Biomedical subjects
Publications and source records attributed to E Gitsch.
The evolution in the management of ovarian cancer at the First Department of Obstetrics and Gynecology of Vienna University is reviewed. The improvement in radical surgery and a more rational application of adjuvant treatment modalities produced a relative improvement in 5 year survival in the last period under review.
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Two sampling methods, biopsy and cell smear, were investigated for their reliability in the biotin in-situ hybridization test for human papilloma virus deoxyribonucleic acid (HPV-DNA)-6/11 and 16/18. Cervical smears and biopsies were obtained simultaneously from 81 women with cervical lesions. The sensitivity of the in-situ hybridization was tested on human cervical carcinoma cell lines. As a reference method, HPV-DNA was probed in biopsies using a Southern blot with 32P-labelled DNA probes. This reference method detected HPV-DNA in 45% of the reactive and reparative cell changes, in 75.9% of intraepithelial neoplasias, and in 83.3% of squamous cell carcinomas of the cervix. Of the examined cervices 61.7% were HPV-DNA-positive. As tested by in-situ hybridization, 56.8% of the biopsies were HPV-DNA-positive. Three biopsies were HPV-DNA-negative by the in-situ hybridization but positive by the Southern blot. One biopsy was HPV-DNA-6/11 positive by the in-situ hybridization but negative in the Southern blot. As tested by in-situ hybridization, 55.6% of the cervical smears were HPV-DNA-positive. Five smears were HPV-DNA-positive by the in-situ hybridization but negative by the reference method, thus demonstrating the dependence of the HPV positive rate on the sampling method. Four cell smears were negative by the in-situ hybridization but positive by the reference method, which shows that the biotin in-situ hybridization is less sensitive. The reference method confirmed the HPV-DNA-positivity of in-situ hybridization for 97.8% of biopsies, and for 91.8% of cell smears.(ABSTRACT TRUNCATED AT 250 WORDS)
Besides a relatively high frequency of perioperative and postoperative dysfunctions of micturition, urogenital fistulae are the most frequent complication occurring after surgical gynaecological interventions. Vesico-vaginal fistulae are the most common communication between the efferent urinary passages and the genital tract. From 1967 to 1987, 42 women who had developed a vesico-vaginal fistula after abdominal or vaginal surgery or irradiation were operated on again. Upon admission, all 42 patients were subjected to surgical closure of the vesico-vaginal fistula according to the vaginal method of Chassar Moir. In 41 women (97.6%) continence was re-established by adequate closure.
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The most important stages in the development of the abdominal radical operation of the carcinoma of the cervix are discussed. These different stages are associated with the following names: Freund and collaboratores; Ries, Rumpf, Clark, Latzko; Wertheim; Bumm; Latzko and Schiffmann; Okabayashi and Meigs. After having reached the limits of the radicality with respect the extirpation of parametrial tissue samples the main emphasis should be the complete lymphonodectomy in the future.
This paper reviews the technique of nuclear placental flow-rate determination developed in 3 stages at the I. Department of Obstetrics and Gynaecology, University of Vienna. It particularly highlights the diagnostic potential of the most recent development, which is based on iterative regression, by quoting pertinent figures. In 153 females with type I flow-rate patterns the diagnosis proved to be correct in 82.2% of cases. 26 patients had pathological flow-rate patterns and 20 of the infants born to this group of mothers had moderate to severe dystrophy due to reduced placental function. The placental perfusion test, another recent development, is of particular significance in differentiating between the causes underlying reduced placental blood flow. These two techniques have internationally conquered a firm position in the battery of placental perfusion studies designed to assist in the diagnosis and treatment of placental insufficiency.
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The radioisotope radical operation may cause an improvement of results in carcinoma of the cervix stage I b, II, and IV. The increased yield of lymph nodes enables a more reliable prognosis in advanced cases. Recurrent tumors at the pelvic wall may be detected earlier by isotope nephrography.
In the period 1972--1975 432 conizations were performed. 76,6% of all patients were dismissed healed after conization without necessity of hysterectomy; the duration of stay in hospital after operation was in uncomplicated cases 7,9 days, in complicated cases 9,9 days. In 13,9% complications were registered, mainly bleedings (10,9%). In more than half of the cases with not totaly removed carcinoma in situ the uterus showed rests of the malignant lesion. That indicates that in such situations a hysterectomy should be done in every case. If there was a suspicion of invasive carcinoma an excochleation was performed instead of cone biopsy. The high rate of false negative results in such cases confirms that the conization at the moment seems to be the method of choice in clarification of positive cytologic or colposcopic findings.
A report is present of 1300 unselected patients investigated for breast cancer by liquid crystal thermography. The value of this method is comparable to the value of mammography, since the number of carcinomas which remained undetected by each diagnostic procedure was equal. The high degree of diagnostic accuracy achieved by the use of liquid crystal thermography indicates that this simple dignostic procedure is recommendable as a screening method for the detection of breast cancer in gynaecological practice.
Determination of the creatinine concentration of the amniotic fluid was undertaken between the 25th and 40th week of gestation in 114 patients. The normal serum creatinine level was simultaneously determined in 43 of these patients. The aim of this study was to examine whether this parameter of fetal renal function allows a conclusion to be drawn with respect to fetal maturity and the length of gestation. With increasing length of gestation a marked increase in the amniotic fluid and the maternal serum creatinine concentration was observed (p less than 0.01). The large scatter of the values made it impossible to relate any particular creatinine concentration to a certain week of gestation. However, if the concentration of creatinine in the amniotic fluid has reached a value of 2 mg% or more, a mature baby can be predicted in most cases. A tendency to raised levels of creatinine was seen in cases of EPH gestosis and latent diabetes mellitus. The determination of creatinine in the amniotic fluid can be recommended with certain reservations as an additional method to assess fetal maturity.
The immunological reactivity of 19 operated cases of breast cancer (14 T1 2, 5T3) was investigated before and at 3-weekly intervals up to 12 weeks after radiotherapy by means of a large panel of techniques. The results were compared with two groups of identically-investigated patients, one consisting of 11 cases of cervical cancer (stage III), treated solely by irradiation and the other of 12 cases of cervical cancer (Stages I a and II b), treated by operation only. Before irradiation and in the non-irradiated group cellular immunity appeared to be more disturbed in cases of breast cancer than in cases of cervical carcinoma, as shown by the lowest number of lymphocytes, the lowest number of spontaneously-rosetting lymphocytes, the lowest percentage of DNCB sensitization in patients and the lowest percentage of Tuberculin-positive skin tests. In both types of carcinoma the humoral immunity appeared to be impaired, as apparent from the lowered immune response to tetanus vaccination. Other parameters of humoral immunity such as the immune globulin concentration, iso- and heteroagglutinine, the titre of measles antibodies or membrane fluorescence of lymphocytes showed no dinstinct trends during the investigation period. After irradiation a) inhibiting and b) stimulating influences were observed: a) The incidence and extent of the immune response to tetanus vaccination was further reduced and a distinct lymphopenic effect was observed. b) The incidence of positive skin tests with varidase, as well as the number of spontaneously-rosetting lymphocytes increased after the commencement of irradiation. Apart from the known sensitization with DNCB and skin tests with tuberculin, determination of the antitoxin titre before and after tetanus vaccination provided the most reliable results in regard to immunological reactivity in the investigated tumour patients.
By performing the radioisotope radical operation (pre-surgical labelling of the lymphatic tissue of the pelvis with colloidal 198Au) with the aid of a gamma camera, it was possible in 78 out of 93 cases to completely extirpate the regional lymphatic tissue of the pelvis. In eight out of 24 cases with positive findings on the lymph nodes we were also able to extirpate with this technique residues of carcinomatous lymphatic tissue during the course of a secondary isotope lymphadenectomy. This fact is likely to further improve the recovery rate--all the more so since even the scanner and eye probe technique already reduced the mortality rate due to recurrence by 16.4% after 5 years.
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