In vitro fertilization and embryo transfer program, Second Department of Obstetrics and Gynecology, University of Vienna, Austria.
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Adult↗
Biomedical subjects
A Reinthaller
Publications and source records attributed to A Reinthaller.
[Fertility following function-preserving surgery in tubal pregnancy].
In the last few years an obvious trend toward conservative technique in tubal surgery is observed. Likewise, at our institution, emphasis was placed on preservation of function, too. 59 patients received conservative surgery of tubal pregnancies between 1979 to 1982. 7 women were lost for follow-up. 28 patients showed further desire for child-bearing. 20 of them have had a subsequent intrauterine conception (71.4%), 11 women have had term pregnancies (39.3%). 3 patients were pregnant at time of investigation. The abortion rate was 17.8%. Recurrent ectopic pregnancies were found in 5 cases (9.5%). However, the operated fallopian tube was involved only in 3 cases (5.7%). In 26 cases the patency of the tubal lumen was examined by means of hysterosalpingography. 50% of those women had remained childless. The results of HSG showed a patent passage of the operated tube in 11 cases. Our results show a high rate of subsequent pregnancies and a rather low incidence of repeat ectopic pregnancies in cases of conservative surgery and justify our decision to save the involved tube whenever fertility is desired.
Abortion, Spontaneous↗
[Effect of late motility on the fertilization of ova in the IVF program].
In the course of the IVF programme at our department we made the observation that even with primarily normal sperm counts late motility often varies widely. The impression that late sperm motility might be related to successful fertilisation caused us to study the influence of late sperm motility on fertilisation rates in a series of 80 patients. Sperm was capacitated with B2 medium (Menezo INRA). Even in the presence of an originally normal sperm count, reduced late motility was associated with lower fertilisation and embryo transfer rates. It seems that late sperm motility will have to be considered as an important parameter in evaluating the prognosis for successful IVF and ET.
Adult↗
Tandem duplication of 10(q21-q22) in a mentally deficient man.
A mentally retarded man with congenital malformations, carrying a tandem duplication of 10(q21-q22) is reported. The clinical picture is compared with the description of previously reported cases and the possible origin of the aberrant chromosome is discussed.
Adult↗
Investigation of beta-endorphin and adrenocorticotropic hormone in placenta, amniotic membrane and umbilical cord using an immunoperoxidase technique.
The identification of immunoreactive beta-endorphin, beta-lipotropin and ACTH from extracts of human placentas by radioimmunoassay suggests a probable synthesis of these peptides in the placenta. In this study we investigated the presence of beta-endorphin and ACTH in placenta, amniotic membranes and umbilical cord using a peroxidase-antiperoxidase staining technique. Tissues were obtained immediately after delivery, fixed in formalin and embedded in paraffin. As control tissues autopsy specimens of pituitary glands from adults and newborns were used. All sections of pituitary glands showed a positive reaction; negative results were observed in sections of placentas, umbilical cords and amniotic membranes. We conclude that no intracellular storage of beta-endorphin and ACTH takes place in the examined tissues.
Adrenocorticotropic Hormone↗
Definitive radiotherapy based on HDR brachytherapy with iridium 192 in uterine cervix carcinoma: report on the Vienna University Hospital findings (1993-1997) compared to the preceding period in the context of ICRU 38 recommendations.
UNLABELLED: According to the reports described in the literature, fractionated HDR brachytherapy seems to represent one option for the primary treatment of cervical carcinoma. In order to render such treatment transparent and comparable for those interested in the field, we have attempted to report our recent experience obtained in Vienna from 1993-1997 using the terminology proposed by the ICRU report 38, focusing in particular on dose and volume reporting and a linear-quadratic model. Based on these parameters, a comparison with the preceding period in Vienna (LDR/HDR) has been made, with an attempt to correlate different methods and parameters with outcome. MATERIAL AND METHODS: One hundred and eighty-nine patients (mean age 67 years) were treated with curative intent (stage Ia: 2, Ib: 11, IIa: 11, IIb: 79, IIIa: 19, IIIb: 59, IVa: 5, IVb: 3 patients) using a combination of intracervical high-dose rate (HDR) brachytherapy (ring-tandem applicator) and a box technique for external-beam therapy (EBT: 48.6-50 Gy, linac 25 MV). Small tumors were treated with 5-6 fractions of 7 Gy at point A and 50 Gy EBT (25 Gy in the brachytherapy reference volume) which is isoeffective to 76-86 Gy at point A. Large tumors received 3-4 fractions of 7 Gy after 50 Gy EBT with open fields, which is isoeffective to 82-92 Gy at point A. TRAK varied from mean 1.4 cGy (3 fractions) to 2.8 cGy (6 fractions) at one meter. 3-D treatment planning for brachytherapy was based on conventional X-rays and in 181/189 patients on computed tomography (CT) with the applicator in place. Computer-calculated volumes of the brachytherapy reference isodose (7 Gy/fraction) ranged from 46-155 ccm (mean 87 ccm); the respective mean hwt-volume (height x width x thickness) was 180 ccm. The 60 Gy HWT volumes (25 Gy from EBT) for the irradiation of small tumors ranged from 240 to 407 ccm (mean 337 ccm) and for larger tumors (50 Gy for EBT) from 452 to 785 ccm (mean 607 ccm). The mean dose for brachytherapy was 16.2 Gy (6.2-37.8 Gy) at the ICRU rectum reference point and 14.4 Gy (4.6-35.7 Gy) at the ICRU bladder point. Taking into account the dose for EBT, the mean isoeffective dose at the ICRU rectum reference point was 69.9 Gy (28.4-98.7 Gy). Overall treatment time was six weeks for small tumors and eight weeks for large tumors. RESULTS: After a mean follow-up of 34 months, actuarial pelvic control and disease-specific survival rates at three years were 77.6/68.6% for all patients, 100/77.1% for stage Ib, 100/100% stage IIa, 87.0/78.0% stage IIb, 52.7/52.1% stage IIIa, 69.1/58.6% stage IIIb and 60/53.3% stage IVa. According to the LENT/SOMA score which had been prospectively introduced, the actuarial late complication rate for grades 3 and 4 was 2.9% for the bladder, 4.0% for the bowel, 6.1% for the rectum and 30.6% for the vagina (shortening and obliteration); in total for all grades 23.6, 18.4, 24.2, and 67.6%, respectively. CONCLUSION: In our experience, HDR brachytherapy combined with EBT is an efficient method if sufficient radiation doses and volumes are applied, both with regard to tumor control and adverse side effects. In future, the therapeutic window will be increased by systematic integration of magnetic resonance imaging (MRI) into treatment planning, thus allowing for a highly individualized approach with further adaptation of radiation dose and volume both to the target and to the individual topography of organs at risk.
Adenocarcinoma↗
CT and MR accuracy in the detection of tumor recurrence in patients treated for ovarian cancer.
OBJECTIVE: The aim of this prospective study was to evaluate the accuracy of clinical examinations (palpation/determination of serum tumor-associated antigen CA125 level), CT, and MRI in the detection of tumor recurrence in patients with treated ovarian cancer. MATERIALS AND METHODS: Twenty-four patients who had been treated for ovarian carcinoma were prospectively examined by clinical means (palpation/serum tumor-associated antigen CA125 level), CT, and MRI to assess their accuracy in detecting recurrent disease; results were correlated with surgical/bioptic/pathoanatomic findings. Nine patients had relapse; 15 women were disease-free. RESULTS: Examinations were true-negative in 14 patients (on palpation/CA125, CT, and MRI) and true-positive in 9 on palpation/CA125, in 6 on CT, and in 7 patients on MRI. False-positive examinations occurred in one patient on palpation/CA125, CT, and MRI and false-negative in zero on palpation/CA125, in three on CT, and in two on MRI, a sensitivity of 100% for palpation/CA125, 66.6% for CT, and 77.7% for MRI and a specificity of 93.3% for palpation/CA125, CT, and MRI. Accuracy of palpation/CA125 examinations was 95.8% in comparison with 83.3% for CT and 87.5% for MRI. CONCLUSION: Our results suggest that in the follow-up of ovarian cancer patients, assessment of serum tumor-associated antigen CA125 level is accurate in the determination of patients with tumor recurrence. Computed tomography is the primary imaging modality to prove macroscopic disease recurrence and can spare these patients from invasive restaging second-look laparotomy; MRI should be performed in women with questionable macroscopic recurrent tumor and negative CT examination. Neither CT nor MRI can confidently exclude microscopic disease.
Antigens, Tumor-Associated, Carbohydrate↗
Serum concentrations of tissue polypeptide antigen in patients with vulvar intraepithelial neoplasia and vulvar cancer.
The aim of the present study was to evaluate the clinical usefulness of the cytokeratin tumor marker tissue polypeptide antigen (TPA) in patients with vulvar cancer. This retrospective study comprises 41 patients with vulvar cancer FIGO stages I-III, 17 patients with vulvar intraepithelial neoplasia (VIN) III, and 40 healthy female controls. Serum concentrations of TPA were measured using a microparticle enzyme immunoassay. Results were correlated to clinical data. Median serum concentrations of TPA in healthy female controls, patients with VIN III, and patients with vulvar cancer were 42 U/l (range 12-192), 53 U/l (range 17-127.9) and 57 U/l (range 4.2-423), respectively (Mann-Whitney U test, p = 0.8). Serum concentrations of TPA were not associated with stage of disease, histological grade, and age at the time of diagnosis. In vulvar cancer patients, elevated serum concentrations of TPA prior to therapy were not associated with a shortened disease-free or overall survival (log-rank test: p = 0.5 and p = 0.9, respectively). In a multivariate Cox regression model comprising tumor stage and TPA, tumor stage, but not TPA revealed a statistically significant influence on disease-free (Cox proportional hazard regression model, p = 0.05 and p = 0.6, respectively) and overall (Cox proportional hazard regression model, p = 0.04 and p = 0.8, respectively) survival of patients with vulvar cancer. We conclude that cytokeratin expression, as reflected by serum concentrations of TPA, does not play a role in the natural history of vulvar cancer. The evaluation of serum concentrations of TPA prior to therapy is not recommended.
Age Factors↗
Tumor anemia and thrombocytosis in patients with vulvar cancer.
The aim of our study was to determine the prevalence of tumor anemia and thrombocytosis in patients with vulvar cancer, and to evaluate the prognostic value or pretreatment hemoglobin (Hb) and platelet count regarding disease-free and overall survival of patients with vulvar cancer. We measured pretreatment Hb and platelet count in 62 patients with squamous cell vulvar cancer. The results were correlated to clinical data. Median Hb and platelet count in patients with vulvar cancer were 13.1 g/dl (range 8.3-16.2) and 268, 500/microl (range 88,000-778,000), respectively. Cut-off levels of 12 g/dl and 300,000/microl were selected for tumor anemia and tumor thrombocytosis, respectively according to published criteria. Tumor anemia and tumor thrombocytosis were present in 30.6 and 27.4% of patients with vulvar cancer, respectively. In a univariate analysis tumor stage and tumor thrombocytosis were significantly associated with a shortened disease-free (log-rank test, p < 0.001 and p = 0. 003, respectively) and overall survival (log-rank test, p < 0.001 and p < 0.001, respectively). Tumor anemia was not associated with a shortened disease-free, but with a shortened overall survival of patients with vulvar cancer (log-rank test, p = 0.1 and p = 0.002, respectively). A multivariate Cox regression model considering tumor stage, tumor anemia, and tumor thrombocytosis showed, however, that pretreatment Hb and platelet count did not confer additional prognostic information to that already obtained by the established prognosticator tumor stage on disease free (multivariate Cox regression model, p = 0.8, p = 0.2, and p = 0.003, respectively) and overall survival (multivariate Cox regression model, p = 0.4, p = 0. 5, and p = 0.04, respectively). Pretreatment tumor anemia and tumor thrombocytosis were associated with a poor prognosis, but were not an independent predictor of outcome in patients with vulvar cancer.
Adult↗
P53 antibody response in patients with vulvar cancer.
BACKGROUND: Mutations in the p53 tumor suppressor gene are the most common genetic changes identified in cancer cells. Several studies report alterations of the p53 gene in vulvar cancer. As observed in a wide variety of human malignomas, mutant p53 protein may provoke a specific humoral immune response. The possible occurrence of p53 antibodies in patients with vulvar cancer has not been investigated so far. MATERIALS AND METHODS: We used a specific p53 antibody ELISA to investigate serum samples of 41 patients with vulvar cancer taken prior to therapy and serum samples of 17 healthy controls. RESULTS: Of the 41 patients with vulvar cancer, 4 (10%) were found to be positive for serum p53 antibodies, contrary to the 17 healthy volunteers without p53 serum antibodies (chi-square test, p = 0.2). No significant correlations were found between p53 antibody status and tumor stage (p = 0.64), histological grade (p = 0.89), and patients' age (p = 0.87). We found no significant association between the p53 serum antibody status in vulvar cancer patients and disease-free (p = 0.67) and overall survival (p = 0.7). CONCLUSIONS: In summary, it is the first time that p53 antibodies have been detected in the sera of patients with vulvar cancer. However, p53 serum antibodies did not serve as prognostic markers in vulvar cancer.
Adult↗
[Determination of alpha 2-macroglobulin and alpha 1-antitrypsin in amniotic fluid using laser nephelometry].
By using Laser nephelometry concentration of alpha 2-macroglobulin and alpha 1-antitrypsin in amniotic fluid was measured in early pregnancy (15th-24th week) and near term (after 37th week). alpha 2-macroglobulin was demonstrable in all cases, concentration of specimen after 37th week were significantly higher than in early pregnancy. Concentration of alpha 1-antitrypsin changes during pregnancy similar to total protein and albumin concentrations.
Amniocentesis↗
[Hormonal pregnancy parameters in the serum following surgery for extrauterine pregnancy].
We did serial determinations of beta-HCG, total-HCG, prolactin, SP-1, and progesterone in maternal serum after operation of an ectopic pregnancy in 38 patients. Prolactin, progesterone and SP-1 rapidly returned to normal values after removal of the ectopic pregnancy. However, the half life of HCG was related to the type of operation: after conservative operation of ectopic pregnancy the half life of HCG was greater than after tubectomy (41.4 +/- 1.9 SEM hours versus 33.4 +/- 2.0 hours), possibly due to lack of complete removal of trophoblast tissue. This fact should be kept in mind when evaluating postoperative HCG levels.
Adult↗
[Facilitation of the diagnosis of colpitis in pregnancy: the line test as a quantitative parameter of vaginal discharge].
To define the vaginal discharge in pregnancy with a numeric quantitative parameter and to determine out its pathognomonic importance, the vaginal discharge of 140 pregnant and 33 non pregnant women was examined and the women were asked to indicate the subjective degree of discharge in a visual linear analog scale (Line-test). Pregnant woman marked high Line test values more frequently than non pregnants irrespective of detection of a vaginitis. With increasing gestational age and parity higher Line test values were found irrespective of the frequency of vaginitis. With a cut off level of 80 mm, the specificity of the Line test concerning vaginitis is high below cut-off, the possibility to have vaginitis is increased. The Line test is simple to use and - because of its specificity and sensitivity - has been found useful in evaluating the degree of vaginal discharge.
Adult↗
[X chromosome recessively transmitted hydrocephalus with congenital aqueduct stenosis].
Although hydrocephalus is usually a sporadic disorder, there exist some rare but well delineated syndroms, in which recurrence is to be expected. The here presented Bickers-Adams-Syndrome of sex-linked hydrocephalus is caused by congenital aqueductal stenosis. A case of this syndrome is presented in regard to anamnesis, diagnosis, pedigree, autopsy findings and clinical management.
Adult↗
[Behavior of the fibronectin content of the amniotic fluid].
Concentration of fibronectin in amniotic fluid was compared in early pregnancy and after 35th week of gestation. Content of amniotic fluid fibronectin between 15th and 20th week was significantly higher than after 35th week. Fibronectin-level was higher in amniotic fluid of female fetuses (15th-20th week) whereas concentration of protein in amniotic fluid of cases with chromosomal anomalies was declined (15th-21st week demonstrable.
Amniocentesis↗
Prognostic value of cytokeratins and carcinoembryonic antigen expression in primary surgically treated cervical cancer.
In a previous study we have shown the prognostic value of expression of cytokeratins and carcinoembryonic antigen (CEA) in cervical cancer FIGO stage III. The present study was performed to evaluate the prognostic value of cytokeratins and CEA in patients with cervical primary cancer stage IB to IIB, surgically treated by radical hysterectomy and lymphadenectomy. Seventy-six patients were included in the study. By application of immunohistochemistry we found AE1/AE3 (cytokeratins) expression in 27 (35.5%) cases and CEA expression in 56 (73.7%) cases. Multivariate analysis for the end points of relapse-free survival and overall survival showed that neither AE1/AE3 expression nor CEA expression had a prognostic value in the studied population. In contrast to patients with primary irradiated cervical carcinoma FIGO stage III, patients with primary surgically treated tumors stage IB to IIB showed no significant prognostic value of cytokeratin or CEA expression of the tumor.
Biomarkers, Tumor↗
Prognostic value of tumour microvessel density in cancer of the uterine cervix stage IB to IIB.
High intensity of tumour angiogenesis has been correlated with an increased potential of metastasis and poor prognosis in human malignancies. We investigated 43 patients with cervical cancer stages IB (n = 13), IIA (n = 8) and IIB (n = 22). All patients were treated by radical hysterectomy and lymphadenectomy. In the tumour specimen blood vessels were highlighted by staining endothelial cells for factor VIII. Microvessels were counted on a 200x field (0.74 mm2) in the most active areas of neovascularisation. The mean microvessel counts per field for stage IB, IIA and IIB tumours were 59.6 +/- 28.1, 56.3 +/- 24.3 and 55.7 +/- 55.6, respectively (p-value = n.s.). We found no significant correlation of microvessel density and established prognostic factors like pelvic lymph node involvement, vascular space invasion and stromal reaction. Patients with tumours showing low microvessel density (< 40 microvessels per field) had a significantly poorer recurrence-free interval (log-rank test: p-value = 0.01).
Female↗
Vascular space invasion and inflammatory stromal reaction as prognostic factors in patients with surgically treated cervical cancer stage IB to IIB.
We assessed the prognostic value of the local tumor characteristics inflammatory stromal reaction (ISR) and vascular space invasion (VSI) together with established prognostic criteria, in cervical cancer patients. One hundred and forty-two patients with carcinoma of the cervix stage IB to IIB undergoing radical hysterectomy and lymphadenectomy between October 1980 and September 1990 were included in the study. Pelvic lymph node involvement, stage, parametrial involvement, age and histological tumor type were analysed together with VSI and ISR as prognostic factors. The most important prognostic parameters for recurrence-free interval and overall survival in the univariate analysis were pelvic lymph node involvement (P-value < 0.0001/0.0001) and stage (P-value < 0.0001/0.0005). ISR and VSI showed a significant prognostic value for recurrence-free interval (both P-values = 0.0014) and overall survival (ISR: P-value < 0.0001; VSI: P-value = 0.0018). In the multivariate analysis ISR showed an independent prognostic value for overall survival (P-value = 0.03, Relative Risk = 5.4, 95%-confidence interval 1.2-24.5). ISR, reflecting the biological behavior of the tumor, should be considered in the evaluation of prognosis in surgically treated squamous cell carcinoma of the cervix.
Adult↗