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H Kucera

Publications and source records attributed to H Kucera.

At least 91 records · Page 5Linked to original sources
PubMed1984

[Complications of preoperative high-dose-rate iridium-192 irradiation in cervix uteri carcinoma].

A report is given about the experience in preoperative, nonfractionated high-dose iridium-192 irradiation in cases of carcinoma of the cervix uteri. A few days prior to radical hysterectomy a dose of 20 Gy (in 2 cm distance) was applied locally by means of a loop-applicator (afterloading technique, Buchler). In cases without postoperative irradiation severe vaginal necroses, in cases with postoperative irradiation severe local and peripheral lesions were observed. In 8 of 10 cases irradiated pre- and postoperatively, another surgical intervention was necessary because of complications in the urinary or intestinal tract. This publication is presented as a warning for preoperative high-dose irradiation with 20 Gy applied locally in cases of carcinoma of the cervix uteri.

Brachytherapy↗
PubMed1984

[Radiomenolysis of the endometrium using high-dose iridium irradiation--clinical and cytologic results].

423 patients with benign recurrent uterine bleeding resistant to other therapy were treated by intracavitary radiotherapy. In all cases there was a contraindication for the operative removal of the uterus. Since 1980 radiomenolysis was performed by high-dose Iridium-192 irradiation (afterloading technique). In 94.3% of our cases with Radium-226 irradiation the bleeding could be treated successfully. Side effects of the irradiation occurred only in a minimal and neglectible percentage. In all cases irradiated with Iridium-192 the bleeding stopped after treatment. Side effects could not be observed. Therefore the intrauterine contact-irradiation therapy with high-dose Iridium-192 should be remembered in cases of uterine bleeding resistant to hormonal therapy or in cases of high risk for operation. With the afterloading device the molestation for the patients could be reduced to a minimum. By intrauterine exfoliative smear performed before and after irradiation the cytomorphologic effect of an Iridium-192 afterloading irradiation was demonstrated. The examinations showed that the cytologic findings were characteristic for the effect if ionizing radiation of the histologically unchanged, not radiosensitive, normal cylindrical epithelium. A marked cellular diathesis and augmentation of size of nuclei and plasma is a characteristic result of the irradiation with Iridium-192.

Adult↗
PubMed1984

[Restriction of indications and first results with the high-dose rate-afterloading technic (iridium-192)].

First experiences with high-dose-afterloading technique (Iridium-192) at the Department for Radiotherapy of the Gynecologic-University-Clinics in Vienna are reported. 1300 applications in about 500 patients were performed. With the one-sound Buchler-apparatus theoretically all forms of isodoses are possible, but in practice we have restricted the indications. Only Radium uterine sounds as well as radium vaginal applications were replaced by high-dose-afterloading technique. Generally only primary or postoperative treatment of endometrial carcinoma was performed. The easy sounding of the uterine cavum is another reason for this restriction of indications. The first results of radiotherapy of endometrial cancer yet shows little better survival rates without any increase of side effects.

Age Factors↗
PubMed1984

[Effect of brachytherapy and teletherapy on treatment results in primary vaginal cancer].

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated at the Radiotherapy Department of the I. University Clinic for Gynecology and Obstetrics in Vienna. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: primarily a focal irradiation of the tumor by plaque-application, then combined intra-uterine and intra-vaginal radium insertion, followed by a vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily , if the tumor was localised in the lower third of the vagina. 5-year overall remission rate amounted to 32% for the years 1971 to 1977; hence it was somewhat lower than for the total time observed (1950 to 1977), which was 39,8%. This could be explained by the sharp increase of very old patients and of progressed stages. For separate stages, the following 5-year healing rates were observed: stage I: 78%; stage II: 48%; stage III: 24% and stage IV: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Only 1 patient of 15 (7%), who were not treated by teletherapy, reached 5-year remission , as compared to 14 of 52 (27%), who received teletherapy. Stages I and II did not show a comparable difference. Intrauterine brachytherapy was of more importance for remission rate in early stages: 11 of 16 (69%) patients with stages I and II, who were treated with intrauterine curietherapy, survived 5 years or more; of those who did not have intrauterine insertion, only 6 of 15 (40%) reached 5-year remission . For stages III and IV, intrauterine curietherapy did not markedly change the healing rate.

Adult↗
PubMed1983

[Clinical course and radiotherapy of primary vaginal cancer (362 cases)].

362 cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynaecology, Vienna, from 1950 to 1977. As method of choice an individually dosed, fractioned and protracted radium-telecobalt therapy was employed. An overall 5-years' survival rate of 39.8% could be achieved, a value which is above the average reported in world literature. Comparing the last period analysed in the present study (1971 to 1977) with another period 20 years earlier (1951-1956), the following differences can be observed: the fraction of stages III and IV rose markedly from 57.2% to 68.7%; associated with this change was an increase of the percentage of older patients (greater than 60a) from 53.6% to 70.7%. These two developments had an impact on the survival rate: in the total population, it was 39.8% as compared to 32% for the period from 1971 to 1977. The 5-year-survival rate in stage I (n = 60) was 75%, in stage II (n = 95) 45.3%, in stage III (n = 145) 30.3% and in stage IV (n = 62) 19.3%. The incidence of rectovaginal or vesico-vaginal fistulas amounted to 8%. The importance of gynaecological screening for old age patients is emphasized being the only possibility for reducing the high percentage of progressed stages.

Adult↗
PubMed1983

[Fractionated short-time-afterloading with high dose rates in ambulant treatment of inoperable cancer of the uterine corpus].

In the period of 1.6. 1980 to 31.12. 1981 110 patients with inoperable endometrial carcinoma were treated by fractionated short-time afterloading with high dose rates (Buchler, Germany; Iridium-192) or with conventional intracavitary radium-therapy (low dose rates). First clinical results concerning 12-months-survival rate and the observed reactions of bladder and rectum in the afterloading-group and in the radium-group are represented. The one-year-survival rate and the side effects in the afterloading-group were comparable to those in the radium-group. 35 out of 40 patients (87,5%) with stage I of the disease treated with Iridium-192 were alive after one year, as compared to 46 out of 59 (77,9%) patients treated with Radium. The rate of radiation side effects showed no statistically significant difference in both groups. In the afterloading-group a hospitalization was not necessary, because anesthesia was not performed during short-time irradiation.

Aged↗
PubMed1983

[Radiotherapy of recurrences of endometrial carcinoma].

In a retrospective study the data of 79 patients undergoing radiation-therapy for recurrent endometrial cancer during the years 1972-1978 were evaluated. Group I consisted of 43 patients, who primarily underwent irradiation, group II consisted of 36 patients, who primarily underwent surgery (total abdominal hysterectomy) mostly without irradiation. All patients were primarily classified as FIGO-stage I, the median age was 69 and 67 years respectively. In 32 cases (74%) of group I the localisation of the recurrence was the uterus, in 8 (19%) the vagina and in 3 (7%) the small pelvis. In group II a vaginal recurrence was found in 25 patients (69%), in 11 (31%) a pelvic recurrence. In two thirds of all cases the recurrences were diagnosed within three years of the primary treatment. Late recurrences after 5 years occurred in group I in 10%, in group II twice as often. The treatment of all recurrences was irradiation. 54 patients (68%) died within 2 years, 25 survived their recurrence for more than 2 years, (32%). In group I 23% survived for more than 2 years, in group II 42%. At the time of performance of the study the 5-year-survival-rate is 13%. Thus in two thirds of patients we succeeded in extending the survival for at least 2 years. The prognosis of a recurrence following surgery is distinctly better than following primary intracavitary irradiation. 56% of vaginal recurrences following primary surgery survived more than 2 years. The 5-year-survival-rate was similar in these vaginal recurrences however to the uterine recurrences following primary irradiation. The prognosis of patients undergoing primary surgery was the better, the later the recurrence occurred.

Aged↗
PubMed1983

[Breast feeding habits before and after the introduction of a partial rooming-in system].

From January 1981 to May 1982 a prospective study was conducted investigating the breast-feeding patterns following the introduction of a partial rooming-in-system in 1978. The present data were compared to a previous survey from the period before 1977. The incidence of breast-feeding increased over that time from 67% to 86,6%. Accordingly the rate of non-breast-feeding mothers decreased from 33% to 13,4%. In 10% of these mothers lactation-inhibition was carried out with drugs and in 3,4% a severe hypogalactia was found. The lactation-inhibition was carried out in 80% for maternal and in 20% for neonatal reasons. Concerning the maternal causes one-third of the mothers did not want to breast-feed; other predominant causes were severe hypogalactia, adoption of the baby, maternal diseases, breast-feeding problems following preceding deliveries and single cases of mastitis and state after mamma-surgery. Among the neonatal reasons prematurity was predominating, followed by antenatal fetal death and perinatal death, malformations and diseases of the infant. Our results suggest, that the introduction of a partial rooming-in led to an increase of the incidence of breast-feeding at our department. Certainly, however, also the current trend back towards breast-feeding has contributed to these results. Nevertheless, we believe that much could still be improved by more adequate medical advice, which should start during pregnancy already. A reasonable promotion of breast-feeding should be the concern of all obstetricians today.

Breast Feeding↗
PubMed1983

[Cytologic endometrial changes following high-dose iridium-192 radiation].

By intrauterine exfoliative smear performed twice in each of seventeen patients, the cytomorphologic effect of an iridium-192 after-loading irradiation was demonstrated. The examinations showed that the cytologic findings were characteristic of the effect of ionizing radiation even in case of the histologically unchanged, not radiosensitive cylindrical epithelium. After the iridium irradiation of malignantly transformed cells of the cylindrical epithelium with 1000 rd, vacuolation and pseudoeosinophilia were the predominant lesions, while after 2000 rd this was above all the presence of macronucleoli. A marked cellular diathesis is a characteristic result of the irradiation with iridium-192. Although hyperchromasia is not an absolute sign of malignancy in case of the adenocarcinoma, it should be mentioned that chromatin concentrations are scarcely found after irradiation.

Adenocarcinoma↗
PubMed1982

[Immunologic stimulation with vitamin A in advanced cervix cancer].

For treatment of patients with inoperable cervical cancer (FIGO III) a randomized trial has been initiated. Patients were randomized to receive either conventional irradiation therapy together with vitamin A palmitate (1.5 mill. I.U./day; total dose: 30 mill. I.U.), applied orally, or irradiation alone. When lymphocyte reactivity to PHA (maximum response during therapy) was compared within the groups, it was found, that 66% of the patients who received irradiation combined with vitamin A palmitate, showed an increase in their blastogenic response, while in irradiated patients without vitamin A palmitate a response was seen only in 33%. This difference being statistically significant in comparison to pretreatment values. From immunological data it can be concluded, that vitamin A has an effect on functional response on T-cells. Concerning the clinical outcome, after an observation period of 12 months relapse rates were lower in the vitamin A group, but not significantly reduced. Therefore further follow up is warranted.

Adjuvants, Immunologic↗
PubMed1982

Endometrial bacteriology in patients with endometrial cancer before and after primary intracavitary irradiation using IR-192 and an afterloading technique.

In a prospective clinical and bacteriological study the endocervical and endometrial flora of 38 patients with biopsy proven cancer of the endometrium was studied before and after intrauterine irradiation with 10 Gy (Ir-192, afterloading device, Buchler, Braunschweig). Bacteriological swabs were taken transcervically. Anaerobic transport media were used and cultures were done aerobically and anaerobically. The mean number of aerobic organisms per patient increased from 2.13 to 2.49 (not significant (n.s.)), and of anerobic organisms from 1.42 to 2.00 (n.s). Neither the recovery rate of aerobic and anaerobic bacteria nor the composition of endometrial flora was altered significantly by intracavitary irradiation. Only aerobic sporeformers increased from 5.3% to 21% (2 p less than 0.05). The most prevalent aerobic species were S. epidermidis, streptococci and E. coli, the predominant anaerobic species Pepto- and Peptostreptococcus and Bacteroides. Our results clearly show that the intrauterine administration of 10 Gy by a Ir-192-afterloading device does not sterilize the endocervix or endometrium and infections may occur after intracavitary radiotherapy.

Aged↗
PubMed1982

[Intracavitary radiotherapy of benign recurrent uterine bleedings (author's transl)].

387 patients with uterine bleeding resistant to other therapy were treated by intracavitary radium-therapy. In all cases there was a contraindication for the operative removal of the uterus. In 94,3% of our cases the bleeding could be treated successfully by the radium-application. Side effects of the irradiation occurred only in a minimal and neglectable percentage. Therefore the intrauterine contact-irradiation-therapy should be remembered in cases of uterine bleeding resistant to hormonal therapy or in cases of high risk for operation. With the new and modern afterloading device the molestation for the patients could be reduced to a minimum.

Adult↗
PubMed1982

[Vaginal bacterial flora of patients with operated endometrial carcinoma prior to and following intracavitary vaginal irradiation (Ir-192, afterloading)].

In a prospective bacteriological and clinical study the vaginal bacterial flora of 35 patients with endometrial carcinoma, who underwent surgery 4 to 6 weeks earlier, was investigated prior to and following intracavitary vaginal irradiation with 10 Gy in 0,75 cm(Ir-192, afterloading device, Buchler). Bacteriological swabs were taken prior to and following ther insertion of a tube applicator. Anaerobic transport-media were used an cultures were performed aerobically and anaerobically. The mean number of aerobic species per patient increased slightly from 3.26 to 3.60 (n.s), anaerobic species remained constant (1.36 before and 1.30 after irradiation). Also the frequency of isolation of most aerobic and of all anaerobic species was statistically not altered following irradiation. Staphylococcus epidermidis decreased from 51.4% to 22.8% significantly (2 p less than 0.05), Micrococci increased from 0.0% to 11.4% (2 p less than 0.05) and aerobic sporeformers form 0.0% to 34.3% (2 p less than 0.01). Among the anaerobes Pepto- and Peptostreptococci were isolated prior to and following intracavitary irradiation in 11 to 14%, Bacteroides-species in 11 to 20%. Our bacteriological results suggest, that intracavitary irradiation in the therapeutically usual doses has no sterilizing effect on the vaginal flora. This flora plays an important role in infection following gynecologic radiotherapy.

Adult↗
PubMed1981

[Therapeutic results in ovarian cancer after replacement of conventional radiotherapy by Co-60 irradiation (author's transl)].

The use of Co-60 screen and pendular irradiation instead of conventional radiotherapy has brought about an improvement in the 5-year survival rate in patients with more advanced stages of ovarian cancer. Although the general side effects of Co-60 irradiation are considered to be more unpleasant than those of X-ray and radium therapy, severe, reversible or irreversible damage to the urogenital tract and intestinal organs was diminished by accurate planning of Co-60 therapy, so that these complications occurred less frequently than with conventional radiotherapy.

Castration↗
PubMed1980

[The possibilities of optimal therapy of corpus uteri cancer (author's transl)].

During the years 1960-1974 out of 1002 patients with endometrial carcinoma 256 underwent primary surgery and 846 primary irradiation. The evaluation of the results of 4 different surgical methods showed despite a different distribution of the stages of the cancer that Werthein's operation and abdominal hysterectomy and adnexectomy with simultaneous lymphnodectomy had statistically significant better results than abdominal hysterectomy without lymphonodectomy. By surgery a 5 years survival time was achieved in 83.6% (214 cases) with a primary mortality rate of 0.39% and an incidence of histologically proved lymphnode-metastases of 6.78%. Out of the 846 patients with generally or locally inoperable endometrial carcinomas, who underwent primary intracavitary irradiation 411 (48.6%) achieved a 5 years survival time. After irradiation in 9.9% reversible reactions (severe proctitis and cystitis) and in 2% irreversible complications (fistulas) were observed. After an observation period of 5 years 625 of the total of 1002 treated patients (62.4%) were alive and free of symptoms.

Evaluation Studies as Topic↗