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Biomedical subjects

F Kubli

Publications and source records attributed to F Kubli.

At least 19 recordsLinked to original sources
PubMed1991

[Breast saving treatment of breast cancer: results, risks, new developments].

In the Departments of Gynaecology and of Gynaecological Radiology of the University of Heidelberg, breast conserving therapy was carried out in 1330 patients with breast cancer between 1975 and 1990. The tumour size was up to 3 cm and 28% showed positive nodes. The median age was 47.6 years, segmental resection was the standard operation and whole breast irradiation with 50 Gy and an additional boost of 10 Gy was the standard irradiation schedule. After 5 years (n = 307), the following results were observed: local failure: 6.8%, regional lymph node recurrence: 2.1%, overall survival: 88.3%, disease-free survival: 81.2%. 5 out of 36 of the cases of mortality died without having had a recurrence. Significant factors for local failure were following: 1. lymphangiosis of more than 1 cm in size around the tumour (p = 0.03) 2. intra-ductal non-invasive cancer of more than 1 cm in size around the primary tumour (p = 0.01) 3. intra-ductal non-invasive cancer reaches the margin of resection (p less than 0.00001) With segmental resection (2 cm margin macroscopically free of tumour), tumour beyond the margins--so-called residuals, showed in 19% histologically. In the other 3 quadrants, additional secondary primaries in 25% (multicentric cancers) of macroscopical size could be confirmed in an additional study. In case of high risk for local failure, more radical surgery as well as more intense irradiation is recommended.

Adult↗
PubMed1988

Correlation of DNA flow cytometric results and other prognostic factors in primary breast cancer.

The percentage of cells in S-phase and DNA-ploidy have been measured in 300 primary mammary carcinomas by means of DNA-flow cytometry (FCM). The data were compared with the age and menopausal status of the patients as well as with the size, regional lymph-node involvement, histologic type, grade and concentration of estrogen (ER) and progesterone (PR) receptors of the tumors. A DNA-diploid distribution of the G0/1-peak was found in 37.6% of the cases. The mean percentage of S-phase fractions was 4.83. DNA-aneuploid tumors had significantly higher amounts of S-phase fractions (6.12%) than DNA-diploid tumors (2.66%). There was also a significant correlation between the DNA measurement data (DNA-ploidy and S-phase fractions) and histologic grade, as well as the content of ER and PR, but not between DNA-ploidy, S-phase fractions, tumor size (T) and evidence of axillary lymph-node metastases. DNA-FCM gives a biological characterization of the tumor in addition to the histopathologic examination. The method can be used as a routine procedure because of the reliability and reproducibility of the results as well as the short time needed for the measurements.

Age Factors↗
PubMed1988

Course and predictive value of fetal heart rate parameters.

The present study concerns the developmental character of the fetal heart rate (FHR) pattern and the implications of predicting the perinatal outcome. Data from 443 patients undergoing 2193 nonstress tests were analyzed retrospectively. We found a significant increase of accelerations more than 15 beats/min, of accelerations associated with fetal movements, of fetal movements registered by the tocotransducer, the frequency of oscillations, and of the Fischer score values throughout gestation. The number of short FHR decreases and the mean baseline level declined throughout gestation. A long duration of absent or reduced baseline variability registered even 6 weeks before delivery was associated with low Apgar score values. Late decelerations and contractions registered early in pregnancy were also correlated to a poor outcome. Tachycardia and a low number of accelerations were only correlated to a poor perinatal outcome shortly before the delivery. Fetal movements not associated with FHR accelerations were an early indicator of a poor neonatal outcome. Scoring systems did not generally improve the predictive value of FHR patterns.

Apgar Score↗
PubMed1988

[Subcutaneous mastectomy: surgical indications and pathologico-anatomic findings in the mastectomy specimen].

This is a report on the histological findings in subcutaneous mastectomy (scM) specimens of 250 patients, who underwent surgery at the Gynaecological Department of the University Hospital Heidelberg between 1978 and 1987. These operations were indicated either because of diagnostic problems (n = 111), a carcinoma of the contralateral breast (n = 41), a histologically proven mastopathy with epithelial atypia (n = 30), non-invasive lobular carcinoma (n = 28) or non-invasive ductal carcinoma (n = 40). In the group of patients with diagnostic problems, a large number of occult carcinoma and precancerous lesions (36%) could only be found where the glandular tissue could be evaluated neither clinically nor radiologically. In cases with preoperatively diagnosed proliferative mastopathies with epithelial atypia, we found occult carcinoma ipsilaterally in 27%, in cases with a preoperative carcinoma lobulare in situ (Clis) in 28% and with a preoperative diagnosed carcinoma ductale in situ (Cdis) in 57%. The percentage of occult carcinoma in the corresponding contralateral breasts was 6%, 25% and 30% respectively. In women with a previously known contralateral carcinoma, occult invasive or non-invasive carcinoma were diagnosed in 20%. There was a correlation between the incidence rate of carcinoma and genetic risk. On the basis of these results the acceptable indications for a scM are: 1. clinical and radiological diagnostic problems with an additional genetic risk, 2. proliferative mastopathy with epithelial atypia in addition to limited mammographic assessment and familial risk, 3. contralateral carcinoma with radiologic dysplasia or high genetic risk, 4. Clis, when there are radiological diagnostic problems, 5. Cdis less than 2 cm.

Breast↗
PubMed1988

[Breast reconstruction using a skin expander prostheses following modified radical mastectomy].

In the period from September 1983 to May 1986, 116 breast reconstructions were performed at Heidelberg University Gynecological Clinic with the aid of skin expander prostheses, following modified radical mastectomy (89 primary and 27 secondary reconstructions). In 18% of all cases, complications occurred due to the expanders, the most common being loss of prosthesis material. A total of 82 women have meanwhile had the expander prosthesis replaced by a definitive gel prosthesis in a "second reconstruction phase". Reconstruction of the nipple and areola has been performed in six cases in a third phase. Today, breast reconstruction in one or two stages following modified radical mastectomy represents an integral part of surgical rehabilitation of primarily operable breast cancer in cases, where a primary conservative procedure is out of the question.

Adult↗
PubMed1988

[Rate of local recurrence and survival in patients with breast reconstruction following mastectomy].

A retrospective study was conducted covering 100 patients who underwent breast reconstruction with plastic prostheses following mastectomy during the period from 1975 to May 1986. They were compared with 100 patients (matched pairs) who had not undergone breast reconstruction. No significant difference between the two groups could be found as regards locoregional recurrences or the overall survival rate. The mean observation period was 86.5 months. Surgical removal of local recurrences did not necessarily involve removal of the prosthesis. Therefore, given adequate operability, and experience on the part of the surgeon, a breast reconstruction following mastectomy can now be performed on any patient desiring it to alleviate mental suffering.

Adult↗
PubMed1988

[Transposition and myocutaneous island flaps in primary or secondary locoregional surgical therapy of breast cancer].

New plastic surgical reconstruction techniques can today make a major contribution to locoregional therapy in breast cancer cases. The present paper reports on indications for and experience gathered in primary and secondary therapy with transposition (medial-pedicled thoracoepigastric) and myocutaneous island flaps (lower transversal rectus and latissimus dorsi) at the University Gynecological Clinic of Heidelberg between October 1981 and June 1987. Thirty-nine patients were treated using these techniques. Altogether nine rectus, 13 latissimus dorsi, and 21 thoracoepigastric flaps were used; in 16 cases for primary treatment with T4 tumors and in 27 cases for secondary treatment. In view of the rate of complications and recurrences seen, the indication must be established strictly and individually according to the location of the defect, the anatomic situation, and the prognosis for the patient. Today, the use of these plastic surgery techniques should lie in the hands of experienced surgeons and be an integral part of the treatment of primary advanced breast carcinomas or large locoregional recurrences.

Adult↗
PubMed1988

Morphology and fertility after re-anastomosis of the rabbit fallopian tube with fibrin glue.

Morphology and fertility were studied in 20 female New Zealand White rabbits after re-anastomosis of the Fallopian tube with fibrin glue and conventional microsurgical techniques. All oviducts were patent postoperatively. No intraperitoneal adhesions were observed. There were no significant differences with regard to the number of corpora lutea, implantations and the nidation index. Morphological studies demonstrated a normal fold pattern and ciliation at the side of anastomosis in the sealed oviducts as well as in the sutured oviducts. No intraluminal fibrin deposits were found. For re-anastomosis of the Fallopian tube with fibrin glue, splinting is necessary. In some instances this may be related to a mucosal trauma. However, under optimal conditions the use of fibrin glue is equivalent to conventional microsurgical anastomosis of the oviduct. For tubocornual, ampullary--ampullary and isthmic--ampullary anastomoses with luminal disparity, fibrin glue seems to be inappropriate.

Adhesives↗
PubMed1988

[Breast-sparing therapy of breast cancer: on the combination of radiation therapy with adjuvant chemotherapy].

From January, 1975 through June, 1986, 426 patients with mammary carcinomas were submitted to primary, breast-preserving therapy at the Gynecological Hospital of the University of Heidelberg. 212 women with a minimum observation time of twelve months fulfilled the criteria of a "typical" treatment: tumor size up to 3 cm, segment/quadrant resection and axillary lymphonodectomy with at least eight lymph nodes removed, radiotherapy of the residual breast with greater than or equal to 45 Gy, in case of histological lymph node manifestation adjuvant hormonal and/or chemotherapy. The average observation time was 38 months, the medium age 48 years. Patients with histological lymph node manifestations were compared with a matched control group of women treated treated by modified radical therapy. According to the error estimation of Kaplan and Meier (1958), no differences were found for local recurrence rate, disease-free survival, and overall survival. Patients treated by organ-preserving therapy with adjuvant chemotherapy were opposed to a matched control group of women treated only by surgical/radiological, organ-preserving therapy. In patients with chemotherapy, the incidence of cutaneous erythema (29% versus 24%), telangiectasia (34% versus 24%), hyperpigmentation (41% versus 34%) showed an upward tendency, but was not significantly increased. There was no difference in the incidence of clinically palpable fibroses (37% versus 42%) and fibroses shown by mammography (54% versus 51%). The frequency of pneumonitis/fibrosis of the retromammary lung area (22% versus 10%) after chemotherapy was two times higher than in the matched control group not treated by chemotherapy.

Antineoplastic Agents↗
PubMed1987

Weight percentile at birth. I. Clinical data of pregnancy and relevance for early childhood development.

The influence of the weight percentile at birth on childhood development was examined in a prospective study of 847 singleton pregnancies. In the first two years of life significant relationships between the birth weight percentiles and the infant's development could be proven, while at the age of four social factors were predominant. Though various clinical data in pregnancy and delivery were related to fetal growth, such as weight of the mother, previous abortions and diseases, additional biochemical and biophysical information is desirable for early recognition of intrauterine growth disorders.

Birth Weight↗
PubMed1987

Weight percentile at birth. II. Prediction by endocrinological and sonographic measurements.

In a prospective study of 847 singleton pregnancies, the importance of various endocrine methods (serum estriol, HPL, SP1, beta-HCG, estradiol-17 beta, urinary estrogen excretion) and of two sonographic measurements (biparietal and thoracic diameter) for the diagnosis of growth retardation in the third trimester was studied. HPL and estriol determinations were best suited for the diagnosis of growth retardation. The thoracic diameter correlated most closely with the birthweight of the newborns. Sensitivity in relationship to growth retardation was between 17 and 35% for the HPL and estriol determinations as well as for both sonographic methods. Specificity was around 90% for these methods. The validity for all methods improved as the time of birth approached. Through the simultaneous measurement of one of the hormones and the thoracic diameter, an antepartal diagnosis of up to 50% of the hypo- and hypertrophic growth disorders was achieved. In the first two years of life a relationship between development and the HPL and estriol concentrations could be observed which was independent of the weight percentile at birth.

Birth Weight↗
PubMed1987

[Significance of the examination position in urodynamic assessment of female urinary incontinence].

The present paper describes a test center which permits urodynamics tests with the patient in various positions, such as lithotomy position (A), supine position with outstretched legs (B) and, by continuously raising the patient, upright position (C). The results of a comparative investigation show the influence of these different examination positions on urodynamic parameters, in particular the functional length of the urethra and maximum urethra closing pressure at rest. Urodynamic tests on 40 patients with urinary incontinence showed that there is a significant increase in the functional length of the urethra when the patient is in lithotomy position (A) as compared to lying with outstretched legs (B), and that it is once again significantly reduced when the patient is raised to upright position. Maximum urethra closing pressure at rest drops significantly when the patient is repositioned from lithotomy (A) to supine (B) position, and once again rises significantly when she is raised to the upright (C) as compared to the supine (B) position. In the light of the changes described, which cause major changes in the form of the urethra pressure profile, it makes sense to perform urodynamic measurements in at least two different positions. The authors recommend the supine position with outstretched legs (B), as it appears more physiological than the lithotomy position (A), and measurement in the upright position (C). The importance of positioning with regard to the diagnostic information value in determining the cause of urinary incontinence is discussed.

Adult↗
PubMed1986

Diagnosis of intrauterine fetal growth retardation by DHAS half-life.

A DHAS test (50 mg i.v.) was performed on 49 women with clinically suspected intrauterine fetal growth retardation (IUGR) in the last trimester of pregnancy. A correlation could be established between the serum DHAS halflife (DHAS-T 1/2) of the mother after DHAS loading and the birthweight percentile of the newborns, which were retrospectively divided into two groups; one with regular intrauterine fetal growth (birthweight greater than 10th percentile) (n = 28) and one with poor intrauterine fetal growth (IUGR) (less than 10th percentile) (n = 21). The DHAS loading test was retrospectively evaluated by the correct diagnosis of intrauterine fetal growth; a DHAS halflife below 4.7 h was taken as a threshold for normal intrauterine fetal growth as indicated by a previous study by our group: DHAS-T 1/2 (less than 10th birthweight percentile): 6.00 +/- 1.43 h (mean +/- S.D.) (n = 18), DHAS-T 1/2 (greater than 10th birthweight percentile): 4.37 +/- 1.06 h (mean +/- S.D.) (n = 28). In 89% (16/18) of the cases (less than 10th birthweight percentile), a prolonged DHAS-T 1/2 (greater than 4.7 h) led to the correct diagnosis of an IUGR. In 75% (21/28) of the cases with regular fetal growth, a DHAS-T 1/2 of less than 4.7 h could be registered. In three cases with intrauterine death of the fetus, a prolonged DHAS-T 1/2 of 7.64 +/- 0.37 h (mean +/- S.D.) was found. Furthermore, IUGR could not be detected in three cases by DHAS loading (DHAS-T 1/2 3.77 +/- 0.51 h (mean +/- S.D.) due to betamethasone induction of lung maturation prior to the DHAS test. Indications for the DHAS test include the diagnosis of an ultrasonographically symmetric IUGR (biparietal and thoracic diameters) in cases with an indefinite gestational age and the detection of a placental sulfatase deficiency by means of a delayed conversion of DHAS to dehydroepiandrosterone.

Birth Weight↗
PubMed1986

[Effects of routine administration of methylergometrin during puerperium on involution, maternal morbidity and lactation].

The objective of the prospective randomized study reported here, based on 880 puerperae, was to study the effects of methylergometrin on involution, puerperal morbidity, and lactation. Over 4 weeks 444 mothers were given 0.125 mg of methylergometrin 3 times a day, while 436 were given the same dose of placebo. The following differences were found: in the treated group involution of the uterus was accelerated in the first few days following birth, but after 4 weeks there were no longer any significant differences. Post-partum pains were almost twice as intense in the treated group as in the untreated group. It proved impossible to reduce the number of cases of infection (lochiostasis, axillary temperature over 37.5 degrees C) by administering Methergin during the puerperium; following spontaneous births there were actually more cases of endometritis in the treated group. The number of patients with severe afterbleeding after spontaneous birth was also higher in this group. Lactation among untreated puerperae averaged 880 g during the first six days, while among treated patients it was only 563 g. Even after 4 weeks there were still differences in the quantity of milk produced. The incidence of infection and afterbleeding was significantly lower in mothers who breast-fed their children, irrespective of whether they had taken Methergin or not. We therefore consider that routine treatment of puerperae with methylergometrin is no longer justified; we continue to advocate breast-feeding, not least in view of the fact that it reduces maternal morbidity.

Breast Feeding↗
PubMed1986

[Successful pregnancy after kidney transplantation and cyclosporin A].

A 21-year-old patient is described who, with a kidney transplant and immunosuppressive treatment with Cyclosporin A, successfully concluded pregnancy. Effective immunosuppression is especially important during pregnancy with its increased risk of transplant rejection. Aside from conventional substances such as azathioprine and steroids, Cyclosporin A (Sandimmun) seems to be the most effective substance available in transplantation medicine today. There is, however, still insufficient knowledge of the effects of Cyclosporin A during pregnancy, so that an endangered pregnancy must be expected during this type of therapy. Because of persistent premature labor in spite of tocolytic treatment, a cesarean section was performed in the 36th week of pregnancy after establishing pulmonary maturity. A review of the literature points out the presently known problems connected with Cyclosporin A intake during pregnancy.

Adult↗
PubMed1986

[The second-look operation in advanced ovarian cancer--experiences since the introduction of cisplatin combination chemotherapy].

In cases of ovarian carcinoma the trend today is toward postoperative cytostatic follow-up therapy which is as aggressive as possible, though of limited duration. The aim is to achieve full clinical remission and to verify it histologically by a second-look-operation. This paper presents the results obtained in 41 women who underwent second-look surgery, out of a total of 87 women with advanced epithelial ovarian carcinoma (FIGO stage III and IV) who had been given combination chemotherapy with cisplatin postoperatively. Taking various well-known prognostic factors into account (stage, age, histologic grading, primary postoperative residual tumor mass), the situation before and after a second-look laparotomy was analyzed. The survival data (life table analyses according to Kaplan-Meier) indicate the importance of these prognostic factors. Approximately one-third of the patients had full clinical remission after aggressive cisplatin combination chemotherapy; complete remission was verified microscopically in 18% of all cases, with a mean of 12 biopsies. The long-term prognosis for such women, who can be cured even if they have primary advanced ovarian carcinoma, is likely to be good. In addition, present-day indications and the standard surgical procedure for a second-look operation are described.

Adult↗