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Biomedical subjects

H Hepp

Publications and source records attributed to H Hepp.

At least 91 records · Page 5Linked to original sources
PubMed1993

[The value of reoperation in the treatment of ovarian cancer].

Recurrent ovarian cancer is still a significant problem despite intensive primary therapy, consisting of radical surgery and subsequent chemotherapy. The primary reason for consequent follow up investigations and immediate start of second-line therapy in cases of recurrence is based on the fact, that patients with relapse more than 12 months after primary therapy have a mean survival of 105 weeks after diagnosis. The value of surgical treatment is controversially discussed in the literature. Several authors argue, that there is no definitive prolongation of survival. Between January 1984 and July 1990, 285 patients presented themselves at our hospital with recurrence or progression of ovarian cancer. 72 of these patients had surgical treatment and those patients are part of the investigation. The mean survival of the patients (n = 18), which were operated with no remaining tumour, was 166 weeks. The average survival time of the 22 women with up to 2 cm remaining tumour was 108 weeks. The average survival time of the 32 patients with more than 2 cm after surgery was 72 weeks. One important criterion for the achievable tumour-free situation after surgery was the distinction between primary progression and relapse, where relapse was defined as recurrence more than 12 months after primary treatment. 29% of the patients with relapse could be operated tumour-free, a situation which could be achieved only in one of 13 patients (8%) with primary progression of the disease. Surgery in recurrent ovarian cancer is only indicated in patients with relapse more than 12 months after primary surgery. Tumour-free patients have significant benefit from the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[EGF receptor and EGF-like activity as prognostic factors in cervix cancer].

The binding of the Epidermal Growth Factor (EGF) and the amount of EGF-like activity (EGF-A) was analysed in 75 cervical carcinomas and possible clinical implications were tested. EGF-A was significantly increased in patients with metastases to the pelvic and/or para-aortic lymph nodes. The EGF-receptor (EGF-R) capacity was inversely related to the histological grade (p < 0.05) and was reduced in highly differentiated tumours. In stage I and II disease, the clinical outcome was significantly reduced, if the receptor capacity or the level of EGF-A was increased (> 100 fmol/mg protein and > 0.5 ng/mg protein, respectively). The measurement of EGF-R capacity and EGF-A provides new and additional information for the prediction of the prognosis in cervical cancer.

Biomarkers, Tumor↗
PubMed1993

[Monitoring fetal delivery by oxycardiotocography].

Oxycardiotocography is a combination of cardiotocography and continuous registration of the foetal arterial oxygen saturation (SaO2). In a few cases, the value of this additional information of foetal SaO2 is demonstrated. During uncomplicated deliveries with normal foetal heart rate patterns, the foetal SaO2 usually ranges between 50% and 70%. Uterine hyperactivity with impaired perfusion of the placenta shows besides a changed heart rate patterns, a significant decrease of the foetal oxygen saturation. Conversely, by supplying oxygen to the mother with a mask, the foetal oxygen saturation can be increased by approx. 10%. In case of a breech presentation and application of the sensor to the buttocks, the measured O2-saturation is approx. 10% to 15% below the values usually obtained from the scalp because the tissue there is supplied with mixed blood after the ductus.

Apgar Score↗
PubMed1993

[Value of tumor-reductive secondary operation (interventional laparotomy) in ovarian cancer].

Only 20-50% of patients with advanced ovarian cancer have minimal residual disease after aggressive primary cytoreductive surgery. For patients with residual tumour, responding to platinum-based chemotherapy, new therapeutic procedures should be attempted. In most cases, the benefit of performing secondary surgery could not be clearly demonstrated. But there is a consensus of opinion that a second-look procedure in order to confirm complete remission does not improve survival. Between January 1984 and July 1990, 346 patients with primary ovarian cancer were treated at our institution. 190 patients underwent secondary surgery, 93 of these had secondary debulking and are part of the study. After secondary cytoreductive surgery 38 patients (41%) had no residual disease, 35 patients (38%) had disease less than 2 cm, and 20 patients (21%) had disease greater than 2 cm. Mean survival in patients with no residual disease after secondary debulking surgery was 46 months and significantly longer as in patients with residual disease. Patients with residual tumour at primary surgery and no secondary cytoreductive operation survived 35 months, with a significant difference to the patients with secondary debulking and no residual disease. Secondary debulking surgery should be performed in all patients in whom minimal residual disease can be achieved. Preoperative diagnostic tools, including CA 125 value, computed tomography and immunoscintigraphy, should predict a tumour-free situation after secondary cytoreductive surgery.

Adult↗
PubMed1993

'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach.

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.

Adult↗
PubMed1993

Combined intra-uterine and extra-uterine pregnancy in the contralateral tube after gamete intra-fallopian transfer.

A case of combined intra-uterine and contralateral tubal pregnancy after gamete intra-Fallopian transfer (GIFT) is presented. Laparotomy with partial tubal resection was performed after tubal rupture. The intra-uterine pregnancy is still ongoing without complications. Heterotopic pregnancies are dangerous conditions for the patient and should be taken into account after transfer of multiple oocytes. To our knowledge this is the first report of a heterotopic pregnancy in the contralateral tube after GIFT.

Adult↗
PubMed1993

Duration of the multifetal gestation, birth weight and infant prognosis.

For the higher numbered multifetal gestation, duration of gestational age decreases in spite of different medical activities. On the other hand increasing gestational age often strongly suggests the need for delivery by caesarean section for maternal indications. After the 32nd week of gestation in general no serious respiratory problems should be expected, and there may be no essential increase in fetal weight, but the risk of intrauterine death increases due to placental insufficiency. Therefore, for logistic reasons we propose liberal indications for caesarean section after the 32nd week of the multifetal gestation.

Birth Weight↗
PubMed1992

[Hormonal and ultrasound monitoring of early pregnancy--differential diagnosis of extrauterine pregnancy and multiple pregnancy].

In this study sonographical and hormonal findings in 63 patients with intrauterine singleton pregnancy were compared with 18 patients with multiple pregnancies and 28 patients with ectopic pregnancy. The earliest detection of the intrauterine gestational sac was obtained with a HCG level of 659 mlU/ml. The sonographical development correlated well with HCG values. There was no statistically significant correlation between gestational age and HCG. In multiple pregnancies with sonographical findings comparable to the development in singletons HCG values were remarkably elevated. A discrimination between multiple and ectopic pregnancies by sonographical and hormonal criteria cannot be performed sufficiently in a HCG zone of 1500 mlU/ml. Close sonographical and hormonal follow-up until diagnosis of the intrauterine pregnancy is necessary.

Chorionic Gonadotropin↗