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Biomedical subjects

G Bastert

Publications and source records attributed to G Bastert.

At least 145 records · Page 8Linked to original sources
PubMed1994

[Hysteroscopic endometrium ablation to avoid hysterectomy in "high risk" patients].

Hysteroscopic endometrial ablation under maximal anaesthesiological surveillance was performed in 34 high-risk patients to avoid hysterectomy. It was a collective of patients with heavy thrombo-embolic or thrombotic disease, either under permanent anticoagulation due to residual disease or multiple endoprosthetic treatment, or with endogenous coagulopathy. In all these women, hysterectomy was either a relative or an absolute contraindication. In 22 patients, treatment resulted in complete amenorrhoea or at least hypomenorrhoea (without menometrorrhagia) respectively cyclic spotting. In 6 further patients, amenorrhoea was achieved after a repeat procedure. Endometrial ablation was thus successful in 28 of 34 cases. In these patients, hysterectomy with the risk of major or even lethal complications, could thus be avoided. Hysterectomy, however, had to be performed in 2 women with extensive adenomyosis uteri interna. Within two respectively three years after endometrial ablation, two other patients died from causes unrelated to the surgical intervention (cardiac infarction, cerebral haemorrhage). Follow-up ranged from 1 to 5 years. Hysteroscopic endometrial ablation proved an effective therapeutic option in this selected group of patients. Other indications require further study.

Adult↗
PubMed1994

[Histologic regression of breast cancer after primary (neoadjuvant) chemotherapy].

Primary (neoadjuvant) chemotherapy of locally advanced breast carcinomas is performed to locally reduce the tumour mass and to improve the operability. Recently, the indication for primary chemotherapy has been extended for preoperative treatment in breast conserving surgery. In an ongoing clinical trial we examined the resection specimens of 51 mammary carcinomas after primary chemotherapy. These patients had received a neoadjuvant therapy with epirubicin/cyclophosphamide for size reduction of large (> 3 cm) but operable tumours (pretreatment median tumour size 4.5 cm by mammography). The tumour response was evaluated pathologically and compared with the clinical tumour regression that was observed in over two-thirds of all cases. We classified the regressive changes using a semiquantitative scoring system from 0 to 4 (0 = no effect, 1 = resorption and tumour sclerosis, 2 = minimal residual invasive tumour [< 0.5 cm], 3 = residual noninvasive tumour only, 4 = no tumour detectable). The aim of this study was to evaluate the improvement of operability objectively and to correlate the histology of the primary tumour with the response to treatment. With invasive lobular carcinomas, the tumour size after therapy was reduced less than average and irrespective of the amount of histological tumour cell reduction, largely due to the stromal content of these neoplasms. Invasive ductal carcinomas with extensive or predominant intraductal component also underwent only a slight decrease in tumour size; this was because of the lack of tumour response with the intraductal component. Well differentiated tubular carcinomas were particularly resistant to primary chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Psycho-oncologic after-care--is there a need in a tumor center? Results of a survey of 200 patients of the Heidelberg University Gynecologic Clinic].

In an ongoing study at the department of gynaecology and obstetrics of Heidelberg University Hospital, 200 patients of the oncological outpatient department have so far been interviewed about how they experienced their illness, their therapy, the success of treatment and the after-care. An interim analysis of the questionnaires produced the following results: 1. Most patients (84%) judge the success of their treatment to be good or very good and place themselves in the upper sector of the scale of quality of life. 2. The time of diagnosis was indicated to have been the hardest period during the illness. 3. When evaluating different forms of treatment, hormone treatment has been described by most of the patients as having been well tolerated, whereas chemotherapy has been rated low (some even discontinued 5.1%). 4. Most of the assistance in coping with the disease seems to have come from the patients' families; however, some described their families as a burden during the illness. 5. Only less than half of the patients (44.2%) seem to have been able to satisfactorily discuss their psychological burdens during the after-care. 6. Most of the patients (77.5%) would like the hospital to look more after psychological problems of cancer patients. 7. Most patients would like to speak about the topics of self-esteem as a woman, happiness, competitiveness, unconventional methods of treatment and fear. 8. The majority of respondents (80%) would prefer a constant counterpart (doctor, nurse) for the oncological after-care. More cases will be necessary to analyse the effects of age, education, and type of cancer (mamma/genital, low/high risk) of the questionnaire results.

Adaptation, Psychological↗
PubMed1994

[Incontinence operation by "Retzius-scopy"? An endoscopic modification of the Marshall-Marchetti-Krantz operation].

The operative treatment of stress incontinence with the Marshall-Marchetti-Krantz procedure has proved effective. A new, endoscopic modification of this procedure is presented here, based on the principle of vesico-urethral suspension with fibrin glueing. Open abdominal surgery is replaced by retziusscopy and a minimal invasive endoscopic intervention in the Retzius' cavity.

Female↗
PubMed1994

[The positive "vocal fremitus" in malignant breast tumors in color MEM ultrasound imaging--an exciting artifact in confirming the diagnosis?].

In the experimental phase of application of a new Non-Doppler technology (MEM system, Acoustic Imaging, Phoenix; Dornier Medizintechnik) we observed, that in patients, who spoke during colour imaging of a breast tumour, artifacts appeared in or around the lesion: the colour artifacts were seen regularly inside the tumour in cases of malignancies, and exactly surrounding benign tumours. Postoperative histological findings served as an objective criterion of classification/differentiation. To examine this phenomenon, we performed a study in 71 patients. These women with a sonographically detectable tumour (37 malignant, 34 benign) were examined on the day before surgery. We observed, that if patients uttered the number "99" with a relatively low voice or alternatively hummed a deep sound, the artifacts could be regularly visualized. In 66/71 patients (93%) status evaluation by artifact generation due to vocal fremitus examination was correct. In 3 patients the tumour was erroneously described as malignant, histology showing a proliferative mastopathy. In 2 cases the tumour was classified as benign, whereas histology revealed a malignancy, in both patients a large ductal-invasive carcinoma (> 3 cm). This phenomena could, however, not be reproduced with other colour techniques. A possible explanation is: Thoracic vibrations during speech can be registered by the MEM technique. These vibrations are not perpetuated into the benign lesion characterised by a displacing growth, due to which the vibrations are "barred off" at the borders of the tumour. Infiltrating growth typical of a malignancy causes transmission of these vibrations into the center of the tumour.(ABSTRACT TRUNCATED AT 250 WORDS)

Artifacts↗
PubMed1994

Production of mouse monoclonal anti-idiotypic antibodies specific to epitopes of tumor-associated mucin TAG-12.

The tumor-associated mucin-glycoprotein TAG-12 is strongly expressed in approximately 96% of all breast cancer patients and nearly 68% of all ovarian cancers. The experimental results of this work indicated that humoral immune response against TAG-12 is possible. Immunization with anti-idiotypic monoclonal antibodies produces this response. In this experiment, anti-idiotypic monoclonal antibodies represent the internal image of a specific epitope on TAG-12. Monoclonal antibody (MAb) 12H12 was selected to produce anti-idiotypic antibodies (anti-Ids) because of its high reactivity with TAG-12. Syngeneic murine anti-Ids were developed by immunization of BALB/c mice with the 12H12-Fab-KLH conjugate. A competitive assay with purified TAG-12 was utilized to identify anti-Ids with mirror image function. Two MAbs with "internal image" specificity were selected, 5H8 and 5H2. Two New Zealand White rabbits were immunized with 5H8. Serum samples tested 6 weeks after the initial immunization showed comparable titers against TAG-12. The binding capacities of the rabbit sera to different human breast as well as nonbreast cancer cell lines demonstrated strong binding with TAG-12-positive breast cancer cell lines. Competitive inhibition assays demonstrate that Ab3 and purified TAG-12 totally inhibit the binding of 12H12 antibody to TAG-12-positive cells. No inhibition was detectable with unrelated MAbs or normal mouse immunoglobulin. Binding assays with polyclonal Ab3 serum and several human cancer cell lines showed reactivity to nearly every tested cell line. Soluble TAG-12 showed no inhibition, indicating that this binding is due to a different set of idiotypes. Anti-Id 5H8 elicited an immune response to TAG-12. Utilization of anti-Id as a vaccine against the breast cancer-associated tumor antigen TAG-12 was successfully demonstrated in a xenogeneic animal model.

Animals↗
PubMed1994

Hydrosalpinx formation and its regeneration after microsurgical reconstruction--a functional and morphological study on rabbits.

The development of mechanically induced hydrosalpinx and the subsequent regeneration of the uterine tube following correction were investigated with reference to morphological and functional parameters in 33 rabbits. Mechanically induced hydrosalpinx leads to reduced fertility. The characteristic morphological alterations are flattening of the folds, deciliation, reduced secretory activity and general de-differentiation of the epithelial cells. The intensity of these changes peaked as little as 4 weeks after induction of the hydrosalpinx. The deciliation is generally patchy. The division into different fields, islet formation and celestial chart phenomena reflect different degrees of vascularization and/or oxygenation. These alterations were completely reversible within 8 weeks after reconstruction. In isolated cases only the formation of polypose stumps was seen, which were, however, covered with a normal epithelial surface. The discrepancy between the reduced tubal function following reconstruction for hydrosalpinx and the complete regeneration of the tubal mucosa suggests that other regulatory mechanisms more important for the function of the uterine tube are impaired.

Animals↗
PubMed1994

Randomized 2 x 2 trial evaluating hormonal treatment and the duration of chemotherapy in node-positive breast cancer patients. German Breast Cancer Study Group.

PURPOSE: In 1984, the German Breast Cancer Study Group (GBSG) started a multicenter randomized clinical trial to compare the effectiveness of three versus six cycles of 500 mg/m2 cyclophosphamide, 40 mg/m2 methotrexate, and 600 mg/m2 fluorouracil (CMF) on day 1 and 8 starting perioperatively with or without tamoxifen (TAM) (3 x 10 mg/d for 2 years). The aim of the trial was to compare recurrence-free and overall survival between the different treatment modalities. PATIENTS AND METHODS: During 5 years, 41 institutions randomized 473 patients (3 x CMF: 145; 3 x CMF + TAM: 93; 6 x CMF 144; 6 x CMF + TAM: 91). Until March 31, 1992, median follow-up time was 56 months with 197 events for disease-free survival and 116 deaths observed. This provides a power of approximately 80% to detect a potential treatment difference corresponding to a relative risk (RR) of 0.67 for recurrence-free survival. Treatment modalities and various patient characteristics were evaluated by means of a multivariate Cox regression analysis. RESULTS: No significant difference in recurrence-free survival was observed with respect to hormonal therapy (RR = 0.75 TAM v no TAM; 95% confidence interval [CI], 0.54 to 1.04; P = .08) as well as duration of chemotherapy (RR = 0.90 of 6 x CMF v 3 x CMF; 95% CI, 0.67 to 1.19; P = .45). Similar results were obtained for overall survival. The multivariate analysis revealed a significant prognostic impact of the number of positive lymph nodes and the progesterone receptor level on recurrence-free survival. Compliance with chemotherapy within the range of 85% to 115% of the target dose was achieved in 94% and 78% of the patients randomized to 3 x CMF and 6 x CMF, respectively. Sufficient compliance with TAM was reported for 141 patients (93%). CONCLUSION: At this stage of follow-up, six courses of CMF are not superior to three courses with respect to recurrence-free survival.

Adult↗
PubMed1994

[Diagnosis of the breast tumor entity with "vocal fremitus" in ultrasound diagnosis].

In the published study a totally new method for the diagnosis of malign and benign tumors of the female breast is presented. During sonographic examinations with the maximum entropy method we found out, purely by chance, that artifacts produced by vibrations of the thorax can be used to differentiate malignant from benign lesions. These artifacts in form of small colour pixels can be provoked by the vocal fremitus of the internal medicine or by humming a deep sound. In case of malignancy, the colour artifacts are visible inside of the tumor, in benign lesions, however, only in the surrounding tissue. On the preoperative day, 95 patients were examined with the method described above. In 91% of the cases the diagnosis of the dignity corresponded with the histological results. Seven times a benign lesion was classified as a malignant tumor and twice malignancy was not correctly diagnosed. Our explanation of these phenomena is the following: Benign lesions of the female breast show a displacing growth and a definable boundary. Thus the vibrations are damped and not conducted into the tumor. In contrast, malignant lesions grow invasively into the surrounding tissue. Consequently, the vibrations can be conducted into the center of the tumor by this dissemination.

Adenocarcinoma↗
PubMed1994

[Surgical hysteroscopy: complications, safety aspects, education and training].

Hysteroscopy has become an integral part of the overall gynaecological surgical concept. On the one hand the experience of our study group as well as a literature survey have demonstrated that results of hysteroscopic metroplasty, resection of submucous myoma and synechiolysis are at least comparable to those of conventional procedures, the advantages of minimal invasive surgery being evident. However, increasing complications, even with a lethal outcome, due to deficient technical equipment or insufficient training of the surgeon are reported. Yet, a survey of complications in literature and in our own series of hysteroscopies (n = 200), shows a median complication rate below 1%. Knowledge of possible complications, symptoms and management alternatives is, however, a first requirement for application of these minimal access procedures. The second major precondition being a well structured training program for surgeon and assisting team. With the recently developed in-vitro-simulation trainer, the HysteroTrainer, training of the entire spectrum of hysteroscopic procedures, including laser and high frequency electrosurgical applications, is now feasible. The simulator may also be employed for security checking of the complex hysteroscopic equipment.

Equipment Safety↗
PubMed1994

[Postoperative management after cesarean section--infusion therapy and role of intestinal stimulation with parasympathomimetic drugs and dexpanthenon].

In the last decade the incidence of cesarean section has raised worldwide to 15-30% of all deliveries. A standardized postoperative protocol can be applied to most cases and it should be easy to handle and at low costs. In the present randomized, prospective study 76 consecutive patients who hat a cesarean section were investigated. Two different infusion therapy protocols were compared and the role of prophylactic stimulation of peristalsis by parasympathometic drugs and by the pantothenic acid derivative dexpanthenon was evaluated. In group A patient (n = 36) were treated postoperatively with intravenous glucose 5% plus electrolytes and received routinely neostigmine and dexpanthenon, while patients in group B (n = 40) were treated with standardized commercially available solutions without intravenous stimulation of the bowel. Both groups were similar in terms of age, parity, gestational age, past medical history and previous abdominal surgery. The volume of urine and the serum electrolyte levels were similar in both groups postoperatively. The first evacuation of the bowel occurred in most cases on day 3 (A = 69.5%, B = 82.5% of the patients). 50% of the patients in group A complained of abdominal discomfort and pain postoperatively and needed some therapy, while in group B only 22.5% of the cases hat similar complaints. This difference was statistically significant (chi 2 Test: p < 0.02). The present data suggest that prophylactic postoperative stimulation of the peristalsis after cesarean section increases the incidence of abdominal discomfort significantly without influencing the bowel function. Standardized solutions can be used mostly for immediate intravenous fluid replacement and oral intake can be started after 2-6 hours.

Adult↗
PubMed1994

[New aspects in therapy of proximal tubal occlusion: hysteroscopic proximal tubal catheterization].

To date, the therapy of first choice in case of proximal tubal pathology is resection of the occluded segment and microsurgical reconstruction. Essential disadvantage of this rather successful method consists in the need of a laparotomy. According to the concept of minimal invasiveness a pilot study has been undertaken to evaluate hysteroscopic proximal tube catheterization (HPTC) and balloon dilatation for recanalization. This attempt has proven intraoperatively successful in more than 80% of the cases and the first pregnancy and birth following HPTC can yet be reported.

Adult↗
PubMed1994

[Anti-hypertensive therapy in pregnancy-induced hypertension with urapidil].

Urapidil is an antagonist of postsynaptic alpha 1 receptors, which leads to a diminution of the increased blood pressure by reducing the peripheral vascular resistance. With this pilot study we examined, whether it is possible to reduce the pregnancy-induced-hypertension with urapidil postpartum. The postpartum dosage of dihydralazine was diminished step by step and finally discontinued. We started i.v. treatment with urapidil at a diastolic blood pressure of more than 100 mm Hg. We observed a declining blood pressure in all cases without any tachycardia or serious side effects. Further studies will have to classify the rank of urapidil in the treatment of hypertension in preeclampsia.

Antihypertensive Agents↗
PubMed1994

[The bipolar needle electrode in surgical laparoscopy. Initial technical experimental and clinical results].

To date the tremendous spread of operative laparoscopic procedures associated with monopolar high-frequency techniques has lead to an increase in complications caused by monopolar leakage currents. Experimental-surgical measurements on minipigs have shown no significant leakage currents in clinical relevant power range during laparoscopic application of a bipolar needle electrode as compared to monopolar electrodes. Practicability and safety of the bipolar electrode was proven in 100 operative laparoscopies for organ preserving or reconstructive surgery. In summary, with the new laparoscopic bipolar needle electrode a secure surgical instrument is available, with which finest tissue handling and minimal thermal damage feasible.

Electrodes↗
PubMed1994

[Thermal preparation techniques in gynecologic endoscopy--technical, experimental and clinical results (n=2000)].

A comparative study on thermal, mainly laser and high frequency electrosurgical techniques, was conducted. Indications, handling and morphometric results were correlated. Morphometrical findings suggest that minimal thermal tissue damage is associated by a decrease in the hemostatic effect. Additional bipolar coagulation is necessary when using the carbon dioxide laser or high frequency electrodes. As thermal tissue lesion is concerned, the two techniques differ only slightly, by fractions of millimeters. Concerning clinical handling and practicability at our department, as well as in the centers participating at the European Consensus Study on Lasers in Gynaecology, high frequency electrosurgery has proven the method of choice for endoscopic ablative procedures. The carbon dioxide laser (at laparoscopy) and the Nd:YAG contact laser (at hysteroscopy) are preferentially employed for reconstructive surgery (e.g. the carbon dioxide laser for treatment of distal tubal pathology or endometriosis, the Nd:YAG contact laser for hysteroscopic synechiolysis).

Animals↗
PubMed1993

Characterization of binding sites for a GnRH-agonist (buserelin) in human breast cancer biopsies and their distribution in relation to tumor parameters.

Gonadotropin-releasing hormone analogs (GnRH-A) have been added to the armentarium in the therapy of hormone-dependent breast cancer in premenopausal women. The effect of chronic GnRH-A-treatment in premenopausal women is based on the suppression of the hypothalamus-pituitary-ovarian axis and the reduction of sex-steroid serum levels. In addition, a number of experimental and clinical data have been accumulated indicating a direct action of GnRH-A on breast cancer cells and tissue. In this study we analyzed 235 human breast cancer biopsies for specific GnRH-A-binding. We demonstrate high affinity GnRH-A binding sites in human breast cancer tissues. The evaluation of clinical data showed no correlation of the level of GnRH-A-binding with classical tumor parameters.

Amino Acid Sequence↗
PubMed1993

The effect of Leboyer delivery on blood viscosity and other hemorheologic parameters in term neonates.

OBJECTIVE: This study was done to compare postnatal alterations in blood viscosity, hematocrit value, plasma viscosity, red blood cell aggregation, and red blood cell deformability in term neonates undergoing both early umbilical cord clamping and delivery according to the Leboyer method. STUDY DESIGN: The umbilical cords of 15 healthy, term infants were clamped within 10 seconds of birth (early cord clamping), and 15 infants delivered according to the Leboyer method were placed on the mother's abdomen, and the umbilical cords were clamped 3 minutes after birth. Hemorheologic parameters were studied in umbilical cord blood at 2 hours, 24 hours, and 5 days from the time of delivery. RESULTS: The residual fetal placental blood volume decreased from 45 +/- 8 ml/kg (x +/- SD) after early cord clamping to 25 +/- 5 ml/kg after delivery by the Leboyer method. After Leboyer-method delivery, the hematocrit value rose from 48% +/- 5% at birth to 58% +/- 6% 2 hours after delivery, 56% +/- 7% at 24 hours, and 54% +/- 8% after 5 days. Blood viscosity in the Leboyer-method group increased by 32% within the first 2 hours but did not change significantly during the following 5 days. Plasma viscosity, red blood cell aggregation, and red blood cell deformability were not affected by the mode of cord clamping. CONCLUSIONS: Delivery by the Leboyer method leads to a significant increase in blood viscosity as a result of increasing hematocrit value, whereas other hemorheologic parameters are similar to those of infants with early cord clamping.

Blood Viscosity↗