Biomedical subjects
Publications and source records attributed to H Pickel.
Tumor recurrences can be detected earlier than in former times by new biochemical and radiological methods. Recurrences could be suspected in 35 (30.4 per cent) of 115 oncological patients 6 months before their clinical manifestation by determination of elevated levels of tumor markers in the serum. In the following time in all cases the suspicion could be proved with computed tomography.
Gonadoblastomas have a propensity to give rise to malignant germ cell neoplasms. This report analyzes the clinicopathologic findings in two phenotypic females with features of 46, XY pure gonadal dysgenesis, who developed dysgerminomas in gonadoblastomas. All stages in the evolution of the dysgerminomas from the germ cells in gonadoblastomas were observed. The pathogenesis of the XY gonadal dysgenesis is briefly discussed. Finally the strict recommendation is given to remove the streak gonads with and without tumors in such individuals.
In cases of rapidly increasing androgenism, virilism and androgenetic cycle disturbances it is essential to exclude the presence of an androgen-producing tumour. Serum levels of testosterone above 1.5 ng/ml and dehydroepiandrosterone sulphate values above 6700 ng/ml are suggestive of tumour. Functional tests, laparoscopy and imaging modalities are often less efficient. Selective vein catheterisation enables the diagnosis and localisation of such hormone-producing neoplasms (Kirschner and Jacobs, 1971). This paper presents the case report of the diagnosis of a Leyding cell tumour of the right ovary by means of selective vein catheterisation. The tumour was not palpable and had not been detected on laparoscopy. The procedure is extensively described and discussed.
From the end of 1979 to September, 1985, radical pelvic lymphadenectomy was performed at the Graz Clinic in 123 cases of Stages IA to IV ovarian cancer following maximum debulking procedure. In 97 patients lymphadenectomy was done primarily. In 26 it was performed during a follow-up operation to chemotherapy. The frequency of pelvic node involvement was 61.8% in the total material and 78.0% in 82 cases of Stage III disease only; 75.0% positive nodes were found in Stage III after chemotherapy. Aortic nodes were positive in 41.4%, but only when pelvic nodes were also positive. The 5-year actuarial survival rate for Stage III disease was 53.0% after pelvic lymphadenectomy compared with 13.0% without. In cases with negative nodes the survival rate was 74.7%; with positive nodes the survival rate was 45.9%.
The total extinction of apparently normal intermediate cell nuclei was microphotometrically measured in formalin-fixed Feulgen-stained paraffin sections of the uterine cervix. We investigated whether reproducible microphotometric results can be obtained from a histologic section expected to contain a certain amount of sectioned nuclei and stained by a standard technique. The results have shown that exact reproduction of microphotometrically measured mean total extinction values of intermediate cell nuclei can be achieved with a threshold value of 90% transmission in 10 microns sections.
Surgical specimens from 14 cases of early invasive squamous carcinoma of the vulva were extensively examined with serial sections to evaluate methods of tumor volume measurement. Using mathematical formulas, three-dimensional parameters were calculated from two-dimensional measurement. A technique of simplified volume estimation was developed and the results correlated with the status of the regional nodes.
A case is reported of secondary hypergonadotropic amenorrhoea following laparoscopic tubal sterilization with unipolar high-frequency current. Before the operation there had been no indication of hormonal disturbance in the 28 year-old woman. Endocrinological investigation of the patient and histological examination of the ovaries confirmed the clinical diagnosis of premature menopause. It is assumed that the ovaries had been irreversibly damaged by the coagulation procedure.
The value of radical resected residual tumors and the involvement of the lymph nodes are discussed on a series of 206 patients with ovarian carcinoma. The following results were achieved: macroscopically no tumor 100 patients; residual tumors smaller than 2 cm 14 patients, residual tumors larger than 3 cm 92 patients. Different chemotherapies were also applied. The survival rate of these groups after 2 years was as follows: 80.5%, 85.7%, 38.6%. After 5 years: 58.7%, 0%, 13.1%. In 48 patients after radical surgery and lymphadenectomy who had no post-operative residual tumors the survival rate was 100%, depending on the involvement of the lymph nodes.
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A group of 51 patients treated surgically for ovarian carcinoma was randomly subdivided to test the efficacy of lithium carbonate in the prevention of leucopenia during systemic chemotherapy. In 26 patients receiving sequential lithium carbonate the side effect of myelosuppression was mitigated and the leucocyte count during treatment, which determines the dosage of the cytostatic drugs, was significantly higher in this group. It was, thus, possible to reduce the number of cytostatic courses of treatment in the lithium group in comparison with the treatment courses in the 25 control patients. Lithium therapy had to be discontinued due to side effects in seven patients, which were then excluded from the trial.
Since the end of 1979 extensive pelvic lymphadenectomy has been performed at the Graz University Clinic of Obstetrics and Gynecology in the operative treatment of ovarian cancer in stages Ib to IV. In 27 of 48 patients (56.3%) positive nodes were found. The frequency of involved nodes in stage III only was 61.1% (N = 22). The incidence of positive paraaortic nodes in 16 evaluated cases was 31.2%, but these were only found when pelvic nodes were involved too. In 12 cases lymphadenectomy was done in second-look laparotomy. It became apparent that after operative and cytotoxic treatment with Adriamycin, Cis-Platinum and Cyclophosphamide (following the regimen of Ehrlich et al.) pelvic lymphnodes were still found positive in 8 of 12 cases (66.7%). The distribution of the nodes involved showed that the caudal lymphnodes were more often affected that than cranial ones. The results so far suggest that extensive pelvic lymphadenectomy may improve survival rates of patients with advanced ovarian cancer.
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Between 1970 and early 1980, 213 patients were treated for ovarian carcinoma (stages Ib-IV) at the Department of Obstetrics and Gynecology, Graz University Medical School. Until mid 1976 patients were given postoperative radiotherapy; after that they were given combination chemotherapy (adriamycin and cyclophosphamide) according to Lloyd or Parker [18, 20, 21]. An analysis of the results led to the following conclusions: The operability at primary surgery is of prime importance, the best survival rates (regardless of postoperative management) being obtained in those patients in whom it is possible to do a pelvic clearance (removal of uterus, tubes and ovaries) with omentectomy. In patients who were operable postoperative chemotherapy was markedly superior to radiotherapy in terms of 1 year survival. But only slightly superior at 2 and 5 years. On the other hand, in patients who had palliative surgery postoperative radiotherapy seemed to give slightly better survival figures. Patients with early carcinoma (up to stage IIa) survived longer than those with late stages of carcinoma (IIb-IV) whether operable or not). The histology of the tumour had no discernible influence on the result both of chemotherapy and of radiotherapy. The patients with endometrioid and mucinous carcinomas had the highest survival rates irrespective of the postoperative treatment. However, the patients with serous cystadenocarcinomas survived longer than those with immature solid carcinomas. Patients who had no tumour at a second-look operation lived longer than those who had tumour at this time. Patients whose tumour recurred after the completion of postoperative radiotherapy and who were then given chemotherapy had the highest survival rates regardless of whether nor not the carcinoma was originally operable. It is felt that radiotherapy followed by chemotherapy should be used routinely especially in patients with late stages of ovarian carcinoma.
Report on the successful embolization of both arteriae iliacae internae in five woman patients with vital vaginal haemorrhages and very advanced gynaecological neoplasms.
Transplacental feto-maternal hemorrhage was diagnosed after delivery of a highly anemic infant from a healthy mother with polyhydramnios by demonstration of fetal red cells in the maternal circulation (145 degrees/00) using a modified Kleihauer technique. Other causes for anemia such as hemolysis, coagulopathies, failure of red cell production or perinatal posttraumatic bleeding were excluded. The transfused volume estimated eexceeded the blood volume of the newborn by several times, thus indicating a chronic blood loss. This was confirmed by hematologic data typical for a normovolemic anemia, a low serum iron level and the development of a congestive heart failure in the newborn infant.
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All maternal deaths which occurred in relation to labour at the Department of Obstetrics and Gynaecology, University Hospital, Graz, between 1963 and 1978 were reviewed and analysed. 24 mothers died over this 15-year period. The maternal death rate was 0.34 per thousand. In all cases a post mortem examination was performed. The youngest woman was 19, the oldest 42 years old. Most of the decreased mothers were primiparae. The main cause of maternal death was post-partum haemorrhage, followed by infection of the uterus especially after Caesarean section. Three mothers died of liver distrophy. The remaining causes were eclampsia (2 cases); pulmonary artery embolism after Caesarean section (2 cases); irreversible shock from amniotic fluid and air embolism (one case each); uraemia due to glomerulo- or pyelonephritis (one case each); malignant melanoma (one case). It is demonstrated that special risk factors are advanced maternal age, low social status and lack of antenatal care.
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