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Biomedical subjects

H Pickel

Publications and source records attributed to H Pickel.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Significance of prophylactic ovariectomy at the time of uterus extirpation for prevention of an ovarian carcinoma].

There is no general recommendation with regard to a certain age, after which prophylactic oophorectomy should be performed at the time of hysterectomy. We investigated how many patients who were treated for ovarian cancer at the University Clinic of Obstetrics and Gynecology in Graz between 1980 and 1989, had a history of hysterectomy because of benign uterine disease. In 42 of 382 patients with ovarian cancer (11%), a hysterectomy had been performed 2 to 43 years before the diagnosis of ovarian cancer. 12 of the 42 patients with ovarian cancer and previous hysterectomy (29%) additionally had unilateral oophorectomy because of benign tumors of the ovary. In 79% of patients, hysterectomy was carried out before the 45th year of age and in 86% of patients before the 50th year of age. Thus, prophylactic extirpation of sound ovaries before the age of 50 years does not seem to be generally indicated in patients with retained ovarian function who undergo hysterectomy. However, the rare genetically determined ovarian cancer is the exception to the rule.

Adult↗
PubMed1990

Radiation therapy in stage III ovarian cancer following surgery and chemotherapy: prognostic factors, patterns of relapse, and toxicity: a preliminary report.

Twenty patients with FIGO stage III epithelial ovarian cancer who had undergone maximum cytoreductive surgery (including pelvic and paraaortic lymph node dissection) and combination chemotherapy (4-10 cycles, median 6) were treated with irradiation to the abdomen and pelvis with 30 Gy followed by diaphragmatic/paraaortic and pelvis boost fields to 42 and 51.6 Gy, respectively. Second-look laparotomy was not performed. Seventeen of 20 patients completed the planned course of radiation. In 2 cases, failure to complete treatment was related to acute hematologic toxicity, and 1 patient refused further treatment. Five patients (29%) required treatment breaks ranging from 8 to 16 days (median, 12 days) due to pancytopenia. Actuarial overall survival and relapse-free survival at 3 years for the 17 patients who completed radiation was 69 and 47%, respectively, with follow-up ranging from 19 to 53 months (median: 24, mean: 27.6 months). Seven patients (41%) relapsed within the abdomen alone and 2 patients developed extraabdominal lymph node metastasis as their sole site of failure. The prognostic factors evaluated for correlation with relapse-free survival included histologic subtype, grade, amount of residual disease at the time of surgery, and nodal involvement; only residual tumor at surgery (none vs less than or equal to 2 cm or greater than 2 cm) was found to be statistically significant (P less than 0.01). Three-year overall survival correlated with amount of residual disease following the initial cytoreductive surgery. It was 100% for patients with no residual disease, 66.7% for less than or equal to 2 cm, and 26.7% for those with greater than 2 cm residual disease, respectively. Radiation treatment was well tolerated, with only one patient developing treatment-related bowel obstruction 7 months after radiation therapy. The results of this planned trimodality treatment approach compare favorably with those reported following surgery and chemotherapy, particularly in patients who have been maximally cytoreduced.

Adult↗
PubMed1990

[Pseudomyxoma peritonei caused by proliferating mucinous adenoma of the fimbria mucosa].

Omentectomy was conducted on a 49 year old patient at the Dept. of Surgery of the UFK Berlin-Charlottenburg because of a mucinous adenocarcinoma, without prior detection of the primary tumour site. Relaparotomy revealed proliferative mucinous adenoma of the Fallopian tube and a consecutive pseudomyxoma peritonei. Up to now, this seems to be the first case report of a mucinous adenoma of the Fallopian tube.

Adenocarcinoma, Mucinous↗
PubMed1990

[Treatment of primary cancer of the fallopian tube].

33 patients treated since 1970 at the Medical School of the University of Graz, were classified using the FIGO system for ovarian carcinoma, fourteen were in stage I, 8 stage II, 8 stage III and 3 stage IV. In 17 patients, surgery consisted of total abdominal or vaginal hysterectomy with bilateral salpingo-oophorectomy; 12 patients underwent additional pelvic +/- paraaortic lymph node extirpation and in 4 the tumour excision was incomplete. Treatment in 6 patients was surgery alone (2/stage I, 4 with advanced disease) (Group A). Adjuvant radiotherapy was performed in 14 patients (Group B); the remaining patients were treated with single (2/13) or multiple agent chemotherapy (11/13) (Group C). The 3-year survival rate was 55% for stage I, 42% for stage II; 10/11 of the stage III/IV patients died within 26 months. The 4-year actuarial survival rate for group B was 68%, for group C 11%. There was no difference between the short-time results of stage II tumours when comparing radiotherapy against chemotherapy. The tumour progression rate was 60%, indicating the need for radical surgery as well as for more aggressive adjuvant treatment. Surgery alone is recommended for stage I disease confined to the mucosa. More advanced disease (extension to the serosa, stage Ic, stage II) requires whole abdominal irradiation with a boost to the pelvic lymph nodes. For stage III/IV tumours a multi-modality treatment is recommended. Chemotherapy (cis-platinum, cyclophosphamide) for recurrent disease resulted in remission in some cases.

Adenocarcinoma↗
PubMed1990

[Scalenus biopsy in diagnosis of ovarian and uterine cancers].

Patients with tumours of the lower pelvis were submitted to a biopsy of the scalene fat pad. The primary tumour was a carcinoma of the ovary in 32, of the cervix in 4, and of the body of the uterus in 2 cases. Microscopic metastases in the pre-scalene lymph nodes were found in 7 of the 32 cases of ovarian carcinoma (21.8%), but in none of the patients with carcinoma of the uterus. Since a histologically positive finding of a scalene lymph node influences the treatment, biopsy of the scalene fat pad is recommended as part of the pre-operative investigation of patients with ovarian carcinoma.

Adipose Tissue↗
PubMed1990

[Tumor marker combination versus second-look operation in ovarian cancer].

Tumour markers are substances that occur at elevated blood levels in patients with certain tumours. When their specificity and sensitivity are known, markers can be used to monitor cancer patients. No single marker is specific and sensitive for a certain tumour, so a tumour-marker combination is used. The efficacy of CA 125, ferritin, TPA and CEA was demonstrated in 162 ovarian cancer patients. With the same combination, we found a statistically significant 91.7% correlation between the clinical course of the disease and the marker profile in 60 further patients. Tumour markers can also help make a prognosis. In 34 patients the marker profile accurately predicated the findings at second-look surgery. Thus, biochemical monitoring may supplant the second-look procedure. 68 patients were followed for a mean of 2.7 years after completion of chemotherapy. In 95.6% the tumour-marker analysis correlated with the clinical and radiologic course. This means that the end of chemotherapy depends on biochemical monitoring, and second-line therapy can be initiated sooner.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

In vitro chemosensitivity testing in the treatment of ovarian carcinoma.

In vitro chemosensitivity to cisplatinum, adriamycin, cyclophosphamide, and 5-fluorouracil was investigated in 58 cases of ovarian carcinoma using Volm's short-term test. These in vitro results were retrospectively correlated with the relapse-free interval. Operative treatment in all patients (FIGO stage I (5), III (43), IV (10)) comprised maximum debulking procedure including hysterectomy, adnexectomy, omentectomy, pelvic and in most cases additionally paraaortic lymphadenectomy. Subsequently, all patients were treated with the cisplatinum-epirubicin-cyclophosphamide regimen. 33/58 tumors (66%) were sensitive in vitro (inhibition of nucleic acid precursor incorporation of more than 45% as compared to untreated controls). The median relapse-free interval of patients with sensitive tumors was significantly longer than that of those with resistant carcinomas (30.3 versus 22.6 months, respectively; P less than 0.05). Histopathological evaluation showed the majority of serous cystadenocarcinomas to be sensitive (26/33 = 79%, P less than 0.05).

Adult↗
PubMed1989

Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer.

To determine the incidence and clinical import of lymphocysts after radical gynecologic surgery including lymphadenectomy, we reviewed the records of 173 patients with cervical cancer and 135 patients with ovarian cancer who were followed up by computed tomography. Lymphocysts were found in 35 (20%) and 43 (32%) of the patients, respectively. Patients with cervical cancer and positive lymph nodes had a significantly higher rate of lymphocyst formation than did those with negative nodes (29% versus 14%, respectively, p less than 0.02). Age, type of lymphadenectomy, volume of fluid furthered by postoperative drains, disease stage, and tumor histology were not related to lymphocyst development. We saw no complications strictly attributable to lymphocysts. The clinical import and treatment possibilities are discussed.

Adenocarcinoma↗
PubMed1989

The spread of ovarian cancer.

Spreading intra-abdominally, ovarian cancer reaches the upper abdomen relatively quickly. Metastases result from the implantation of cells from the primary tumour or, perhaps, may arise de novo from the peritoneal epithelium. The tumour also spreads via the lymphatics directly to the pelvic nodes, directly to the para-aortic nodes, or directly to both. Pelvic nodes were positive in 57.9% of patients of all stages. The highest incidence, 70.4%, was found in Stage III. The percentage of positive para-aortic nodes was lower, namely 50.9% overall incidence and 67.6% in Stage III. Concerning the concomitant involvement of pelvic and para-aortic nodes, 40.4% of patients with positive pelvic nodes also had positive para-aortic nodes. Of patients with negative pelvic nodes, 36.8% also had negative para-aortic nodes. Of all patients, 12.3% had positive pelvic nodes and negative para-aortic nodes. Conversely, 10.5% of all patients had positive para-aortic nodes and negative pelvic nodes. There is a significant association between the involvement of the diaphragm and that of the pelvic and para-aortic nodes. Of those patients with tumour deposits on the diaphragm, 84.4% also had positive retroperitoneal nodes. Conversely, 55.9% of patients with positive nodes also had tumour deposits on the diaphragm. This means that ovarian cancer spreads almost simultaneously in two ways: intra-abdominally and retroperitoneally. Surgical treatment must address both modes.

Female↗
PubMed1989

Prognostic implications of residual tumour volume in stage III ovarian cancer patients undergoing adjuvant cytotoxic chemotherapy.

Despite recent improvements, the survival of patients with advanced ovarian cancer remains unsatisfactory. In our patients who underwent radical debulking surgery, including systematic pelvic (and, additionally, in about one-third, para-aortic lymphadenectomy), the size of residual tumour volume prior to cytotoxic chemotherapy was the most critical single prognostic determinant. The value of complete tumour removal was reflected in the survival curves. Patients with no residual disease following debulking surgery who underwent complete adjuvant chemotherapy showed a significantly better survival than did women with residual tumour burdens (P less than 0.05). The actuarial 1-year survival rate in patients with no RD, RD less than 2 cm, and RD greater than 2 cm was 96%, 88%, and 83%, the 3-year survival rate was 78%, 56%, and 37%, and the 5-year survival rate was 78%, 40%, and 21%, respectively. Our results agree with previous studies. The data underline the need for aggressive debulking, including systematic lymphadenectomy and subsequent chemotherapy. The smaller the initial cell population the smaller the probability of drug-induced resistance. The greater the diameter of a tumour the greater the number of cells which remain in the G0 phase--and which are thus not susceptible to chemotherapeutic compounds.

Adult↗
PubMed1989

Efficacy of adjuvant carboplatin-epirubicin chemotherapy in advanced ovarian cancer after radical surgery.

Postoperatively, 13 patients with stage III ovarian cancer received a combination of carboplatin and epirubicin (PE) at 300 and 60 mg/m2 respectively. The results of the 13 patients receiving the PE regimen were retrospectively compared to those of 24 patients who received the conventional PAC schedule (cisplatin, Adriamycin and cyclophosphamide at a dosage of 50, 50 and 750 mg/m2, respectively). All 37 patients had undergone radical debulking surgery including pelvic and paraaortic lymphadenectomy. At 8 months, relapse-free rates of 42.2 and 79.2% were observed in the PE and PAC groups, respectively. This difference was highly significant (p = 0.011). The data suggest that the PE combination has less antineoplastic activity than the PAC schedule and thus cannot be recommended in the adjuvant treatment of advanced ovarian cancer.

Adult↗