenchyms. Auch bei hoher klinischer E 39-Dosierung ist u.U. mit ahnlichen Folgen am Mesenchym zu rechnen.

Es wurde uber elektronenmikroskopische und histochemische Befunde an der Basalmembran und dem perivascularen Bindegewebe der Capillaren bei experimentell erzeugter vascularer Purpura und deren Beeinflusbarkeit durch Ostriolsuccinat berichtet. Neben den bereits an anderer Stelle beschriebenen histochemisch nachweisbaren Veranderungen an der Grundsubstanz des perivascularen Bindegewebes fanden sich elektronenmikroskopisch analoge Befunde an der Basalmembran in Form von Auflockerung bzw. Aufsplitterung der gesamten Membran sowie osmiophile Verklumpungsherde. Nach Gabe von Ostriolsuccinat waren diese strukturellen Veranderungen an der Basalmembran deutlich geringer nachweisbar.

In-vitro sensitivity to cystostatic agents was tested in 137 cases of breast carcinoma, with 125 tests being analysable. Inhibition of in-vitro incorporation of 3H-uridine or 3H-thymidine into RNA or DNA of the original tumour cells after incubation with antineoplastic substances was used as the index for the in-vivo sensitivity of the tumour. 30% of the carcinoma cells were sensitive in-vitro, 70% resistant. About 75% of sensitive cancers were sensitive against several agents. Cyclophosphamide proved to be most effective in-vitro: it was tested via 4-hydroxycyclophosphamide or 4-hydroperoxycyclophosphamide. There was a correlation between histological type and in-vitro sensitivity of the cancer, as well as between proliferative activity and in-vitro sensitivity in that proliferation-active tumours were more frequently sensitive in-vitro than proliferation-poor ones. Primary tumours and metastases of the same patient frequently showed different sensitivity. In some cases the development of resistance against cytostatic drugs was demonstrated during treatment. Testing tumours against combinations of cytostatic drugs demonstrated an additive effect of the antineoplastic substances in-vitro.

In 30 cases of breast-cancer, including 24 primary cases, the tumor-associted fibrinolysis was investigated using agar plate method. In 60% of the tissue sample fibrinolytic activity was found. No activity could be detected in the remaining 40%. There was evidence of a positive correlation between tumor-associated fibrinolysis and tumor size as well as the rate of axilla metastases. Among the fibrinolytic active cases there was a disproporionate number of adenocarcinoma, whereas in the inactive collective the solid and scirrhous carcinoma prevailed. There was no relation between the tumor-associated fibrinolysis and the percentage of tumor cells in the tissue. The firbinolytic inactive tumors showed a better histopathological adaptation to the surrounding tissue than the active ones. There was less small-cell infiltrate in the stroma of the fibrinolytic active tumors than in the inactive cases. No significant difference was found in the form of growth and the occurence of fibre structure. For clinical assessment a longer period of observation and a larger study are necessary.

When the causes and pathophysiology of the various types of ileus are known there are numerous possibilities of preventing them and logical therapeutic approaches, in particular in the case of functional ileus. Careful postoperative monitoring is obligatory! With regard to stimulation of bowel function, the principle of elimination of inhibition of motility by sympathicolysis has a place alongside the well-known nonspecific measures and direct stimulation. If conservative measures fail laparotomy must be repeated as soon as possible to procure relief. In the treatment of ileus associated with peritonitis the numerous new methods of flushing the abdomen, the involvement of anaerobes in some cases, and the possibilities offered by new antibiotics should be kept in mind. The involvement or predominance of mechanical ileus factors in the clinical picture must be recognized early and surgery performed without delay. Early consultation of an abdominal surgeon is recommended.