[Significance of mammography for preventive screening of breast cancer].
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Breast Neoplasms↗
Biomedical subjects
J Bahnsen
Publications and source records attributed to J Bahnsen.
Malignant melanoma--its precursors and its topography of proliferation. DNA-Feulgen-cytophotometry and mitosis index.
DNA-content and size of the nuclear areas in different zones of malignant melanomas of different histological types and in dysplastic naevi were measured in order to provide information on the histogenesis and proliferative behaviour of human malignant melanoma. The results were compared with those from normal epidermis, common naevi, and reactive melanocytic hyperplasias. The mitotic index of melanomas--divided into different topographic zones in an analogous way--was also determined. The DNA-histographs of all naevi and reactive melanocytic hyperplasias showed a diploid maximum, but the dysplastic naevi had a larger proportion of nuclei with hyperdiploid and tetraploid DNA-content, indicating an increased proliferative activity. The mean values (X) of nuclear areas in dysplastic naevi (DN) were about the same as in common naevi (CN) and slightly lower than in superficial spreading melanomas (SSM). The coefficient of variability (cv) as an indicator of anisokaryosis was markedly higher in DN (27.8) and SSM (29.3) than in CN (20.2). In DNA-content we found similar results: almost no difference in mean values, but DN taking an intermediate position between CN and SSM with respect to cv (CN: 12.3; DN: 21.0; SSM: 36.6). There was no unequivocal evidence in these data for DN being a precancerous stage. Superficial melanomas with a nodular component ("SSM/NM") differed from SSM and NM by increased DNA-content and greater variability of nuclear areas and showed the clearest features of malignancy in their DNA-histographs. The mitotic indices had rather low values in SSM and intraepidermal marginal zones of "SSM/NM" on one hand and markedly higher values in NM and nodular parts of "SSM/NM" on the other. The highest mitotic counts were found in the three investigated metastases.
Cell Cycle↗
[Analysis of the axis in patients with patellar dislocation].
The authors investigated in 25 patients with luxations of the patella if an increased incidence of defective torsions of the leg skeleton could be demonstrated. The torsion conditions of the lower extremity can be easily shown by computed tomography. This was confirmed when 32 femur preparation and 95 sound extremities were examined. The comparison of measuring results does not show any difference between patients and control group regarding the torsion of tibia and femur and the position of the tuberosity of the tibia. Patients with luxations of the patella show an increased external rotation of the tibia with respect to the femur due to a lack of medial muscular and ligamentary guide.
Femur↗
Relation between receptor status and ultrastructure in breast cancer: E+P+ versus E-P-.
Invasive breast cancer specimens were selected, which were either estrogen and progesterone receptor positive (E+P+), (30 cases) or both negative (E-P-). Light microscopical typing and grading were performed. From electron microscopic sections 27 nuclear and cytoplasmic features were recorded. Both estrogen and progesterone receptor content were evaluated using agar gel electrophoresis. As regards grading, highly differentiated tumors were significantly associated with E+P+ receptor status. Among the nuclear ultrastructural features, marked polymorphia, irregular chromatin distribution and multiple nucleoli were associated with lack of receptors. E+P+ tumors more often had surface structures which establish cell interconnection, such as desmosomes, halfdesmosomes and membrane interdigitations, and structures indicating special membrane differentiation, such as microvilli and intracytoplasmic ductuli. Most correlations with receptor content were observed in the assortment of cytoplasmic organelles studied. E-P- tumors were rich in organelles which indicate high metabolic activity, such as mitochondria and ribosomes. A polar organization and smooth ER were more frequent in E+P+ tumors. The biochemical-ultrastructural correlations presented in this study support the hypothesis that the formation of steroid receptors runs parallel to the individual degree of cytoplasmic and nuclear organization and is independent of the histological tumor type. The functional integrity of the complete estrogen response mechanism in E+P+ tumors is indicated by high grades of ultrastructural organization.
Breast Neoplasms↗
Immunohistochemical demonstration of carcinoembryonic antigen (CEA) in 120 mammary carcinomas and its correlation with tumor type, grading, staging plasma-CEA, and biochemical receptor status.
Antisera to CEA were used for the immunohistochemical localization and quantification of this antigen in 120 Bouin-fixed, paraffin embedded mammary carcinomas. These results were compared to tumor type, grading, staging, biochemical receptor status, cytosolic CEA-levels of the same tumors, and preoperative plasma CEA-levels. Mammary carcinomas were usually characterized by a low percentage of CEA-positive tumor cells: 50.9% of the cases contained more than 5% CEA-positive tumor cells and were therefore defined as being CEA-histopositive in this study. A relation could be shown between CEA-histopositivity and the histologic tumor type. The majority of invasive lobular carcinomas, tubular, and cribriform carcinomas was CEA-negative (72%). Conversely, 70% of invasive ductal carcinomas were CEA-positive. There was a significantly higher percentage of CEA-histopositivity in grade III tumors than in grade I/II carcinomas. The results obtained by quantification of the immunohistochemical staining of CEA were positively correlated with the results obtained by cytosolic CEA-assay. The overall concordance between tissue and plasma determinations of CEA was found to be 57.1%. A positive trend could be found between CEA-positivity and staging. However, no correlation was observed between CEA-positivity and estrogen receptor status.
Adult↗
[Intraductal breast carcinoma. Clinical, x-ray and histological findings and their therapeutic consequences].
116 cases of early ductal breast cancer diagnosed during 1971 to 1981 were analysed. In 65 cases no invasion was detectable. 37 cases showed an early stromal invasion and in 14 cases the invasion was questionable. A palpable mass was seen in 32% of the noninvasive and in 46% of the early invasive cases. The most important mammographic signs were grouped, suspicious microcalcifications (87%). Multicentricity occurred in 26% of the noninvasive and 43% of the early invasive cases. Two cases of the noninvasive and two of the early invasive group had axillary metastasis. Positive nodes were seldom in early ductal carcinoma (3%) compared to 42 invasive comedo-carcinomas (36% positive axillary nodes). In the follow-up five local recurrences were detected in the noninvasive group and one each in the other groups. In the noninvasive group 17% local recurrences occurred after breast conserving modalities compared to 4% in mastectomy patients. As no reliable data for the selection and the results of breast preserving modalities are available now, mastectomy and axillary dissection may be the safest therapy. Only in small intraductal breast cancer (under 25 mm) the breast may be conserved (wide excision, segmental resection, quadrantectomy), if complete excision is carefully controlled by mammography and histology and follow-up is guaranteed.
Breast Neoplasms↗
[Borderline tumors of the ovary. New aspects on morphologic prognosis determination].
Epithelial tumours of the ovary with a tumour status between benign and malignant are classified as borderline tumours (BOT). They are particularly frequent in women between 30 and 40 years of age, emphasising the need for effecting a therapy directed at preserving fertility. To keep the risk of this therapy at a minimum it is imperative to effect accurate determination of the prognosis on the basis of an examination of the histological preparation. Conventional histology is insufficient for this purpose, thus requiring the use of additional morphological methods. In the present study the DNA of the cell nucleus was determined via quantitative cytophotometry and also via several tumour or differentiating markers by immunohistology, in healthy ovaries, 10 benign and 20 malignant ovarian tumours and in 20 borderline tumours (BOT). The DNA histograms of the tumours classified histologically as BOT, yielded distribution patterns pointing towards a benign, proliferative or malignant potency of the tumours without a correlation to conventional histology being present in each case. Immunohistological identification of the carcinoembryonal antigen (CEA) and of the blood group substances (A, B, Lewis, Lewis) produced characteristic distribution patterns which correlated with the tendency to proliferation in DNA cytophotometry. To achieve relevant determination of prognosis of BOT in individual cases, conventional histology should be complemented by additional examinations using DNA cytophotometry and immunhistology as diagnostic tools.
ABO Blood-Group System↗
[Radiotherapy in primary radically operated ovarian cancer].
The basis of primary treatment is consequent surgery. Radiation therapy is not necessary for borderline tumors. An effect has been seen in stages Ib to III with a small amount of post-operative residual tumor. A comparison with the value of alternative chemotherapy has not yet been made. Instillation of the radioisotopes is effective. The value of radiation therapy after successful chemotherapy of stages III/IV has not yet been investigated enough. The results of radiation therapy after surgical and chemotherapeutical failure are poor.
Adenocarcinoma, Mucinous↗
Peanut lectin histochemistry of 120 mammary carcinomas and its relation to tumor type, grading, staging, and receptor status.
Peanut lectin (PNL) is known to bind beta-D-galactosyl-(1-3)-N-acetyl-D-galactosamine, which provides antigenic determination of the Thomsen-Friedenreich antigen ( TFAg ). The aim of this study was to analyse the expression of peanut lectin binding sites in mammary carcinomas and to correlate these with tumor type, histological grading, staging and biochemical receptor status. The series comprised 120 invasive mammary carcinomas and 14 cases with normal breast tissue or benign epithelial proliferations as controls. In controls mainly luminal or apical PNL-binding was discovered, however, in all except three carcinomas a cytoplasmatic localisation of TFAg with three major patterns was found: diffuse, granular-globular and vacuolar reactions. The quantitative-qualitative evaluation of the PNL-staining revealed a statistically significant correlation between globular-vacuolar PNL-reaction and tumor type with a higher percentage of this type of reaction in invasive lobular carcinomas as opposed to tubular and invasive ductal carcinomas. Furthermore a statistically significant relationship was disclosed between PNL- histopositivity and estrogen positive - progesterone positive cases. However, the findings of contradictory PNL-status and hormone-receptor status illustrates clearly the difficulty of predicting the biochemical receptor status. No correlation was found between PNL-histochemistry, histological grading, and pathological staging. The practical implications of PNL-histochemistry of mammary carcinomas are discussed.
Arachis↗
[Tocolysis with beta sympathomimetics alone or combined with the calcium antagonist verapamil? I. Effect of verapamil on maternal cardiovascular parameters and the course of pregnancy].
In a retrospective study covering 471 cases the influence of the calcium antagonist Verapamil on tocolytic therapy with beta-mimetics was examined. 308 patients received Fenoterol therapy (group A) and 163 were treated with a combination of Fenoterol and Verapamil in a dosage-relation 1/20 (group B). There was no significant difference between group A and B in respect of age, parity, week of gestational age at the beginning of therapy and at delivery, and mode of delivery. The cardiovascular parameters demonstrated alterations as described in literature. The heart frequencies increased significantly in all patients while the systolic and the diastolic blood pressures decreased significantly in hypertonic patients only. These alterations of the cardiovascular parameters were the same in both groups. The efficiency of the tocolytic therapy was tested by comparing the prolongation index (Richter) and the frequency of uterine contractions measured by external cardiotocography. There was no significant difference between groups A and B. Severe complications occurred in 6 patients so that the therapy had to be discontinued (3 women suffered from pulmonary oedemas). These complications were also seen under additional Verapamil application during tocolytic treatment. The side effects as far as reported by the patients were restricted to a significantly lower rate of obstipation in the Fenoterol/Verapamil treated group B. We conclude that administration of the calcium antagonist Verapamil is of no additional value in tocolytic treatment with beta-mimetics.
Adult↗
[Tocolysis with beta sympathomimetics alone or combined with the calcium antagonist verapamil? Influence of verapamil on the fetus].
In a retrospective study, patients who underwent tocolytic therapy by beta-mimetics were investigated. 308 received Fenoterol monotherapy (group A) and 163 a combination of Fenoterol with the calcium-antagonist Verapamil in a dosage-relation of 1/20 (group B). The review of 287 cardiotocograms showed a significant increase in the foetal heart rate in both groups by about 13% after 114 minutes (A) and 146 minutes (B). Although the diaplacental transfer of Fenoterol to the foetus is very small, a high percentage of foetuses showed an increase in heart rate (84.7% in A, 86% in B). There was a significantly longer duration of foetal tachycardia in group B. Both groups were not different in respect of perinatal mortality (5.4% in A, 5.2% in B), birth weight, APGAR score, and the reasons for paediatric care. The great difference in placental permeability for Fenoterol and Verapamil may cause a danger for the foetus. Since no reasonable improvements are seen, additional Verapamil therapy is not recommended.
Apgar Score↗
[Post-operative complications following Caesarean section. A comparative study of the years 1957-1958 and 1977-1978].
104 Caesarean sections of the Obstetric Department of the University in Hamburg-Eppendorf of the years 1957-1958 were compared with 399 Caesarean sections of the years 1977-1978 in a retrospective study. An attempt was made to correlate the post-operative complications with possible causes. There was a marked rise in wound infections, endometritis, post-operative pyrexia and a decrease of thromboembolic complications and retained lochia. Differences in the old and new years were in the management of labour, the operative technique and the post-operative treatment. In the Caesarean sections of 1977 to 1978 a clear cut correlation between wound infections uterine complications and pyrexia and the number of vaginal examination following rupture of the membranes the duration of rupture of the membranes and the length of labour was found. To reduce the post-operative complication rate at attempt should be made to reduce the number of vaginal examinations, to be stringent in the indications for rupture of the membranes and to avoid delay in inevitable Caesarean sections.
Cesarean Section↗
9. Steroid receptors. Correlation of estrogen and progesterone receptor status with ultrastructural differentiation in breast tumors.
The interrelationships of ultrastructural and biochemical parameters have been studied in a multivariate analysis of 139 cases of invasive breast carcinoma. There was no relationship between the histologic subclassification and distribution of estrogen and progesterone receptors. However, significant correlations could be found between receptor status and certain ultrastructural features of the tumor cells. A prevalence of well differentiated cancers had a significant correlation with a positive estrogen receptor status. Estrogen receptors were more frequently associated to tumors showing great complexity of cytoplasmic organization, high degrees of cell interconnections by desmosomes and membrane interdigitations, presence of intracytoplasmic ductules, specific secretory granules, and low grades of nuclear pleomorphy. In a series of 120 non-selected cases, receptor status was assessed by the fluorescent technique. Of the cases, 38.3% have proved to be ER+, 49.2% showed low binding capacity and 12.5% were negative. The correlation of receptor content with the histological type of breast cancer revealed some type-dependent connections. While only 36.9% of the solid tumors were receptor positive the proportion increased to 54.2% for the more differentiated glandular type of ductal carcinoma. 8 out of 13 (61.5%) infiltrating lobular carcinomas and 4 (4) colloid cancers were found to be receptor positive. The plotting test showed a good correlation of histochemical receptor status and histological grading. Although the type of "receptor", which is localized by the indirect fluorescent technique is still incompletely defined, there is no doubt, that the selective binding affinity reflects a specific capacity of the tumor cells depending on their degree of differentiation.
Breast Neoplasms↗
Paget's disease of the vulva with underlying apocrine adenocarcinoma and local lymph node invasion.
A case of Paget's disease of the vulva with an underlying apocrine adenocarcinoma and local lymph node invasion is reported in a female aged 70. Subjective symptoms of pruritus, burning and pain were associated with typical, but unspecific clinical findings of an erythematous, indistinctly limited, weeping lesion of palm-size with small superficial erosions. Near the right labium majus a solid measuring 2.5 X 1.5 cm in diameter was palpable. The diagnosis was established by microscopic examination of biopsy material, showing intraepidermally the typical Paget's disease with a subjacent, highly differentiated apocrine adenocarcinoma of the sweat glands combined with inguinal lymph node invasion. Other epidermal malignancies were excluded by histochemical reactions. For therapy, telecobalt irradiation combined with high energy electron was applied.
Adenocarcinoma↗
[Tumorgrading in breast cancer by light microscopic and electron microscopic criteria. Part I. Relation between light microscopic grading and electron microscopic criteria. (author's transl)].
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Breast Neoplasms↗
[Cost-utility-analysis of the obstetrical intensive care].
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Costs and Cost Analysis↗
[Labor course during caudal anesthesia and possible complications].
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Anesthesia, Caudal↗
[Caudal anaesthesia in obstetrics (author's transl)].
The advantages of caudal anaesthesia in obstetrics far outweigh the few disadvantages. The perinatal mortality of premature infants is reduced under caudal anaesthesia. Breech deliveries are easier under caudal anaesthesia. In these cases regional anaesthesia is considered an obstetrical indication. It is possible to carry out all vaginal and abdominal procedures with this anaesthesia. The elimination of pain during labor and delivery permits a more intensive experience of labor and delivery for the mother under caudal anaesthesia.
Anesthesia, Caudal↗